Bacterial Meningitis Patients Research Articles

Features of the course of nosocomial meningitis in patients of neurosurgical intensive care unit

To determine the incidence rate and risk factors of nosocomial meningitis in patients with complicated postoperative period. We report the results of prospective observation of the course of bacterial meningitis in patients with complicated postoperative period at neurosurgical intensive care unit in 2010-2014. Nosocomial meningitis (NM) developed in 146 patients, which accounted for 12.6±1.0% (CI, 10.74-14.66). Patients with meningitis were characterized by longer stay at ICU, prolonged mechanical ventilation, need for central venous access and invasive hemodynamic monitoring, as well as longer course of antibacterial therapy. Frequency of invasive monitoring of intracranial pressure was similar in these two groups of patients. Bloodstream infections (14.8% vs. 4.9%; p<0.000), respiratory tract infections (55% vs. 35.6%; p<0.000), and urinary tract infections (56.4% vs. 30.9%; p<0.000) were more frequently observed in patients with NM. The following significant differences were observed between the group of NM patients and the control group: more frequent use of external ventricular drain (72.5% vs. 26.1%; p<0.000), number of reoperations (64.7% vs. 36.3%; p<0.000), and the total operating room time (417.3 min vs. 337.5 min; p<0.000). Etiology was ascertained in 61.0±4.0% of cases of nosocomial meningitis. CoNS (33.0%) and Acinetobacter baumannii (21.3%) were the main pathogens isolated from cerebrospinal fluid. The mortality in patients with meningitis was 31.5±3.8%. External ventricular drain, repeated surgery, long-term stay in the operating room, as well as other types of infections may be considered as risk factors for developing nosocomial meningitis in neurosurgical patients at ICU.

Comparison of Childhood Aseptic Meningitis with Bacterial Meningitis in a Tertiary Childrens Hospital of Taiwan

Objective: The initial clinical appearances of aseptic and bacterial meningitis in children are similar, but the treatment and outcome are quite different. To clarify the clinical presentation and laboratory results, we retrospectively reviewed our patients. Methods: The charts of hospitalized children under age 18 with discharge diagnosis of aseptic meningitis and bacterial meningitis during 2007~2014 were reviewed. Patients with aseptic meningitis were recruited as pleocytosis and negative bacterial growth in cerebrospinal fluid (CSF), while those with bacterial meningitis were recruited only who had positive CSF bacterial culture results. Traumatic tapping, contaminated cultures, or having received previous intravenous antibiotic therapy were excluded. Viral pathogens in CSF of aseptic meningitis were identified by CSF culture or polymerase chain reaction. Results: A total of 141 patients were enrolled as aseptic meningitis and 56 patients as bacterial meningitis. Aseptic meningitis occurred more in older than one-month-old children. Fever, headache, vomiting, and neck stiffness were significantly more in aseptic meningitis children, while convulsion, consciousness change, fontanelle bulging, and desaturation were significantly more in bacterial group. Significant laboratory differences were lymphocyte dominant in CSF, lower CSF protein level, higher CSF glucose level, and lower blood CRP level in aseptic meningitis group. Aseptic patients had shorter hospital duration (5.0 ± 2.0 days vs. 20.0 ± 8.0 days, p<0.001). All aseptic meningitis patients survived and were discharged without significant neurologic sequel. Among bacterial meningitis patients, 54.5% recovered completely, 10.9% died, and 34.5% had sequel. The outcome of aseptic meningitis group was significantly better than bacterial group. Conclusion: Aseptic meningitis occurred more in toddLers and older children, and had more meningeal symptoms/signs. More than half bacterial meningitis occurred in neonates and revealed more dreadful systemic presentations. Laboratory results can be helpful for differentiation of aseptic meningitis from bacterial meningitis. Careful monitoring clinical conditions and laboratory results are mandatory.

Prognosis of bacterial meningitis patients according to clinical criteriae and laboratory results on admission

Aim: The purpose of this study was to detect prognostic factors of acute bacterial meningitis on admission. Methods: Analysis of clinical and laboratory data of 60 adult acute bacterial meningitis patients admitted at Alexandria fever hospital between July 2014 to February 2015 including: age, sex, vital signs, conscious level, CSF findings, routine lab tests, metabolic acidosis, and causative organism was done initially on admission and then correlated with the patients' outcome on discharge which was either complete recovery (68.3%), recovery with sequelae (13.3%), or death (18.3%). Results: Factors associated with poor outcome were: Old age (P= 0.019), hypotension (p=0.003), low GCS (P=0.001), uremia (p=0.041), metabolic acidosis (P= 0.016), history of chronic hypertension (P= 0.018), Delayed referral &long duration of symptoms (P= 0.024). Conclusion: Acute bacterial meningitis patients having any of those poor prognostic criteria should be considered high risk patients and should have the priority for ICU admission and intensive monitoring.

Applying the bacterial meningitis score in children with cerebrospinal fluid pleocytosis: a single center's experience.

PurposeThe widespread introduction of bacterial conjugate vaccines has decreased the risk of cerebrospinal fluid (CSF) pleocytosis due to bacterial meningitis (BM) in children. However, most patients with CSF pleocytosis are hospitalized and treated with parenteral antibiotics for several days. The bacterial meningitis score (BMS) is a validated multivariate model derived from a pediatric population in the postconjugate vaccine era and has been evaluated in several studies. In the present study, we examined the usefulness of BMS in South Korean patients.MethodsThis study included 1,063 patients with CSF pleocytosis aged between 2 months and 18 years. The BMS was calculated for all patients, and the sensitivity and negative predictive value (NPV) of the test were evaluated.ResultsOf 1,063 patients, 1,059 (99.6%) had aseptic meningitis (AM). Only four patients (0.4%) had BM. The majority of patients (98%) had a BMS of ≤1, indicating a diagnosis of AM. The BMS was 0 in 635 patients (60%) and 1 in 405 patients (38%). All four BM patients had a BMS of ≥4.ConclusionTo our knowledge, this is the first study to investigate the diagnostic strength of the BMS in South Korea. In our study, the BMS showed 100% sensitivity and 100% NPV. Therefore, we believe that the BMS is a good clinical prediction rule to identify children with CSF pleocytosis who are at a risk of BM.

Polymorphisms in DNA Repair Gene XRCC1 (Arg194Trp) and (Arg399Gln) and their Role in the susceptibility of Bacterial Meningitis

Meningitis is a contagious infectious disease with high rates of mortality. Most pathogenic microbes in humans have the ability to cause bacterial meningitis. However, the most common pathogens are Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae type b (Hib). It was found that the susceptibility to this infectious disease may be related to genetic characteristics of the host, such as the occurrence of single nucleotide polymorphisms (SNPs). In our previous work, association of SNPs in DNA repair genes with bacterial meningitis (BM) was demonstrated. In this study we evaluated two non-synonymous SNPs of the repair gene XRCC1 Arg194Trp (rs 1799782) and Arg399Gln (rs 25487) in patients with BM and health volunteers. The patient genotypes were investigated by PCR-RFLP. DNA damages were quantified using the genomic DNA with formamidopyrimidine DNA-glycosylase (FPG). Cytokines and chemokines were quantified from cerebrospinal fluid samples from BM patients. Concerning the SNP XRCC1 Arg194Trp, none association was found relation to BM. However, a higher frequency of heterozygous genotype for XRCC1 Arg399Gln was observed in the control group compared to the BM group (P=0.043; OR=0.426). DNA damage and cytokine/chemokines levels were not positively correlated with polymorphic genotypes. In conclusion, there is an indication that the SNP XRCC1 Arg399Gln could have a possible protective effect against BM.

Patterns of Local and Systemic Cytokines in Bacterial Meningitis and its Relation with Severity and Long-Term Sequelae.

Bacterial meningitis (BM) is a pyogenic infection present in the subarachnoid space, potentially fatal and frequently associated with neurological sequelae. During BM, cytokines (CTs) are locally produced. We sought to determine the CTs’ clinical role as disease severity predictors in adults, which is not completely clear. Using a bead-based flow cytometric assay, levels of six CTs were determined in cerebrospinal fluid (CSF) and plasma from 18 adult BM patients and 19 uninfected controls. Long-term neurological sequelae were evaluated using the Glasgow Outcome Scale (GOS). All evaluated CTs were higher in CSF than in plasma, and the levels of CSF interleukin (IL)-6, IL-8, IL-10, IL-1β, and tumor necrosis factor-α and plasma IL-10 and IL-12p70 were significantly higher in patients with severe sepsis than with sepsis, suggesting an association with clinical severity. There was a strong negative correlation between CSF IL-6 and plasma IL-12p70 with GOS score, supporting the possible role of these CTs in the development of neurological long-term sequelae. These findings could be helpful to identify candidates to receive neuroprotective treatments and early physiotherapy schemes.

Analysis of clinical outcomes in pediatric bacterial meningitis focusing on patients without cerebrospinal fluid pleocytosis.

Cerebrospinal fluid (CSF) cell count and biochemical examinations and cultures form the basis for the diagnosis of bacterial meningitis. However, some patients do not have typical findings and are at a higher risk of being missed or having delayed treatment. To better understand the correlation between CSF results and outcomes, we evaluated CSF data focusing on the patients with atypical findings. This study enrolled CSF culture-proven bacterial meningitis patients aged from 1 month to 18 years in a medical center. The patients were divided into "normal" and "abnormal" groups for each laboratory result and in combination. The correlations between the laboratory results and the outcomes were analyzed. A total of 175 children with confirmed bacterial meningitis were enrolled. In CSF examinations, 16.2% of patients had normal white blood cell counts, 29.5% had normal glucose levels, 24.5% had normal protein levels, 10.2% had normal results in two items, and 8.6% had normal results in all three items. In logistic regression analysis, a normal CSF leukocyte count and increased CSF protein level were related to poor outcomes. Patients with meningitis caused by Streptococcus pneumoniae and hyponatremia were at a higher risk of mortality and the development of sequelae. In children with bacterial meningitis, nontypical CSF findings and, in particular, normal CSF leukocyte count and increased protein level may indicate a worse prognosis.

The kynurenine pathway is involved in bacterial meningitis.

BackgroundBacterial meningitis (BM) is characterized by an intense host inflammatory reaction, which contributes to the development of brain damage and neuronal sequelae. Activation of the kynurenine (KYN) pathway (KP) has been reported in various neurological diseases as a consequence of inflammation. Previously, the KP was shown to be activated in animal models of BM, and the association of the SNP AADAT + 401C/T (kynurenine aminotransferase II - KAT II) with the host immune response to BM has been described. The aim of this study was to investigate the involvement of the KP during BM in humans by assessing the concentrations of KYN metabolites in the cerebrospinal fluid (CSF) of BM patients and their relationship with the inflammatory response compared to aseptic meningitis (AM) and non-meningitis (NM) groups.MethodsThe concentrations of tryptophan (TRP), KYN, kynurenic acid (KYNA) and anthranilic acid (AA) were assessed by HPLC from CSF samples of patients hospitalized in the Giselda Trigueiro Hospital in Natal (Rio Grande do Norte, Brazil). The KYN/TRP ratio was used as an index of indoleamine 2,3-dioxygenase (IDO) activity, and cytokines were measured using a multiplex cytokine assay. The KYNA level was also analyzed in relation to AADAT + 401C/T genotypes.ResultsIn CSF from patients with BM, elevated levels of KYN, KYNA, AA, IDO activity and cytokines were observed. The cytokines INF-γ and IL-1Ra showed a positive correlation with IDO activity, and TNF-α and IL-10 were positively correlated with KYN and KYNA, respectively. Furthermore, the highest levels of KYNA were associated with the AADAT + 401 C/T variant allele.ConclusionThis study suggests a downward modulatory effect of the KP on CSF inflammation during BM.

Predictive Value of Cerebrospinal Fluid Matrix Metalloproteinase-9 and Tissue Inhibitor of Metalloproteinase-1 Concentrations in Childhood Bacterial Meningitis

Increased concentrations of matrix metalloproteinases (MMP) in cerebrospinal fluid are part of the host response in bacterial meningitis (BM). We investigated whether the concentrations of MMP-9 and the tissue inhibitor of metalloproteinase (TIMP)-1 predict the outcome in childhood BM. Cerebrospinal fluid MMP-9 and tissue inhibitor of metalloproteinase-1 (TIMP-1) were quantified by an enzyme-linked immunosorbent assay from 264 and 335 patients, respectively; 43 children without BM served as controls. The results were compared with previously known independent predictors of death and sequelae. Higher MMP-9 and TIMP-1 values distinguished the controls from the BM patients (P < 0.0001). A MMP-9 concentration >940 ng/mL proved an independent predictor of death [adjusted odds ratio: 4.03; 95% confidence interval (CI): 2.09-7.77; P < 0.0001]. If the patient additionally presented with a Glasgow Coma Score below 9, the odds increased to 13.21 (95% CI: 5.44-32.08; P < 0.0001). TIMP-1 levels correlated with the severity of sequelae (ρ: 0.30; P < 0.0001), but not with death. Its concentration above 390 ng/mL increased the likelihood of sequelae 3.43-fold (95% CI: 1·73-6·79; P = 0.0004), and up to 31.18-fold (95% CI: 4.05-239.8; P = 0.0009) if the patient also presented a Glasgow Coma Score < 12. Elevated cerebrospinal fluid MMP-9 and TIMP-1 values predict 2 important outcomes in childhood BM. Combined with a clinical evaluation, quantification of these indices augments the chances to identify the patients in greatest need of better treatment modalities.

Role of Clinical Presentations and Routine CSF Analysis in the Rapid Diagnosis of Acute Bacterial Meningitis in Cases of Negative Gram Stained Smears.

Background and Aim. Bacterial meningitis is a lethal, disabling endemic disease needing prompt antibiotic management. Gram stained smears is rapid accurate method for diagnosis of bacterial meningitis. In cases of negative gram stained smears diagnosis is delayed till culture results. We aim to assess the role of clinical presentations and routine CSF analysis in the cost-effective rapid diagnosis of negative gram stained smears bacterial meningitis. Methods. Cross sectional study including 623 acute meningitis patients divided into two groups: bacterial meningitis and nonbacterial meningitis groups. The clinical presentations, systemic inflammatory parameters, and CSF analysis were evaluated and compared in both groups. Results. Altered conscious level, localizing neurological signs, Kernig's and Brudzinski's signs together with peripheral leucocytosis (>10.000/mm3), high CRP (>6) together with high CSF protein (>50 gl/dL), CSF neutrophilic count (≥50% of total CSF leucocytic count), and low CSF glucose level (<45 gm/dL) and CSF/serum glucose ≤0.6 were significantly diagnostic in bacterial meningitis patients. From the significant CSF analysis variables CSF protein carried the higher accuracy of diagnosis 78% with sensitivity 88% and specificity 72%. Conclusions. High CSF protein (>50 mg/dL) together with plasma inflammatory markers and CSF cytochemical parameters can diagnose bacterial meningitis in gram stain negative smear till culture results.

Bacteriological Profile of Acute Meningitis: A One Year Study in a Tertiary Care Centre in Assam

Bacterial meningitis is still a life threatening epidemiological problem especially in many developing countries. The aim of the present study is to ascertain different bacterial agents from cerebrospinal fluid of patients with signs and symptoms of acute meningitis admitted in Gauhati Medical College and Hospital, Guwahati and to determine their in vitro antimicrobial susceptibility pattern of different bacterial isolates. A total of 316 cerebrospinal fluid specimens were processed by standard procedures for culture and antibiotic susceptibility patterns the Department of Microbiology, Gauhati Medical College and Hospital, Guwahati, from August 2009 to July 2010. Bacterial pathogens were isolated from 44 patients showing an isolation rate of 13.91%. The predominant organism in CSF culture was Staphylococcus aureus 15 (34.1%), followed by Klebsiella sp. 8 (18.18%), Escherichia coli 6 (13.63%), Acinetobacter sp. 4 (9.09%), Neisseria meningitidis 2 (4.54%) and Streptococcal pneumoniae, 2 (4.54%). All the Gram positive isolates were 100% sensitive to Linezolid and Vancomycin. The Gram negative bacilli isolates were found to be highly sensitive to Polymyxin B, Imipenem and Piperacillin-Tazobactum. Among the cephalosporins, least sensitive was Cefoperazone followed by Ceftriaxone, Cefotaxime and Ceftazidime. The present study reveals the changing epidemiological trend of acute bacterial meningitis in this part of the country along with their changing in vitro antimicrobial susceptibility pattern. This microbiological study may provide a guideline to formulate the initial empiric antibiotic therapy for the patients of acute bacterial meningitis.

Expansion of activated regulatory T cells by myeloid‐specific chemokines via an alternative pathway in CSF of bacterial meningitis patients

Previous studies have demonstrated that activation/expansion by certain cytokines as well as recruitment by specific chemokines is involved in enrichment of regulatory T (Treg) cells in local tissues or organs under pathological conditions. Recent evidence indicates that human Treg cells are a heterogeneous population that comprises three distinct subpopulations: CD25⁺CD45RA⁺ resting Treg (rTreg) cells, CD25(hi)CD45RA⁻ activated Treg (aTreg) cells, which are both suppressive, and CD25⁺CD45RA⁻ cytokine-secreting T cells with proinflammatory capacity. Moreover, rTreg cells can proliferate and convert to aTreg cells. Here, we found an increase in aTreg-cell frequency in the cerebrospinal fluid (CSF) of patients with postneurosurgery bacterial meningitis. We revealed that such an increased aTreg-cell frequency in the CSF was not due to enhanced chemotaxis. Instead of a classic conversion pathway from rTreg to aTreg cells, we identified an alternative route of Treg-cell conversion from cytokine-secreting cells to aTreg cells induced by myeloid-specific chemokine CXC chemokine receptor (CXCR) ligand 5 via CXCR1 and CXCR2 receptors, or by CSF myeloid cells in a cell-cell contact manner. Our results reveal a different view of how the immune system controls overwhelming local immune responses during infection, and provide evidence of how innate immunity negatively regulates adaptive immunity.

Histopathology of the Clarion Cochlear Implant Electrode Positioner in a Human Subject

A Silastic electrode positioner was introduced by the Advanced Bionics Corporation in 1999 and it was designed to achieve a perimodiolar position of the stimulating electrode. The positioner was voluntarily recalled in the United States in July 2002 due to an apparent higher risk of bacterial meningitis in patients in whom the electrode positioner had been placed. A detailed histopathologic study of the positioner in the human has not previously been published. The histopathologic findings in a 74-year-old woman who underwent bilateral cochlear implantation using the positioner are presented. Findings include a large track caused by the combined electrode and its positioner with considerable disruption of the basilar membrane and osseous spiral lamina. Although there was a fibrous sheath around the electrode and positioner at the cochleostomy in both ears, this fibrous sheath did not extend deeply into the cochlea except at the apical end of the electrode beyond the positioner. This resulted in a large fluid space around and between the positioner and electrode within the cochlea and presumably in fluid continuity with the cerebrospinal fluid space. Possible clinical implications are discussed.

Risk score for identifying adults with CSF pleocytosis and negative CSF Gram stain at low risk for an urgent treatable cause

We aimed to derive and validate a risk score that identifies adults with cerebrospinal fluid (CSF) pleocytosis and a negative CSF Gram stain at low risk for an urgent treatable cause. Patients with CSF pleocytosis and a negative CSF Gram stain were stratified into a prospective derivation (n = 193) and a retrospective validation (n = 567) cohort. Clinically related baseline characteristics were grouped into three composite variables, each independently associated with a set of predefined urgent treatable causes. We subsequently derived a risk score classifying patients into low (0 composite variables present) or high (≥ 1 composite variables present) risk for an urgent treatable cause. The sensitivity of the risk score was determined in the validation cohort and in a prospective case series of 214 adults with CSF-culture proven bacterial meningitis, CSF pleocytosis and a negative Gram stain. A total of 41 of 193 patients (21%) in the derivation cohort and 71 of 567 (13%) in the validation cohort had an urgent treatable cause. Sensitivity of the dichotomized risk score to detect an urgent treatable cause was 100.0% (95% CI 93.9-100.0%) in the validation cohort and 100.0% (95% CI 97.8-100.0%) in bacterial meningitis patients. The risk score can be used to identify adults with CSF pleocytosis and a negative CSF Gram stain at low risk for an urgent treatable cause.

Laboratory evaluation of cases of meningitis attending a tertiary care hospital in India: An observational study

Context: Diagnosis of infection involving the central nervous system is of critical importance. Aims, Settings and Design: Objectives were to isolate and identify the organisms causing bacterial meningitis in patients admitted in the intensive care unit of a tertiary care hospital in Bihar, India. To assess the clinical presentation and to further determine the isolates causing meningitis by antigen testing. Materials and Methods: Cerebrospinal fluid (CSF) and blood samples were collected from 83 patients with signs and symptoms of meningitis and were cultured on 5% sheep blood agar, MacConkey's agar and chocolate agar. Smears were made with the centrifuged deposit of CSF and stained by Gram stain, Ziehl Neelsen stain and negative staining. The supernatant was used for latex agglutination test (LAT). Antibiotics susceptibility tests were also performed for all isolates. Statistical Analysis Used: S.S.P.E version 11. Results: Most of the cases of meningitis occurred in winter and spring. Out of 83 cases 38 (45.8%) were found to be cases of bacterial meningitis. The most common presenting feature in both bacterial and aseptic meningitis was fever, followed by altered sensorium. Only 15.7% (13/83) of cases had neck rigidity. The organisms isolated were Escherichia coli 25.6% (10/39), Staphylococcus aureus 15.4% (6/39), Streptococcus pneumonia 10.2% (4/39), Klebsiella species 10.2% (4/39) and Pseudomonas areuginosa 10.2% (4/39). LAT detected bacterial antigens in 16.9% (14/38) cases. The common etiological agent identified was E. coli 10/38 (71.4%) and followed by Streptococcus pneumonia 4/38 (28.6%). Conclusions: To conclude, Gram negative bacilli were found to be more frequently isolated in our series of patients with E. coli being the most common isolate. Established organisms of meningitis such as Haemophilus influenzae and Niesseria meningitidis were not isolated at all, despite all our efforts.

Diagnostic Characteristics of Symptom Combinations over Time in Meningitis Patients

Objective: The aim of this study was to investigate diagnostic characteristics to distinguish bacterial meningitis (BM) from aseptic meningitis (AM) in meningitis patients. Indicators from the initial consultation were combined with a measure of time since the onset of fever. Methods: This was a retrospective chart review. We examined the sensitivity and specificity of the clinical information for BM. The diagnostic characteristics for BM were analyzed by considering the duration of fever for each patient at consultation, together with the presence or absence of changes in their mental status. The study examined 117 inpatients diagnosed with meningitis in their clinical record at the time of admission. The patients were admitted into two emergency hospitals in Japan between 2001 and 2011. Meningitis was defined as the presence of five or more cells per mm3 of CSF. Results: Twenty-five patients were diagnosed with BM and 92 patients with AM. There was no single clinical symptom that could distinguish BM from AM in patients suspected of meningitis. The sensitivity and specificity of the clinical information for fever duration and disturbance of consciousness at consultation were 95.0% and 40.3%, respectively, for BM patients with disturbance of consciousness or with duration of fever less than three days. Thus, the proportion of BM patients without disturbance of consciousness for three or more days after fever onset was only 5%. Conclusions: Patients without disturbance of consciousness for three or more days after fever onset are rarely suffering from BM.

Delayed cerebral thrombosis in bacterial meningitis: a prospective cohort study

To study the incidence and clinical characteristics of delayed cerebral thrombosis in bacterial meningitis patients. We assessed the incidence and clinical characteristics of delayed cerebral thrombosis in adults with cerebrospinal fluid (CSF) culture-proven community-acquired bacterial meningitis included in a prospective nationwide study in The Netherlands performed from 2006 to 2012. Delayed cerebral thrombosis occurred in 11 of 1,032 episodes (1.1%). CSF culture yielded Streptococcus pneumoniae in ten patients and Listeria monocytogenes in one. Adjunctive dexamethasone therapy was administered before or with the first dose of antibiotics in 9 of 11 patients; two patients were initially not treated with dexamethasone. All patients made good initial recovery, followed by sudden deterioration after 7-42 days. Cranial imaging studies showed multiple cerebral infarctions in all patients. The outcome was unfavorable in all but one patient. In an explorative analysis, patients with delayed cerebral thrombosis had eightfold higher complement C5a CSF concentrations on the diagnostic lumbar puncture as compared in those without delayed cerebral thrombosis (p = 0.04). Delayed cerebral thrombosis is a rare but devastating complication of bacterial meningitis. Adjunctive dexamethasone therapy seems to predispose patients with bacterial meningitis to this complication. We found some evidence that this thrombotic complication is associated with activation of the complement system.

Validation of diagnostic algorithm to differentiate between tuberculous meningitis and acute bacterial meningitis

BackgroundDiscrimination between tuberculous and acute bacterial meningitis is difficult by clinical features alone and laboratory methods may only supplement the clinical suspicion. We aimed to validate the diagnostic criteria by Thwaites et al. [1] and construct our own diagnostic predictors based on the clinical and laboratory features. Methods380 patients of acute bacterial meningitis (ABM) and 210 patients of tuberculous meningitis (TBM) were enrolled retrospectively from June 2004 to June 2007 and prospectively from July 2007 to September 2008. HIV positive patients were excluded. Detailed history, clinical examination CSF analysis, haematological, biochemical investigations and imaging was performed in all patients. ResultsFactors associated with the diagnosis of TBM in the present study included rural area of residence, longer duration of disease, presence of clear CSF, lower percentage of CSF neutrophils, presence of diplopia and hemiparesis. On validation, age did not appear as a significant factor in our population. The diagnostic algorithm from our study group had a sensitivity of 95.71% and specificity of 97.63%. ConclusionsThe diagnostic criterion has a fair validation in our population when the age factor is excluded. The rule is useful in HIV negative patients with low CSF sugar and negative organism yield in the CSF.

Childhood Acute Bacterial Meningitis in Benin City, Nigeria

Childhood acute bacterial meningitis (ABM) is a leading cause of morbidity and mortality in Nigeria. The usual practice of commencing antibiotic therapy before the complete laboratory result is available necessitates the knowledge of the current most frequent aetiologic agents of meningitis and the antibiogram in the local population.This study was undertaken to prospectively investigate childhood acute bacterial meningitis in patients attending the children emergency unit at the University of Benin Teaching Hospital. One hundred and fifty CSF specimens obtained from children suspected to have acute bacterial meningitis were analyzed using microscopy, culture, biochemical tests and latex agglutination tests. A total of 23 (15.3%) out of 150 were confirmed bacterial meningitis. Eleven (47.8%) out of the 23 cases were caused by Streptococcus pneumoniae, 7 (30.4%) Haemophilus influenzae type b, 3 (13.0%) Neisseria meningitidis and 2 (8.7%) for others comprising of Staphylocuccus aureus and Klebssiella pneumoniae. No statistically significant association was established between ABM and variables like age 0.05). Penicillin and ampicillin resistances were established among 16.7% and 11.1% of Haemophilus influenzae and Streptococcus pneumoniae isolates respectively. There is need for periodic surveillance of prevalence, aetiology and antibiotic resistance pattern of childhood bacterial meningitis in order to optimize antibiotics management.

A New Diagnostic Scoring for Discrimination of Tuberculous and Bacterial Meningitis on the Basis of Clinical and Laboratory Findings

Objectives: The aim of this study was to develop a new diagnostic index (DI) on the basis of clinical and laboratory findings including serum C-reactive protein (CRP) for tuberculous meningitis (TM) and bacterial meningitis (BM). Subjects and Methods: During a 7-year period, 96 adult patients with meningitis (30 with TM and 66 with BM) were studied retrospectively. Multivariate logistic regression analysis was performed to investigate the diagnostic value of clinical and laboratory parameters as independent predictors on discrimination of tuberculous from BM patients. Results: Six features predictive for diagnosis including age, CSF leukocyte count, PML dominance, length of illness, serum CRP level and blood WBC count were used. The DI model developed from these features had very high sensitivity and specificity rates of 100.0 and 95.4%, respectively. The sensitivity and specificity rates were 97.4 and 100%, respectively, in microbiologically proven cases. Conclusion: Our results suggested that this new DI which consists of simple clinical and laboratory parameters had the power to discriminate adult patients with documented tuberculous and BM (excluding Brucella meningitis). It should, however, be tested in prospective studies.