Acute Purulent Meningitis Research Articles

Impact of Nonspecific Antipidemic Measures against COVID-19 on the INCIDENCE of Acute Purulent Meningitis during the Pandemic

Relevance. Nonspecific anti-epidemic measures against СOVID-19 (mask-wearing, social distancing, lockdowns, homework, quarantines, school closures, tourism bans, etc.) resulted in a significant decrease in the incidence of many respiratory infections. Scientific publications have reported a decrease in the incidence of bacterial purulent meningitis (BMP) during the development of the COVID-19 pandemic.Aims. To review the scientific publications on the decline in the incidence of BMP during the СOVID-19 pandemic.Conclusions.Undoubtedly non-specific anti-epidemic measures taken during the COVID-19 pandemic helped to reduce the incidence of respiratory infections regardless of their etiology and could serve as an indirect indicator of the activity of these measures.

Quantitative Electroencephalography Indicators in Children with Acute Purulent Meningitis.

The aim of the present work was to assess the state of brain bioelectrical activity in children during the acute period of bacterial purulent meningitis, with quantitative mathematical analysis of the changes found. The studies included 31 children on days 1 and 6 from onset of illness: 16 children (8.9 ± 2.4 years) admitted to the Pediatric Scientific Clinical Center for Infectious Diseases with laboratory confirmation of diagnoses of purulent meningitis (due to Neisseria meningitidis) (n = 11) or Streptomyces pneumoniae (n = 2) or unidentified pathogen (n = 3)), along with 15 healthy children. Electroencephalogram (EEG) traces were recorded from all these children in the state of calm waking using a Neuron-Spectrum 4/VP 16-channel electroencephalograph. Clinical assessment of the EEG included analysis of background rhythms, zonal differences, and detection of pathological types of activity. Quantitative analysis consisted of the mean power (μV2) and amplitude (μV) of the α, θ, and δ rhythms, along with mean power ratios – α/θ and α/δ. Visual analysis of the EEG in 100% of children in the acute period of purulent meningitis showed diffuse slowing with detection of δ and θ waves. Focal changes in the form of sharp waves were seen in 18.8% of cases (three patients). No cases displayed periodic activity. Meningitis patients showed significant reductions in the α/δ (p = 0.001) and α/θ (p = 0.048) spectral ratios. ROC analysis showed that the α/θ value was <0.18 and the α/δ value was <0.02 (sensitivity 100% and specificity 80%, AUROC 0.9), which may be evidence of the likely development of cerebral edema. Thus, pediatric patients with acute purulent meningitis showed significant impairments to the normal α/θ and α/δ rhythm power ratios on the EEG, which is presumptively explained by suppression of the functional activity of the thalamus and thalamocortical pathways, as well as the reticular formation of the brain.

Evaluation of Rat Brain Morphology Following the Induction of Acute Meningitis Treated with Ceftriaxone.

The soft and delicate tissue of the brain, which is the center of our coordination, is protected by its surrounding layers. The disruption of these layers results in complicated situations and serious health problems. The brain has three protective layers of bone or skull tissue, the blood tissue layer, and finally the meningeal layer. The layer of blood tissue contains the blood vessels that are located between the skull and the meningeal membranes. If germs or foreign matter enter the fluid through the blood vessels under any circumstances and cause infection, the bones that protect the meninges will break and cause tissue damage. The present study aimed to assess the histological and immunohistochemical characteristics of the brain of rats that underwent induced acute purulent pneumococcal meningitis after antibiotic therapy with Ceftriaxone. A number of 20 white adult male Wistar rats were assigned to three groups. The first group (n=5) regarded as the control were injected with a saline solution into the subarachnoid space in an equivalent amount. The second and third groups of rats (n=5 and 10, respectively) were infected with acute purulent meningitis by the injection of 10 μl of Streptococcus pneumoniae (S. pneumonia) suspension into the subarachnoid space of the brain using a 23-G needle. The various areas of the brains of rats after meningitis inducedby S. pneumoniae were examined after the treatment with Ceftriaxone. The S. pneumoniae culture was injected into the subarachnoid space in the area of the rhomboid fossa. Treatment started 18 h after the injection. On day 10, a repeated puncture was performed with the analysis of cerebrospinal fluid in order to confirm the absence of meningitis; thereafter, the animals were taken out of the experiment. No signs of meningitis were found on histological examination. Mild perivascular and pericellular focal edema were revealed with signs of overload of the lymphatic system in the brain and focal ischemic changes in neurons. The investigation of expression with caspase-3 revealed a positive reaction of individual neurons. A positive reaction with antibodies to NeuN and Doublecortin was detected in most neurons; moreover, Glial fibrillary acidic protein (GFAP)-positive astrocytes and their processes were visualized in all layers of the brain substance. The reaction with neuron-specific enolase (NSE), microtubule-associated protein 2 (MAP-2), CD 31, and CD 34 was negative. Typical structure and pictures pointed to an intact brain and purulent meningitis in the first and second groups. The microscopic image and the changes revealed during immunohistochemistry by dual corticosteroid antibodies and neuronal nuclear protein were characterized by predominantly cytoplasmic and perinuclear reactions, respectively. Some neurons are positive for caspase-3 and are related to changes in the characteristic of premature aging.

ELECTROLYTE DISORDERS IN ACUTE PURULENT MENINGITIS AND ENINGOENCEPHALITIS IN CHILDREN

Objective: To investigate the disorders of electrolyte in acute purulent meningitis and meningoencephalitis in children. Methods: A cross-sectional study with convenient sample of 37 pediatric patients with acute purulent meningitis and meningoencephalitis treated in the Pediatric Center of Hue Central Hospital. Results: The average blood sodium concentration is 130 ± 6.1 mmol/l, the lowest concentration is 115 mmol/l, the largest one is 143 mmol/l. Hyponatremia accounted for a high rate of 67.6%, of which the purulent meningitis is 60.0% and the meningoencephalitis is 72.7%. The mild and moderate level of hyponatremia is 76.0%, the severity level is 24.0%. There is no relationship between group disease, signs and symptoms; and outcome with hyponatremia. Other electrolyte disorders are less: slightly hypokalemia in 16.2% and mild hypochloremia in 13.5% of cases. Conclusion: Hyponatremia is a common electrolyte disorder with high ratio and all levels, should be paid attention in monitoring and treating the children with acute purulent meningitis and meningoencephalitis. Key words: hyponatremia, acute CNS infection, purulent meningitis, meningoencephalitis, children.

Structural study of Topoisomerase IV-DNA-Levofloxacin complexes from Streptococcus pneumoniae

S. pneumoniae is an important pathogen causing pulmonary infection, acute otitis media and purulent meningitis in infants and children. Type II topoisomerases are enzymes that play essential roles in DNA replication, chromosome segregation and recombination throughout all living organisms. Topoisomerases IV can make a transient break in DNA strands in one chromosome. These enzymes are very important antibacterial as well as anticancer targets and potential anti-trypanosomal targets. Levofloxacin has shown efficient inhibition of Type II topoisomerases in S. pneumoniae. Its mechanism of action is to inhibit the activity of DNA topoisomerase, prevent bacterial DNA synthesis and replication leading to bacterial death. We focused on solving the key structures of topoisomerase IV-DNA-levofloxacin complexes by negative staining electron microscopy and the resulting model was obtained at 32 Å by 3D autorefine in Relion 3.0. This study was to try and obtain the structure of the whole complex with DNA bound in the G-gate and the T-gate in order to study DNA capture and transport in type II topoisomerases.

Akut Pürülan Menenjit mi, HIV’a Bağlı Fırsatçı İnfeksiyon mu?

Akut Pürülan Menenjit mi, HIV’a Bağlı Fırsatçı İnfeksiyon mu?

THE ROLE OF STAPHYLOCOCCUS AUREUSIN THE CLINICAL DIAGNOSIS OF DIABETIC PATIENTS

Abstract Discovering interactions between the etiology of the infection and diabetic patients’ immune system activity may be essential for the relevant clinical diagnosis. The dynamics of colonization of the nasal vestibule by Staphylococcus aureus and the development of the prevention strategies against infection are different for various populations. Moreover, the colonization of the nasal vestibule might involve both molecular and epidemiological ctorsfa. Researchers have reported that the identification of methicillin-resistant strains S. aureus(MRSA) with similar molecular characteristics allows to assess the ability of the microorganism to spread and the risk of infection in diabetic patients. Knowledge of these characteristics allows to take precautions in patients exposed to S. aureus. S. aureus is an ethiological factors of many severe diseases both in people with weakened immune system and in healthy individuals. Usually, excess weight and obesity contribute to the incidence of diabetes mellitus type 2 (DM2). However, the colonization by S. aureus is a probable risk factor for infection. Among S. aureus virulence factors, superantigens (SAgs) are essential for pathogenicity. The long-term effect of the superantigen toxic shock syndrome toxin-1 (TSST-1) might be glucose intolerance. This toxin also induces systemic inflammation as a result of the increased exotoxin concentration in blood, and, therefore, may be the causative factor of diabetes. Chronic exposure to staphylococcal superantigens may contribute to the development of diabetes, suggesting a need to conduct targeted therapies against S. aureus superantigens. 1. Introduction. 2. Risk factors for infection in patients with diabetes. 2.1. Immunodeficiency. 2.2. Obesity 2.3. Staphylococcal carriage. 3. Staphylococcal infections in patients with diabetes. 3.1. Staphylococcal superantigens. 3.2. Skin and soft tissue infections. 3.3.Diabetic foot syndrome. 3.4. Sepsis. 3.5. Infective endocarditis. 3.6. Acute purulent meningitis. 4. Vaccination. 5. Conclusions

Why Did the Patient Not Heal? A Case of Chronic Meningitis Who Was Hospitalized Due to Acute Purulent Meningitis

Why Did the Patient Not Heal? A Case of Chronic Meningitis Who Was Hospitalized Due to Acute Purulent Meningitis

Streptococcus sanguinis meningitis following endoscopic ligation for oesophageal variceal haemorrhage

We report a case of acute purulent meningitis caused by Streptococcus sanguinis after endoscopic ligation for oesophageal variceal haemorrhage in a cirrhotic patient without preceding symptoms of meningitis. Initial treatment with flomoxef failed. The patient was cured after 20 days of intravenous penicillin G. This uncommon infection due to S. sanguinis adds to the long list of infectious complications among patients with oesophageal variceal haemorrhage.

&lt;i&gt;Streptococcus sanguis&lt;/i&gt; Meningitis: Report of a Case and Review of the Literature

Viridans streptococcus, an indigenous bacterial species of the mouth and gastrointestinal tract, is thought to be a rare cause of bacterial meningitis. The type of streptococcus involved is important because each type causes a different kind of meningitis and is associated with a different outcome. A 39-year-old previously healthy man was admitted due to the onset of acute purulent meningitis. A cerebrospinal fluid culture grew Streptococcus sanguis (S. sanguis). Although the patient was asymptomatic for dental caries, odontogenic maxillary sinusitis was found to be the cause of the meningitis. Treatment with intravenous antibiotics was successful. Following a review of the pertinent literature, we discuss the characteristics of S. sanguis meningitis.

Pooled Analysis of 2,408 Cases of Acute Adult Purulent Meningitis from Turkey

Objectives: The aim of this study was to systematically review the Turkish literature of acute adult purulent meningitis. Materials and Methods: The published series of three national databases and two international databases were searched to perform the review. In addition to the databases, abstracts of congresses held between 1994 and 2003 by the Turkish Clinical Microbiology and Infectious Diseases Association, Turkish Microbiology Association, and the Antibiotic and Chemotherapy Association were searched for reports about acute purulent meningitis. Results: Data for 2,408 patients with a diagnosis of acute purulent meningitis were obtained from 30 reports. In terms of clinical findings, 1,254 of 1,570 (79.8%) had fever (>38°C), 1,408 of 1,595 (88.2%) headache, 1,403 of 1,562 (89.8%) stiffness of the neck, and 649 of 784 (82.7%) leukocytosis (>10,000/mm³). Cerebrospinal fluid culture yielded a pathogen in 873 of 2,260 (38.6%) patients. The most common pathogen was Streptococcus pneumoniae, followed by Neisseria meningitidis and Staphylococcus aureus. Overall mortality was 425 of 2,408 (17.6%). Pathogen-specific mortality was 60 of 202 (29.7%) for S. pneumoniae and 6 of 100 (6%) for N. meningitidis. Conclusion: Meningitis is a serious, life-threatening disease. More preventive measures should be sought to further decrease the mortality and morbidity related to acute purulent meningitis.

Occult anterior skull base defect without rhinorrhea as a cause of recurrent meningitis

Background We present a case of recurrent meningitis in a patient with an occult skull base defect and without clinically or radiologically demonstrable rhinorrhea. Case Description A 34-year-old female patient presented with headache, fever, and cervical pain and was diagnosed with acute purulent meningitis. Her medical history revealed another meningitis episode following an upper respiratory tract infection 4 years before. She did not have any rhinorrhea complaint. Nasal endoscopy and computerized tomography with metrizamide failed to demonstrate any subclinical rhinorrhea. However, a bony defect in the cribriform plate and a submucosal nasoseptal collection of cerebrospinal fluid behind an intact septal nasal mucosa were detected in computerized tomography and magnetic resonance imaging studies. An endoscopic repair of the defect at the anterior cranial fossa was performed with a composite middle turbinate graft. Conclusion We suggest that even if anamnesis and radiological evaluation do not confirm rhinorrhea, dehiscence of bony roof and additional submucosal collection of fluids should be investigated in patients with recurrent meningitis.

Purulent meningitis with unusual diffusion-weighted MRI findings

We describe unusual findings obtained by diffusion-weighted magnetic resonance imaging (MRI) in a patient with acute purulent meningitis caused by penicillin-resistant Streptococcus pneumoniae. Along cerebral convexities and the Sylvian fissure, multiple small intense lesions showed high signal intensity in these sequences. This may be the first report of diffusion-weighted in purulent meningitis.

Low cerebrospinal fluid β-amyloid 42 in patients with acute bacterial meningitis and normalization after treatment

CSF-Aβ42 may be a marker of Alzheimer's disease (AD). A decreased level of CSF-Aβ42 is consistently found in AD and has been suggested to be related to the deposition of amyloid plaques in the brain. However, low CSF-Aβ42 levels have also been found in disorders devoid of plaques, for instance Creutzfeldt–Jakob disease. To examine if the level of Aβ42 in CSF is related to inflammatory processes, we studied CSF-Aβ42 levels in eight patients with acute purulent bacterial menignitis, 10 patients with acute viral meningitis and 18 age-matched controls. In acute purulent bacterial meningitis, the CSF-Aβ42 level was markedly reduced (28% of that in controls, P<0.0001), whereas no change was found in viral meningitis. After successful treatment of bacterial meningitis, the CSF-Aβ42 level increased ( P<0.05 compared to baseline) and did no longer differ from that in controls (ns). The decrease could not be explained by interference with high protein levels, since addition of increasing volumes of serum did not influence the CSF-Aβ42 levels. Our findings suggest that the reduction in CSF-Aβ42 found in bacterial meningitis is not a direct consequence of the inflammatory process. The cause may be disturbance of the clearance of Aβ42 from the brain.

In vitro antibiotic sensitivity pattern of common bacterial isolates from cases of acute bacterial meningitis with special reference to ceftriaxone.

Ceftriaxone (RO 13-9904) has only recently been introduced in Benghazi and many parts of the word. We determined its in-vitro antibacterial activity against the primary aetiological agents of childhood meningitis in Benghazi, that included eighteen (23.3%) strains of H. influenzae, 17 (22.1%) of Str. pneumoniae and 1 (1.3%) of N. meningitidis isolated from 77 cases of acute purulent meningitis above the age of neonatal period. All strains of H. influenzae. Str. pneumoniae and N. meningitidis were sensitive to ceftriaxone and showed wide zones of inhibition by the disc diffusion technique of Kirby-Bauer. Ampicillin and chloramphenicol resistance was observed for H. influenzae (23% and 11% respectively), and Str. pneumoniae (12% and 0% respectively), in addition, 18% of strains of Str. pneumoniae showed resistance to penicillin. The broad spectrum activity of ceftriaxone has been confirmed for our locality and this finding, together with its exceptionally long half-life, excellent penetration into the C.S.F. and ease of administration (single daily dose) warrants it as the drug of choice in empherical treatment of cases of acute bacterial meningitis in children in Benghazi and in cases where resistance to ampicillin and chloramphenicol are found on subsequent testing.

Classical and current aspects of purulent meningitis

Even today acute purulent meningitis is a life-threatening disease requiring immediate diagnosis and therapy. Despite the availability of bactericidal antibiotics, the mortality has not changed within the last 20 years. A therapeutic approach interfering specifically with the pathogenesis of inflammation is necessary in order to prevent long-term neurological sequelae and death associated with bacterial meningitis. In this paper we discuss the present level of understanding of antibiotics and adjunctive therapy, especially with regard to the molecular pathophysiological events occurring during a CNS infection.

Die eitrige Meningoenzephalitis - Untersuchungen zum Verlauf und zur Prognose

The course of acute purulent meningitis and meningocephalitis was investigated in 101 patients using records and a questionnaire directed to all patients. Patients who survived meningoencephalitis were asked to come to a neurological examination. Neuropsychological status, EEG and Tc-HMPAO-Spect were also performed in these patients. The patients were treated with a combination of three antimicrobial agents which was commonly used at our hospital during the investigation time consisting of penicillin, a cephalosporine of the third generation and an aminoglycoside. 40% of the patients suffered from more or less severe neurologic sequelae; remaining cognitive deficits were also frequent. On the whole there was a tendency towards improvement in patients who suffered from less severe deficits at the time of discharge from hospital, patients with more severe deficits also showed slight improvement but generally did not reach a restitutio ad integrum. Regarding this, in our opinion a broad initial antimicrobial therapy should be used, although a statistically significant improvement of the patient's outcome by this could not be shown. Lethality as well as the frequency of complications do not seem to differ over many years although antimicrobial and intensive care treatment were improved. Thus, the outcome seems to depend largely on the occurrence of secondary focal complications or brain oedema.

Current Concepts in Acute Purulent Meningitis

Central nervous system (CNS) infection continues to be a significant cause of morbidity and mortality in children. Nonfatal CNS infections produce neurological and audiological sequelae in 5 to 30% of cases. Current case fatality rates in bacterial meningitis are between 3 and 7% in infants and children, increasing to approximately 30% in newborns.

Meningites purulentas em crianças no primeiro ano de vida

A series of 169 children with diagnosis of acute purulent meningitis during the first year of life was studied. Clinical and neurological findings are discussed, and for this purpose patients were separated in subgroups concerning their age. The great frequency in suckling until 6 months of age is emphasized.

Features of a Large Epidemic of Group A Meningococcal Meningitis in Khartoum, Sudan in 1988

A large epidemic (February-August 1988) of group A sulphonamide resistant, clone III-1 meningococcal meningitis in Khartoum, Sudan is described. A total of 10,099 cases were admitted to treatment centers with 8,397 cases during March and April, corresponding to an annual incidence of 1,679/100,000 inhabitants during this period. The age profile showed a high morbidity in adults (31% of the cases greater than or equal to 20 years). The male dominance was marked especially in the adult cases with a proportion of 3.2:1. The epidemic started during the hot and dry season and declined when the clouds came, humidity rose, temperature fell and a mass vaccination campaign had been implemented together with other epidemic precautions. Vaccination with a combined group A/C polysaccharide vaccine had been given 4 weeks-1 year before hospitalization to 11% of the children, 80% of whom were greater than 18 months of age. The estimated case fatality rate was 6.3%. Since 47% of the cases came from periurban and rural areas, the actual mortality during the epidemic might have been higher when considering those who may have died before reaching any of the treatment centres. Fatal cases had a short history of acute illness and a septic condition. Septicaemia was rare and seen in only 3.7% of the cases, the rest had acute purulent meningitis. Hearing loss/impairment and hemiplegia was diagnosed in 2-3% of the cases. The epidemiology, based on detailed typing/subtyping and restriction enzyme patterns of meningococcal strains, was apparently associated with the Mecca outbreak in August 1987.