Laboratory-Based Cytological and Biochemical Profile of Cerebrospinal Fluid for Children With Acute Bacterial Meningitis in Bangladesh

An attempt was made to analyze the cerebrospinal fluid (CSF) for a cytological and biochemical profile to identify etiological agents from children with suspected acute bacterial meningitis. The cerebrospinal fluid (CSF) samples from 371 suspected meningitis cases were examined, and the highest bacterial meningitis was found in 52(14.0%) cases in this study. Among a total of 371 samples of CSF, 272(73.3%) were crystal clear, 52(14.0%) were moderately turbid, 47(12.7%) highly turbid. The total leukocyte cell count of the CSF was proportionate to the turbidity. In the case of crystal clear CSF’s, total leukocyte counts (TLC) were normally ranging from <5 to 45 per mm3 with predominant lymphocytes. Moderately turbid fluid showed 46 to 500 cells per mm3 and highly turbid fluid showed from 501 to more than 10,00 cells/mm3. In the latter cases, differential counts demonstrated polymorphonuclear predominance. In addition, about 100% (52 cases) of positive and 12.5% (40/319) of negative cases had CSF protein concentration >100 mg/dL. CSF protein concentration greater than 100 mg/dl and sugar level below 40 mg/dl were considered as suspected bacterial meningitis in this study. Surprisingly, the C-Reactive Protein (CRP) values were found to be >40 mg/dL in both culturally positive and negative cases. Most of meningitis positive cases showed increased total cell counts as well as protein concentration, and decreased serum sugar concentrations. J. Asiat. Soc. Bangladesh, Sci. 47(2): 137-147, December 2021

Accuracy of Meningitis Bacterial Score (MBS) as an indicator in establishing the diagnosis of acute bacterial meningitis in adults

Bacterial meningitis persists as a worldwide threat contributing to high mortality and morbidity rate, where differentiating bacterial meningitis from aseptic meningitis is key for better management and outcomes. Hence, this study aimed to assess the Bacterial Meningeal Score (BMS) as a tool for early diagnosis of acute bacterial meningitis. This study employed a retrospective cross-sectional method using medical records of patients with meningitis and meningoencephalitis who were hospitalized at Dr. Soetomo Hospital, from January 2018 to September 2021. Data of demographics, clinical, laboratory and cerebrospinal fluid (CSF) profile and culture were collected. The diagnostic performance of the BMS in diagnosing acute bacterial meningitis was evaluated by its sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR +) and negative likelihood ratio (LR -). A total of 128 patients who had been diagnosed with meningitis and meningoencephalitis were included. Out of total patients, 53 samples were diagnosed with acute bacterial meningitis as confirmed by CSF culture. The sensitivity and specificity of BMS with cutoff >2.5 in diagnosing acute bacterial meningitis were 92.4% and 92.0%, respectively with PPV 89.1% and NPV 94.5%. The area under the curve (AUC) of BMS in diagnosing of acute bacterial meningitis was 95.6% (95%CI: 92.3%, 99%). A BMS score of greater than 2.5 indicates a high likelihood of acute bacterial meningitis, whereas a score less than 2.5 indicates a low likelihood.

Clinical profile and outcome of children with acute bacterial meningitis in a tertiary care centre in eastern Nepal

Background: Bacterial meningitis is a severe infection of the central nervous system with varied clinical presentations. It is associated with substantial mortality and morbidity. Objectives: The objective of this study was to assess the clinical profile, including the clinical features, laboratory and radiological parameters, clinical course, treatment, response to treatment, complications, and outcome of children at discharge. Methods: A prospective observational study was conducted among 52 inpatient children of acute bacterial meningitis aged one month to 14 years over a period of six months. The patients were enrolled during admission and followed up daily till discharge. Socio-demographic, clinical, and diagnostic details and outcomes were recorded and analysed using statistical package for social sciences version 20. Results: The median age of the patients was two years with male to female ratio of 2:1. Fever (45, 87%), vomiting (37, 71%), seizure (33, 64%) and headache (22, 46%) were the most common symptoms. The cerebrospinal fluid culture was positive in three (6%) cases. Complications were seen in 20 (39%) patients including four (7.7%) deaths. Patients with prolonged fever, malnutrition, loss of consciousness, ear discharge, presence of meningeal signs, abnormal pupil, high cerebrospinal fluid protein, positive cerebrospinal fluid, and blood culture, low blood pH, and hyperlactataemia were significantly associated with complications (p <0.05). Conclusion: Factors like malnutrition, longer duration of fever, and abnormal neurological and laboratory findings were associated with higher rates of complications.

Treatment outcome and associated factors of bacterial meningitis at pediatric wards of southwestern Ethiopian hospital: a prospective observational study

Background Meningitis is a common infectious cause of morbidity and mortality in pediatric age-groups. Acute bacterial meningitis is considered a medical emergency, because it is a life-threatening infection that requires immediate treatment. Therefore the study was aimed to assess the magnitude and predictors of poor treatment outcome among pediatric patients admitted to Bedele General Hospital. Methods A prospective observational study was conducted at pediatric wards of Bedele General Hospital from February 12, 2020 to August 11, 2020. Lumbar puncture, in the absence of contraindications, was performed under aseptic conditions for all patients with suspected bacterial meningitis to collect cerebrospinal fluid specimen. Multivariable logistic regression was used to determine the predictors of poor treatment outcome. Result Of the 196 pediatric patients involved, 112(57.1%) were male and the mean and standard deviation of their age was 6.09 ± 4.46. Regarding to their clinical profile, a total of 101(51.5%) were completely immunized and 115(58.7%) were given corticosteroid during their treatment. In our study the most frequently occurred clinical manifestation of meningitis was fever 164(83.67%), neck rigidity149 (76.02%), and irritability 122(62.24%). Regarding to their pharmacotherapy, the most commonly prescribed antibiotics were Ampicillin 104(24.82%), and Gentamycin 102(24.34%). The magnitude of good treatment outcome was 132(67.35%) whereas 64(32.65%) were poorly controlled. The presence of comorbidity (AOR = 3.64, 95CI%:1.83–7.23,P = < 0.001),corticosteroid use (AOR = 2.37, 95CI%:1.17–4.81,P = 0.017) and oxygen administration (AOR = 3.12, 95CI%: 1.34–7.25, P = 0.008) was a predictor of meningitis treatment outcome. Conclusion The treatment outcome of meningitis was good in of two-third of the patients. It was found that the presence of comorbidity, the administration of oxygen and use of corticosteroid was predictors of the treatment outcomes of bacterial meningitis in children. Therefore, in patients with these factors, appropriate meningitis treatment should be encouraged and locally applicable treatment guidelines should be prepared to improve patient outcome. Finally, the meningitis patients should be given corticosteroid and oxygen as treatment and special attention should be given for patients having co-morbidities.

Haemophilus influenzae infection among children with acute bacterial meningitis.

Objective: To determine the frequency of haemophilus influenzae infection in children less than 5 years with acute bacterial meningitis (ABM). Study Design: Descriptive Cross Sectional study. Setting: Department of Pediatric Medicine, The Children’s Hospital and Institute of Child Health, Multan. Period: October 2019 to March 2020. Material & Methods: A total of 165 children aged 5 – 60 months of either gender having acute bacterial meningitis with duration of < 2 weeks were enrolled. Cerebrospinal fluid (CSF) of each child was sent for microbiological analysis. Results: There were 106 (64.2 %) boys and 59 (35.8 %) girls. Mean age was 2.72 ± 1.07 years. Most cases, 112 (67.9 %) belonged to urban areas. Maternal literacy was positive in 65 (39.4%) cases while 59 (35.8%) were fully vaccinated. Mean disease duration was 56.25 ± 15.36 hours and 112 (67.9%) had duration of illness more than 36 hours. Frequency of Haemophilus Influenzae was noted in 35 (21.2%) cases. Conclusion: Frequency of Haemophilus Influenzae was high among children with acute bacterial meningitis. Early diagnosis and appropriate management might help reducing prolonged hospitalization and disease morbidity related to Haemophilus Influenza.

Neurology

Impaired consciousness, Headache, Raised intracranial pressure, Acute bacterial meningitis, Epidemic meningococcal disease, Viral meningitis, Chronic meningitis, Encephalitis, Rabies, Tetanus, Stroke, Subarachnoid haemorrhage, Subdural haemorrhage, Extradural haematoma, Blackouts/syncope, Space-occupying lesions (SOL), Brain abscess, Hydrocephalus, Epilepsy, Status epilepticus, Cysticercosis, Weak legs and spinal cord disease, Guillain-Barré syndrome, Poliomyelitis (polio), Peripheral neuropathy, Leprosy, Dementia

Frequency of ischemic stroke in patients with bacterial meningitis visiting to Jinnah Postgraduate Medical Center Karachi. Cross-sectional study

Objective. To determine the frequency of ischemic stroke in patients presenting with bacterial meningitis visiting to JPMC. Material and method. Descriptive cross-sectional study, held in Neurology ward of Jinnah Postgraduate Medical Centre, Karachi, from 20thapril 2018 to 20th October 2018. Patients aged >18 years of either gender with acute bacterial meningitis were included, written informed consent was obtained from all participants and also approval of ethical review committee of the institute was obtained. CT scan brain or MRI brain performed in all the included patients to assess ischemic stroke. All the collected data were recorded on proforma. The data was analyzed using SPSS version 20. Results. 168 patients of bacterial meningitis were included. Mean ± SD of age was 63.48 ±10.53 (61.87-65.08) years. Out of 168 patients, 118 (70.28%) were male and 50 (29.76%) were female. The frequency of ischemic stroke in patients with bacterial meningitis was found to be 22(13.09%). In stratification of age group, 18-40 years and > 40 years, ischemic stroke was found in 4 (6.2%) and 18 (17.3%) patients respectively. In stratification of gender frequency of ischemic stroke in patients with bacterial meningitis in our study was found to be (16.9% among males and 4% among females). Conclusions. The frequency of ischemic stroke in patients with bacterial meningitis was 13.09% and it is associated with poor outcome so high degree of suspicion is necessary for timely diagnosis and treatment of this life threatening complication. Ischemic stroke was found to be significantly more common in old patients as compared to young adults, also more common in males as compared to females.