Bulging Fontanelle Research Articles

ETMR-12. INFANTILE CENTRAL NERVOUS SYSTEM JUVENILE XANTHOGRANULOMA WITH SOMATICCSF1R MUTATION - RESPONSIVE TO IMATINIB MONOTHERAPY

Abstract BACKGROUND Juvenile xanthogranuloma (JXG) of the central nervous system(CNS) is a rare non-Langerhans cell histiocytosis typically affecting children and young adults. CSF1R mutations have been reported for peripheral JXG but have not previously been reported in CNS JXG. Treatment of CNS JXG relies on maximal safe surgical resection followed by cytotoxic chemotherapy, radiotherapy and/or molecular targeted therapy involving MAPK signaling pathway. Imatinib has been effective in treating tenosynovial giant cell tumor with CSF1R mutations. METHODS Case Report RESULTS A 3 month old male presented with fever, lymphadenopathy, and macrocephaly (45.5cm, 99.97%) with bulging fontanelles. Head ultrasound revealed dilated ventricles and brain MRI demonstrated multiple dural-based masses, the largest measuring 6.6 x 5.3 x 5.7 cm was located along the right tentorium and caused obstructive hydrocephalus. Patient underwent right frontal endoscopic third ventriculostomy and choroid plexus cauterization to treat hydrocephalus and right parietal craniotomy to resect the superficial dural-based mass for tissue diagnosis. Pathology was most consistent with a JXG that harbored a somatic CSF1R (NM_001288705.3) mutation. DNA Methylation profiling was unmatched. PET scan was negative for non-CNS lesions. Due to the multiple masses on presentation, the surgical risks of resection of the largest lesion, as well as having a targetable mutation, we opted for medical therapy. As Pexidartinib, a selective CSF1R inhibitor, was not available for infants, patient was started on liquid imatinib 340 mg/m2/day monotherapy. Three months after initiation of imatinib, the smaller parietal lesions resolved and after six months, the largest mass continued to shrink (6.3 x 2.9 x 2.9 cm). Treatment has been well tolerated without adverse events or drug interruptions. CONCLUSION This is the first report of CNS JXG with a CSF1R mutation. Importantly, it demonstrates that imatinib is a potentially safe and effective form of monotherapy for this rare disease.

Effects of primary or secondary prevention with vitamin A supplementation on clinically important outcomes: a systematic review of randomised clinical trials with meta-analysis and trial sequential analysis

ObjectivesThis systematic review with meta-analyses of randomised trials evaluated the preventive effects of vitamin A supplements versus placebo or no intervention on clinically important outcomes, in people of any age.MethodsWe...

Prediction models for post-discharge mortality among under-five children with suspected sepsis in Uganda: A multicohort analysis.

In many low-income countries, over five percent of hospitalized children die following hospital discharge. The lack of available tools to identify those at risk of post-discharge mortality has limited the ability to make progress towards improving outcomes. We aimed to develop algorithms designed to predict post-discharge mortality among children admitted with suspected sepsis. Four prospective cohort studies of children in two age groups (0-6 and 6-60 months) were conducted between 2012-2021 in six Ugandan hospitals. Prediction models were derived for six-months post-discharge mortality, based on candidate predictors collected at admission, each with a maximum of eight variables, and internally validated using 10-fold cross-validation. 8,810 children were enrolled: 470 (5.3%) died in hospital; 257 (7.7%) and 233 (4.8%) post-discharge deaths occurred in the 0-6-month and 6-60-month age groups, respectively. The primary models had an area under the receiver operating characteristic curve (AUROC) of 0.77 (95%CI 0.74-0.80) for 0-6-month-olds and 0.75 (95%CI 0.72-0.79) for 6-60-month-olds; mean AUROCs among the 10 cross-validation folds were 0.75 and 0.73, respectively. Calibration across risk strata was good: Brier scores were 0.07 and 0.04, respectively. The most important variables included anthropometry and oxygen saturation. Additional variables included: illness duration, jaundice-age interaction, and a bulging fontanelle among 0-6-month-olds; and prior admissions, coma score, temperature, age-respiratory rate interaction, and HIV status among 6-60-month-olds. Simple prediction models at admission with suspected sepsis can identify children at risk of post-discharge mortality. Further external validation is recommended for different contexts. Models can be digitally integrated into existing processes to improve peri-discharge care as children transition from the hospital to the community.

Complete Intraventricular Migration of Ventriculoperitoneal Shunt: Once in a Blue Moon Phenomenon of Shunt Surgery

AbstractShunt surgery is a very common neurosurgical procedure for hydrocephalus. It is associated with numerous complications, and intraventricular shunt migration is one of rarest. Various mechanisms have been described to explain this rare entity. Hereby we present an index case of this rare complication of shunt surgery in which patient presented with tuberculous meningitis with hydrocephalus having intraventricular shunt migration and will discuss possible mechanisms responsible for it. A 1-year old male infant, previously diagnosed case of tuberculous meningitis with hydrocephalus with right-sided ventriculoperitoneal shunt in situ, presented to the emergency department with bulging fontanelles secondary to shunt malfunction. Left-sided ventriculoperitoneal shunt was inserted. After few months, patient turned up again with left-sided shunt malfunction and right-sided intraventricular migrated shunt. Endoscopy-assisted removal of intraventricular migrated shunt and simultaneous third ventriculostomy was done. Patient improved in postoperative period. Being an extremely uncommon complication, intraventricular migration of shunt described as “once in a blue moon” phenomenon. It can be avoided by proper surgical technique with adequate-sized burr hole. Removal of shunt is preferred for prevention of infection.

Clinical factors associated with need for neurosurgical care in young children with imaging for macrocephaly: a case control study

BackgroundMacrocephaly is present in 2.3% of children with important neurosurgical conditions in the differential diagnosis. The objective of this study was to identify clinical associations with actionable imaging findings among children with head imaging for macrocephaly.MethodsWe conducted a case-control study of head imaging studies ordered for macrocephaly among children 24 months and younger in a multistate children’s health system. Four neurosurgeons reviewed the images, determining cases to be a ‘concern’ if neurosurgical follow-up or intervention was indicated. Electronic health records were reviewed to collect patient-level data and to determine if surgery was performed. Controls were matched 3:1 to cases of ‘concern’ in a multivariate model using conditional logistic regression.ResultsIn the study sample (n = 1293), 46 (4%) were concern cases, with 15 (1%) requiring surgery. Significant clinical factors associated with neurosurgical concern were bulging fontanel [aOR 7.47, (95% CI: 2.28–24.44), P < 0.001], prematurity [aOR 21.26, (95% CI: 3.76–120.21), P < 0.001], any delay [aOR 2.67, (95% CI: 1.13–6.27), P = 0.03], and head-weight Z-score difference (W_diff, defined as the difference between the Z-scores of head circumference and weight) [aOR 1.70, (95% CI: 1.22–2.37), P = 0.002].ConclusionsHead imaging for macrocephaly identified few patients with findings of concern and fewer requiring surgery. A greater head-weight Z-score difference appears to represent a novel risk factor for neurosurgical follow-up or intervention.

C5 (Clinical Case) Coccobacillary Meningitis and Septic Embolic Infarcts in an Ex-Preterm Infant: An Unexpected Pathogen

Abstract Introduction/Background Pasteurella multocida causes life-threatening zoonotic invasive infections in immunocompromised individuals and those at extremes of age (neonates and elderly). Bacteremia, meningitis, and endocarditis are serious complications that are associated with up to 25-30% mortality. Case Description A 7-week-old ex-34-week preterm female infant presented with a one-day history of fever, irritability, and poor feeding without exposure to sick contacts. Household contacts included a constantly drooling Shi Tzu dog. Examination revealed an irritable, febrile infant with a bulging fontanelle and scant purulent eye discharge. No focal neurological deficits, skin rashes or murmurs were appreciated. Empiric antibiotics were initiated following a full work-up for sepsis. Cerebrospinal fluid (CSF) analysis showed neutrophilic pleocytosis with 7608 x106L nucleated cells (95% neutrophils), protein 7360 mg/L, glucose &amp;lt;0.2 mmol/L and gram-negative coccobacilli. Blood and CSF cultures grew Pasteurella multocida, prompting a switch to crystalline penicillin. An echogenic mitral valvular mass was identified in the absence of underlying cardiac defects. Head imaging confirmed ventriculitis with multiple small infarcts. No sequelae of abscess, hydrocephalus or hearing loss were demonstrated after the completion of 6 weeks of penicillin therapy. Discussion Haemophilus influenzae, serotype b, is the typical cause of coccobacillary meningitis in a 7-week-old infant. In addition to non-b serotypes, non-typeable species which cause conjunctivitis may also cause invasive disease in young infants. The resultant growth of P. multocida from cultures was, therefore, unexpected, particularly given there were no preceding animal bites or scratches. In vulnerable hosts, this pathogen can be transmitted across skin or mucous membranes after close animal contact, such as licking and sniffing. The constant drooling and spraying of saliva from the pet dog, a flat-faced breed known to have stenotic nares and chronic nasal secretions, likely provided an opportunity for mucosal contamination. This infant’s young age, prematurity, and exposure to a flat-faced dog placed her at high risk for Pasteurellosis, which manifested as complicated meningitis and endocarditis. Conclusion Pasteurella infections most often arise as local infections following an animal bite or scratch, are rare but important causes of life-threatening severe coccobacillary invasive infection, even without preceding trauma, in young infants. Families of at-risk individuals who own pets should have adequate education about zoonotic infections that address risk factors, including animal breed and behaviour, presenting features and preventive strategies to reduce the potential for serious morbidity and even mortality.

Pitfalls in Diagnosis of Shunt Malfunction in Children

Background: In children with a potential shunt malfunction, pediatricians and emergency physicians are often the first to assess these children prior to neurosurgical referral. Most shunts fail within the first year (67%), with 14% of children having a shunt failure within the first month of insertion, and 40% within the second year of insertion. Classical symptoms of raised ICP, such as nausea, vomiting, coma and bulging fontanelle have a high predictive value for shunt failure, but are not always present. Some patients may be asymptomatic of shunt failure and the age of the patient will also confound this symptom spectrum. Clinical signs of shunt failure are well varied and age dependent. This article presents a series of four cases of shunted patients with atypical presentations of shunt malfunction. Materials and Methods: Clinical, radiological and surgical data of the patients were collected to demonstrate atypical presentations of shunt malfunction. All shunt malfunctions were confirmed upon review of the shunt in the operating theatre. Results: Four patients are shown to have atypical presentations of shunt malfunction. The first child was completely well despite an incidental finding of papilloedema on routine follow up, despite the lack of clinical and radiological evidence for shunt malfunction. The second child was completely well with a minor intermittent CSF leak at the drain wound. The third was an expanding pseudomeningocele after tumor resection. The final child had an expanding lower back pseudomeningocele but was otherwise well. All patients had resulting successful shunt revisions. Conclusion: It is important for neurosurgeons, paediatricians and emergency doctors to be able to identify these atypically presenting children and to correct their shunt malfunction to prevent long-term complications of insidious raised ICP, such as blindness or worsening of pre-existing neurological deficits and more importantly to prevent the child having a rapid and devastating decompensation.

Interhemispheric arachnoid cysts: case series

Objective: Interhemispheric arachnoid cysts (IHACs) are a rare congenital malformation arising from the duplication of the arachnoid membrane of the cerebral meninges associated with malformations of the corpus callosum. The scope of this study is to describe a series of cases of IHACs treated via neuroendoscopy in a reference center. Method: description of a case series of children diagnosed with IHAC undergoing neuroendoscopic treatment (cystoventriculostomy) between 2015 and 2022, describing the main clinical manifestations, the surgical indication, and the neuroendoscopic technique performed. Results: Four children diagnosed with IHACs, with a predominance of males (3:1), were included in the study. Considering the Mori and Barkovich classification systems, magnetic resonance imaging of the brain showed multiseptate extra-axial interhemispheric cysts without communication with the ventricular system in all cases. Macrocrania and bulging fontanel were the clinical manifestations that indicated urgent hospitalization for the proposed neurosurgical treatment. Conclusion: Signs of increased intracranial pressure were observed in all cases of IHACs in the first months of life. Endoscopic cystoventriculostomy was performed in all cases with satisfactory results, showing that this is an option to be evaluated for the treatment of IHACs classified as multiseptate extra-axial and without communication with the ventricular system or brain cisterns, according to Mori and Barkovich classification systems.

A Case of Infant-type Hemispheric Glioma with NTRK1 fusion (P9-13.003)

<h3>Objective:</h3> Not applicable <h3>Background:</h3> The incidence of childhood central nervous system tumors in infants is about 6 per 100,000 children with glioma having the highest incidence at 1.38 per 100,000. A study by Wu et al. showed recurrent fusion of the <i>NTRK</i> gene in 10% of non-brainstem high grade glioma in very young children suggesting an oncogenic effect of the <i>NTRK</i> fusion genes. Here we present a rare case of a full-term neonate who was noted to have widely splayed sutures and a bulging fontanelle at birth who was found to have infant-type hemispheric glioma with <i>NTRK1</i> fusion. <h3>Design/Methods:</h3> Not applicable <h3>Results:</h3> A full-term infant with normal prenatal course, including a 20-week anatomy scan, was born with widely splayed sutures, bulging anterior fontanelle and head circumference &gt;99^th percentile (40 cm). Head ultrasound showed severe hydrocephalus and a large intracranial mixed echogenicity lesion in the left cerebral hemisphere with hemorrhage. He had sustained leftward gaze, and video EEG revealed seizures. MRI demonstrated a large 6×7cm lesion, hydrocephalus with subfalcine herniation and mass effect on the brainstem (figure, A–B). He underwent biopsy and ventriculoperitoneal shunt placement. MRI 2 weeks later showed tumor enlargement, obstructive hydrocephalus and severe brainstem compression (figure, C–D). Pathology was consistent with infant-type hemispheric glioma with <i>NTRK1</i> fusion. Due to the dismal prognosis, the family prioritized palliative care. <h3>Conclusions:</h3> Infant-type hemispheric glioma, previously termed glioblastoma (GBM), is a rare, rapidly-growing congenital tumor, and prenatal imaging is often normal. Mixed-age hemorrhages and diffusion restriction is suggestive of the diagnosis. The neurotrophic tyrosine receptor kinase (NTRK) genes <i>NTRK1, NTRK2</i>, and <i>NTRK3</i> are involved in infant-type hemispheric gliomas and are typically high grade in histology. A recent study by Torre et al. showed most <i>NTRK-</i>fused gliomas were hemispheric and had a higher prevalence in non-brainstem high grade gliomas in patients younger than 3 years old. <b>Disclosure:</b> Dr. Garcia has nothing to disclose. Dr. Bell has nothing to disclose. Dr. Nelson has nothing to disclose. Dr. Miller has nothing to disclose. Dr. Segal has nothing to disclose.

Abstract Number ‐ 116: Palliative Embolization on an Infantile Dural Sinus Malformation with Giant Lakes.

Introduction Dural Sinus Malformation (DSM) is a rare and high risk mortality vascular pathology identified early postnatal due to common clinical symptoms like macrocephaly, downward wandering eyes, bulging and pulsatile fontanels and heart failure. Most DSMs resolves prenatally. It is characterized by giant venous lake at the torcular region expanding towards the infratentorial and supratentorial spaces with usually existence of Dural arteriovenous fistulas (dAVF). Pathophysiology of DSMs are ballooning and malformation of the distal jugular bulb or persistence abnormal of the transverse sinus. Methods We performed the staged trans arterial Onyx‐18 embolization 5 times of a 3 mo infant boy with dural sinus malformation with multiple arteriovenous fistula using the 4 French GlideSim 2 Catheter, Headway Duo 167 micro catheter, and numerous microwires including Aristotle 014, Chikai Black Soft 014 and 010 and Synchro 014, 010 and 080 through alternated sides of transfemoral accesses. Embolizations were performed through the bilateral branches of the left and right middle meningeal arteries, posterior meningeal arteries and left occipital artery. Limitations during procedure are body weight to use contrast, fluoroscopy time and access sides. Results Post embolization injections demonstrated significant flow reduction into the malformation through ECA branches. No neurological complications occurred due to the procedures. MRI Brains in following weeks did not show large thrombus formation, hydrocephalus, or parenchymal injury. Patient showed clinical improvements with stable macrocephaly and decreased frontal pulsation and bulging. Conclusions Staged trans arterial embolization seems a safe approach on high mortality DSM. Thrombus is not formed all at once and mass effect from thrombosed sinus is avoided. Sinus has time to shrink.

679 - Levofloxacin associated drug-induced intracranial hypertension revealed by a bulging fontanelle

679 - Levofloxacin associated drug-induced intracranial hypertension revealed by a bulging fontanelle

The Prevalence and Risk Factors of Late Onset Neonatal Sepsis in SCANU (Special Care Newborn Unit)

Background: Despite significant attempts to mitigate its effects, neonatal sepsis including late onset neonatal sepsis is regarded as a major cause of morbidity and death in newborns. Objective: In this study our main goal is to evaluate the prevalence and risk factors of late onset neonatal sepsis in SCANU (Special Care Newborn Unit). Method: This cross sectional study was carried out at tertiary medical college and hospital where 100 neonates suspected of having neonatal sepsis and admitted in the neonatal unit were included. Clinical sepsis was diagnosed based on presence of one or more of clinical features. Clinical features considered were fever (≥38.0°C), hypothermia (≤36.5°C), convulsions, lethargy, poor feeding, respiratory distress, vomiting, bulging fontanels, jaundice, and umbilical pus infections. Results: The research found that 46% of the instances occurred in the 15-22 day age range, and that 88% of the participants were female. Seventy-five percent of the babies were fed formula, 20 percent of the babies used a bottle, and 80 percent of the patients had poor hygiene status. There were 6% instances of very low birth weight and 35% occurrences of low birth weight. In addition, a cough was seen in 51.7% of cases, a cough accompanied by respiratory distress in 66.0% of cases, a fever in 76.0% of cases, a reduction in urine output in 50% of cases, convulsions in 20% of cases, a skin rash in 92.0% of cases, and jaundice in 18.0% of cases. Sixty percent were given antibiotics for 1-5 days, and 58 percent of those admitted remained in the hospital for 6-10 days. The prevalence of Klebsiella pneumoniae was highest (38%), followed by staphylococcus aureus (27%), Pseudomonas aeruginosa (15%), Citrobacter species (10%), and Klebsiella oxytoca (8%). As part of the therapy, many antibiotics were administered all at once. These included Tazid, meropenem, kacin, Gentamicin, and others. 62% of patients were advised to follow up once therapy was completed (DA). ....

Neonatal Sepsis; Incidence and Microbiological Profile along with Antibiotic Sensitivity of Causative Microorganisms

Objective: To find the incidence of neonatal sepsis, microorganisms involved and their antibiotic sensitivityamong neonates admitted with neonatal sepsis during the study period.Study Design: Prospective observational study.Place and Duration of Study: The study was carried out at neonatal intensive care unit (NICU) of combinedmilitary Hospital (CMH), Kharian, Pakistan from January 2019 to December 2020.Materials and Methods: After getting permission from Ethical Review Board of hospital, all the neonates whowere admitted in neonatal intensive care unit (NICU) of hospital with neonatal sepsis were included in subjectstudy. All the neonates with fever, irritability, difficulty in feeding, respiratory distress, fits, bulging fontanels,jaundice, bleeding etc. were suspected as case of "Neonatal sepsis". Venous blood sample of neonates wasdrawn under aseptic technique and collected in sterile BacT/ALERT (PF) blood collecting culture bottles andsent to laboratory immediately for culture, sensitivity procedure and reporting.Results: A total of 4892 neonates were admitted in neonatal intensive care unit from January 2019 toDecember 2020. Out of these, 342 neonates were clinically diagnosed as cases of neonatal sepsis. Incidence ofneonatal sepsis was 6.99%, comprising 185 males (54.1%) and 157 females (45.9%). The age range was from 2days to 88 days with a mean age 35.47+23.40 days. Staphylococcus aureus was found to be the most commonlyinfectious microorganism (33.9%) followed by Candida species (18.5%), Klebsiella pneumoniae (14.5%) andCoagulase negative Staphylococci (12.3%). Non-fermenting Gram negative bacteria were found to be infecting26 (11.5%) out of the total positive cases (Acinetobacter baumannii complex 8.4%, Stenotrophomonasmaltophilia 3.1% and Pseudomonas aeruginosa 2.6%).Conclusion: Staphylococcus aureus was the most prevalent organism found to be responsible for neonatalsepsis with majority being resistant to Methicillin. Methicillin-resistant Staphylococcus aureus (MRSA) is a100% percent sensitive to vancomycin and Teicoplanin. On the other hand, Gram Negative organisms haveshown promising sensitivity to Colistin.

Pasteurella multocida Bacterial Meningitis in a 33-Day-Old Infant.

A 33-day-old previously healthy term female is admitted to the pediatric intensive care unit with fever, lethargy and bulging fontanel. Given concern for meningitis, a lumbar puncture is performed and empiric treatment is initiated. The cerebrospinal fluid culture results reveal Pasteurella multocida. The patient is treated with intravenous ampicillin for 3 weeks and discharged with close outpatient follow-up.

Outcomes of children presenting to the emergency department with fever and bulging fontanelle

BackgroundIn infants aged 3-18 months presenting with a bulging fontanelle and fever it is often necessary to exclude central nervous system infection by performing a lumbar puncture. Several studies have shown that well-appearing infants with normal clinical, laboratory and imaging studies have a benign (non-bacterial) disease. At our institution, we often observe such infants and withhold lumbar puncture. ObjectiveTo determine the clinical characteristics and outcomes of well-appearing, febrile infants with a bulging fontanelle, whether they did or did not undergo lumbar puncture. DesignA retrospective chart review of the medical records of all febrile infants with a bulging fontanelle seen between March 2018 and March 2020 at Dana Children's Hospital. The following data were extracted: age of the patient, gender, previous medical history, general appearance, vomiting, appetite, fever, blood test results and CSF results (when taken), final diagnosis, disposition status, and whether or not the patient returned to our ER. Stats: Descriptive statistics were used to describe the study population. ResultsThe study group included 40 children, 22 males, and 18 females. Their age ranged from 3 to 13 months. Only 8 of the patients in the study group were admitted and 32 were discharged. Only 13 (32.5%) had an LP performed, three of which had elevated levels of WBC in the CSF, two of them had a positive culture. None of the patients who were discharged returned to the ED. ConclusionsOur study, combined with previous works, supports the assumption that management of well-appearing infants with normal medical history who present with fever and bulging fontanelle could be done without a lumbar puncture. Larger and prospective studies are needed to support this observation.

Umbilical Cord Entanglement.

Umbilical Cord Entanglement.

Organic Acidemias.

Organic Acidemias.

Case Report on Management Hydrocephalus as a Complication of Meningitis in Infant; Nurse Prospective

Introduction: Hydrocephalus is one of the commonest complications of meningitis in children with the disease. It is more severe in children than in adults. Fewer cases cause chronic Meningitis. Finding and treating the culprit organism is quite tough. In patients with chronic meningitis, complications such as hyponatremia, hydrocephalus, and neurological impairment should always be identified early and treated with a multidisciplinary team approach. We came across a case of severe brain damage due to Escherichia coli that progressed to meningitis which further also cause hydrocephalus, which she was treated for numerous times before being returned home with some neurological disability.&#x0D; Clinical Findings: A 1.5 month old female child was brought to A.V.B.R. Hospital Sawangi (meghe) wardha on date 18th November 2021 by her parents with High fever, refusal of feed, seizures like activity, bulging fontanel.&#x0D; Diagnostic Evaluation: Hb: 10.7, TLC : 21,500 . platelet: 5.1 eql CBC , elevated WBC count of 23,511/ul KFT and LFT are normal , Brain MRI showed restricted diffusion, Lumbar Puncture was also performed same day E.coli gram negative bacteria are present in CSF collection&#x0D; Therapeutic intervention: Injection Ceftriaxone 650 mg 6 hourly intravenous, Injection Pan 15 mg 24 hourly intravenous, Injection Emeset 2 ml 4 hourly intravenous DNS with injection KCL 3.8 ml 8 hourly intravenous.&#x0D; Outcome: After treatment of 6 days the child show improvement like fever and seizers decreased.&#x0D; Conclusion: After proper treatment like medication, monitoring vitals and also by continous observation her condition was improved.

Are Pathogenic Leptospira a Possible Cause of Aseptic Meningitis in Suspected Children in Sudan?

IntroductionClinical presentations of leptospirosis are diverse, with meningitis easily confused with other microbial causes. We aimed to investigate the involvement of pathogenic leptospira in the cerebrospinal fluid (CSF) of meningitis-suspected children in Sudan.MethodsA total of 153 CSF specimens were collected over 5 months from patients attending a reference pediatric hospital in Omdurman, Sudan. All patients had provisionally been diagnosed with meningitis on admission. Demographic, clinical, and conventional laboratory findings were obtained. DNA was extracted using a QIAamp mini kit, and the secY gene investigated using real-time PCR.ResultsNine of 153 (6%) CSF specimens were positive for pathogenic leptospiral DNA. All these patients were male (seven infants and two toddlers aged ˂4 years). Typical conventional laboratory findings for aseptic meningitis (ie, CSF turbidity/pleocytosis, normal or reduced CSF glucose, normal or elevated proteins) were seen in five (56%). All patients presented with fever and seizures, 56% vomiting and stiff neck, and 29% bulging fontanel. Most (67%) patients presented in summer (March to May). Polymicrobial infections were identified in three patients (33%).ConclusionWe conclude that pathogenic leptospira are probably a common cause of meningitis in children in Sudan; therefore, we recommend including leptospirosis in the differential diagnosis of CNS infections and other undifferentiated febrile illnesses in this country.

Obstructive Hydrocephalus in Children: Predictive Factors of Ventriculocisternostomy Dysfunction at the University Hospital Center of Conakry

The treatment of hydrocephalus is surgical and uses two (2) main methods to date: ventriculoperitoneal shunt (DVP) and endoscopic ventriculocisternostomy (VCS). The latter offers the advantage of avoiding the implantation of a foreign body (valve) in the body. However, there are sometimes dysfunctions that can lead to the evolutionary continuation of hydrocephalus. The objective of this study is to identify factors predictive of VCS dysfunction in cases of obstructive hydrocephalus in children at the University Hospital Center (CHU) in Conakry. This is a mixed analytical study of 32 cases of children aged 0-15 years who received VCS during the study period. Outcomes were evaluated according to Drake and Canadian Pediatric Neurosurgery Group clinical criteria. The hospital frequency was 17% and a sex ratio (M/F) of 1.13. Clinical signs were dominated by progressive macrocraniality (93.8%), bulging fontanel (84.4%), ectasia of scalp veins (68.8%). CSF leakage (9.4%) was the most frequent post-operative complication. We recorded one case of death. The success rate of CSF according to Drake's criteria was 56%. The factors often associated with the dysfunction of the VCS found in this study are essentially: age, bulging fontanelle, ectasia of the scalp veins, arachnoid adhesions, closure of the Sylvius aqueduct and pulsation of the bottom of the 3rd V. In the absence of a statistically significant relationship, it would be useful to analyse these parameters closely on a much larger sample.