Different Types Of Meningitis Research Articles

Evaluation of cerebrospinal fluid levels for ALOX5, S100B, DEFA1, and GFAP in infectious meningitis.

The aim of this study was to determine how the levels of peptide and protein-based biomarkers in cerebrospinal fluid change in bacterial, tuberculous, and aseptic meningitis, and to determine the success of these agents in distinguishing between different types of infectious meningitis. The levels of arachidonate-5-lipoxygenase, S100 calcium-binding protein B, defensin-α 1, and glial fibrillary acidic protein in cerebrospinal fluid samples from 20 tuberculosis, 40 bacterial, 25 aseptic meningitis patients, and 55 control groups were measured and compared using an enzyme-linked immunosorbent assay. The mean age of the patients was 37.9 ± 14.4 years. The parameter that contributed the most to the differential diagnosis of the infectious meningitis groups was S100 calcium-binding protein B. The S100 calcium-binding protein B levels were significantly higher in the tuberculous meningitis group than in the other groups, and arachidonate-5-lipoxygenase levels were significantly higher in the tuberculous meningitis and bacterial meningitis groups (P < .05). This study showed that cerebrospinal fluid arachidonate-5-lipoxygenase, and S100 calcium-binding protein B levels may differ in bacterial, aseptic, and tuberculous meningitis, and the results obtained may be quite effective as important potential biomarkers in the differential diagnosis of different types of meningitis.

Epidemiological evaluation of meningitis in hospitalized patients in shahid Madani Hospital in Khorramabad

Background: Bacterial meningitis is an acute infection of the meninges requiring immediate diagnosis and treatment. Clinical, laboratory, and epidemiological findings of meningitis are of utmost importance for rapid diagnosis and treatment. The present study aimed to evaluate patients with meningitis based on their epidemiological, clinical, and laboratory findings and compare these variables between patients with septic and aseptic meningitis. Materials and Methods: In this retrospective cross-sectional descriptive study, all children with suspected meningitis in Shahid Madani Hospital in Khorramabad in 2014-2015 were examined for spinal fluid culture, age, gender, seasonal distribution, and antibiogram results. Results: Among 63 patients with meningitis, 30 (47.6%) cases had septic meningitis, and 33 (52.4%) subjects had aseptic meningitis. Out of 30 patients with septic meningitis, 4 (13.3%) patients had positive microbial culture. Among patients with septic meningitis, only four bacterial isolates were isolated by the microbial culture method, out of which Streptococcus pneumoniae was the most common bacterium and the prevalence was higher in autumn and winter. The most effective antibiotics were cotrimoxazole and vancomycin with a sensitivity of 100%; nonetheless, there was relatively high resistance to cloxacillin, erythromycin, and clindamycin. The number of white blood cells (WBCs), sugar, and protein in cerebrospinal fluid (CSF) in septic meningitis were compared with aseptic meningitis, and a significant difference was observed between the two groups. There was also a significant difference between gender and septic meningitis, and male patients were more likely to suffer from septic meningitis. Conclusion: The prevalence of aseptic meningitis was higher than that of septic meningitis. Microbial tests are very effective in the correct diagnosis and treatment; however, the level of WBC, glucose, and protein in CSF can also be of great help in diagnosing different types of meningitis, especially septic meningitis.

Cerebrospinal Fluid and Serum C-Reactive Protein among Children with Acute Encephalitis Syndrome

Abstract Objectives This study aimed to evaluate the positivity of C-reactive protein (CRP) in cerebrospinal fluid (CSF) and serum in children presented with clinical diagnosis of acute encephalitis syndrome (AES). Methods A total of 164 children between 6 months and 14 years with clinical diagnosis of AES were investigated. Qualitative CRP (slide agglutination) was determined in CSF and serum sample of each patient. On the basis of clinical examination and investigations, all the patients were divided into four groups as pyogenic meningitis, viral encephalitis, tuberculous meningitis, and cerebral malaria. The positivity of CRP in CSF and serum were compared in these groups. Results CSF CRP was found to be positive in the majority of patients with pyogenic meningitis and a statistically significant (p ≤ 0.001) association was found between CSF CRP and final diagnosis of AES, while this association was nonsignificant (p = 0.141) in case of serum CRP. When we compared the CSF and serum CRP, serum CRP was found to be more suggestive of tuberculous meningitis, viral encephalitis, and cerebral malaria while CSF CRP was more sensitive and specific for the diagnosis of pyogenic meningitis. Conclusion The sensitivity and specificity of CSF CRP for pyogenic meningitis was quite high. Serum CRP with a high sensitivity can be used as a screening test for different types of meningitis and cerebral malaria; however, its diagnostic accuracy has yet to be established.

CSF analysis in a patient with meningitis with special reference to LDH

Acute infections of the nervous system are among the hugest issues in the medicine considering the way that early affirmation, gainful dynamic and speedy association of the treatment can be lifesaving. Standard routine assessment of CSF in meningitis doesn't commonly give speedy definitive information without a doubt. Therefore there was need for additional tests. The present study conducted in Department of Medicine. The study included clinical appraisal and CSF assessment of 65 occurrences of meningitis. Lumbar cut was done in each consistent case and CSF was assembled in sterile containers.In majority cases of meningitis sugar less than two third of blood sugars, and majority of TBM cases had sugar level between 40-60 mg%. Higher cell count was seen in pyogenic meningitis cases. In context to LDH levels among the different types of meningitis, significant increased CSF LDH levels was observed in TBM and PM as compared to VM and CM but no noteworthy distinction between TBM and PM. Overall conclusion of study was that estimation of CSF LDH levels is not only supplementary aid but diagnostic and differentiating aid for meningitis.

Childhood Meningitis in an Urban Tertiary Medical Center: A 20-year Review

Background: Meningitis is a neurological emergency causing significant morbidity and mortality. This research determined the etiologies, clinical presentation, and ancillary work-up findings of different types of meningitis. Objective: To characterize the documented pediatric meningitis cases in a tertiary hospital admitted between January 1, 1997 to August 31, 2017. Methods: This was a retrospective study which entailed review of charts of all pediatric cases 0 to 18 years old with a discharge diagnosis of meningitis (bacterial, viral, tuberculous or fungal) from January 1, 1997 to August 31, 2017 at an urban tertiary medical center. Results: This study included 127 subjects, where 74 (58.3%) had bacterial, 34 (26.8%) had viral, 17 (13.4%) had tuberculous, and 2 (1.6%) had fungal meningitis. Streptococcus pneumoniae (12.2%), Haemophilus influenzae type b (6.8%) and Salmonella enteritidis (6.8%) were the top bacteria identified. Neonatal infections were caused by gram-negative bacilli (66.7%) and gram-positive cocci (33.3%). Bacterial, tuberculous, and viral meningitis were seen in the 1-11 months, 2-4 years and 5-10-year age groups respectively. Prolonged fever (mean 27.2, median 14 days) and cranial nerve palsies (23.5%) were noted in tuberculous meningitis (TBM). The highest CSF mean WBC (2043±9056 WBC/µL) and mean protein (300±365.6mg/dL) were seen in bacterial and tuberculous meningitis respectively. The combination of hydrocephalus, basal enhancement and infarct was unique to patients with tuberculous meningitis. Recurrent seizures were the most common complication of bacterial (36.5%), viral (20.6%) and tuberculous (100%) meningitis. Ceftriaxone (24.3%), acyclovir (38.2%), and isoniazid/rifampicin/pyrazinamide/ethambutol (76.5%) were the most common antimicrobials for bacterial, viral, and tuberculous meningitis. Fever duration before admission was significantly longer in TBM (14 days) than in viral (4 days) and bacterial meningitis (2 days). Length of hospital stay for viral meningitis (6.5 days) was significantly shorter than for TB (14 days) and bacterial meningitis (12 days). Mortality rates were 12% and 11% for bacterial and viral meningitis respectively. No mortality was seen in patients with TB and fungal meningitis. Conclusions: In this 20-year review of childhood meningitis, bacterial meningitis was the most common type of pediatric meningitis which presented with marked CSF pleoctyosis. The longest fever duration and the highest proportion of cranial nerve involvement were seen in TBM, which also had the unique combined findings of leptomeningeal enhancement, hydrocephalus and infarct on imaging. Ceftriaxone was the most commonly used antibiotic for bacterial meningitis, except in neonates where a combination of cefuroxime-amikacin was initially given until microbiological confirmation became available. Recurrent seizures were the most common complication of bacterial, viral and TB meningitis. The shortest hospital stay with the highest full recovery rate was seen in viral meningitis.

An observational study on the relative incidence of different types of meningitis in different age and sex groups in Jharkhand

An observational study on the relative incidence of different types of meningitis in different age and sex groups in Jharkhand

Meningitis: An overview of signs, symptoms and management

Meningitis is a potentially deadly infection of the tissue surrounding the brain, which children are particularly susceptible to. The severity varies from viral infections, which are not life-threatening, to bacterial infections during which the bacteria can enter the blood and cause sepsis, which may be fatal. Bacterial meningitis requires early recognition to allow early antibiotic therapy and supportive treatment which substantially improves outcomes. School nurses have a key role in identifying meningitis symptoms in their pupils and raising awareness among children, school staff and parents about the signs and potential severity of meningitis. Despite vaccination programmes, meningitis continues to kill children highlighting the importance of being familiar with symptoms and the appropriate management. This article will explore the different types of meningitis, key symptoms to look out for and the management of suspected meningitis both in the community and in hospital.

The Role of CSF LDH Estimation to Differentiate Different Types of Meningitis

The Role of CSF LDH Estimation to Differentiate Different Types of Meningitis

Study of adenosine deaminase levels in Tb meningitis and its comparision with other types of meningitis

Tubercular meningitis is a type of septic meningitis and is a significant cause of morbidity and mortality in developing countries like India due to lack of early and timely diagnosis and so the case of fatality remains higher. Cerebrospinal fluid (CSF) evaluation is single most important aspect of lab diagnosis in meningitis. Aims: 1. To evaluate the diagnostic significance of CSF adenosine deaminase (ADA) activity in tuberculous meningitis. 2. To compare the values of CSF ADA in different types of meningitis and with that of controls. Materials and Methods: It was clinical cross-sectional study of 25 cases of tuberculosis, 25 cases of pyogenic meningitis, and 25 cases of aseptic meningitis. Twenty five controls with age and sex matched individuals without evidence of any neurological diseases served as control for CSF ADA. Results: In this study of 100 patients, 25 (100%) patients of the tubercular group had CSF ADA levels of more than 10 IU/dL with a mean of 13.68 IU/dL with 80% of the patients having ADA levels between 11 and 15 IU/dL. Mean ADA levels of aseptic meningitis was 8.00 IU/dL, pyogenic was 5.76 IU/dL, and control group had mean ADA of 2.12 IU/dL. Conclusion: All patients with tuberculous meningitis had elevated CSF ADA activity. CSF ADA activity in tuberculous meningitis was significantly higher when compared with pyogenic meningitis, aseptic meningitis, and controls.

Evaluation of lactate dehydrogenase isoenzyme activity and biochemical profile in cerebrospinal fluid for different types of meningitis

Evaluation of lactate dehydrogenase isoenzyme activity and biochemical profile in cerebrospinal fluid for different types of meningitis

Adenosine deaminase activity in cerebrospinal fluid: diagnostic investigation in central nervous system disorders in children

Background: Tubercular meningitis (TBM) is an endemic disease in developing countries. Adenosine deaminase activity (ADA) has been of great importance for many years in TBM diagnosis. The objective of this study was to determine the CSF-ADA levels in different CNS disorders, to compare the CSF-ADA activity in different types of meningitis, to find out the sensitivity and specificity of CSF-ADA in the diagnosis of TBM and to establish the prognostic value of CSF-ADA in TBM in comparison to Control group.Methods: For control group CSF was collected from the patients of simple febrile convulsions and idiopathic epilepsy.Results: The present study was carried out in the 112 cases of different CNS disorders, age ranging from 4 months to 12 years with a mean age of 4.12 years and 38 cases (27+11) of control group (simple febrile convulsion and idiopathic epilepsy). In the present study CSF-ADA level was statistically significantly increased in all types of meningitis (p&lt;0.05). In case of TBM, the mean CSF-ADA level increased statistically significantly with increase in CSF protein level (p&lt;0.05). In case of TBM, there was no significant difference in the mean ADA value according to CSF sugar level (p&lt;0.10). In case of TBM, the mean CSF-ADA level increased significantly with increase in CSF cell count (p&lt; 0.01) mainly lymphocytes.Conclusions: Thus it can be concluded from our study that CSF-ADA estimation is relatively simple and inexpensive procedure in the early diagnosis of tuberculous meningitis with high sensitivity (100%) and specificity (97.5%) at a cut-off level of 5IU/L and can be used in differentiating TBM from other types of meningitis. Along with diagnostic utility of CSF-ADA, it has also prognostic value in the follow-up case of tuberculous meningitis.

Clinical Status of Lactate Dehydrogenase Activity in Cerebrospinal Fluid with Age and Sex Distribution in Different Types of Meningitis

Aim: The cerebrospinal fluid concentrations of Lactate dehydrogenase (LDH) were studied in patients with pyogenic, tubercular and viral meningitis in different age and sex group. Material and methods: A total of 160 cases, aged between 1 month and 60 years, including patients with bacterial meningitis (n=50), pyogenic meningitis (n=46), viral meningitis (n=24) and a control group (n=40), were analyzed on the basis of data from the initial clinical examinations. Results:Significant increase in LDH level (P<0.001) were observed in the test group when compared to the control group. Bacterial meningitis is more common than non bacterial meningitis. Pyogenic meningitis is more prevalent under 1 year of age group while tuberculous meningitis is seen most frequently betweens 3 to 5 year of age. Conclusion:The maximum prevalence of different types of meningitis was in the age group of 1 to 10 years age. The LDH level did rise quite significantly in pyogenic meningitis.

English

English

Epidemiology of Different Types of Meningitis Cases in Gaza Governorates, Occupied Palestinian Territory, December 2013- January 2014

Background: Meningitis remains one of the most significant infections in children. In Gaza Strip (GS), meningitis is endemic and the incidence is fluctuating from 22 to 94/100000 population. There was an outbreak of aseptic meningitis in 1997, 2004 and 2013 resulting in an elevation of the rate to higher than 100/100000. Aim of the study: To determine and characterize the epidemiology of meningitis in GS in order to design adequate management, prevention and control strategies. Methods and material: This study is a cross sectional descriptive study of meningitis in GS. From December 1, 2013 through January 31, 2014, data of all registered cases of meningitis in Ministry of Health pediatric hospitals were collected and analyzed. 20 cerebrospinal fluid samples (CSF) were sent to Norway through the institute of public health for viral study. Results: During the study period, a total of 129 cases with meningitis were reported in GS. The majority of cases were male (57.4%) with a male:female ratio of 100: 74. The mean age was 28 months and infants were the most affected age group (48.8%). The majority of cases (62%) were diagnosed as non-specific meningitis and 38% as bacterial meningitis. The majority of CSF and blood cultures for bacteria were negative (96% and 97% respectively). 3 cases were diagnosed as Neisseria Meningitides by Gram staining. All these patients were hospitalized and received parenteral antibiotics. Out of 20 samples sent to Norway, seven samples (35%) were positive for enterovirus. No deaths were reported among all reported cases. Discussion: However, we found in our study very large differences in CSF lab testing parameters with similar studies or even with the globally used cut-off between bacterial and aseptic meningitis. In GS except CSF culture no available lab tests for distinguishing different types of meningitis. Different statistical significant differences were found between the types of meningitis and different CSF or blood tests but it is not a reliable to differentiate the types of meningitis. These findings are due to the lack of a clear standard guideline for dealing with suspected cases of different types of meningitis and management of the disease. Conclusion: Aseptic meningitis is the most prevalent type of meningitis in GS where children and infants are more at risk. No available unified and adequate standard guidelines for dealing with meningitis and the available CSF lab tests are not fully reliable for differentiation of meningitis types.

EVALUATION OF CSF FERRITIN AS AN EARLY MARKER FOR DIFFERENTIATING MENINGITIS IN PEDIATRIC PATIENTS

Background and Objectives: - Bacterial meningitis is a medical emergency with a potential for serious neurological damage or even death. Rapid diagnosis is important and henceforth critical for the early intervention by antibiotic therapy to prevent complications. Therefore the aim of the present study was to evaluate CSF ferritin levels in children with different etiologies of meningitis. Materials and Methods: - 65 children (1-124 months) with suspected meningitis admitted at Chacha Nehru Bal Chikitsalya hospital were included in the study. CSF sample was analyzed for glucose, protein, cell count, ferritin, gram stain and culture. Results: - Based on the laboratory findings the 65 children were classified into 3 groups: 21 cases had bacterial meningitis, 18 had aseptic (viral) meningitis and 26 cases as the no-meningitis group. A significant relationship was observed between age and ferritin level in the non-meningitis group (p&lt;0.05). CSF ferritin in bacterial meningitis group was 34.80 ± 11.20 ng/mL and was significantly higher than the aseptic meningitis group. Cut off value of ferritin to differentiate meningitis vs. no-meningitis group was estimated at 18.2ng/ml with a sensitivity of 94.9% and specificity of 96.2 %. However on differentiating bacterial from aseptic meningitis cutoff value was 20.3 ng/mL with a sensitivity of 98% and specificity of 33.3%. Conclusion: - CSF ferritin levels were found to be significantly different between the meningitis and the no-meningitis groups. However due to low specificity it may not prove useful for the early differentiation of different types of meningitis. Further studies are required on a larger sample size before we can substantiate our findings.     Â

Glucose status in cerebrospinal fluid (CSF) in different meningitic children in a hospital in Chittagong, Bangladesh

Meningitis is referred to as an inflammatory process of the leptomeninges and cerebrospinal fluid (CSF) within the sub-arachnoid space of the brain. We have investigated glucose status in CSF in different types of meningitis together with detailed medical history in children. In addition, we have also carried out the detailed cytological and microbiological examinations. A total of 40 subjects were investigated. We observed that the glucose level was significantly decreased (&lt;20 mg/dl) in 65%, moderately decreased (20-40 mg/dl) in 20% and mildly decreased (40-50mg/dl) in 15% of the patients in our study. Patients with Pyogenic meningitis had tremendously reduced glucose level (9.0 mg/dl) in their CSF whereas in viral meningitis the CSF glucose level is highly variable (10 to 65 mg/dl). Furthermore, 5 (12.5%) patients showed high lymphocyte counts and 34 (85%) patients showed high neutrophil counts. Interestingly, in Pyogenic meningitis, the neutrophil count was very high compared to that in viral meningitis. The present study clearly demonstrates that biochemical parameters such as glucose level in CSF might be a potential tool for detecting meningitis and as well as differentiation of the different types of meningitis. DOI: http://dx.doi.org/10.3329/cujbs.v6i1-2.17080 The Chittagong Univ. J. B. Sci.,Vol. 6(1&amp;2):41-49, 2011

Is Cerebrospinal Fluid C-reactive Protein a Better Tool than Blood C-Reactive Protein in Laboratory Diagnosis of Meningitis in Children ?

This study aimed to test whether C-reactive protein (CRP) measurement could differentiate between different types of meningitis and become a routine test. A prospective study included 140 children admitted to Manipal Teaching Hospital, Pokhara, Nepal, between July 2009 and June 2011. The subjects had a blood test and detailed cerebrospinal fluid (CSF) analysis, including blood and CSF CRP levels. Of those admitted, 31.1% had pyogenic meningitis (PM), 26.2% partially treated meningitis (PPM), 33% viral meningitis (VM), and 9.7% tubercular meningitis (TBM), with 26.4% controls. Organisms were isolated in 12.5% of the cases by blood culture and 25% of cases through CSF culture. Blood CRP was positive in all groups, with the highest values in PM (53.12 ± 28.88 mg/dl) and PPM (47.55 ± 34.34 mg/dl); this was not statistically significant (P = 0.08). The CSF CRP levels were significantly higher (P <0.001) in PM (45.75 ± 28.50 mg/dl) and PPM (23.11 ± 23.98 mg/dl). The sensitivity and specificity of blood CRP was 90.62%, 88.88%, 64.7%, 70% and 32.4%, 30.97%, 24.52%, 26.12% and that of CSF CRP was 96.87%, 66.66%, 20.58%, 10% and 74.73%, 63.71%, 50.94%, 55.35% for PM, PPM, VM and TBM, respectively. Because of its high sensitivity, both CSF CRP and blood CRP can be used to screen for bacterial meningitis (both PM and PPM). CSF CRP screening yielded results with a higher specificity than blood CRP; hence, it can be a supportive test along with CSF cytology, biochemistry, and microbiology for diagnosing meningitis.

Evaluation of Cerebrospinal Fluid Adenosine Deaminase Activity for the Differential Diagnosis of Tuberculous and Nontuberculous Meningitis

IntroductionThe diagnosis value of adenosine deaminase (ADA) activity in cerebrospinal fluid (CSF) of tuberculous meningitis (TBM) has been well documented. However, the cutoff point of CSF ADA has not been fully assessed. In the current study, the authors set to calculate the cutoff points of ADA and monitor the changes of CSF ADA activities in patients with TBM after antitubercular therapy. MethodsCSF ADA activity in patients with different types of meningitis was measured by Trinder enzyme-coupled assay. ResultsThe mean CSF ADA values in the patients with TBM, bacterial meningitis, viral meningitis, cryptococcal meningitis and noninfectious neurologic disorders were 14.1 ± 5.4, 9.6 ± 5.5, 4.3 ± 2.5, 7.8 ± 3.4 and 2.6 ± 1.3 U/L, respectively. CSF ADA activity was significantly higher in TBM compared with patients with non-TBM (P < 0.05). Moreover, the best cutoff point for differentiating between TBM and non-TBM was 9.5 U/L. In addition, CSF ADA activity was decreased in patients with TBM after antitubercular therapy in a time-dependent manner. ConclusionsThe determination of ADA with a cutoff value of 9.5 U/L in CSF is a useful aid for the differential diagnosis of TBM and non-TBM. Moreover, dynamic monitoring of CSF ADA activity may be an indicator for evaluating antitubercular therapy in TBM.

The clinical diagnostic significance of cerebrospinal fluid d‐lactate for bacterial meningitis

BackgroundTo study the clinical and laboratory significance of d‐lactate in the diagnosis of bacterial meningitis (BM). MethodsThe levels of d‐lactate, l‐lactate, IL-6, IL-8, and other biochemical markers were determined in 83 CSF samples from different types of meningitis and the controls. ResultsThe CSF values of d‐lactate, l‐lactate, IL-6, IL-8, erythrocytes, leukocytes, and protein were higher in patients with BM than those in the controls and patients with viral meningitis. The levels of d‐lactate, l‐lactate, IL-6, and erythrocytes in the BM group were higher than those in the tuberculous meningitis group. At the cutoff 12.8 μmol/l, d‐lactate showed the diagnostic sensitivity of 94.7%. d‐lactate gave the area under the curve (AUC) 0.905, which was higher than those of other markers. Using multiple marker detection, the AUC reached 0.956, which was the highest among all the parameters. Pearson correlation analysis revealed that d‐lactate was positively correlated to IL-6 and l‐lactate (r=0.727, 0.789 and P=0.000, 0.000, respectively). ConclusionsThe CSF concentrations of d‐lactate are significantly increased in the presence of BM. Measurement of d‐lactate provides a rapid diagnosis and differential diagnosis for BM. Combination of d‐lactate with other biochemical markers improves the specificity.

The Haemophilus influenzae type b (Hib) vaccine: a pre-launch qualitative study of parental perceptions

HAEMOPHILUS influenzae type b (Hib) is the com monest cause of bacterial meningitis in young chil dren. In October 1992 a vaccine was launched to offer protection against the disease. Prior to the launch, the Health Education Authority commissioned re search to explore potential responses to the new vac cine and to inform the development of a public education campaign. This paper outlines results on qualitative research conducted among parents in November 1991, to gain insight into how the vaccine might be promoted. The research indicated that the fact of there being different types of meningitis was either already understood, or was easily compre hended. However, it emerged that there was a dan ger the vaccine would be dismissed as unimportant if the type of meningitis in question was not shown to be one of the most common and most serious. The study also indicated that the key to any public edu cation campaign would be the issues associated with the risk of not immunising and of vaccine safety. For this reason, a separate campaign was suggested for the new vaccine, as opposed to a low profile intro duction through a revised schedule.