Cases Of Bacterial Meningitis Research Articles

Postpartum Listeria Meningitis: A Case Report (P2-10.006)

<h3>Objective:</h3> n/a <h3>Background:</h3> Acute bacterial meningitis is a neurological emergency and fatal if left untreated. Here we present a case of bacterial meningitis, highlighting postpartum listeria monocytogenes infection. <h3>Design/Methods:</h3> <h3>Description:</h3> We present a case of 27 years-old woman with past medical history of migraine and hyperthyroidism, brought to the hospital with acute onset of reduced level of consciousness. A day prior to presentation, she woke up with a severe retro-orbital headache of 10/10 intensity along with nausea, vomiting, photophobia and phonophobia. Her symptoms further progressed to worsening confusion/somnolence with agitation. She had an uncomplicated vaginal delivery a month earlier. On admission, vitals were significant for high grade fever, hypotension, tachypnea and tachycardia. On examination, she was restless, combative, was not following any commands. No focal motor deficit. Nuchal rigidity and Babinski were negative. Labs showed mild anemia, leukocytosis, mild hyponatremia and lactic acidosis. MRI Brain showed faint diffuse leptomeningeal enhancement. CSF analysis showed WBC 732/Ul, SEG: 66%, protein&gt; 300mg/dl and CSF glucose &lt;20mg/dl. Meningitis panel and CSF culture were positive for listeria monocytogenes. Post CSF analysis, her broad spectrum antibiotics were deescalated to ampicillin for 21 days and gentamycin for 7 days for synergistic effects. During the initial treatment phase, she developed horizontal binocular diplopia and her exam showed isolated sixth nerve palsy. MRI brain revealed worsening diffuse leptomeningitis, involving the basal cisterns and the ependymal walls of the lateral ventricles. Eventually, she responded to the treatment and her symptoms resolved slowly. <h3>Results:</h3> n/a <h3>Conclusions:</h3> Listeria Monocytogenes can be a possible cause of postpartum meningoencephalitis due to the underlying transient immunosuppressive condition. Return to a normal immune response may take as long as up to one year after childbirth. Treatment should not be delayed in highly suspicion cases to avoid complications like rhombencephalitis, progressive neurological deficits and eventually death. <b>Disclosure:</b> Mr. Tang has nothing to disclose. Dr. Kausar has nothing to disclose. Dr. Rivera has nothing to disclose. The institution of Dr. Cruz-Flores has received research support from University of Texas System. Dr. Yerram has nothing to disclose.

Streptococcus suis causes bacterial meningitis with hearing loss in patients without direct exposure to pigs in a regional pork industry territory

&lt;i&gt;Streptococcus suis&lt;/i&gt; (&lt;i&gt;S. suis&lt;/i&gt;) is an emerging zoonotic pathogen that causes bacterial meningitis in humans. &lt;i&gt;S. suis&lt;/i&gt; is an encapsulated gram-positive facultative anaerobic bacterium and is an important pathogen in pigs. This infectious disease usually manifests in humans as meningitis, endocarditis, septicemia, and arthritis. Most cases originate in Southeast Asia, and human &lt;i&gt;S. suis&lt;/i&gt; infections are often reported in countries with a high density of pigs. Meningitis is a common clinical manifestation of &lt;i&gt;S. suis&lt;/i&gt; infection. Moreover, hearing loss is a common complication that can be bilateral, profound, and/or permanent. This report presents two cases of bacterial meningitis and hearing loss caused by &lt;i&gt;S. suis&lt;/i&gt; in patients without a history of direct exposure to pigs in an intensive pork industry region.

Prevalence of neuroinfectious diseases and outcomes in Africa

Prevalence of neuroinfectious diseases and outcomes in Africa

Factors Associated with the Death of Children Aged 0 to 15 Years with Bacterial Meningitis in the Pediatric Department of Donka National Hospital

Introduction: Bacterial meningitis is a serious, life-threatening infection; its diagnosis must be early and its management must be rapid. Bacteria commonly implicated in children are Neisseria meningitidis, Streptococcus pneumonia and Haemophilus influenzae type b. The specific etiology is a function of age, immune function, vaccination status, genetics, and geographic location. Objective: To identify the factors associated with death in children aged 0 to 15 with bacterial meningitis in the pediatric department of Donka National Hospital. Methods: Prospective, descriptive and analytical study of 6 months (April 12 to October 12, 2022) including children aged 0-15 years with bacterial meningitis confirmed by cyto-bacteriological analysis of CSF. Results: From of a total of 766 children, we collected 118 cases of bacterial meningitis, either frequency of 15.4%. The average age was 3.97 ± 4.06 years with extremes of 1 month and 15 years. The sex ratio was 1.5 in favor of boys. Altered consciousness (p &lt; 0.001), delay in consultation &gt; 3 days (p = 0.01), poor nutritional status (p = 0.0000063904), cloudy appearance of the CSF (p = 0.003) and presence of serious signs (p = 0.0000050753) such as shock, generalized hypertonia, signs of decortication and decerebration were poor prognostic factors. The mortality rate observed in this work was 23.7%. Conclusion: Child hood bacterial meningitis often leads to death in children admitted to the pediatric ward of Donka National Hospital. Children who received this diagnosis and who also had an alteration of consciousness a consultation delay of more than 3 days with signs of severity had an increased risk of dying.

Acinetobacter Meningitis: A Retrospective Study on its Incidence and Mortality Rates in Postoperative Patients at a Tertiary Care Centre in Northern India

Introduction: Acinetobacter species is a non fermenting, Gram negative bacillus, a causative pathogen of hospital-acquired infections due to its inherent Multidrug-Resistant (MDR) property. It is held responsible for the majority of nosocomial meningitis in patients undergoing neurosurgical procedures. Aim: To identify the clinical characteristics, drug-resistance and mortality rate among the patients suffering from meningitis caused by Acinetobacter baumannii. Materials and Methods: This retrospective study was carried out in the Bacteriology section of the Department of Microbiology at Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India, from February 2019 to February 2022. A total of 150 Cerebrospinal Fluid (CSF) samples from routine bacterial culture-confirmed patients were included in the study. All clinical data were extracted from the Hospital Information System (HIS). All the isolates were identified by Matrix Assisted Laser Desorption/Ionisation-Time of FlightMass Spectrometry (MALDI-TOF-MS) assay and antibiotic sensitivity testing was performed according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: The study included 150 (7.55%) cases of culture-proven bacterial meningitis among 1,986 CSF samples collected from February 2019 to February 2022. There were 45 (30.0%) cases of Acinetobacter meningitis. Thirty-five (77.8%) patients had undergone neurosurgical procedures for the removal of spaceoccupying lesions from the brain parenchyma. Forty-two (93.3%) isolates were resistant to amikacin and a cumulative resistance of almost 93.3% to 95.6% was observed among cephalosporins. Fluoroquinolone resistance was observed in 43 (95.6%) patients and carbapenem resistance was observed in 42 (93.33%) isolates. Overall, 12 (26.7%) succumbed to their infections. Conclusion: Acinetobacter meningitis causes delay in the recovery of the patient undergoing intracranial surgery, amounting to a delay in brain parenchyma healing in the case of neurosurgical patients.

Diagnostic Accuracy of Cerebrospinal Fluid Presepsin as a Marker of Bacterial Meningitis in Patients with External Ventricular Drainage – A Cross-Sectional Study in a Tertiary Intensive Care Unit

Background: External ventricular drainage (EVD)-related meningitis is one of the most dreaded nosocomial infections, causing severe neurological sequelae leading to high morbidity and mortality. Blood-contaminated cerebra spinal fluid (CSF) hinders prompt diagnosis and, thus, treatment of such infections. In this study, we aim to establish the usefulness of CSF presepsin as a marker of nosocomial bacterial meningitis in suspected patients with EVD against other CSF markers. Methodology: We conducted a cross-sectional study by enrolling all neurosurgical patients with EVD during a 10-month study period. Patients were divided into two groups: the test arm of already-diagnosed bacterial meningitis cases versus the control arm of aseptic meningitis cases. Presepsin in CSF was measured along with other CSF markers such as total leukocyte count, percentage of neutrophils and lymphocytes, glucose, protein, multiplex and polymerase chain reaction test, and cultures were analyzed for both the groups. Results: A total of 33 adult patients with EVD were analyzed during the study period: 18 cases were in the test arm group, and 15 were in the control arm group. Compared with all the measured parameters, CSF presepsin, with a cutoff value of 300 pg/ml, was the only marker that could differentiate between the groups with a diagnostic accuracy of 0.817, with a sensitivity of 84.2%, and a specificity of 82.1%. Conclusion: Presepsin in CSF is a reliable diagnostic marker of bacterial meningitis in suspected patients with EVD.

Using AAP Guidelines for Managing Febrile Infants Without C-Reactive Protein and Procalcitonin.

In 2021, the American Academy of Pediatrics (AAP) published the Clinical Practice Guideline (CPG) for management of well-appearing, febrile infants 8 to 60 days old. For older infants, the guideline relies on several inflammatory markers, including tests not rapidly available in many settings like C-reactive protein (CRP) and procalcitonin (PCT). This study describes the performance of the AAP CPG for detecting invasive bacterial infections (IBI) without using CRP and PCT. This retrospective cohort study included infants aged 8 to 60 days old presenting to Kaiser Permanente Northern California emergency departments between 2010 and 2019 with temperatures ≥38°C who met AAP CPG inclusion criteria and underwent complete blood counts, blood cultures, and urinalyses. Performance characteristics for detecting IBI were calculated for each age group. Among 1433 eligible infants, there were 57 (4.0%) bacteremia and 9 (0.6%) bacterial meningitis cases. Using absolute neutrophil count >5200/mm3 and temperature >38.5°C as inflammatory markers, 3 (5%) infants with IBI were misidentified. Sensitivities and specificities for detecting infants with IBIs in each age group were: 8 to 21 days: 100% (95% confidence interval [CI] 83.9%-100%) and 0% (95% CI 0%-1.4%); 22 to 28 days: 88.9% (95% CI 51.8%-99.7%) and 40.4% (95% CI 33.2%- 48.1%); and 29 to 60 days: 93.3% (95% CI 77.9%-99.2%) and 32.1% (95% CI 29.1%- 35.3%). Invasive interventions were recommended for 100% of infants aged 8 to 21 days; 58% to 100% of infants aged 22 to 28 days; and 0% to 69% of infants aged 29 to 60 days. When CRP and PCT are not available, the AAP CPG detected IBI in young, febrile infants with high sensitivity but low specificity.

Purulent Bacterial Meningitis in the Russian Federation: Epidemiology and Immunization

Relevance: Purulent bacterial meningitis and invasive meningococcal disease remain relevant throughout the world and are of particular concern due to high mortality and disability rates, as well as regular outbreaks of meningococcal infections. Objective: To establish epidemiological features of purulent bacterial meningitis and meningococcal disease in the Russian Federation and to highlight the problem of immunization. Materials and methods: Data were collected at the Russian Reference Center for Bacterial Meningitis Monitoring of the Central Research Institute of Epidemiology in the personified system for registering cases of purulent bacterial meningitis, including meningococcal disease, meningitis of non-meningococcal and unknown etiology. We examined 28,440 registered cases. Results: We established that three pathogens, that is, meningococcus, pneumococcus and Haemophilus influenzae, accounted for 84 % of all cases of bacterial meningitis, the most vulnerable age group being children under 5 years of age. Despite a general decrease in the incidence of purulent bacterial meningitis in the Russian Federation in 2010–2019, we noted an increasing incidence of pneumococcal meningitis and invasive meningococcal disease by the end of the study period. In terms of age, the 10-year observation period demonstrated a decrease in the incidence of invasive meningococcal disease in children and its rise among adolescents and young adults; an increase in the incidence of pneumococcal meningitis in adults and a null decrease in children; and the absence of a downward trend in the incidence of Haemophilus meningitis in children. Discussion: Organization of epidemiological monitoring of bacterial meningitis within the system of epidemiological surveillance in the Russian Federation in 2010, its testing and 12-year implementation has enabled us to trace changes in the incidence, mortality, and fatality of the disease and to establish age groups at risk. To reduce the burden of the disease, it is expedient to further improve the existing immunization programs in the Russian Federation.

Bacterial Meningitis among Intracranial Surgery Patients at a University Hospital in Northern India.

Cerebrospinal infections are the cause of poor prognosis among post-neurosurgery patients owing to delay in improvement of neurological functions, leading to increased length of hospital stay, proceeding to disability or death. This retrospective observational study was performed at a tertiary care center in Northern India, where all patients with bacterial cerebrospinal infections from July 2019 to July 2022 were evaluated for post-neurosurgery cerebrospinal shunt infections, and all demographic data and risk factors were extracted from the hospital information system (HIS). The study includes 150 (150/1986, 7.55%) culture-confirmed cases of bacterial meningitis out of 1986 cases of suspected bacterial meningitis patients. Ninety-six (96/150, 64.0%) post-neurosurgery patients with cerebrospinal fluid (CSF) leaks were managed using external ventricular drain (EVD) or ventriculoperitoneal (VP) shunt. Seventy-four (74/96, 77.08%) patients were managed only on EVD, whereas 22 (22/96, 22.92%) patients were managed only on VP shunt. Eighty-two (82/96, 85.4%) multidrug-resistant microorganisms (MDROs) were isolated and 70 (70/82, 85.36%) were gram-negative bacteria, of which 56 (56/74, 75.68%) gram-negative bacteria showed extended-spectrum beta-lactamase (ESBL)-producing character in those with an EVD, 14 (14/22, 63.63%) with a VP shunt. Among gram-negative bacteria, Acinetobacter baumannii showed high rates of resistance: 21 (21/23, 91.30%) and 8 (8/8, 100%) were ESBL-producing A. baumannii in patients managed on EVD and VP shunt, respectively. This study determines the risk factors, the spectrum of pathogenic microorganisms, multidrug resistance, and the nature of intracranial lesions isolated among the patients who developed bacterial cerebrospinal infections in post-neurosurgery patients. Kar M, Jamwal A, Dubey A, Sahu C, Patel SS. Bacterial Meningitis among Intracranial Surgery Patients at a University Hospital in Northern India. Indian J Crit Care Med 2022;26(12):1244-1252.

The Specificity, Sensitivity, and Diagnostic Accuracy of CSF-CRP in the Diagnosis of Acute Bacterial Meningitis- A Hospital-Based Study

Introduction: Bacteria that enter the bloodstream and mobile to the brain cord cause bacterial meningitis. The disease is less frequent in developed countries compared to developing countries. In Bangladesh, bacterial meningitis constitutes 25% and the case fatality rate was 14%. The mortality from meningitis is near 100% in untreated individuals and can still be up to 40% in children who received appropriate antibiotic therapy in developing countries. Aim of the Study: The study aims to investigate the specificity, sensitivity, and diagnostic accuracy of CSF-CRP in the diagnosis of Acute Bacterial Meningitis (ABM). Methods: An observational cross-sectional study was carried out in the Department of Pediatric Medicine, Dhaka Shishu Hospital (DSH), from 01 Jan-2017 to 30 Jun-2017. A total of 100 patients were enrolled in this study following the inclusive criteria. Data were collected using the predesigned semi-structured questionnaire. Verbal consent was taken before recruiting the study population. Completed data forms were reviewed, edited, and processed for computer data entry. Result: Among the study population majority of patients (43, 43.0%) were 0-2 years old. One-third of bacterial meningitis (35,35.0%) occurs commonly at an early age (0-2 years). Out of fifty- seven cases (n=57) of bacterial meningitis, twenty-two cases were culture negative and thirty-five cases were culture positive. In the case of bacterial meningitis, in fifty-one cases (51,89.4%) out of fifty-seven, the CSF CRP test was truly positive, with mean±SD 21.7±10.9, false negative were only six cases (6, 10.5%). In aseptic meningitis thirty-nine cases (39,90.6%) out of forty-three cases, the CSF-CRP test was truly negative, and false positive were four cases (4,9.3%). The sensitivity of CSF CRP in differentiating bacterial meningitis from aseptic meningitis was 89.47%, specificity 90.69%, &amp; diagnostic accuracy was 90%. Conclusion: Bacterial meningitis is fatal and more communal in children under one year of age to sixteen years of age. Increased consciousness and initial gratitude and apposite antibiotic treatment can decrease morbidity and mortality. Diagnostic accuracy can be applied as the initial test for the diagnosis of bacterial meningitis.

Identifying the Importance of Cerebrospinal Fluid C - reactive protein (CSF-CRP) in Establishing a Diagnosis of Acute Bacterial Meningitis

Introduction: Acute meningitis is a major cause of death and disability worldwide. Differentiating bacterial from nonbacterial meningitis is very important in deciding on treatment. Bacterial meningitis is a life-threatening neurological condition and needs prompt parenteral antibiotics, compared to viral and aseptic meningitis which carries relatively better outcomes. Aim of the study: The aim of the study was to identify the importance of the CSF-CRP test in diagnosing acute bacterial meningitis. Methods: This cross-sectional observational study was conducted at the Department of Pediatric Medicine, Dhaka Shishu Hospital, Dhaka, Bangladesh. The study duration was 6 months, from January 2017 to June 2017. A total of 100 children visiting the inpatient department of the hospital were selected for the present study following inclusion and exclusion criteria. Result: 57% were diagnosed as bacterial meningitis cases, while 43% were diagnosed with aseptic meningitis. Among the 57 cases of bacterial meningitis, 61.40% belonged to the youngest age group of 0-2 years, while among the aseptic meningitis cases, 37.21% belonged to the age group of 3-6 years. Total WBC and PBN were significantly higher among the bacterial meningitis cases. The sensitivity of CSF-CRP was 89.47%, specificity 90.69%, accuracy 90%, a positive predictive value of 92.72%, and a negative predictive value of 86.66% in diagnosing bacterial meningitis. Conclusion: The study findings conclude CSF-CRP to be an important prognostic factor and initial testing method in diagnosing acute bacterial meningitis. CSF CRP has high diagnostic accuracy in determining the incidence of acute bacterial meningitis.

Study of CSF C-Reactive Protein for the Differentiation of Bacterial Meningitis from Aseptic Meningitis in Children

Background: Acute meningitis is a major cause of death, and disability worldwide. Differentiating bacterial from nonbacterial meningitis is very important in deciding on treatment. Bacterial meningitis is a life-threatening neurological condition, and needs prompt parenteral antibiotics, compared to viral, and aseptic meningitis which carries relatively better outcomes. Objective: To identify the importance of Cerebrospinal fluid C- reactive protein (CSF-CRP) to establish the diagnosis of ABM. Method: This study was conducted from 01 January 2017 to 30th June 2017 at the indoor department of Pediatric Medicine at Bangladesh Sishu Hospital &amp; Institute (BSH &amp; I) to the measure of CSF C-Reactive protein for the differentiation of bacterial meningitis from aseptic meningitis in children. One hundred patients had participated after meeting the inclusion, and exclusion criteria. Patients were selected by purposive sampling. Ethical clearance was obtained from the National Health Research Ethics Committee, BangladeshShishu Hospital&amp; Institute, Dhaka. Results: Out of 57 cases of bacterial meningitis, 22 cases were culture-negative, and 35 cases were culture-positive. 22 cases (62.85%) out of 35 cases culture positive were Streptococcus Pneumoniae followed by 08 cases (22.85%) were Neisseria Meningitis, Haemophilus Influenza 3 cases (8.57%), E.coli were 02 cases (5.71%). WBC count &amp; PMN (%) were increased significantly in bacterial meningitis, compared to aseptic meningitis. Protein and glucose levels in CSF were not significantly different between bacterial meningitis, and the aseptic meningitis group (Table 2). In the case of bacterial meningitis, in 51(89.47%) cases out of 57, the CSF CRP test was truly positive, mean±SD 21.7±10.9, and false negative were only 6 cases (10.52%). In aseptic meningitis 39 cases (90.69%) out of 43 cases, the CSF-CRP test was truly negative, and false positives were 04 cases (9.30%). (Table-4) shows outcome in the meningitis group showed .....

Salmonella Infantis Meningitis in a Pediatric Patient After in-Utero Exposure to Ustekinumab

Abstract Introduction/Objective Salmonella meningitis is associated with a significant neurological sequelae, subdural effusions, cerebral infarction, encephalitis, cerebral abscess, and high mortality. It is a rare complication of Salmonella sepsis and occurs almost exclusively during early infancy. Salmonella is identified as pathogen in less than 1% of confirmed cases of bacterial meningitis in infants. Immunocompromised individuals have higher risk of having invasive salmonellosis. Methods/Case Report We present a case of 4-month-old male with no significant past medical history who was presented to emergency department with five days history of fever, cough and decreased oral intake. At the time of admission, complete blood count was obtained and showed a platelet count of 702 x 10(3)/mcL, hematocrit of 25% and WBC of 17.0 x 10(3)/mcL with differential showing absolute neutrophilia and absolute monocytosis. Head ultrasound was concerning for meningoencephalitis with bilateral parenchymal echogenicity and bilateral subdural collections. Lumbar puncture showed WBC cell count of 229 (36 % PMNs, 52% lymphocytes, 12% monocytes), red blood cells of 0, glucose of 13 mg/dL, protein of 151 mg/dL. Meningitis multiplex PCR panel of the CSF was negative. MRI of the brain showed findings suggestive of meningitis with associated subdural empyema and ventriculitis without hydrocephalus. CSF culture identified Salmonella species that is susceptible to ampicillin and ceftriaxone which later identified as Salmonella infantis by the State laboratory. Immunodeficiency workup including next generation sequencing immunodeficiency panel did not reveal any known causes. Of note, mother has psoriasis and was treated with ustekinumab; an antibody against a cytokine subunit shared by IL12 and IL23, during pregnancy. The patient responded to antibiotic treatment and was discharged in a stable condition. Results (if a Case Study enter NA) N/A. Conclusion This case report highlights Salmonella infantis meningitis in a pediatric patient who was exposed to ustekinumab in utero which could cause drug induced immunodeficiency state as IL-12 is known to activate macrophages and macrophages are critical for Salmonella clearance. Although ustekinumab level was undetected in the patient right prior to discharge, the long half-life and mechanism of action of this medication could have caused an immunodeficiency state which allowed rare Salmonella infantis meningitis.

Spatial epidemiology of bacterial meningitis in the Upper West Region of Ghana: Analysis of disease surveillance data 2018-2020.

The use of a Geographic Information System in identifying meningitis hotspots in the Upper West Region (UWR) remains underutilized, making spatial targeting of meningitis hotspots difficult. We therefore utilized surveillance data enabled with GIS technology to target meningitis outbreaks in the UWR. Secondary data analysis was conducted in the study. The dynamics of bacterial meningitis in space and time were studied using epidemiological data from 2018 to 2020. Spot map and choropleths were used to depict the distribution of cases in the region. Moran's I statistics were used to assess spatial autocorrelation. Getis-Ord Gi*(d) and Anselin Local Moran's statistics were used to identify hotspots and spatial outliers within the study area. A Geographic Weighted Regression model was also used to examine how socio bio-climatic conditions influence the spread of meningitis. There were 1176 cases of bacterial meningitis, 118 deaths, and 1058 survivors between 2018 and 2020. Nandom municipality had the highest Attack Rate (AR) at 492/100,000 persons, followed by Nadowli-Kaleo district at 314/100,000 persons. Jirapa had the highest case fatality rate (CFR) at 17%. The spatio-temporal analysis showed spatial diffusion of meningitis prevalence from the western half of the UWR to the east with a significant number of hotpots and cluster outliers. Bacterial meningitis does not occur at random. Populations (10.9%) under sub-districts identified as hotspots are exceptionally at higher risk of outbreaks. Targeted interventions should be directed towards clustered hotspots, focusing on zones with low prevalence fenced off by high prevalence zones.

Hypervirulent carbapenem-resistant Klebsiella pneumoniae causing highly fatal meningitis in southeastern China.

Klebsiella pneumoniae (K. pneumoniae) is one of the most common causes of bacterial meningitis worldwide. The purpose of this study was to investigate the clinical and microbiological characteristics of K. pneumoniae meningitis, as well as the association of antimicrobial resistance, virulence, and patient prognosis. The clinical data of patients with K. pneumoniae meningitis from 2014 to 2020 in a tertiary teaching hospital were retrospectively evaluated. Antimicrobial susceptibility profiles were performed by the agar dilution method and broth microdilution method. The isolates were detected for virulence-related genes, resistance genes, capsular serotypes, and molecular subtypes. A total of 36 individuals with K. pneumoniae meningitis were included in the study, accounting for 11.3% (36/318) of all cases of bacterial meningitis. Of the 36 available isolates, K1, K47, and K64 were tied for the most frequent serotype (7/36, 19.4%). MLST analysis classified the isolates into 14 distinct STs, with ST11 being the most common (14/36, 38.9%). Carbapenem resistance was found in 44.4% (16/36) of the isolates, while hypervirulent K. pneumoniae (HvKP) was found in 66.7% (24/36) of the isolates. The isolates of hypervirulent carbapenem-resistant K. pneumoniae (Hv-CRKP) were then confirmed to be 36.1% (13/36). Importantly, individuals with meningitis caused by Hv-CRKP had a statistically significant higher mortality than the other patients (92.3%, 12/13 vs. 56.5%, 13/23; P < 0.05). The high percentage and fatality of K. pneumoniae-caused meningitis, particularly in Hv-CRKP strains, should be of significant concern. More effective surveillance and treatment solutions will be required in future to avoid the spread of these life-threatening infections over the world.

P449 Semi-quantitative cryptococcal antigen rapid test (CryptoPS, Biosynex®) for cryptococcal meningitis in patients living with HIV in Sub-Saharan Africa: prospective multicenter diagnostic accuracy study (DREAMM)

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PMBackgroundCryptococcal meningitis (CM) remains a leading cause of HIV-related meningoencephalitis in African low- and middle-income countries (LMICs), causing 15%-20% of HIV-related deaths. Rapid Diagnostic Tests (RDTs) are powerful tools and key to speeding-up the diagnosis at the bedside, allowing for rapid and targeted treatment, especially in LMICs. For the past 10 years, Cryptococcal Antigen (CrAg) RDTs have a major role in CM management.Driving Reduced AIDS Meningo-Encephalitis Mortality (DREAMM) was a multicenter implementation science study and a capacity-building project to reduce the mortality of HIV-related central nervous system infections (CNS). One of the main DREAMM approaches was to improve the diagnosis of CNS infections at the bedside and in parallel in local laboratories. Within DREAMM, HIV-infected, adult people living with HIV (>18 years old) with suspected CNS infections were recruited in five hospital sites in Cameroon, Malawi, and Tanzania.ObjectivesOur objective was to evaluate the implementation of CrAg CryptoPS (Biosynex, Illkirch Graffenstaden, France), a new semi-quantitative RDT, in routine care settings in Sub-Saharan Africa.MethodsAll CrAg CryptoPS performed were compared to the reference CrAg lateral flow assay (Immy®). The evaluation was done by the local research teams in four DREAMM laboratories sites. CrAg CryptoPS's implementation was evaluated in 301 plasma samples and 258 cerebrospinal fluid (CSF) samples from 320 participants (patients diagnosed with cerebral toxoplasmosis did not have a lumbar puncture). In this analysis, the results will be considered in a binary way (positive/negative).ResultsBetween January 2018 and March 2021, 356 participants were prospectively enrolled with suspected HIV-related CNS infections, including CM, tuberculous meningitis, cerebral toxoplasmosis, and bacterial meningitis cases. Cryptococcal meningitis was the leading cause of CNS infections in Malawi and Tanzania with 66.3% (53/80) and 59.6% (59/99) cases respectively, and the second cause in Cameroon with 40.0% (39/90) cases after cerebral toxoplasmosis.In plasma, CryptoPS's sensitivity was 99.23% (95% CI, 0.98-1.01) and specificity was 94.15% (95% CI, 0.91-0.98); positive and negative predictive values were 92.8% and 99.4%, respectively. In CSF, the sensitivity and specificity of CryptoPS were 100% (95% CI, 0.0-0.0), and 99.26% (95% CI, 0.98-1.01), respectively; positive and negative predictive values were both 100%. A low number of false-positives were observed (<4% in plasma and <0.5% in CSF).ConclusionCryptoPS was evaluated in a context of hospitalized patients within a project including all causes of HIV-related CNS infection, not only CM. The sensitivity and specificity of CryptoPS calculated in these preliminary results are promising. Semi-quantitative CryptoPS has the potential to be used to tailor antifungal therapy but further optimizations need to be done prior to large-scale implementation in African LMICs. In addition, future work to determine CrAg antigen titres is planned, in the perspective to optimize treatment of CrAg positive cases who decline lumbar puncture.

Serious Bacterial Infections in Young Febrile Infants With Positive Urinalysis Results.

To determine the prevalence of bacteremia and/or bacterial meningitis in febrile infants ≤60 days of age with positive urinalysis (UA) results. Secondary analysis of a prospective observational study of noncritical febrile infants ≤60 days between 2011 and 2019 conducted in the Pediatric Emergency Care Applied Research Network emergency departments. Participants had temperatures ≥38°C and were evaluated with blood cultures and had UAs available for analysis. We report the prevalence of bacteremia and bacterial meningitis in those with and without positive UA results. Among 7180 infants, 1090 (15.2%) had positive UA results. The risk of bacteremia was higher in those with positive versus negative UA results (63/1090 [5.8%] vs 69/6090 [1.1%], difference 4.7% [3.3% to 6.1%]). There was no difference in the prevalence of bacterial meningitis in infants ≤28 days of age with positive versus negative UA results (∼1% in both groups). However, among 697 infants aged 29 to 60 days with positive UA results, there were no cases of bacterial meningitis in comparison to 9 of 4153 with negative UA results (0.2%, difference -0.2% [-0.4% to -0.1%]). In addition, there were no cases of bacteremia and/or bacterial meningitis in the 148 infants ≤60 days of age with positive UA results who had the Pediatric Emergency Care Applied Research Network low-risk blood thresholds of absolute neutrophil count <4 × 103 cells/mm3 and procalcitonin <0.5 ng/mL. Among noncritical febrile infants ≤60 days of age with positive UA results, there were no cases of bacterial meningitis in those aged 29 to 60 days and no cases of bacteremia and/or bacterial meningitis in any low-risk infants based on low-risk blood thresholds in both months of life. These findings can guide lumbar puncture use and other clinical decision making.

A Case of Recurrent Bacterial Meningitis in a Girl with Mondini Deformity

A Case of Recurrent Bacterial Meningitis in a Girl with Mondini Deformity

Recurrent Bacterial Meningitis Associated with Inflammatory Nasal Polyp

In case of no head trauma history and intact immunity, adultonset recurrent bacterial meningitis is scarce. Parameningeal infection is the crucial latent cause of recurrent bacterial meningitis in adults. Nasal polyp can cause a variety of nasal symptoms, depending on its location and size. Chronic sinusitis with nasal polyp tends to have more severe symptoms than those without nasal polyp. We report a case of adult onset third recurrent bacterial meningitis associated with inflammatory nasal polyp.

Investigation of Concurrent Pneumococcal Meningitis in Two Children Attending the Same Day-Care Center

Only a few clusters of invasive pneumococcal disease have been described globally in children, and most of these cases occurred before pneumococcal vaccination implementation. Two unusual cases of pneumococcal meningitis, occurring in the same daycare center over a 3-day period, were reported. Both cerebrospinal fluid (CSF) were sent to the National reference center for pneumococci. In addition, we decided to perform a pneumococcal carriage study on all children and staff of the daycare center to analyze the pneumococcal serotypes circulating in this DCC and to discuss an antibiotic chemoprophylaxis. CSF culture was positive for pneumococcus, and serotype 25A was identified by latex agglutination. The second case had negative CSF culture, but CSF antigen test and gene amplification results were positive for Streptococcus pneumoniae. Serotype 12F was identified by using molecular biology. The absence of correlation between these strains was confirmed by multi-locus sequence typing. In the carriage study, we included 29 children (median age 1.9 years, interquartile range 1.4–2.5) and 10 adults. Among the children, 24 carried Streptococcus pneumoniae (83%). The main serotypes isolated were 23A for 6 children and 25A for 5 children; serotypes were non-typeable for 3 children. Only 1 of 10 adults tested carried Streptococcus pneumoniae (serotype 12F). Despite this temporo-spatial pattern, the cases were unrelated and not due to carriage of a particular serotype. No specific action has been taken for the other children attending this DCC, and no other case of bacterial meningitis occurred.