Cases Of Bacterial Meningitis Research Articles

Childhood encephalitis in the Greater Mekong region: critical to public health policy

Childhood encephalitis in the Greater Mekong region: critical to public health policy

Clinical management and outcomes for febrile infants 29-60days evaluated in community emergency departments.

ObjectiveDescribe emergency department (ED) management and patient outcomes for febrile infants 29–60 days of age who received a lumbar puncture (LP), with focus on timing of antibiotics and type of physician performing LP.MethodsRetrospective observational study of 35 California EDs from January 1, 2010 through December 31, 2019. Primary analysis was among patients with successful LP and primary outcome was hospital length of stay (LOS). Logistic regression analysis included variables associated with LOS of at least 2 days. Secondary outcomes were bacterial meningitis, hospital admission, length of antibiotics, and readmission.ResultsAmong 2569 febrile infants (median age 39 days), 667 underwent successful LP and 633 received intravenous antibiotics. Most infants (n = 559, 88.3%) had their LP before intravenous antibiotic administration. Pediatricians performed 54% of LPs and emergency physicians 34%. Sixteen infants (0.6% of 2569) were diagnosed with bacterial meningitis, and none died. Five hundred and fifty‐eight (88%) infants receiving an LP were hospitalized. Among patients receiving an LP and antibiotics (n = 633), 6.5% were readmitted within 30 days. Patients receiving antibiotics before LP had a longer length of antibiotics (+ 7.9 hours, 95% confidence interval [CI] 3.8–13.4). Primary analysis found no association between timing of antibiotics and LOS (odds ratio [OR] 0.67, 95% CI 0.34–1.30), but shorter LOS when emergency physicians performed the LP (OR 0.66, 95% CI 0.45–0.97).ConclusionsFebrile infants in the ED had no deaths and few cases of bacterial meningitis. In community EDs, where a pediatrician is often not available, successful LP by emergency physician was associated with reduced inpatient LOS.

Decline in the number of patients with meningitis in German hospitals during the COVID-19 pandemic

Background and objectivesIn 2020, a wide range of hygiene measures was implemented to mitigate infections caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In consequence, pulmonary infections due to other respiratory pathogens also decreased. Here, we evaluated the number of bacterial and viral meningitis and encephalitis cases during the coronavirus disease 2019 (COVID-19) pandemic.MethodsIn a multicentre retrospective analysis of data from January 2016 until December 2020, numbers of patients diagnosed with bacterial meningitis and other types of CNS infections (such as viral meningitis and encephalitis) at 26 German hospitals were studied. Furthermore, the number of common meningitis-preceding ear-nose-throat infections (sinusitis, mastoiditis and otitis media) was evaluated.ResultsCompared to the previous years, the total number of patients diagnosed with pneumococcal meningitis was reduced (n = 64 patients/year in 2020 vs. n = 87 to 120 patients/year between 2016 and 2019, all p < 0.05). Additionally, the total number of patients diagnosed with otolaryngological infections was significantly lower (n = 1181 patients/year in 2020 vs. n = 1525 to 1754 patients/year between 2016 and 2019, all p < 0.001). We also observed a decline in viral meningitis and especially enterovirus meningitis (n = 25 patients/year in 2020 vs. n = 97 to 181 patients/year between 2016 and 2019, all p < 0.001).DiscussionThis multicentre retrospective analysis demonstrates a decline in the number of patients treated for viral and pneumococcal meningitis as well as otolaryngological infections in 2020 compared to previous years. Since the latter often precedes pneumococcal meningitis, this may point to the significance of the direct spread of pneumococci from an otolaryngological focus such as mastoiditis to the brain as one important pathophysiological route in the development of pneumococcal meningitis.

National, regional, and provincial disease burden attributed to Streptococcus pneumoniae and Haemophilus influenzae type b in children in China: Modelled estimates for 2010–17

SummaryBackgroundVaccination against Streptococcus pneumoniae (pneumococcus) and Haemophilus influenzae type b (Hib) is not included in China's national immunization programme. To inform China's immunization polices, we estimated annual national, regional, and provincial childhood mortality and morbidity attributable to pneumococcus and Hib in 2010–17.MethodsWe estimated proportions of pneumonia and meningitis deaths and cases attributable to pneumococcus and Hib using evidence from vaccine clinical trials and surveillance studies of bacterial meningitis and pathogen-specific case fatality ratios (CFR). Then we applied the proportions to model provincial-level pneumonia cases and deaths, meningitis deaths and meningitis CFR in children aged 1–59 months, accounting for vaccine coverage. Non-pneumonia, non-meningitis (NPNM) invasive disease cases were derived by applying NPNM meningitis ratios to meningitis estimates.FindingsIn 2010–17, annual pneumococcal deaths fell by 49% from 15 600 (uncertainty range: 10 800–17 300) to 8 000 (5 500–8 900), and Hib deaths fell by 56% from 6 500 (4 500–8 800) to 2 900 (2 000–3 900). Severe pneumococcal and Hib cases decreased by 16% to 218 200 (161 500–252 200) in 2017 and 29% to 49 900 (29 000–99 100). Estimated 2017 national three-dose coverage in private market was 1·3% for PCV and 33·4% for Hib vaccine among children aged 1–59 months. Provinces in the west region had the highest disease burden.InterpretationChildhood mortality and morbidity attributable to pneumococcal and Hib has decreased in China, but still substantially varied by region and province. Higher vaccine coverage could further reduce disease burden.FundingBill & Melinda Gates Foundation.

Clinical and laboratory profile of patients with presumptive clinical diagnosis of acute bacterial meningitis and its short-term complications.

Worldwide, one million cases of bacterial meningitis are estimated to occur and 200,000 of them die annually. Case fatality rates vary with age at the time of illness and the species of bacterium causing infection. In view of variable clinical features and complication rates in various studies, the present study was planned to assess the clinical and laboratory profile of patients with acute bacterial meningitis and analyze the therapeutic response and short-term sequelae. This study was conducted in the department of pediatrics at Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences (PGIMS), Rohtak. A total of 50 pediatric patients with signs and symptoms of acute bacterial meningitis who satisfied the inclusion or selection criteria were enrolled in the study. Appropriate statistical tests were applied for analysis and trial registry was done with PGIMS. In the present study, slightly more males (54%) were found than females (46%). The sequelae and mortality were 33.3%, 26.1% and 7.4%, 8.7% in males and females, respectively. There were higher chances of sequelae or mortality in males as compared to females (OR 1.289, 95% CI 0.073-6.11, P > 0.05). Predominant cells were polymorphonuclear (PMN) cells except in >120 months age group where both PMN (50%) and mononuclear (50%) cells were equally visualized. Mean CSF protein was slightly higher in 2-24 months age group. We compared the group with sequelae with the group with no sequelae and found neurological deficit (P < 0.01), and presence of complications (P < 0.01) were significantly associated with sequelae.

Effect of High-Fidelity Simulation on Clinical Judgment Among Nursing Students.

IntroductionNursing education needs to be improved in order to bridge the gap between education and clinical practice. However, clinical placements for nursing students are limited and student nurses often take merely an observer role, especially in critical situations. High-fidelity simulation (HFS) is a teaching method that can bridge the gap between education and clinical practice. The purpose of this study was to evaluate the influence of using HFS as a teaching method on clinical judgment among pediatric nursing students at the Arab American University utilizing a bacterial meningitis case scenario.MethodsA quasi-experimental study with a convenience sample of one hundred and fifty baccalaureate nursing students enrolled in a pediatric health nursing course. Nursing students were randomly assigned to high-fidelity simulation experience or traditional methods. The clinical judgment was assessed using Lasater Clinical Judgment Rubric Tool.ResultsResults revealed that the high-fidelity simulation experience has improved pediatric nursing students’ clinical judgment. The mean clinical judgment differed significantly at post-test in the intervention group after the simulation (t (148) = 7.20, P < .001).ConclusionThe HFS can be an effective tool to provide a safe and effective learning environment for pediatric nursing students, consequently improving their clinical judgment

Ventrikulo-peritoneal Şantlı Çocukta Serratia Spp. Menenjiti

Serratia species are opportunistic, gram-negative, motile bacteria classified in the large family Enterobacteriaceae and differentiate from Klebsiella spp. with slow fermenting lactose and DNAase positive (1,2). One of the characteristics of Serratia bacteria that distinguishes them from other bacteria is to synthesize the red pigments, prodigiosins. It can cause nosocomial infections especcialy in newborns and patients in intensive care units. Serratia spp.; responsible for approximately 2% of nosocomial infections; has been reported as the responsible agent especially in respiratory tract infections, urinary tract infections and bacteremia. An outbreak of S. marcescens blood stream infection has been identified in patients receiving contaminated parenteral nutrition bags (2). It has been reported to cause S. marcescens meningitis, wound infections, arthritis and outbreaks in pediatric wards (3). In this text we aimed to present a three and a half year old girl case of acute bacterial meningitis due to Serratia spp. with ventriculo-peritoneal shunt.

Evaluation of Real-Time Polymerase Chain Reaction in Culture-Negative Cerebrospinal Fluid Samples of Bacterial meningitis Patients

Background: Meningitis is a rigorous childhood disease with high morbidity and mortality. It is the main cause of under five mortality in India. Mainly three bacteria Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae are responsible. In low economic set up country like India, documented bacterial meningitis mainly depend on gram staining, cerebrospinal fluid (CSF) culture results or latex agglutination test resulting in less number of positive due to the prior antimicrobial intake which affects culture and latex agglutination test results. This study was taken up rapid and accurate molecular method like RT PCR to diagnose bacterial meningitis in culture-negative CSF samples.&#x0D; Materials and Methods: Fifty culture-negative CSF samples from suspected cases of bacterial meningitis were examined by real-time polymerase chain reaction (real-time PCR) for the presence of lytA, bexA, and ctrA genes specific for Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis respectively.&#x0D; Results: Positive real-time PCR results for Streptococcus pneumoniae were detected in 36 (72%) of culture-negative CSF samples while 10% positive results for Haemophilus influenzae type b. Nine (18%) samples were negative by real-time PCR for all tested organisms.&#x0D; Conclusion: The use of molecular techniques as real-time PCR can provide a valuable addition to the proportion of diagnosed cases of bacterial meningitis especially in settings with high rates of culture-negative results.

Polymicrobial anaerobic bacterial meningitis secondary to dermal sinus: a case report

Anaerobic bacterial meningitis is a rare infectious disease, and there are some special predisposing factors for it. We report a case of polymicrobial anaerobic bacterial meningitis in a nine-month-old boy who visited our hospital due to “fever with drowsiness and vomiting for 2 days”. It was confirmed by the method of sanger sequencing after polymerase chain reaction (PCR) that the purulent meningitis was caused by a mixture of four anaerobic bacteria (Finegoldia magna, Campylobacter ureolyticus, Bacteroides fragilis and Porphyromonas bennonis). Even though there was no obvious structural abnormality on the skin surface, magnetic resonance imaging (MRI) examination suggested the presence of a sacrococcygeal dermal sinus. It was proven that anaerobic bacterial meningitis was secondary to retrograde infection of the dermal sinus. Finally, he was cured by a combination of anti-infection measures and surgical treatment. In conclusion, using appropriate molecular diagnostic techniques may quickly and accurately determine the pathogenic bacteria of anaerobic bacterial meningitis. When anaerobic bacterial meningitis occurs, the presence of structural abnormalities such as dermal sinus needs to be ruled out to avoid recurrence of the disease. In addition to anti-infective treatment, patients with dermal sinuses should undergo surgery as soon as possible to address abnormal structures and their root causes.

Enterococcus spp. Meningoencephalitis, Ventriculitis, and Hypophysitis in a Dog.

A 13 yr old spayed female Yorkshire terrier was hospitalized for a dull mentation, anorexia, presumptive gastroenterocolitis, and a suspected gastrointestinal bleed with melena. Despite supportive therapy, the patient's clinical signs persisted. Throughout hospitalization, the patient became progressively dull to stuporous with a progressive hypernatremia. On day 3 of hospitalization, the patient acutely developed neurological signs with a neuroanatomical localization consistent with a process at the caudal cranial fossa. Per the owner's wishes, the patient was euthanized with necropsy performed. Histopathology revealed a suppurative meningoencephalitis, ventriculitis, hypophysitis, otitis interna, and an ulcerative pharyngitis. Aerobic culture collected from the area of the pituitary gland grew an Enterococcus spp. Enterococcal meningoencephalitis is rare in humans but has not been reported in veterinary medicine. In future cases of canine bacterial meningitis, Enterococcus spp. should be considered. Because of the inherent resistance patterns of Enterococcus spp., targeted antibiotic selection would be required for treatment.

MULTIFACTORIAL MENINGITIS IN A PATIENT WITH PREVIOUS EPSTEIN BARR VIRUS ENCEPHALITIS

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Gram negative bacillary meningitis is rare and mostly occurs in patients with recent neurosurgery. We present such a case of bacterial meningitis combined with other etiologies in a patient with previous Epstein Barr Virus (EBV) encephalitis. CASE PRESENTATION: 62-year-old male with history of diabetes, stroke and EBV encephalitis (1 month ago) presented with altered mentation. Lumbar puncture (LP) showed neutrophil predominant leukocytosis but cerebrospinal fluid (CSF) culture was negative. Brain imaging showed developing hydrocephalus. He was started on empiric meningitis coverage with antibacterial, antifungal and antitubercular regimen (due to basilar changes on imaging and mildly elevated adenosine deaminase in the CSF). He underwent right craniotomy with ventriculo-peritoneal (VP) shunt placement. Course complicated by worsening mentation requiring intubation for airway protection. Due to concern of hospital acquired pneumonia (HAP), piperacillin-tazobactam was added. Repeat LP showed improved leukocyte count but culture was again negative. He had persistent fevers after finishing piperacillin-tazobactam course; subsequent sputum culture and 3rd CSF culture now grew pseudomonas aeruginosa. He finished 21 days of systemic cefepime and 7 days of intrathecal tobramycin for pseudomonas; and 14 days of empiric amphotericin B (although fungal CSF culture was negative). He remains on empiric antitubercular regimen (isoniazid/rifampin/pyrazinamide/ethambutol) - culture negative. Mentation remains poor and family is currently deciding on aggressive care with tracheostomy or palliative care approach. DISCUSSION: In our case, meningitis on admission was likely some bacterial superinfection after viral encephalitis. After neurosurgery, 2nd CSF culture was negative likely due to ongoing antibiotics for HAP. 3rd CSF culture grew pseudomonas as patient was now off of piperacillin-tazobactam. Pseudomonas meningitis is rare and can occur as complication of neurosurgery, chronic cranial osteomyelitis, mastoiditis or trauma. The mortality rate ranges from 40 to 80%. Complications include hydrocephalus, brain abscesses, seizures, ventriculitis etc. The CSF gram stain is positive in 50% of cases with a positive culture result. Bacteremia is also present in about 50% of the cases. The usual empiric meningitis regimen does not cover pseudomonas and antipseudomonal agents can be added in patients with above risk factors. Cefepime/ceftazidime are empiric therapy and should be adjusted based on sensitivities. Dual therapy with intrathecal/intraventricular regimens can be started in resistant cases. Adjuvant steroids have shown no benefit. CONCLUSIONS: Timely recognition of risk factors for gram negative bacillary meningitis and starting empiric treatment regimen can improve the prognosis of such patients. REFERENCE #1: Berk SL, McCabe WR. Meningitis caused by gram-negative bacilli. Ann Intern Med. 1980;93(2):253. REFERENCE #2: Rahal JJ, Simberkoff MS. Host defense and antimicrobial therapy in adult gram-negative bacillary meningitis. Ann Intern Med. 1982;96(4):468. REFERENCE #3: S. Pai, L. Bedford et al. Pseudomonas aeruginosa meningitis/ventriculitis in a UK tertiary referral hospital. An International Journal of Medicine, Volume 109, Issue 2, February 2016, Pages 85–89, https://doi.org/10.1093/qjmed/hcv094 DISCLOSURES: No relevant relationships by Sahib Singh, source. Web Response no disclosure on file for Parth Jamindar

The Global Landscape of Pediatric Bacterial Meningitis Data Reported to the World Health Organization-Coordinated Invasive Bacterial Vaccine-Preventable Disease Surveillance Network, 2014-2019.

BackgroundThe World Health Organization (WHO) coordinates the Global Invasive Bacterial Vaccine-Preventable Diseases (IB-VPD) Surveillance Network to support vaccine introduction decisions and use. The network was established to strengthen surveillance and laboratory confirmation of meningitis caused by Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis.MethodsSentinel hospitals report cases of children <5 years of age hospitalized for suspected meningitis. Laboratories report confirmatory testing results and strain characterization tested by polymerase chain reaction. In 2019, the network included 123 laboratories that follow validated, standardized testing and reporting strategies.ResultsFrom 2014 through 2019, >137 000 suspected meningitis cases were reported by 58 participating countries, with 44.6% (n = 61 386) reported from countries in the WHO African Region. More than half (56.6%, n = 77 873) were among children <1 year of age, and 4.0% (n = 4010) died among those with reported disease outcome. Among suspected meningitis cases, 8.6% (n = 11 798) were classified as probable bacterial meningitis. One of 3 bacterial pathogens was identified in 30.3% (n = 3576) of these cases, namely S. pneumoniae (n = 2177 [60.9%]), H. influenzae (n = 633 [17.7%]), and N. meningitidis (n = 766 [21.4%]). Among confirmed bacterial meningitis cases with outcome reported, 11.0% died; case fatality ratio varied by pathogen (S. pneumoniae, 12.2%; H. influenzae, 6.1%; N. meningitidis, 11.0%). Among the 277 children who died with confirmed bacterial meningitis, 189 (68.2%) had confirmed S. pneumoniae. The proportion of pneumococcal cases with pneumococcal conjugate vaccine (PCV) serotypes decreased as the number of countries implementing PCV increased, from 77.8% (n = 273) to 47.5% (n = 248). Of 397 H. influenzae specimens serotyped, 49.1% (n = 195) were type b. Predominant N. meningitidis serogroups varied by region.ConclusionsThis multitier, global surveillance network has supported countries in detecting and serotyping the 3 principal invasive bacterial pathogens that cause pediatric meningitis. Streptococcus pneumoniae was the most common bacterial pathogen detected globally despite the growing number of countries that have nationally introduced PCV. The large proportions of deaths due to S. pneumoniae reflect the high proportion of meningitis cases caused by this pathogen. This global network demonstrated a strong correlation between PCV introduction status and reduction in the proportion of pneumococcal meningitis infections caused by vaccine serotypes. Maintaining case-based, active surveillance with laboratory confirmation for prioritized vaccine-preventable diseases remains a critical component of the global agenda in public health.The World Health Organization (WHO)-coordinated Invasive Bacterial Vaccine-Preventable Disease (IB-VPD) Surveillance Network reported data from 2014 to 2019, contributing to the estimates of the disease burden and serotypes of pediatric meningitis caused by Streptococcus pneumoniae, Haemophilus influenzae and Neisseria meningitidis.

Ability of Procalcitonin and C-Reactive Protein for Discriminating between Bacterial and Enteroviral Meningitis in Children Using Decision Tree

Bacterial meningitis (BM) is a public health burden in developing countries, including Central Asia. This disease is characterized by a high mortality rate and serious neurological complications. Delay with the start of adequate therapy is associated with an increase in mortality for patients with acute bacterial meningitis. Cerebrospinal fluid culture, as a gold standard in bacterial meningitis diagnosis, is time-consuming with modest sensitivity, and this is unsuitable for timely decision-making. It has been shown that bacterial meningitis differentiation from viral meningitis could be done through different parameters such as clinical signs and symptoms, laboratory values, such as PCR, including blood and cerebrospinal fluid (CSF) analysis. In this study, we proposed the method for distinguishing the bacterial form of meningitis from enteroviral one. The method is based on the machine learning process deriving making decision rules. The proposed fast-and-frugal trees (FFTree) decision tree approach showed an ability to determine procalcitonin and C-reactive protein (CRP) with cut-off values for distinguishing between bacterial and enteroviral meningitis (EVM) in children. Such a method demonstrated 100% sensitivity, 96% specificity, and 98% accuracy in the differentiation of all cases of bacterial meningitis in this study. These findings and proposed method may be useful for clinicians to facilitate the decision-making process and optimize the diagnostics of meningitis.

The Value of Combined Measuring of the Cerebrospinal Fluid Lactate and ‎Serum Procalcitonin in Diagnosis of Acute Bacterial Meningitis ‎

Backgroundand study aim:The differential diagnosis between bacterial meningitis and aseptic meningitis is a critical clinical issue and ‎searching for reliable and valid markers is required. This work aimed to assess the role of the combined ‎measuring of CSF lactate and serum procalcitonin in the diagnosis of acute bacterial meningitis‎‎‎. Patients and Method:‎A cross-sectional study including 42 meningitis patients was conducted at Zagazig Fever Hospital and Zagazig ‎University Hospitals in the period from November 2018 to June 2019, Patients were divided according to their ‎final diagnosis into two groups; group I included 13 patients with bacterial meningitis ( positive CSF bacterial ‎culture and/or Gram stain ), group II included 29 patients with aseptic meningitis (negative CSF bacterial ‎culture and Gram stain), The data collection sheet included clinical assessments, lumbar puncture with CSF ‎analysis, CSF lactate level testing, and Serum procalcitonin level testing‎‎.‎ Results: One hundred five of house officer participated Serum procalcitonin and CSF lactate levels were significantly higher in the bacterial meningitis group (1.16 ‎‎±1.24, 7.5 ± 6.6, respectively) than patients with aseptic meningitis (0.059 ± 0.04, 3.98 ± 2.1, respectively). ‎The measuring of both serum procalcitonin and CSF lactate levels had got a higher sensitivity, specificity, and ‎accuracy (96.6%, 76.9%, 90.9% respectively) for the diagnosis of bacterial meningitis more than measuring ‎either of them only‎‎‎. Conclusion: The combined measuring of both serum procalcitonin and CSF lactate levels is highly accurate in the diagnosis ‎of bacterial meningitis cases and helps to differentiate bacterial meningitis from aseptic meningitis‎‎‎‎.

Nationwide Population-Based Epidemiological Study for Outcomes of Adjunctive Steroid Therapy in Pediatric Patients with Bacterial Meningitis in Taiwan.

Although corticosteroids can serve as an effective anti-inflammatory adjuvant therapy, the role of adjunctive steroid therapy in pediatric bacterial meningitis in Taiwan remains under-investigated. Cases of acute bacterial meningitis, aged between 1 month and 20 years, were divided into a steroid group (empirical antibiotics with adjunctive steroid therapy) and a non-steroid group (empirical antibiotics only). Data were identified from the annual hospitalization discharge claims of the National Health Insurance Research Database using the International Classification of Diseases, Ninth Revision codes. Of the 8083 episodes enrolled in this study, 26% (2122/8083) and 74% (5961/8083) were divided into the steroid and non-steroid groups, respectively. The fatality rates were 7.9% in the steroid group and 1.7% in the non-steroid group during hospitalization (p < 0.0001). In the steroid and non-steroid groups, the median length of hospital stay was 13 and 6 days, respectively (p < 0.0001). Medical costs (median (interquartile range)) of hospitalization were 77,941 (26,647–237,540) and 26,653 (14,287–53,421) New Taiwan dollars in the steroid and non-steroid groups, respectively (p < 0.0001). The steroid group had a more fulminant course at baseline, a higher fatality rate, length of hospital stay, and medical cost of hospitalization. Therefore, the beneficial effects of the adjunctive use of corticosteroids in pediatric bacterial meningitis are inconclusive, and additional prospective multicenter investigations are required to clarify this issue.

Clinical Significance of Positive Results of the BioFire Cerebrospinal Fluid FilmArray Meningitis/Encephalitis Panel at a Tertiary Medical Center in the United States.

The FilmArray Meningitis/Encephalitis (ME) panel is the first US Food and Drug Administration-cleared multiplex polymerase chain reaction panel for the detection of central nervous system infections. While the assay's performance characteristics have been described, the real-world significance of positive results has not been fully characterized. To evaluate the clinical significance of positive ME panel results in a tertiary care medical center in New York, New York. Four physicians independently performed retrospective clinical assessments of all positive ME panel results at Columbia University Irving Medical Center, including the Children's Hospital of New York, during an 18-month period. Each reviewer determined the likelihood of central nervous system infection for all cases and whether cases fit Brighton diagnostic criteria for meningitis, encephalitis, or meningoencephalitis. Among 119 cases, there was 75% positive agreement (95% CI, 54%-89%) between ME panel results and clinical consensus, which varied among panel targets. The ME panel showed good agreement with expert clinical consensus for patients presenting with acute meningitis/encephalitis. Factors contributing to clinically insignificant ME positive results included low pretest probability, traumatic lumbar puncture, specimen contamination, and detection of incidental viral targets such as human herpesvirus 6. Notably, the ME panel detected more than twice the number of cases of bacterial meningitis detected by culture alone, particularly among patients receiving empiric antimicrobial therapy before lumbar puncture. Appropriate test use and contextual interpretation of results are critical to leveraging the advantages of the platform while avoiding potential pitfalls.

Hospital-based sentinel surveillance for bacterial meningitis in under-five children prior to the introduction of the PCV13 in India

IntroductionA hospital-based sentinel surveillance network for bacterial meningitis was established in India to estimate the burden of bacterial meningitis, and the proportion of major vaccine-preventable causative organisms. This report summarises the findings of the surveillance conducted between March 2012, and September 2016 in eleven hospitals. MethodsWe enrolled eligible children with bacterial meningitis in the age group of one to 59 months. CSF samples were collected and processed for biochemistry, culture, latex agglutination, and real-time PCR. Pneumococcal isolates were serotyped and tested for antimicrobial susceptibility. ResultsAmong 12 941 enrolled suspected meningitis cases, 586 (4.5%) were laboratory confirmed. S. pneumoniae (74.2%) was the most commonly detected pathogen, followed by H. influenzae (22.2%), and N. meningitidis (3.6%). Overall 58.1% of confirmed bacterial meningitis cases were children aged between one, and 11 months. H. influenzae meningitis cases had a high (12.3%) case fatality rate. The serotypes covered in PCV13 caused 72% pneumococcal infections, and the most common serotypes were 14 (18.3%), 6B (12.7%) and 19F (9.9%). Non-susceptibility to penicillin was 57%. Forty-five (43.7%) isolates exhibited multidrug resistance, of which 37 were PCV13 serotype isolates. ConclusionsThe results are representative of the burden of bacterial meningitis among under-five children in India. The findings were useful in rolling out PCV in the National Immunization Program. The non-susceptibility to penicillin and multidrug resistance was an important observation. Timely expansion of PCV across India will significantly reduce the burden of antimicrobial resistance. Continued surveillance is needed to understand the trend after PCV expansion in India.

Developing a Prognostic Model to Predict Mortality in Patients with Acute Bacterial Meningitis.

Bacterial meningitis is one of the harmful and deadly infectious diseases, and any delay in its treatment will lead to death. In this paper, a prognostic model was developed to predict the risk of death amongst probable cases of bacterial meningitis. Our prognostic model was developed using a decision tree algorithm on the national meningitis registry of the Iranian Center for Disease and Prevention (ICDCP) containing 3,923 records of meningitis suspected cases in 2018-2019. The most important features have been selected for the model construction. This model can predict the mortality risk for the meningitis probable cases with 78% accuracy, 84% sensitivity, and 73% specificity. The identified variables in prognosis the death included age and CSF protein level. CSF protein level (mg/dl) <= 65 versus > 65 provided the first branch of our decision tree. The highest mortality risk (85.8%) was seen in the patients >65 CSF protein level with 30 years < of age. For the patients <=30 year of age with CSF protein level >137 (mg/dl), the mortality risk was 60%. The prognostic factors identified in the present study draw the attention of clinicians to provide early specific measures, such as the admission of patients with a higher risk of death to intensive care units (ICU). It could also provide a helpful risk score tool in decision-making in the early phases of admission in pandemics, decrease mortality rate and improve public health operations efficiently in infectious diseases.

Capnocytophaga canimorsus Meningitis – Diagnosis with 16S rDNA PCR when Conventional Methods Failed to Identify the Causative Agent

Meningitis whether bacterial or viral, poses many challenges to clinicians as the causative agent is often not found. According to guidelines, it is standard to start empiric treatment before a Cerebrospinal Fluid (CSF) sample is obtained. Meningitis, if not diagnosed and treated early, can lead to high morbidity and mortality rates with serious neurological sequelae. While the most common cases of bacterial meningitis are related to Streptococcus pneumoniae and Neisseria meningitidis, this clinical case report found a rare case of meningitis caused by a zoonotic pathogen, Capnocytophaga canimorsus; a commensal found as part of the normal flora of dogs and cats. This rare organism was identified with the help of broad range 16S ribosomal DNA Polymerase Chain Reaction (rDNA PCR), an emerging technique that is now increasingly useful in rapid diagnosis especially if the offending agent is not timely identified and conventional methods have failed, making diagnosis and management difficult for physicians.

The Impact and Burden of Neurological Sequelae Following Bacterial Meningitis: A Narrative Review.

The burden, impact, and social and economic costs of neurological sequelae following meningitis can be devastating to patients, families and communities. An acute inflammation of the brain and spinal cord, meningitis results in high mortality rates, with over 2.5 million new cases of bacterial meningitis and over 236,000 deaths worldwide in 2019 alone. Up to 30% of survivors have some type of neurological or neuro-behavioural sequelae. These include seizures, hearing and vision loss, cognitive impairment, neuromotor disability and memory or behaviour changes. Few studies have documented the long-term (greater than five years) consequences or have parsed out whether the age at time of meningitis contributes to poor outcome. Knowledge of the socioeconomic impact and demand for medical follow-up services among these patients and their caregivers is also lacking, especially in low- and middle-income countries (LMICs). Within resource-limited settings, the costs incurred by patients and their families can be very high. This review summarises the available evidence to better understand the impact and burden of the neurological sequelae and disabling consequences of bacterial meningitis, with particular focus on identifying existing gaps in LMICs.