Cerebrospinal Fluid Culture Research Articles

NIMG-86. DISSEMINATEDCRYPTOCOCCUS NEOFORMANS MIMICKING CENTRAL NERVOUS SYSTEM PROGRESSION OF DIFFUSE LARGE B-CELL LYMPHOMA

Abstract A 57-year-old male with stage IV diffuse large B-cell lymphoma (DLBCL), non-germinal center subtype, underwent 6 cycles of polatuzumab, rituximab, cyclophosphamide, doxorubicin, prednisone, and pegfilgrastim (Pola-R-CHP) then presented to the hospital with progressive confusion, double vision, hearing loss, and lower extremity weakness. MRI of the brain and spinal cord with and without IV contrast revealed extensive leptomeningeal enhancement along the brain, several cranial nerves, cervical and thoracic spinal cord with enhancement of the cauda equina. Cerebrospinal fluid (CSF) analysis studies revealed 41 nucleated cells/mm3, protein to 264 mg/dL, and an initial cryptococcal antigen titer of 1:1280; serial lumbar punctures peaked at an opening pressure of 39.5 cm H2O before improvement. Flow cytometry was negative on two CSF studies. Multiple cultures grew Cryptococcus neoformans before sterilization of CSF culture on day 13. He received induction therapy for 4 weeks with amphotericin B and flucytosine. Flucytosine treatment was limited due to cytopenias on day 9 and continued induction with amphotericin B and fluconazole. Fluconazole was switched for voriconazole based on minimal inhibitory concentrations by broth dilution, however, the drug was undetectable on therapeutic drug monitoring 2 weeks later and switched back to fluconazole. Subsequent positron emission tomography revealed ongoing hypermetabolic thoracic, mediastinal, and hilar lymph nodes compared to PET scans prior to chemotherapy for which he underwent transbronchial fine needle aspiration concerning for Cryptococcus involvement. He remained on fluconazole 800mg/day and MRI 11 months after the initial presentation demonstrated ongoing but slightly improved leptomeningeal enhancement. Due to persistent symptoms despite sterile CSF cultures, he underwent a three-day course of IV methylprednisolone 1000mg with some incomplete improvement in symptoms. The opening pressure normalized and the cryptococcal antigen titer decreased to 1:20 about 11 months after initial treatment. This case highlights the risk of opportunistic infections like cryptococcal meningitis in patients undergoing chemotherapy.

Brain abscess caused by Mycobacterium tuberculosis in an immunocompetent patient: a case report and literature review.

Brain abscesses caused by Mycobacterium tuberculosis are rarely reported and are typically found in immunocompromised patients. The challenges in identifying the pathogen and the frequent delays in initiating appropriate therapy often result in a poor prognosis for patients. We herein report a rare case of a brain abscess caused by M. tuberculosis in a 63-year-old patient with a history of hypertension but no history of pulmonary tuberculosis. The patient was hospitalized twice because of worsening right upper limb weakness and speech difficulties. Both a pus culture and cerebrospinal fluid culture were negative. Ultimately, the diagnosis of M. tuberculosis infection was confirmed through next-generation sequencing and the tuberculosis-specific T-cell test (T-SPOT). The patient's symptoms improved following anti-tuberculosis treatment. This case highlights the importance of considering M. tuberculosis as a potential cause of brain abscesses, even in immunocompetent individuals, and underscores the need for early diagnosis for effective treatment.

Etiologies and Comorbidities of Meningitis Deaths in Children Under 5 Years in High-Mortality Settings: Insights from the CHAMPS Network in the Post-Pneumococcal Vaccine Era

BackgroundThe role of meningitis in causing deaths and in children under 5 is unclear, especially since widespread use of vaccines to prevent common causes of meningitis. Child Health and Mortality Prevention Surveillance (CHAMPS) uses post-mortem minimally invasive tissue sampling (MITS) and ante-mortem data to explore death causes. We aimed to assess meningitis’s contribution to mortality and identify causative pathogens in children under 5 within CHAMPS Network sites. MethodIn this observational study, we analyzed deaths in live-born children <5 years of age that occurred between December 16, 2016, and December 31, 2023, in CHAMPS catchments in six sub-Saharan African countries (Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, South Africa) and Bangladesh. MITS was conducted within 24–72hours of death, including blood and cerebrospinal fluid (CSF) culture, multi-organism targeted nucleic acid amplification tests on blood, CSF and lung tissue, and histopathology of lung, liver and brain. Expert panels at each site reviewed data to attribute causes of death following ICD-10 standards. ResultMeningitis was in the causal pathway for 7.0% (270/3857) of deaths; in 4.8% (13/270) meningitis was considered the underlying condition. Neonates accounted for 65.9% (178/270) and infants or children 34.1% (92/270). Among neonatal meningitis deaths, 55.6% (99/178) occurred ≥72hours post-hospital admission; and common pathogens were Acinetobacter baumannii (49.5%, 49/99; mainly from South Africa) and Klebsiella pneumoniae (40.4%, 40/99). Forty-four percent (79/178) of neonatal meningitis deaths were community-associated, primarily due to K. pneumoniae (35.4%, 28/79) and Escherichia coli (13.9%, 11/79). Among infant and child meningitis deaths, 43.5% (40/92) occurred ≥72hours post-admission; and common pathogens were K. pneumoniae (42.5%,17/40) and A. baumannii (17.5%, 7/40). Among community-associated meningitis deaths in infants and children (56.5%, 52/92), Streptococcus pneumoniae (34.6%, 18/52) and K. pneumoniae (19.2%, 10/52) were common pathogens. Pathogen prevalence varied by region. ConclusionOur study highlights meningitis as a significant contributor to under-5 mortality in low-middle-income countries. The prominent role of K. pneumoniae and A. baumannii, particularly in healthcare settings and specific regions, highlights the need for better infection control, targeted interventions, and more effective treatment strategies.

Streptococcus equi Subspecies zooepidemicus Endocarditis and Meningitis in a 62-Year-Old Horse Rider Patient: A Case Report and Literature Review

The present article presents a case report and literature review concerning the Streptococcus equi subspecies zooepidemicus (SEZ), a rare zoonotic pathogen in humans. The case involves a 62-year-old man with no prior heart disease, presenting with endocarditis, pneumonia, and meningitis following close contact with a horse. The patient underwent urgent aortic valve replacement due to severe valvular damage caused by the infection. Blood and cerebrospinal fluid cultures confirmed the presence of SEZ, and the patient was treated with a combination of antibiotics, followed by a successful step-down to oral therapy using linezolid. A review of 25 additional Streptococcus equi endocarditis cases highlights the rarity of the condition, its association with animal contact, and its tendency to cause multi-site infections, such as pneumonia and meningitis. Early diagnosis, appropriate antibiotic therapy, and, in severe cases, surgical intervention are critical for a favorable outcome. This report emphasizes the importance of recognizing zoonotic infections in at-risk populations and the potential need for public health surveillance in these scenarios.

Infantile Intraparenchymal Brain Abscess due to Streptococcus pyogenes

Introduction Group A ß-hemolytic streptococcus (GABHS) are the most common bacterial cause of tonsillitis, and can cause noninvasive diseases such as pharyngitis and impetigo, as well as more severe invasive diseases. The incidence of invasive disease is 1-3/100,000 per year, and the morbidity and mortality rate is high. GABHS is rarely lead to brain abscesses. Case Report Acute phase reactants were found to be high in a 40-day-old patient who presented with fever, irritability and focal seizures. Acute phase reactants were high. Transfontanel ultrasonography showed increased thickness, echo and blood supply in the meninges. Brain magnetic resonance imaging (MRI) and diffusion MRI revealed a thick-walled abscess in the right cerebral hemisphere and parietooccipital parenchyma with diffusion restriction on diffusion-weighted images. Cerebrospinal fluid (CSF) polymerase chain reaction (PCR) test revealed S. pyogenes,and S. pyogenes grown in CSF culture. Initially, meropenem, vancomycin, metronidazole antibiotherapy was applied. Treatment was revised to cefotaxime and vancomycin after culture antibiogram and was completed for 8 weeks. Seizures regressed. Control brain imaging showed improvement. Restriction in left lower extremity movements remained. Physical therapy and rehabilitation was recommended and he was discharged. Conclusion GABHS, which is the causative agent of acute tonsillitis, rarely causes invasive disease which has high mortality and morbidity.

43 Etiology of community-acquired bacterial meningitis in children seen in the emergency department in Canada

Abstract Background Bacterial meningitis poses a significant threat to paediatric health, resulting in substantial morbidity and mortality in children. Though previous studies have delineated the causative agents behind community-acquired meningitis, recent vaccination initiatives may have reshaped its underlying etiology. Objectives This study aimed to identify the bacteria responsible for community-acquired bacterial meningitis in children in Canada. Design/Methods This was a retrospective cohort study including children aged 1 day-18 years with confirmed bacterial meningitis, evaluated at a tertiary-care, Canadian emergency department between July 1st 2014 and December 31st 2022. The primary outcome was the pathogen identified. Other variables of interest were mortality, complications, age, sex, and diagnostic method. Medical charts were identified via the hospital’s archives and reviewed by a single co-author. A random sample of 20 (23%) medical charts were independently reviewed by a second co-author to assess inter-rater reliability. We set a target of evaluating at least 50 cases to allow narrow confidence intervals (+/- 13%) for proportions. Results All variables showed excellent inter-rater reliability with Kappa scores and intraclass correlation coefficients higher than 0.60. All 79 eligible cases were included. The main causal agents were Group B Streptococcus (GBS) (n=20; 25%), Streptococcus pneumoniae (n=16; 20%), Neisseria meningitidis (n=16; 20%) and Haemophilus influenzae (n=9; 11%). Etiology exhibited age-dependent variations, with 85% of GBS and 100% of E. coli infections identified in children under two months, while all pneumococcal and Group A Streptococcus cases were in children older than six months. All children infected by S. pneumoniae were vaccinated against pneumococcal infection but the serotype was not covered by vaccination in 7/8 infections. All children with N. meningitidis were either too young to be vaccinated (n=10) or infected by a serotype not covered by the vaccine. Six (7%) patients died and 29 (34%) suffered complications, including hearing impairment (n=5), cerebral ischemia (n=4), seizures (n=4), and subdural abscess (n=3). Fifty-nine bacterias were identified by cerebrospinal fluid culture, 13 by PCR and 7 by both methods. Conclusion GBS is the leading etiology of paediatric community-acquired bacterial meningitis in Canada. Causal agents of bacterial meningitis vary greatly by age. Future studies should work on improving the serotype spectrum of vaccines, prophylaxis in mothers who are GBS carriers, and use of PCR as a diagnostic tool for timely clinical interventions.

Etiology of community-acquired bacterial meningitis in children at a tertiary-care centre in Montreal, Canada

Abstract Objectives This study aimed to identify the bacteria responsible for community-acquired bacterial meningitis in infants and children. Methods This was a retrospective cohort study including children aged 1 day to 18 years with confirmed bacterial meningitis, evaluated at a tertiary-care, Canadian emergency department between 2014 and 2022. The primary outcome was the pathogen identified. Other variables of interest were complications, age, and diagnostic method. Medical charts were reviewed by a co-investigator and 25% were assessed in duplicate. Results All 79 eligible cases were included. The main causal agents were Group B Streptococcus (GBS) (n = 20; 25%), Streptococcus pneumoniae (n = 16; 20%), Neisseria meningitidis (n = 16; 20%), and Haemophilus influenzae (n = 9; 11%). Etiology exhibited age-dependent variations, with 85% of GBS and 100% of Escherichia coli infections in children under 2 months. All pneumococcal and Group A Streptococcus cases were in children older than 6 months. All children infected by S. pneumoniae were vaccinated but the serotype was not covered by vaccination in 7/8 infections. All children with N. meningitidis were either too young to be vaccinated (n = 10) or infected by a serotype not covered by the given vaccine. Fifty-five bacteria were identified by cerebrospinal fluid culture, 17 by Polymerase Chain Reaction (PCR), and 7 by both methods. Conclusion GBS is now the leading etiology of paediatric community-acquired bacterial meningitis at our centre. The etiology of bacterial meningitis varies greatly by age. Future studies should focus on improving the serotype spectrum of vaccines, identifying strategies to lower GBS infection, and improving the use of PCR as a diagnostic tool.

Efficacy of Endovascular Glue Embolization in Treating Ruptured Intracranial Mycotic Aneurysms: A Single Center Experience.

Intracranial mycotic aneurysms (IMAs), rare and often life-threatening, result from arterial wall infections typically caused by bacteria such as Staphylococcus and Streptococcus. The standard treatment for ruptured aneurysms is not well-defined and often individualized. This study investigates the efficacy of endovascular glue embolization in managing ruptured IMAs, based on our center's experience. A retrospective analysis was conducted for ruptured IMAs treated with glue embolization between January 2016 and December 2023. The procedure involved aneurysm sac and parent vessel occlusion with glue delivery. Data included patient demographics, clinical presentations, and neuroimaging. Clinical outcomes were assessed using the modified Rankin scale (mRS) at 3 months, and angiographic follow-up was conducted at 6 months. The study included 28 patients, predominantly male (64.3%), with a mean age of 48 years. Headache was the primary symptom in 92.9% of cases, and positive blood/cerebro spinal fluid cultures were found in 82.14% of cases. All aneurysms were located in the distal circulation, primarily in the anterior circulation system. Glue embolization was successfully performed in all cases, achieving complete aneurysm sac and parent vessel obliteration. Follow-up at 3 months indicated mRS scores of 0 or 1 in 96.5% of cases. Six-month angiographic follow-up showed no aneurysm regrowth or new formations. Endovascular glue embolization demonstrated high efficacy and safety in treating ruptured IMAs, with a 100% obliteration rate and favorable clinical outcomes in this single-center experience. Despite limitations such as its retrospective design and small sample size, the study supports glue embolization as a viable, less invasive alternative to traditional surgery. Further comparative studies are needed to confirm these findings and refine treatment approaches.

Worsening abdominal pain leading to false laparotomy: a case of acute intermittent porphyria

Acute intermittent porphyria (AIP), one of the most severe types of acute hepatic porphyria, is an autosomal dominant inherited disorder of heme biosynthesis. We present a case of a 16-year-old girl who presented with severe abdominal pain, subjected to a laparotomy and later developed seizures and other neurological manifestations. Initial investigations showed hyponatraemia. Magnetic Resonance Imaging of brain showed cerebritis. She underwent several investigations including an ultrasound of abdomen, a computed tomography scan of abdomen and pelvis, cerebrospinal fluid routine examination and culture, and autoimmune investigation which were found to be normal. HM urine porphobilinogen levels were found to be raised. The diagnosis was made based on investigation and clinical symptoms. AIP should be suspected when a patient presents with chronic abdominal pain and neurological symptoms. Keywords: Acute Intermittent Porphyria, false laparotomy, appendicitis, acute abdomen, hyponatremia, tonic-clonic seizures.

Utility of cell index in the diagnosis of healthcare-associated ventriculitis and meningitis: an analytical cross-sectional study

BackgroundThe diagnosis of healthcare-associated ventriculitis and meningitis (HCAVM) can be complex because multiple factors confound the interpretation of cerebrospinal fluid (CSF) tests. The cell index (CI) may help in the diagnosis of HCAVM. It does not incur additional medical cost and it avoids delays from the turnaround time of CSF cultures. It is derived by calculating the ratio of CSF white blood cell (WBC) and red blood cell (RBC) divided by the ratio of peripheral WBC and RBC. This study aimed to evaluate the diagnostic utility of this parameter.MethodsAn analytic, observational, cross-sectional study was conducted at the University of the Philippines – Philippine General Hospital. All admitted pediatric and adult patients from 2015 to 2022 who underwent external ventricular drain (EVD) insertion for hydrocephalus secondary to intracranial hemorrhage (ICH), acute ischemic stroke, intracranial neoplasms, traumatic brain injury, or congenital hydrocephalus were screened. Records of patients fulfilling the inclusion criteria were then reviewed.ResultsA total of 363 patients underwent EVD insertion from 2015 to 2022. Of these, 161 were included in the study. Two-thirds (66.5%) were adults ≥ 19 years old whereas the remaining were pediatric patients 1 to < 19 years old. There were no patients < 12 months old as they fulfilled at least one exclusion criteria. Forty-nine of them were later confirmed to have HCAVM based on the CDC/NHSN criteria. A CI cut-off of ≥ 1.21 gave a maximum sensitivity of 30.6% and specificity of 86.4%. Receiver operating characteristic area under the curve (AUC-ROC) analysis was 0.585. Subgroup analysis by age showed sensitivity of 52.9% in the pediatric age group and 3.13% in adults. Subgroup analysis by neurologic indication showed sensitivity of 27.6% for ICH and 35.0% for neoplasms. Subsequent AUC-ROC analyses, however, showed that CI failed to adequately diagnose HCAVM in these subgroups.ConclusionsIn our population of neurologic patients who underwent EVD insertion, the cell index is not a reliable parameter in the diagnosis of HCAVM.

Long-Term Trends in Antibiotic Use in a Low-Resource Medical Setting: Amman, Jordan (2010–2023)

Abstract Background Antimicrobial resistance (AMR) contributes to substantial morbidity and mortality. The misuse and overuse of antibiotics are major drivers of AMR. Lack of point-of-care testing to discern viral from bacterial infections complicates appropriate management in low-resource settings. This study examines antibiotic prescription practices in Amman, Jordan. Methods We conducted three prospective viral surveillance studies at the largest public hospital in Amman Jordan (2010–2013, 2020, and 2023). Our target population for this study was children &amp;lt;2 years old hospitalized with fever or respiratory symptoms. Through parental interviews and chart abstractions, we collected demographic and clinical data, including antibiotic use, as well as results of any blood, urine, and cerebrospinal fluid cultures performed at providers’ discretion. We classified antibiotics according to the 2023 World Health Organization AWaRe (Access, Watch, Reserve) antibiotic classification system, focusing on the utilization of Watch group antibiotics, which are recommended when first-line Access group antibiotics are ineffective or inappropriate. Research personnel also collected nasal or throat swabs from enrolled children, and these samples were tested in a research laboratory for common respiratory viruses using RT-PCR. Providers were unaware of viral testing results. We described categorical variables using absolute and relative frequencies and summarized continuous variables using the median and interquartile range (IQR). Results Of 4,950 children enrolled, we included 4,703. The median age was 3.5 months (IQR, 1.6–8.3), and 59.4% (n=2,793) were male. Most children were enrolled from the general ward (n=4,312 [91.9%]), with the remaining 380 (8.1%) being enrolled from the pediatric intensive care unit. Only 8 children (0.2%) among those eligible for seasonal influenza vaccination (n=1,624) had been vaccinated at presentation. The five most common admission diagnoses were bronchopneumonia (n=1,255 [26.7%]), rule-out sepsis (n=1,217 [25.9%]), bronchiolitis (n=866 [18.4%]), pneumonia (n=606 [12.9%]), and paroxysmal coughing or pertussis-like cough (n=273 [5.8%]). Blood, urine, or CSF samples were collected from 2,556 children (54.5%), 355 (13.9%) of whom tested positive for at least one bacterial species (Figure 1A). During hospitalization, 4,356 children (92.6%) received at least one antibiotic. Of those, 4,227 (97.0%) received at least one antibiotic from the Watch group (Figure 1B). The three most common Access group antibiotics prescribed were ampicillin (n=830 [17.7%]), gentamicin (n=96 [2.0%]), and amikacin (n=85 [1.8%]), whereas the three most common Watch group antibiotics prescribed were ceftriaxone (n=1,956 [41.7%]), cefuroxime (n=1,628 [34.7%]), and azithromycin (n=754 [16.1%]) Overall, 3,898 children (82.9%) were positive for at least one respiratory virus (Figure 1C). Providers ordered cultures most often for children 0–2 months old (n=1,575 [73.5%]) and those with an admission diagnosis of rule-out sepsis (n=1,161 [95.4%]). Despite seasonal variation, prescription and testing practices were consistent across study years. Conclusion Inappropriate antibiotic use remains a significant healthcare challenge in Jordan. Incorporating point-of-care viral testing for suspected respiratory infections and improving diagnostic testing for bacterial infections is crucial. Preventive strategies including influenza vaccination and the use of emerging therapies for RSV or other pathogens associated with high morbidity could indirectly limit inappropriate antibiotic use. Development of context-specific management guidelines and antimicrobial stewardship programs are urgently required to guide prescription practices.

Clinical importance of cerebrospinal fluid protein levels in HIV-associated cryptococcal meningitis: Insights from a prospective cohort study in Uganda.

Cerebrospinal fluid (CSF) protein levels exhibit high variability in HIV-associated cryptococcal meningitis; however, its clinical implications remain unclear. We analyzed data from 890 adults with HIV-associated cryptococcal meningitis randomized into two clinical trials in Uganda between 2015 and 2021. CSF protein was grouped into < 100mg/dl (72%, n =641) and ≥ 100mg/dl (28%, n =249). We described baseline clinical variables and 18-week mortality by CSF protein groups. Those with CSF protein ≥ 100mg/dl were more likely to present with Glasgow coma scale score<15 (P < .01), self-reported seizures at baseline (P = .02), higher CD4 T-cell count (P < .001), and higher CSF white blood cells (P < .001). Moreover, those with a baseline CSF protein ≥ 100mg/dl also had a lower baseline CSF fungal burden (P < .001) and a higher percentage of sterile CSF cultures at day 14 (P = .02). Individuals with CSF protein ≥ 100mg/dl demonstrated a more pronounced immune response consisting of upregulation of immune effector molecules, pro-inflammatory cytokines, T-helper cell type 1 and 17 cytokines, and immune-exhaustion marker (P < .05). 18-week mortality risk in individuals with a CSF protein < 100mg/dl was 34% higher (unadjusted Hazard Ratio 1.34; 95% Confidence Interval, 1.05-1.70; P = .02) than those with CSF protein ≥ 100mg/dl. In HIV-associated cryptococcal meningitis, individuals with baseline CSF protein ≥ 100mg/dl more frequently presented with neurological symptoms, higher CSF inflammatory cytokines, reduced fungal burden, and lower mortality risk. The findings underscore the prognostic significance of baseline CSF protein levels in predicting disease severity and mortality risk in cryptococcal meningitis.

Patterns of Microbial Infections in Post-Infective Hydrocephalus and Treatment Methods at Bugando Medical Center

Background: Post Infective Hydrocephalus is among the complicated types of hydrocephalus and poses a challenge in management of these patients, globally. Antibiotics susceptibility patterns of common bacteria implicating in pyogenic ventriculitis complicated with hydrocephalus were not clearly known at our setting. Therefore, we determined antibiotics susceptibility patterns of common bacteria implicating in pyogenic ventriculitis complicated with hydrocephalus to recommend empirical therapy while waiting for culture and sensitivity results at Bugando Medical Centre (BMC) in Mwanza, Tanzania. Methods: Thirty-five patients with hydrocephalus who had undergone cerebrospinal fluid (CSF) tapping and analysis were selected randomly retrospectively and their bacteriological culture and sensitivity results were analyzed to determine the common microbial patterns. Patients were rationally prescribed antibiotics depending on laboratory results for 7 days and were later done control CSF cultures until negative cultures were achieved. Results: A total of 35 patients with median (interquartile range [IQR]) age was 5.5 [2-8] months were reviewed. The majority of participants were males, 62.9% (22/35). 20% (7/35) and 37.1% (13/35) had turbid CSF-shunt sample and first culture positive results, respectively, whereas one patient had culture positive with two pathogens resulting to 14 isolates. Gram positive bacteria were predominantly isolated (66.7%, 8/14), whereby S. aureus was frequently encountered (35.7%, 5/14). Overall, gram positive and negative bacteria exhibited least resistance against tetracycline (16.7% and 25%) and ciprofloxacin (16.7% and 25%) respectively. Three (8.6%) patients died from respiratory complications. Conclusion: Post infective hydrocephalus is a clinically challenging but treatable form of hydrocephalus and Staphylococcus aurous is the most common cause. This study found that the use of a seven-day regimen as cost effective and associated with a shorter hospital stay with the focus on CSF analysis with subsequent microbial targeted antibiotic therapy to achieve sterile CSF culture. Treatment strategy should be multidisciplinary approach with collaboration from microbiologists, radiologists, pediatricians and neurosurgeons.

Prevalence and associated risk factors of staphylococcus aureus and methicillin-resistant staphylococcus aureus isolates obtained from patients seeking treatment in Nakuru county referral and teaching hospital, Kenya

Staphylococcus aureus is a pathogenic bacterium that can evolve rapidly to methicillin-resistant Staphylococcus aureus (MRSA). MRSA is a global health concern that is associated with significant morbidity and mortality. This study was to determine the prevalence and Associated Risk Factors of staphylococcus aureus and MRSA isolates obtained from patients seeking treatment in Nakuru County Referral and Teaching Hospital. A descriptive cross-section study design was used with a laboratory experimental component and it was carried out in Nakuru County Referral and Teaching Hospital, Kenya. A total of 354 laboratory samples were randomly collected from different laboratory samples/sites: blood, urine, wound, nasal swabs, pus, tissue, abscess, sputum, ear swabs, as well as cerebrospinal fluid (CSF) culture, skin swabs and synovial fluid culture over a period of six months. These samples were tested for presence of staphylococcus aureus and MRSA isolates using Culture methods and Antibiotic Sensitivity Tests. The study analyzed 354 participants, with a median age of 35 years. Most participants (56.7%) were from medical wards, 20.4% from outpatient clinics, and 11% from Diabetic Care Centre. Staphylococcus aureus was found in 7.1% of samples, with MRSA present in 2.3%. Other isolated organisms included Coagulase Negative Staphylococci (7.1%), E. coli (6.8%), Proteus spp. (5.1%), and Pseudomonas spp. (5.9%). The prevalence of MRSA among the participants is low.

Frequency, risk factors, and outcome of neonatal meningitis in sepsis.

To determine the frequency, associated risk factors, and outcome of meningitis in neonates presenting with sepsis at Aga khan Tertiary Care Hospital, Karachi. A descriptive cross-sectional study was conducted at pediatrics department of Aga Khan Tertiary University Hospital, Karachi, Pakistan from July 31, 2020, till January 30, 2021. Neonates of either gender admitted with neonatal sepsis were enrolled using non-probability consecutive sampling technique. Meningitis was diagnosed as per the findings of cerebrospinal fluid (CSF) along with the outcome in terms of death and early neurological complications such as subdural effusions and hydrocephalus. Of 209 neonates with sepsis, meningitis was observed in 59 (28.2%) neonates. A significantly lower mean weight (p-value 0.024) while significantly higher mean duration of stay (p-value <0.001) was observed in patient with meningitis. Moreover, a significantly higher proportion of meningitis was observed in neonates who had fever (p-value 0.048), vomiting (p-value 0.009), abdominal distension (p-value <0.001), and blood culture positivity (p-value <0.001). Blood culture positive Methicillin-sensitive Staphylococcus aureus (MSSA) was considerably higher among neonates with meningitis. Of 59 neonates with meningitis, mortality was observed in 2 (3.4%) neonates. Positive CSF culture was observed in 6 (2.9%) while hydrocephalus was observed in 7 (11.9%) and effusion in 6 (10.2%) neonates. Neonatal meningitis is common in neonates presenting with sepsis, but mortality rate is low. Positive cultures, particularly with MSSA, further underscore the bacterial etiology in neonatal meningitis.

Clinical-Laboratory Outcome of Cryptococcus sp. Multifocal Choroiditis in Acquired Immunodeficiency Syndrome Patients

ABSTRACT Purpose This study aims to describe the clinical and laboratory outcomes of patients with Acquired Immunodeficiency Syndrome (AIDS) presenting multifocal choroiditis secondary to Cryptococcus sp. infection. Methods We reviewed the clinical records of AIDS patients diagnosed with cryptococcal multifocal choroiditis at the Laboratory of Infectious Disease in Ophthalmology, Oswaldo Cruz Foundation, from January 2022 to March 2024. Patients meeting the criteria of typical fundus appearance associated with disseminated cryptococcosis laboratory diagnosis were included. Data collected included age, gender, symptoms, plasma HIV viral load, serum T-CD4+ cell count (cells/mm3), initial visual acuity (VA), laboratory methods for cryptococcosis diagnosis, treatment, and final VA. All patients underwent multimodal evaluation including spectral domain optical coherence tomography, fluorescein angiography (FA), and indocyanine green angiography (ICG). Results Six patients were evaluated, comprising five males (83%) and one female (17%), with a mean age of 36.5 years (standard deviation, SD: 10,46). Five patients (83%) presented with meningeal syndrome. Mean HIV plasma viral load was 262.959 copies/mm3 (SD: 209.469), and the mean serum T-CD4 count was 13.33 cells/mL (SD: 14,63). All patients tested positive for serum cryptococcal antigen (CRAG). Four patients (67%) had positive cerebrospinal fluid (CSF) culture and CRAG. Treatment included intravenous Amphotericin B and oral Fluconazole. Among twelve eyes (100%), four (33%) achieved visual recovery, while eight (67%) maintained initial VA. Lesions were more numerous and distinct on ICG compared to fundus examination and FA. Conclusion This study underscores the importance of clinical, laboratory, and multimodal evaluations in AIDS patients presenting with cryptococcal multifocal choroiditis.

Febrile young infants and the association with enterovirus infection

BackgroundEnterovirus is a common pediatric infectious disease, but the epidemiological data in young infants were lacking. This study aims to evaluate the role of enterovirus in febrile young infants and identify risk factors for severe infections. MethodsWe enrolled febrile infants younger than 90 days admitted to National Taiwan University Hospital from January 2010 to June 2021. Enterovirus infection was confirmed via viral isolation or pan-enterovirus PCR. Central nervous system involvement was defined by positive culture or PCR in cerebrospinal fluid. Severe complications included sepsis, hepatic failure, myocarditis, shock, encephalitis, acute kidney injury, respiratory failure, and multiorgan failure. ResultsOut of 840 febrile infants, 17.4% (n = 146) had enterovirus infection. Among these, 46% (n = 67) presented with meningitis and/or encephalitis. Early-onset enterovirus infection within the first two weeks of life was significantly linked to increased risks of anemia (hemoglobin <9 g/dL), ICU admission, central nervous system involvement, shock, hepatic failure, and mortality. Multivariable logistic regression identified high-risk serotypes (aOR 17.4, [95% CI 1.58, 191.5], p = 0.019) and hemoglobin <9 g/dL (aOR 44.9, [95% CI 5.6, 357.6], p < 0.001) as significant risk factors for severe complications. ConclusionsEnterovirus accounted for 17.4% of the etiology in febrile young infants and the case-fatality rate was 2%. Febrile young infants who had risk factors of enterovirus infection should consider viral culture or PCR examination for confirmation.

Successful treatment of Enterococcus gallinarum infection in a neonate with vancomycin: a case report

BackgroundEnterococcus gallinarum (EG) is typically found in the gastrointestinal tracts of birds and mammals. Although its strains are rarely isolated from clinical specimens, EG can lead to septicemia in immunocompromised individuals. EG infections are uncommon in household settings, but their incidence has been rising due to increased antibiotic usage and invasive treatments, particularly in Neonatal Intensive Care Units (NICUs). EG inherently exhibits resistance to vancomycin but is highly sensitive to linezolid. Despite showing in vitro resistance, vancomycin has shown clinical efficacy in treating EG meningitis.Case presentationA neonate born at 30 + 2 weeks gestation was admitted to the Neonatal Intensive Care Unit (NICU) after EG was detected in blood and cerebrospinal fluid cultures. Susceptibility testing indicated that the bacterial strain was resistant to vancomycin and sensitive to linezolid. Initially, vancomycin was selected for treatment. However, due to persistent EG cultures in the blood and cerebrospinal fluid, the treatment was adjusted to linezolid. This led to a rapid decrease in platelet (PLT) count, suspected to be an adverse reaction. Concurrently, the patient experienced recurrent fever and elevated inflammatory marker levels, prompting the discontinuation of linezolid and a return to vancomycin. Subsequent administration of vancomycin stabilized the patient’s condition, as evidenced by improved C-reactive protein (CRP), procalcitonin (PCT), and cerebrospinal fluid parameters, ultimately leading to discharge after an eight-week treatment period.ConclusionThis retrospective analysis highlights the efficacy of vancomycin in treating EG infections, suggesting that specific genetic phenotypes may influence treatment sensitivity. Monitoring vancomycin blood levels is crucial for determining treatment effectiveness.

Early-Onset Sepsis as an Early Predictor for Retinopathy of Prematurity: A Meta-analysis.

Neonatal sepsis has been established as a risk factor for retinopathy of prematurity (ROP) but previous meta-analyses have predominately focused on late-onset sepsis (LOS). This meta-analysis aims to explore the association between early-onset sepsis (EOS) and the risk of ROP. Observational studies reporting (unadjusted) data on proven EOS in neonates with ROP were included. PubMed, Embase, and Cochrane Library were searched. Proven EOS was defined as a positive blood or cerebrospinal fluid culture. Effect sizes were calculated by using logistic random-effects models and meta-regression analyses. Primary outcomes were any stage ROP and severe ROP (≥stage 3, type I, aggressive [posterior] ROP, plus disease or requiring treatment). Potential confounders explored were gestational age at birth, birth weight, small for gestational age, maternal steroid use, necrotizing enterocolitis, LOS, and mechanical ventilation duration. Seventeen studies reporting the incidence of proven EOS in neonates with ROP were included. Proven EOS showed no significant association with any stage ROP (odds ratio [OR] = 1.90; 95% confidence interval [CI]: 0.96-3.79, p = 0.067) but heterogeneity between studies was significantly high. Neonates with proven EOS had an increased risk for severe ROP (OR = 2.21; 95% CI: 1.68-2.90), and no significant confounders influencing this effect size were found in the meta-regression analysis. Neonates with proven EOS are at increased risk of severe ROP. Neonatologists need to be aware that EOS is an early predictor of ROP and should adapt their policy and treatment decisions where possible to reduce ROP. · This meta-analysis reveals a 2.2-fold increased risk of severe ROP in neonates with proven EOS.. · Future studies should distinguish between EOS and LOS when investigating risk factors of ROP.. · Treatment decisions should be adapted where possible in neonates with EOS before ROP screening begins..

Persistence Pays: Diagnosing Tuberculous Meningitis after 11 Negative Polymerase Chain Reaction Evaluations.

Managing tuberculous meningitis (TBM) is challenging because of its poor prognosis and the difficulty in making an early diagnosis due to the low sensitivity of cerebrospinal fluid (CSF) polymerase chain reaction (PCR) evaluations. A 75-year-old woman presented with fatigue and multiple enlarged lymph nodes and was initially suspected of having metastatic cancer of unknown primary origin. Differential diagnoses included carcinomatous meningitis, neurosarcoidosis, and TBM, as suggested by the presence of multiple enhancing cerebral nodules. Despite 11 negative PCR evaluations, including nested PCR of CSF and biopsied lymph nodes within the first 3 days of empirical anti-tubercular treatment, TBM was eventually confirmed by CSF cultures 32 days later. This case highlights the need for repeated sampling.