Diagnosis Of Acute Meningitis Research Articles

Sensitivity and Specificity of Jolt Accentuation Maneuver in Diagnosis of Acute Meningitis

Background: Acute meningitis is a potentially fatal illness that necessitates immediate identification and medical intervention. The Jolt Accentuation Maneuver (JAM) is a straightforward and non-invasive diagnostic test that can help in diagnosis of acute meningitis. Objectives: This study assessed the accuracy of JAM in detecting acute meningitis by evaluating its sensitivity and specificity. Methods: The study was done at Pak Emirate Military Hospital, Rawalpindi, from January 2024 to June 2024, using prospective observational method. 280 patients with symptoms indicative of meningitis were included in the study. Every patient received JAM procedure, followed by an examination of CSF, which was used as the definitive method for diagnosis. Results: The study group had average age of 35.2 years and was almost equally divided between males (50.7%) and females (49.3%). The prevalent symptoms consisted of headache (97.1%), fever (92.9%) and neck stiffness (82.1%). The JAM test demonstrated sensitivity of 88.9% (p<0.001) and specificity of 60.0% (p<0.05). The positive predictive value (PPV) was 80.0% (p<0.05) and negative predictive value (NPV) was 75.0% (p<0.05). The overall accuracy of the data was 82.1% (p<0.001) indicating statistical significance. The study of ROC curve revealed an area under the curve of 0.90, indicating a high level of diagnostic accuracy. Conclusions: JAM is a diagnostic test for acute meningitis that is quite sensitive and has a decent level of specificity. Due to its high sensitivity, it is highly effective tool for initial screening, particularly in emergency circumstances. Nevertheless, because of its moderate specificity, it is necessary to confirm positive JAM results with other diagnostic testing. Incorporating JAM into clinical practice can expedite diagnosis and prompt treatment, potentially enhancing patient outcomes. Keywords: Acute meningitis, Diagnosis, Jolt Accentuation Maneuver, Sensitivity, Specificity.

Ultrasound-derived Optic Nerve Sheath Diameter to Eyeball Transverse Diameter Ratio in the Diagnosis of Acute Meningitis in Adults.

Ultrasound-derived Optic Nerve Sheath Diameter to Eyeball Transverse Diameter Ratio in the Diagnosis of Acute Meningitis in Adults.

“Study of Estimation of Cerebrospinal Fluid C-Reactive Protein in Diagnosis of Acute Meningitis.”

Objectives:To assess the diagnostic role of CSF C-reactive protein quantitatively in acute meningitisand to evaluate the efficacy of CSF C-reactive protein in differentiating pyogenic meningitis fromnon-pyogenic meningitis.Material and Methods: It is a prospective observational study of total 102children with suspected meningitis allocated into three groups based on initial investigations; group-I Pyogenic meningitis, group-II Non-Pyogenic meningitis and group-III No meningitis (Controlgroup). Quantitative CSF C-reactive protein was detected by the latex agglutination method. Datawere analyzed to establish the diagnostic role of CSF-CRP and to evaluate the efficacy of CSF-CRP indifferentiating pyogenic meningitis from non-pyogenic meningitis.Results: A total of 102 clinicallysuspected meningitis patients were studied. Based on CSF findings, the study population (102cases) was categorized into 3 groups. Group I was pyogenic meningitis consist 53 cases (51.96%).Group II was Non-Pyogenic meningitis consists 27 cases (26.47%). Group III was normal CSFfindings consist 22 (21.56%). 98.1% cases of pyogenic meningitis had elevated CSF-CRP level >1.1μg/ml of CSF. In the case of Non-Pyogenic meningitis, 96.2% were found to have CSF- CRP in therange of 0.05-0.10 μg/ml. The mean value of CSF-CRP in groups I,II and III were 5.57±1.48,0.09±0.042 and 0.01±0.010 respectively. Conclusion: Detection of CSF-CRP provides a newdimension to establish the diagnosis of pyogenic meningitis. It is a rapid, reliable and sensitivediagnostic test. From this study it is concluded that CSF-CRP can be used to differentiate pyogenicfrom non-pyogenic meningitis. Early, accurate and appropriate therapy can ameliorate the morbidityand mortality rates in such cases.

Point-of-care cerebrospinal fluid Gram stain for the management of acute meningitis in adults: a retrospective observational study

BackgroundGram stain of cerebrospinal fluid (CSF) is widely used in the diagnosis of acute meningitis, however, it is often conducted in the laboratory, as only some hospitals have access to point-of-care Gram stain (PCGS). The purpose of this study was to demonstrate the clinical impact and utility of PCGS in diagnosing and treating both bacterial and aseptic meningitis in adults.MethodsThis was a hospital-based, retrospective observational study at a referral center in Okinawa, Japan. We reviewed the records of all patients aged 15 years or older who were admitted to the Division of Infectious Diseases between 1995 and 2015 and finally diagnosed with bacterial (n = 34) or aseptic meningitis (n = 97). For bacterial meningitis, we compared the treatments that were actually selected based on PCGS with simulated treatments that would have been based on the Japanese guidelines. For aseptic meningitis, we compared the rates of antibiotic use between real cases where PCGS was available and real cases where it was not.ResultsPCGS was the most precise predictor for differentiating between bacterial and aseptic meningitis (sensitivity 91.2%, specificity 98.9%), being superior in this regard to medical histories, vital signs and physical examinations, and laboratory data available in the emergency room (ER). In bacterial meningitis, PCGS reduced the frequency of meropenem use (1/34 = 3.0%) compared with simulated cases in which PCGS was not available (19/34 = 55.9%) (p< 0.001). In aseptic meningitis cases, the rate of antibiotic administration was lower when PCGS was used (38/97 = 39.2%) than when it was not (45/74 = 60.8%) (p = 0.006).ConclusionsPCGS of CSF distinguishes between bacterial and aseptic meningitis more accurately than other predictors available in the ER. Patients with bacterial meningitis are more likely to receive narrower-spectrum antimicrobials when PCGS is used than when it is not. PCGS of CSF thus can potentially suppress the empiric use of antimicrobials for aseptic meningitis.

Diagnostic Value of Clinical and Laboratory Findings in Childhood Meningitis

Abstract Objective Acute meningitis in childhood is a serious infectious disease that requires immediate medical assessment to ensure appropriate treatment and healthy outcomes. The aim of this retrospective study was to evaluate clinical and laboratory findings in the diagnosis of acute meningitis in children. Materials and Methods Between February 2011 and March 2013, 258 children aged between 1 month and 18 years who were admitted to Konya Training and Research Hospital, Turkey, with clinically suspected meningitis and undergoing lumbar puncture were enrolled in the study. Patient charts were reviewed using a standardized data collection tool. Fifty-nine patients were excluded because of incomplete data or because they did not meet the enrollment criteria. Further statistical analysis was conducted on the remaining 199 patients. The diagnostic values of clinical and laboratory findings for acute meningitis were investigated. IBM SPSS 21.0 for Windows was used for the statistical analysis. Results Of the 199 patients (61.3% male; median age: 24 months), 101 (50.8%) were diagnosed with meningitis. A definitive diagnosis of bacterial meningitis was made in 16 patients, while 5 patients had probable bacterial meningitis. In addition, 80 patients diagnosed as aseptic meningitis and 47 of these patients had human enterovirus meningitis. Headache was more common in patients with meningitis. In patients without meningitis, the most common complaints were seizures or seizures accompanied by fever. Erythrocyte sedimentation rates (ESR), levels of cerebrospinal fluid protein, and cell counts in cerebrospinal fluid examinations were higher in the meningitis group. C-reactive protein, ESR, and procalcitonin higher than 22.55 mg/L, 36.5 mm/hour, and 6.795 mg/mL, respectively, indicated bacterial meningitis. Conclusion Our results showed that a combination of clinical and laboratory markers could facilitate recognition of bacterial meningitis in children.

345. Diagnosis of Acute Bacterial Meningitis by Polymerase Chain Reaction Vis-a-vis Conventional Culture Method

BackgroundBacterial Meningitis is one of the leading causes of mortality and morbidity worldwide requiring immediate diagnosis followed by medical intervention to prevent sequeale. Molecular methods can help to detect the pathogens offering a prompt and accurate diagnosis.MethodsOne hundred CSF and blood samples were collected from suspected/clinically diagnosed cases of meningitis over a period of 1year. CSF samples were processed by conventional and molecular methods. The objectives of the study were to identify the common bacterial etiological agent, to assess the utility of PCR in diagnosis of acute bacterial meningitis, and to know the antimicrobial susceptibility pattern.ResultsOut of 100 samples, maximum cases presented with frank meningeal signs (45%) followed by clinically suspected cases (42%). Microscopic examination, CSF culture, PCR detected 7%, 24%, and 40% positive cases, respectively. Thirteen percent were detected positive by blood culture. The positivity on CSF culture was comparable to the study done by Mani et al. (40.5%). The predominant pathogens isolated were K. pneumoniae (37.5%) followed by Streptococcus pneumoniae and Acinetobacter spp. (each 16.67%). PCR positive followed by Gene sequencing revealed Pseudomonas aeruginosa (34.78%) as the predominant pathogen. Culture is considered as the gold standard. However, it fails to identify fastidious organisms and often gives false-negative results. Therefore, the gold standard was modified to consider parameters like-clinical signs of meningitis, CSF biochemistry indicative of meningitis and CSF positive on any one microbiological test (CSF staining/CSF culture/blood culture). The performance of PCR was then improved to sensitivity (67.74%); specificity (72.46%); diagnostic accuracy (71%); PPV 52.50% and NPV 83.34%. The kappa coefficient −0.372 showed a fair agreement, considering the modified gold standard. This criterian was also used in study done by Welinder-Olsson et al.ConclusionGram-negative enteric bacteria were the most common etiology reported by both the methods. PCR could detect more cases than conventional culture method indicating its utility in the diagnosis of acute meningitis. Apart from microbiological parameters, clinical and other laboratory parameters should be considered to achieve a precise diagnosis.Disclosures All authors: No reported disclosures.

Value of Cerebrospinal Fluid Tumor Necrosis Factor-Alpha ( TNF-Alpha ) for Rapid Diagnosis of Bacterial Meningitis

Meningitis is common in tropical areas and also in Egypt and has a world-wide distribution. This study evaluated the potential role of CSF TNF alpha in diagnosis and differenfial diagnosis of acute meningitis (bacterial versus asepic meningitis). This case-control study was conducted between Ain Shams University Tropical Medicine Department and Embaba Fever Hospital. Fifty patients with suspected meningitis were recruited during from January 2014 to June 2014. They were divided according to culture results into 2 groups: GI: 40 patients with acute bacteria men ingitis (proved by CSF culture), G2: 10 patients matched according to age and sex with clinical sings of CNS infection but without laboratory evidence of bacterial origin, (Suspected cases, and negative culture). Both groups were subjected to thorough history taking, full clinical examination, and laboratory invistigations including CSF analysis & CS TNF was measured by ELISA. The results showed a highly significantdifference between cases and control reading CSF TNF (P=0.00). The criteria's of diagnostic validity test as 100% for all at cutoff > or = 275 ng/ml and < or = 700 ng/ml with 100% specificity and sensitivity. A significant correlation between CSF-TNF and each of ESR (P=003) & CSF cells (P=0.015), without significant correlation regarding other parameters (P>0.05).

The Role and Reliability of Rapid Bedside Diagnostic Test in Early Diagnosis and Treatment of Bacterial Meningitis

To evaluate the role and reliability of rapid bedside diagnostic test in early diagnosis and treatment of bacterial meningitis in children using reagent strips. This prospective, single blinded study was conducted in the Department of Pediatrics of VMMC & Safdarjung Hospital, New Delhi in collaboration with the Department of Microbiology of VMMC & Safdarjung Hospital, New Delhi, over a period of 15 mo (August 2009 to Nov 2010). Seventy-five children aged 3 mo to 12 y admitted in the pediatric ward with suspected diagnosis of acute meningitis were included. All enroled patients underwent lumbar puncture. CSF samples were taken and divided in 2 parts for laboratory evaluation and rapid strip analysis. The sensitivity, specificity, positive predictive value and the negative predictive values of the reagent strips for the diagnosis of bacterial meningitis were calculated. Accuracy of the reagent strips was established using kappa statistics. Latex agglutination for antigen detection and microbiological culture were also done. Highly significant association was observed between CSF examination in routine laboratory method and dipstick method. The number of laboratory values that correlated were- for cells 71(94.63%), for protein 68 (90.67%), for glucose 68(90.67%) out of total 75 cases. The sensitivity and specificity of reagent strip in diagnosing acute bacterial meningitis were 96.7% and 97.8% respectively. The positive predictive and negative predictive values of reagent strip in diagnosing acute bacterial meningitis were 96.7% and 97.8% respectively. Staphylococcus aureus was found to be the most common organism isolated (50%). Thus reagent strip analysis is a very rapid, reliable and effective method for diagnosis of acute bacterial meningitis in children. Staphylococcus aureus was the most common organism isolated.

Expressions of Brain-Derived Neurotrophic Factor (BDNF) in Cerebrospinal Fluid and Plasma of Children With Meningitis and Encephalitis/Encephalopathy

ABSTRACTMany reports in the field of childhood brain disorders have documented that brain-derived neurotrophic factor (BDNF) affects central nervous system (CNS) functions. In this clinical study, BDNF levels were evaluated in association with pediatric CNS infections. BDNF levels in the serum and cerebrospinal fluid (CSF) of 42 patients admitted during 5-year period, due to CNS infections, were measured by enzyme-linked immunosorbent assays (ELISAs). Control samples were collected from 108 patients with non-CNS infections (urinary tract infection, acute upper respiratory infection, acute gastroenteritis, etc.). Mean values of BDNF levels, at various ages, were determined and compared. BDNF levels were below the sensitivity of the ELISA in most CSF samples from the control group, but were significantly elevated in the patients with bacterial meningitis. The serum BDNF levels were elevated in all subgroups of patients with CNS infections, and the elevation was particularly notable in those with bacterial meningitis. BDNF expression in the CSF was correlated with CSF interleukin (IL)-6 levels as well as with blood platelet counts and neurological prognoses in those with bacterial meningitis. No correlation was found between BDNF levels and serum leukocyte numbers or C-reactive protein (CRP) levels. BDNF levels were found to be elevated in the serum and CSF of pediatric patients with CNS infections, particularly those with bacterial meningitis. Monitoring the changes in serum and CSF levels of BDNF may facilitate the diagnosis of acute meningitis and acute encephalopathy and allow the differential diagnosis of specific CNS infections.

PP-034 Jolt accentuation of headache in diagnosis of acute meningitis

PP-034 Jolt accentuation of headache in diagnosis of acute meningitis

Silver hair in a 3-year-old

Conflict of interest: none declared. A 32‐month‐old girl of Pakistani origin, whose parents were first cousins, was referred to the paediatric department with a short history of abdominal pain, lethargy and a history of developmental delay. She became progressively unwell, developed neck stiffness and refused to walk. A diagnosis of acute meningitis was made, and a pre‐lumbar puncture computed tomography scan showed hydrocephalus with enlarged third and lateral ventricles, which was treated by ventriculostomy. Magnetic resonance imaging showed multiple enhancing lesions in the cerebellum. She was referred for a dermatological opinion as she was noted to have silver hair and eyebrows (Fig. 1). ... Histological examination of a cerebellar lesion showed evidence of a histiocytic tumour with a degree of erythrophagocytosis and lymphophagocytosis (Fig. 2). ... What is your diagnosis? Griscelli's syndrome. Griscelli's syndrome (GS) is a rare autosomal recessive condition resulting in partial albinism with immunodeficiency.1 There is usually absent or impaired delayed‐type hypersensitivity, hypogammaglobulinaemia and impaired natural killer‐cell function. Patients with this syndrome are predisposed to ‘accelerated phases’ with lymphohistiocytic infiltration of several organs including liver, bone marrow and brain, although the latter is rarely reported. These episodes are often associated with infections, particularly Epstein–Barr virus (EBV), as in our case, where PCR performed on the blood was positive for EBV.

Investigation of pituitary functions in patients with acute meningitis: A pilot study

Although long-term pituitary consequences of tuberculous meningitis are well documented in the literature, there have been few case reports of pituitary dysfunction after acute bacterial or viral meningitis. In this preliminary study, we have assessed the pituitary functions in adult patients who had acute bacterial or viral meningitis. Fourteen patients (8 men, 6 women; mean age 35.3+/-13.3) were included in the study. The diagnosis of bacterial and viral meningitis was proven by clinical findings, cerebrospinal fluid (CSF) examination, gram staining, and blood and CSF cultures. Pituitary functions were evaluated ranging from 6 to 48 months (mean 20 months) after acute meningitis. GH deficiency was investigated by the GHRH+arginine stimulation test. Four of 14 patients (28.6%) had isolated GH deficiency. In GH-deficient patients, the earliest duration was 6 months and the latest duration was 48 months after the diagnosis of acute meningitis. Three of the GH-deficient patients had acute bacterial meningitis and 1 patient had acute viral meningitis. Pituitary magnetic resonance imaging revealed normal pituitary gland in the patients with GH deficiency. This is the first systematic study evaluating the anterior pituitary function long term after the diagnosis of acute meningitis. Based on the present study, it is tempting to speculate that pituitary dysfunction is a more common sequel of acute bacterial or viral meningitis than hitherto reported. Studies with high numbers of patients are warranted to ascertain the prevalence of meningitis-induced hypopituitarism.

Oral 2, Silver hair in a 3-year-old child

A 32‐month‐old girl of Pakistani origin presented to the paediatricians with a short history of abdominal pain, decreased appetite and lethargy and a history of developmental delay. She was referred to us when it was noted that her hair and eyebrows were silver in colour. While in hospital, she became progressively more unwell, developed neck stiffness and refused to walk. A diagnosis of acute meningitis was made and a prelumbar puncture computed tomographic scan showed hydrocephalus with enlarged third and lateral ventricles. She underwent a third ventriculostomy and insertion of a reservoir. Magnetic resonance imaging showed multiple focal ill‐defined enhancement with larger enhancing masses in the cerebellum. These appearances were initially thought suggestive of widely disseminated lymphoma or leukaemia. Surgical biopsy of these lesions was performed and histology showed some evidence of histiocytic tumour with a degree of erythrophagocytosis and lymphophagocytosis. In view of the histology and the phenotypic features, Griscelli syndrome was considered. Blood and hair from the patient were analysed and she was confirmed to be homozygous for a mutation in the RAB27A gene, which has been described in Griscelli syndrome. She has subsequently undergone bone marrow transplantation. Griscelli syndrome is a rare autosomal recessive disorder resulting in partial albinism and a combined immunodeficiency.1 Our case is unusual in that the presentation was neurological with no evidence of cytopenia. 1 Mancini AJ, Chan LS, Paller AS. Partial albinism with immunodeficiency: Griscelli syndrome: report of a case and review of the literature. J Am Acad Dermatol 1998; 38:295–300.

Acute meningitis due to Brucella spp

Brucella spp. should be considered in the differential diagnosis of acute meningitis of children living in areas where brucellosis is endemic.

Particularités des méningites du sujet âgé

Purpose. – Elderly patients being more at risk for infections than younger people, this study was aimed at defining the epidemiological and clinical features of meningitis in this population, with the objective of improving diagnosis and management. Methods. – Over a period of 10 years, all cases admitted to an infectious diseases unit for acute meningitis were reviewed. Patients infected by human immunodeficiency virus (HIV), fungi meningitis, and who were younger than 15 years of age were excluded from the study. According to age, two groups were constituted (group A: < 65 years and group B: ≥ 65 years) and compared. Results. – One hundred fifty-two patients were included in the study: 110 (72.4%) in group A (29 with bacterial and 81 with viral meningitis) and 42 (26.7%) in group B (32 with bacterial and ten with viral meningitis); the mean age was, respectively, 32.7 ± 12.9 years (range: 15–61 years) and 75.9 ± 7.6 years (range: 65–94 years). Diagnosis was less frequently evoked in the elderly (n = 11; 26%) than in younger patients (n = 78; 71%) (P < 0.001). Streptococcus pneumoniae, Listeria monocytogenes , and herpes simplex virus were the three most common causal agents in group B. Confusion was the most common symptom among the elderly (88 vs. 17%; P < 0.001). The mortality rate was more important in group B than in group A (11.9 vs. 2.7%; P = 0.04). Conclusion. – Diagnosis of acute meningitis is difficult and must be evoked in the presence of any new neurologic sign. Cranial computerized tomography should not delay lumbar puncture, except in the presence of focal neurologic symptoms. Antimicrobial therapy takes into account the bacterial epidemiology.