Low Cerebrospinal Fluid Glucose Research Articles

Prominent cerebral veins on susceptibility-weighted angiography in acute meningoencephalitis.

We have commonly observed prominent cerebral veins on susceptibility-weighted angiography (SWAN) in acute meningoencephalitis. This study aimed to investigate the clinical significance of these findings. Cerebral veins on SWAN of 98 patients with acute meningoencephalitis diagnosed from February 2016 through October 2020 were classified into three groups according to the degree of venous prominence (mild, 23; moderate, 53; and prominent, 22). Clinical variables and laboratory findings were compared between these groups. The influence of variables on the prediction of prominent cerebral veins was measured by random forest (RF) and gradient boosting machine (GBM). As cerebral veins became more prominent, cerebrospinal fluid (CSF) glucose level decreased (69.61±29.05vs. 59.72±22.57vs. 48.36±20.29mg/dL, p=.01) and CSF protein level increased (100.73±82.98vs. 104.73±70.99vs. 159.12±118.15mg/dL, p=.03). The etiology of meningoencephalitis, neurological symptoms, and increased intracranial pressure (ICP) signs differed between groups (p<.05). RF and GBM demonstrated that CSF protein level was the variable with the highest power to predict the prominent cerebral vein (mean decrease in node impurity: 4.19, relative influence: 50.66). The presence of prominent cerebral veins on SWAN in acute meningoencephalitis was significantly associated with a low CSF glucose level and a high CSF protein level, as well as ICP. Thus, the visual grade of the cerebral veins on SWAN may be utilized for the management of patients with acute meningoencephalitis.

The clinical utility of metagenomic next-generation sequencing for the diagnosis of central nervous system infectious diseases.

To evaluate the clinical utility of metagenomic next-generation sequencing (mNGS) for the diagnosis of central nervous system infections (CNSI). Cerebrospinal fluid (CSF) from 54 patients who were high-level clinical suspicion of CNSI was collected and sent for mNGS and conventional tests from January 2019 to March 2022. Twenty out of 54 patients were diagnosed with CNSI and 34 non-CNSI. Among the 34 non-CNSI, one was false positive by mNGS. Among the 20 CNSI, 11 had presumed viral encephalitis and/or meningitis, 5 had presumed bacterial meningitis, 2 had presumed TMB, 1 had Crytococcus meningitis and 1 had neurosyphilis. The sensitivity of viral encephalitis and/or meningitis was 0.73 (8/11); 10 virus were detected; 9/10 was dsDNA; 1/10 was ssRNA. SSRN ranged from 1 to 13. The accuracy rate was 0.4, the accuracy rate was positively correlated with SSRN (r = 0.738, P = 0.015), SSRN ≥ 1, the accuracy rate was 0.4; SSRN ≥ 3, the accuracy rate was 0.66; SSRN ≥ 4, the accuracy rate was 0.75; SSRN ≥ 6, the accuracy rate was 1. The sensitivity of bacterial meningitis was 1. Seven kinds of bacteria were detected, among which 3/7 were gram positive, 3/7 were gram negative, and 1/7 was infected NTM (nontuberculous mycobacteria). The accuracy rate was 0.43 (3/7). The sensitivity of TBM was 0.66 (2/3), the accuracy rate was 1. The sensitivity of Crytococcus meningitis was 1, the accuracy rate was 0.5. PPV (positive predictive value) of mNGS was 0.94, NPV (negative predictive value) of mNGS was 0.89, specificity was 0.97 and sensitivity was 0.8. The AUG for CSF mNGS diagnosis of CNSI was 0.89 (95% CI = 0.78-0.99) Headache, meningeal irritation sign and image of meninges abnormal were correlated with the sensitivity of mNGS (r = 0.451, 0.313, 0.446; p = 0.001, 0.021, 0.001); CSF Glucose and CSF Chloride were negatively correlated with sensitivity of mNGS (r = -0.395, -0.462; p = 0.003, ＜ 0.001). mNGS is a detection means with high sensitivity, wide coverage and strong timeliness, which can help clinicians to identify the pathogen diagnosis quickly, conduct targeted anti-infection treatment early and reduce antibiotic abuse. The pathogen which causing low CSF Glucose, low CSF Chloride or meninges infections was more likely to be detected by mNGS. It may be related to growth and structural characteristics of the pathogen and blood-brain barrier damage.

Autosomal Recessively Inherited Glucose Transporter-1 Deficiency Syndrome with Acanthocytosis: A Case Report

AbstractGlucose transporter-1 deficiency syndrome (GLUT-1DS) is a rare, autosomal dominantly inherited disorder due to a heterozygous mutation in the gene solute channel 2A1 (SLC2A1).This gene encodes the glucose transporter protein-1. Autosomal recessive inheritance is extremely rare. Similarly, only very few reports are found in the literature of hematological manifestations in this syndrome. We report an autosomal recessively inherited GLUT-1DS, due to a de novo mutation, with the classical infantile presentation associated with concomitant acanthocytosis. In this case report, the second child born to consanguineous parents with initial refractory neonatal seizures and subsequent poorly controlled epilepsy and developmental regression is discussed. The most notable investigation findings supportive of his underlying diagnosis were very low cerebrospinal fluid (CSF) glucose and CSF lactate levels. His CSF:plasma glucose ratio was 1:7.6. He was anemic with a hemoglobin of 8.8 g/dL with his blood film showing marked acanthocytosis. His elder brother who also had refractory epilepsy and developmental regression had similar hypoglycorrhachia, low CSF:plasma glucose ratio, and mild anemia with acanthocytosis, and he died before establishment of a diagnosis. Our patient was diagnosed to have a novel mutation SLC2A1 c.184A &gt; G p.(Thr62Ala), for which both parents were heterozygous, confirming autosomal recessive inheritance. Commencement of a ketogenic diet resulted in improvement of his seizures and slow gain in development. It also resulted in gradual disappearance of acanthocytes from his peripheral blood. This case describes a rare case of classical GLUT-1DS, autosomal recessively inherited, due to a novel mutation. The acanthocytosis in his blood smear is another rare association minimally reported in GLUT-1DS. The cause of his abnormal red blood cell morphology is unclear. It is possibly related to cation leakage reported in some rare mutations of the SLC2A1 gene needs reference.

Clinical profile and mortality predictors in hospitalised patients of tuberculous meningitis

Background&amp; Objective: Tuberculous meningitis (TBM) is a serious public health problem in developing countries like India as it leads to significant mortality and neurological sequelae. Aim of study was to describe clinico-radiological profile of TBM and determine predictors of mortality. Methods: This was a prospective study and data collected including demographic details, clinical, laboratory parameters and neuroimaging finding. Diagnosis of TBM was based according to a standard case definition proposed by Marais et al.(2010). Results: One hundred and forty two TBM patients were recruited with 54.93% males and 45.07% females. Fever was most common symptom followed by headache, vomiting, altered sensorium and seizure. Most common cranial nerve palsy was of 6th cranial nerve followed by 2nd cranial nerve. Cerebrospinal fluid (CSF)study in 77.46% of patients showed protein &gt;100 mg/dL, 61.27% patients had CSF sugar &lt;40 mg/dL while 87.32% of patients had total cell count &gt;10 cells/cumm. Most common Neuroimaging finding was meningeal enhancement followed by hydrocephalus, infarcts, basal exudates and tuberculoma. In-hospital mortality was 17.61%. Higher age, low Glasgow Coma Scale (GCS) score, absence of headache, seizure, altered sensorium, anemia, low CSF glucose, infarct, hydrocephalus, and British medical research council (BMRC) Stage III at presentation were predictors of in-hospital mortality. Conclusions:. Age, GCS score, absence of headache, seizure, altered sensorium, anemia, low CSF glucose, infarct, hydrocephalus, and BMRC Stage III at presentation were predictors of in-hospital mortality based on this study from Bihar, India.

Lack of Association between YEASTONE Antifungal Susceptibility Tests and Clinical Outcomes of Cryptococcus Meningitis.

The relation between antifungal susceptibility and treatment outcomes is not well-characterized. There is paucity of surveillance data for cerebrospinal fluid (CSF) isolates of cryptococcus investigated with YEASTONE colorimetric broth microdilution susceptibility testing. A retrospective study of laboratory-confirmed cryptococcus meningitis (CM) patients was conducted. The antifungal susceptibility of CSF isolates was determined using YEASTONE colorimetric broth microdilution. Clinical parameters, CSF laboratory indices, and antifungal susceptibility results were analyzed to identify risk factors for mortality. High rates of resistance to fluconazole and flucytosine were observed in this cohort. Voriconazole had the lowest MIC (0.06 µg/mL) and lowest rate of resistance (3.8%). In a univariate analysis, hematological malignancy, concurrent cryptococcemia, high Sequential Organ Failure Assessment (SOFA) score, low Glasgow coma scale (GCS) score, low CSF glucose level, high CSF cryptococcal antigen titer, and high serum cryptococcal antigen burden were associated with mortality. In a multivariate analysis, meningitis with concurrent cryptococcemia, GCS score, and high CSF cryptococcus burden, were independent predictors of poor prognosis. Both early and late mortality rates were not significantly different between CM wild type and non-wild type species.

Clinical features and risk factors of surgical site infections in HIV-negative patients with cryptococcal meningitis underwent ventriculoperitoneal shunt operations: a retrospective study

BackgroundTo investigate the clinical features and risk factors of ventriculoperitoneal shunt (VPS) associated surgical site infections (SSIs) in HIV-negative patients with cryptococcal meningitis (CM).MethodsWe retrospectively reviewed the medical records of HIV-negative patients with CM underwent VPS operation admitted to The Third Affiliated Hospital of Sun Yat-sen University in Southwest China over the past 7 years.Results193 patients were included, of whom 25 (12.95%) had SSIs in 6 (median duration, 1–48 days) days after operation. Compared with patients without SSIs, patient with SSIs tended to be shorter preoperative stay. 52% patients in SSIs group and 25% patients in no-SSIs group underwent VPS operations within 3 days after admission (p = 0.017). Although body temperature and infectious indicators slightly elevated postoperative in both groups. The patients with SSIs experienced more fever; more central nervous system symptoms; higher PCT value and lower cerebrospinal fluid (CSF) glucose in contrast to the no-SSIs group. Multivariate regression analysis found a 2.653 fold increase in the risk of infection for every 1 °C increase in postoperative body temperature. Among the 25 patients, 9 patients had positive culture results, three samples reported to be oxacillin resistant coagulase-negative Staphylococci.ConclusionsSSIs was one of the serious surgical complications after VPS operation. High body temperature, the occurrence of dizziness and headache, low postoperative hemoglobin are risk factors. Postoperative patients with high fever, high PCT and low CSF glucose should be paid more attention to.

OS11.5.A Utility of lumbar puncture (LP) and cerebrospinal fluid (CSF) profile in the diagnosis of neoplastic meningitis (NM): a retrospective cohort study and meta-analyses

Abstract Background CSF cytology remains the gold standard for diagnosing NM, but the sensitivity of this test is low (approximately 50% with one LP). Little is known about the predictive value of routine CSF and clinical findings for a positive cytology. We addressed these questions by analyzing 337 consecutive patients at our institution, and by conducting exhaustive evidence-based literature reviews and meta-analyses of relevant research. Material and Methods 337 consecutive patients at a single institution were evaluated. Of these, 210 met criteria for NM (a positive CSF cytology on at least one of four pre-treatment samples) or no NM (four consecutive negative CSF cytologies). CSF white blood cell count, glucose, protein, and lactate were collected, as well as the presence of neurological symptoms. Optimal threshold values were identified using ROC curves. Sensitivity (Sn), specificity (Sp), and likelihood ratios were calculated for each variable. Two PRISMA-compliant meta-analyses were also performed: one analyzed studies reporting the cytology results of multiple LPs, and one analyzed the frequency of abnormal CSF findings as predictors of NM. Results All published results describe outcomes in patients with known NM. These results are, therefore, strongly distorted by spectrum bias, which artificially inflates the apparent sensitivity and specificity of those outcomes. Thus, 25 studies report the yield of positive CSF cytology on the first, second, and third LP as 73%, 87%, and 94%, but also do not describe the parameters of the procedure. Our series in patients with suspected NM (the cohort most relevant to the practicing physician) reports 74%, 85%, and 92% for immediately processed, 10 mL or greater, lumbar and ventricular specimens. Similarly, while 50 studies suggested that low CSF glucose, high CSF protein, and suggestive symptoms are associated with NM, we found very poor Sn/Sp for elevated protein (61%/61%), low glucose (35%/85%), elevated lactate (35%/91%), and symptoms consistent with NM (74%/73%). Of these values, only an elevated lactate and symptoms were even marginally helpful in predicting a positive CSF cytology. No variable predicted a negative cytology, and 22.8% of patients with a positive CSF cytology had completely normal CSF findings. Conclusion Generally accepted concepts about the frequency of CSF and clinical findings in patients with suspected NM are based on biased estimates in the literature. No CSF chemistry or clinical finding reliably predicts the presence of NM, and almost a quarter of patients with cytologically proven NM have completely normal findings. In patients with positive CSF cytologies, about 73% are detected after one LP, and more than 90% after 3, but again these findings represent overestimates because of pervasive spectrum bias and differences in sample acquisition/handling. Better diagnostic techniques are desperately needed.

Aseptic Meningitis and Its Viral Etiologies, Clinical Characteristics and Management Practices in Children: A Retrospective Hospital-Based Study From Jordan.

PurposeIn this study, we aimed to describe the clinical characteristics, laboratory findings, aetiologies, and role of PCR in the decision on the management plan and duration of hospital stay in Jordanian children diagnosed with aseptic meningitis.MethodsThis retrospective observational cohort study included children diagnosed with meningitis who were admitted to the paediatric ward at Jordan University Hospital (JUH) during the period from January 2016 to August 2020. Patients were identified through the ICD9 discharge code of meningitis. Patients diagnosed with aseptic meningitis (defined as a patient with signs and symptoms of meningitis with a cerebrospinal fluid (CSF) white cell count of >5 cells/mm3, and a negative CSF Gram stain) were included, while patients who had low CSF glucose (<50% of serum) positive cerebrospinal fluid Gram stain and/or culture for bacterial meningitis were excluded.Files were reviewed to collect data on the clinical picture, viruses identified by the CSF viral polymerase chain reaction (PCR) panel, duration of medication, and hospital stay in patients with identified virus versus those with negative viral PCR.ResultsOne hundred and thirty-one patients were included: 87 males (66.4%) and 44 females (33.5%). Fever was the most common presenting symptom, followed by headache, vomiting, and excessive sleep in 48.0%, 42.7%, and 35.8% of the patients, respectively. Prior oral antibiotic use was reported in 48/125 (38.4%) patients.White blood cell count (WBC) ranged from 4.800 to 22.000. cells/mL, 45 patients (34.3%) had counts above 15.000 cells/mL. C-reactive protein level was high in 61/103 (59.2%) patients. CSF WBC count was <100 in 62 (47.3%) patients while neutrophils predominance of >70% was present in 27 (20.6%) patients. Viral panel PCR was done for 100/131 (76.3%) patients and was positive in 66/100 (66%) patients; with enterovirus being the most common identified viruses (60/100; 60%).The average duration of hospital stay was 5.9 and 5.5 days for those with negative and positive PCR respectively. Ten (7.6%) patients had seizures upon presentation. None of the patients had any neurological sequel related to his meningitis.ConclusionEnteroviruses are the most common identified cause of paediatric aseptic meningitis in Jordan. Although PCR revealed an identified virus in around half of the patients, nevertheless, there was no adjustment in the management plan regarding duration of empirical antibiotic use and hospital stay. Increasing knowledge and awareness among clinicians on viral meningitis’ lab characteristics might have great impact on duration of hospital stay and thus would be reflected on the patient and the healthcare system as well.

Cerebrospinal fluid analysis is associated with enhancement on MRI in bacterial and tuberculous meningitis: A retrospective observational study

ObjectiveAlong with cerebrospinal fluid (CSF) analysis, enhancement on contrast-enhanced MRI is useful to diagnose meningitis. However, the conditions for its appearance have not been clarified. This study aimed to investigate the association between CSF parameters and enhancement on contrast-enhanced head or spinal MRI in patients with bacterial meningitis (BM) or tuberculous meningitis (TM). MethodsA total of 12 patients with BM and 23 patients with TM who underwent both CSF analysis and contrast-enhanced MRI were included. The correlation between CSF analysis and MRI findings has been examined using receiver operating characteristic (ROC) analysis. ResultsContrast enhancement was found in 7 and 10 patients with BM and TM, respectively. Both CSF analysis and MRI were useful to distinct between BM and TM, and the enhancement implied the severity of them. In patients with BM, higher CSF protein and lower CSF glucose were associated with enhancement on MRI, while not only CSF protein and glucose but also leukocyte and lymphocyte counts were associated with it in TM. CSF adenosine deaminase (ADA) did not show discriminant ability of the MRI findings. ConclusionsCSF analysis is associated with enhancement on contrast-enhanced MRI both in BM and TM. Our findings indicate the importance of CSF analysis in assessing the need to perform contrast-enhanced MRI, which may be useful in diagnosis, distinction, and estimation of prognosis in those patients.

Bacterial meningitis without pyrexia after spinal anesthasia for caesarean section: A case report.

Introduction and importancyMeningitis happening in post spinal anesthesia is rare. But it has potentially life threatening or permanent neurological sequel if delayed or left untreated. The cause can be infectious or noninfectious. In this case, uncommon pathogen is described causing bacterial meningitis. Incidence varies from 0% to 0.04%.Case presentationA term pregnant lady came to the Operation room (OR) for an emergency caesarian section(C/S) because of cervical dystocia. She has no history of known medical illness. The anesthetist planned to administer spinal anesthesia. Under aseptic technique, the senior anesthetist wore a tight-fitting surgical mask, cap, and sterile gloves after hand hygiene with alcohol-based solutions.In sitting positioning between L(lumbar) 3 and L4 interspaces 10 mg bupivacaine +10 μg fentanyl was administered. Surgery and anesthesia were uneventful, 16 h into the postoperative period the mother develop severe headache, agitation, confusion, and forgetfulness.She has no fever but meningeal sign was positive. Lumbar puncture (LP) reveals purulent cerebrospinal fluid (CSF).Immediately, empirical treatment began. CSF sent for analysis and Culture, hematology, urinalysis, and organ function tests requested. Diagnosis was confirmed by clinical picture, low CSF glucose, and high body fluid protein, culture growth; showed Escherichia coli (E.coli). Treatment was instituted and patient has recovered fully.Clinical discussionE.coli is a very rare cause of bacterial meningitis but manifests a similar clinical picture like other bacterial meningitis but in our case no pyrexia. We believe there is a sterility breach somewhere in the process. The use of hospital sterilized spinal set, multidose antiseptics; institute sterility practice might be challenged.ConclusionThe use of modern packaging is recommended. Despite absent of pyrexia empiric treatment must start earlier besides the application of national guideline developed by the Joint Commission of different associations including America society of regional anesthesia (ASRA) is recommended.

&amp;lt;i&amp;gt;Kocuria Kristinae&amp;lt;/i&amp;gt; Meningitis and Cranial Nerve Palsies Secondary to Sphenoid Sinusitis: About a Case

Kocuria spp, previously classified as the members of Micrococcacae family, was rarely reported as a human pathogen. <i>Kocuria Kristinae</i> could cause invasive infections of large variety of tissues in patients of any age. We report the first case of meningitis with sixth and third nerve palsies secondary to sphenoid sinusitis caused by <i>Kocuria Kristinae</i> in a previously healthy 13 year-old boy. In effect, his cerebrospinal fluid (CSF) showed a cloudy appearance of the CSF, white blood cells count was 600 cells/µl (polymorphs 90% and 10% lymphocytes), red blood cells count was 200 cells/µl, protein level was elevated at 5.3 g/l and glucose level was low at 0.1 mmol/l. The direct examination showed positive-gram diplococci. The patient was initially treated with intravenous cefotaxim and vancomycin. The CSF culture was positive for gram-positive diplococci, which was identified as <i>Kocuria kristinae</i>. The meningitis was characterized by insidious evolution and persistent very low CSF glucose level. It was difficult to diagnose the sphenoid sinusitis because it is not accessible to direct clinical examination. It was diagnosed after the occurrence of a complication due to its anatomical location and proximity to the intracranial and orbital content. At day 5, the patient had remarkable resolution of symptoms. Complete recovery of cranial nerve palsy was noted at day 8. The aim of this case report is to present the first isolation of <i>Kocuria Kristinae</i> from cerebrospinal fluid sample and describe the clinical presentation and management outcomes.

The role of molecular analysis of SLC2A1 in the diagnostic workup of glucose transporter 1 deficiency syndrome

The study aimed to investigate the role of molecular analysis of SLC2A1 in the diagnostic workup of glucose transporter 1 deficiency syndrome (Glut1DS). During 2006–2020, we received 100 requests for SLC2A1 variant analysis of patients clinically suspected for Glut1DS. Pathogenic variants were detected in 37 patients, among whom 11 were familial cases. Most patients presented with epilepsy (n = 31; 84%), movement disorders (MD) (n = 28; 76%), and intellectual disabilities (ID) (n = 29; 78%). Moreover, paroxysmal dyskinesias (PD) (n = 10; 27%) were more frequently seen in familial cases (55%) than in sporadic cases (15%) (p < .05). The Glut1DS patients with ID typically had either epilepsy or MD. The presence of MD, particularly when associated with epilepsy or ID, indicated Glut1DS (p < .05). The cerebrospinal fluid (CSF) glucose levels were at or below the 10th percentile in all 32 SLC2A1-positive patients but only in 16 of 52 (31%) SLC2A1-negative patients (p < .05). Thus, CSF analysis is an essential tool in the diagnostic workup of Glut1DS. SLC2A1 molecular analysis should be performed in patients with a family history of Glut1DS or with at least one of the following clinical features, such as epilepsy, MD, and PD with or without ID, and low CSF glucose level. This would help in precise molecular diagnosis of the disease and facilitate effective treatment and appropriate genetic counseling.

Increased cryptococcal meningitis mortality among HIV negative, non-transplant patients: a single US center cohort study.

Cryptococcal meningitis (CM) is an opportunistic fungal infection associated with human immunodeficiency virus (HIV) and other forms of immunosuppression. We lack a clear understanding of CM associated mortality among HIV-negative, non-transplant patients in the United States (US). This article compares clinical features and outcomes across HIV status in patients with laboratory-confirmed CM.Methods:A retrospective cohort study was performed that included adult patients with laboratory-confirmed CM treated at an academic tertiary hospital between January 2000 and September 2018. Those with a history of organ transplant or non-meningeal infections were excluded. Data were gathered on demographics, HIV status, clinical presentation, cerebrospinal fluid (CSF) profiles, neurological outcomes, hospital course, and mortality.Results:A total of 70 patients with cryptococcal disease were identified. Our final sample included 36 CM patients, mean age was 48.8 ± 13.2 years; of this group, 66.7% (n = 24) had HIV. Median [interquartile range (IQR)] absolute CD4 count for the HIV group was 35 cells/μl (10–80 cells/μl). Non-HIV/non-transplant patients were significantly older (p < 0.001) and had higher rates of altered mental status (AMS) on presentation (58.3% versus 25%, p = 0.05). Non-HIV patients/non-transplant patients had significantly higher CSF white blood cell (WBC) count (p = 0.02), lower CSF glucose (p = 0.005), and higher CSF protein (p < 0.001) compared with HIV patients. There was no significant variation in temperature, blood pressure, WBC count, serum sodium, CSF opening pressure, length of stay, intensive care unit admission, or neurological outcomes. Overall, 90-day all-cause mortality was 19.4%: mortality rates were significantly higher in non-HIV/non-transplant patients at both 90 days (41.7% versus 8.3%, p = 0.017) and 1 year (41.7% versus 12.5%, p = 0.047).Conclusion:Compared with HIV-infected individuals, non-HIV/non-transplant CM patients have a higher CSF WBC count at the time of diagnosis, higher rates of AMS on presentation, and higher rates of 90-day and 1-year all-cause mortality. Further prospective research is needed to identify the hallmarks of CM in non-HIV/non-transplant patients to facilitate early identification and intervention.

Developmental outcomes and prevalence of SLC2A1 variants in young infants with hypoglycorrhachia

IntroductionThe neurodevelopmental outcomes of young infants with hypoglycorrhachia that is comparable to glucose transporter 1 deficiency syndrome (GLUT1DS), i.e. cerebrospinal fluid (CSF) glucose ≤40 mg/dL and CSF lactate <2.2 mM without causes of secondary hypoglycorrhachia are unknown. This study investigated the developmental outcomes and possibility of GLUT1DS in infants with hypoglycorrhachia, or low CSF glucose concentration. Material and methods1655 neurologically asymptomatic infants aged <4 months had CSF examinations for fever workup from 2006 to 2016. Among the infants with normal CSF cell counts and without isolated pathogens, there were hypoglycorrhachia group who had CSF glucose levels that were comparable to GLUT1DS, and age- and gender-matched non-hypoglycorrhachia group. Both groups were at a mean age of 5.9 ± 2.4 years (ranged 1–10 years) at neurodevelopmental evaluation in 2017. Mutational analysis of solute-carrier-family 2, which facilitated the glucose transporter member 1 (SLC2A1) gene was performed. ResultsAmong the 722 infants with normal CSF cell counts and without isolated pathogens, 30 (4.2%) had hypoglycorrhachia that was comparable to GLUT1DS. In the 25 infants with hypoglycorrhachia available for follow-up, 4 (16%) had abnormal outcomes, of which 3 (12%) had the history of mixed-type developmental delay before age 6 and 1 (4%) had type 1 diabetes mellitus. In the non-hypoglycorrhachia control group (n = 50), 2 patients (4%) showed abnormal outcomes, both with the history of pure speech delay. The hypoglycorrhachia group had a higher rate of the history of mixed-type of developmental delay than the control group (12% vs. 0%, P = 0.034). No SLC2A1 pathogenic variants were observed in the hypoglycorrhachia group. ConclusionHypoglycorrhachia may be a potential biomarker for neurodevelopmental delay instead of for GLUT1DS in neurologically asymptomatic young infants.

Unique clinical features of cryptococcal meningitis among Chinese patients without predisposing diseases against patients with predisposing diseases.

The clinical features of cryptococcal meningitis (CM) in patients without predisposing diseases (PD) remain unclear. In sum, 162 of the 167 patients without PD and 162 of the 309 patients with PD were enrolled after propensity score matching. Demographic characteristics, symptoms, blood, and cerebrospinal fluid (CSF) characteristics were compared between the two groups. Kaplan-Meier curves and a Cox proportional hazards model were used to assess the factors associated with 10-week mortality. In total, approximately 35.1% of CM patients were without PD. CM patients without PD had blood profiles of higher white blood cells (WBC) [8.9(6.7-11.0) × 109/l], hemoglobin (128.4 ± 20.9g/l), platelets [(226.2 ± 64.1) × 109/l], and serum albumin (41.2 ± 5.8g/l) (all P ≤ .001) and CSF profiles of lower glucose (2.0 ± 1.2mmol/l), pleocytosis [65.0 (18.0-160.0) × 106/l] and higher total protein [0.9 (0.7-1.4)g/l] (all P < .05). CM patients without PD had lower Cryptococcus culture positivity in CSF (62.5%vs. 74.1%, P = .039) but higher 2-week of CSF culture sterilization rates (69.4%vs. 51.3%, P = .031). The overall 10-week survival rate was 84.7% in patients without PD and 81.1% in patients with PD (Log-rank P = .439). CSF glucose <1.5mmol/l, CSF fungal burden >20 cells/high power field and treatment lacking amphotericin B had a 3-4 times higher risk of death in patients without PD, whereas serum albumin <35g/l, CSF glucose < 1.5mmol/l, and CSF WBC <55 × 106 cell/l were risk factors for patients with PD. CM patients without PD had unique blood and CSF profiles, especially, had lower Cryptococcus culture positivity in CSF, and higher 2-week CSF culture sterilization. Low CSF glucose levels, higher fungal burden, and treatment without amphotericin B were risk factors for 10-week mortality.

Risk Factors in Predicting Prognosis of Neonatal Bacterial Meningitis-A Systematic Review.

Background: Neonatal bacterial meningitis is a severe infection with high mortality and morbidity. It is necessary to identify factors associated with a high risk of a poor prognosis so that we can prevent them with more appropriate treatments. This study was performed to summarize the prognostic factors known to predict adverse outcomes in neonatal bacterial meningitis.Methods: The Medline/PubMed, Cochrane Library and Embase databases were searched for studies of prognostic risk factors in neonates with bacterial meningitis. Studies published from the initiation of the database to April 30th, 2017 were included. The quality of cohort studies was assessed by the Newcastle-Ottawa Scale (NOS). The quality of cross-section studies was assessed by the Agency for Healthcare Research and Quality (AHRQ) scale. Each prognostic factor known to cause adverse outcomes is summarized.Results: Sixteen studies were identified, including 7 cohort studies and 9 cross section studies. Seizure and high protein levels in the cerebrospinal fluid (CSF) predict a poor prognosis in this disease. Coma, the need for ventilation support, and leukopenia also had some value for predicting poor prognoses. A bulging anterior fontanelle was valuable for predicting mortality. Low CSF glucose levels, thrombocytopenia, gestational age (GA) < 37 weeks and an altered sensorium were correlated with a poor prognosis. A birth weight < 2500 g, early onset meningitis and positive CSF cultures were correlated with mortality.Conclusions: This study provides a preliminary exploration of prognostic factors in neonatal bacterial meningitis and thereby fills some of the gaps in the study of prognoses in this disease. These prognostic factors can be used to predict and estimate outcomes in neonatal bacterial meningitis. Without a meta-analysis, the reliability of these factors cannot be assured. In addition, these results emphasize that there is an urgent need for a standardized protocol for follow-up and well-designed prognostic studies in neonatal bacterial meningitis.

Characteristics of Cerebrospinal Fluid in Tuberculous Meningitis Patients with Hydrocephalus

Objective: To describe cerebrospinal fluid (CSF) characteristics in tuberculous meningitis (TBM) with hydrocephalus patients as diagnostic criteria of TBM. Methods: A cross-sectional using retrospective method was applied in this study by obtaining medical records of TBM with hydrocephalus patients that were treated at Department of Neurosurgery Dr. Hasan Sadikin General Hospital, Bandung from January 2014–September 2016. Results: Sixty one records were included in the study. Patient characteristics such as age, gender, and CSF laboratory features such as color and clarity, cells and differential count, protein, and glucose were recorded and descriptively analyzed. The majority of CSF macroscopic appearance was seen to be clear (88%) and colorless (88%). Median for CSF cell count was 25 cells/mm3 with lymphocyte predominance (median: 76%). Increased protein from normal value range was seen in CSF (median: 50 mg/dL) while the mean for CSF glucose in this study remained in its normal value range (mean: 58.9±26.68 mg/dL) with lower CSF to blood glucose ratio (mean: 0.41±0.27). Conclusions: Clear CSF with colorless appearance, lymphocyte pleocytosis, high protein level, and low CSF glucose as well as blood glucose ratio remain typical CSF characteristics of TBM patients found at the Department of Neurosurgery, Dr. Hasan Sadikin General Hospital, Bandung. Keywords: Cerebrospinal fluid, hydrocephalus, tuberculous meningitis DOI: 10.15850/ijihs.v6n2.1129

Healthcare-Associated Meningitis or Ventriculitis in Older Adults

Background/Objectives Healthcare-associated meningitis or ventriculitis (HCAMV) is a serious and life-threatening complication of invasive neurosurgical procedures or penetrating head trauma. Older adults are at higher risk of adverse outcomes in community-acquired meningitis but studies of HCAMV are lacking. Therefore, we perform the study to define the differences in clinical outcomes between older and younger adults with HCAMV. Design Retrospective study. Setting A large tertiary care hospital in Houston, Texas, from July 2003 to November 2014. Participants Adults with a diagnosis of HCAMV (N = 160) aged ≥65 (n = 35), aged 18–64 (n = 125). Measurements Demographic characteristics, clinical presentation, laboratory results, treatments, and outcomes (Glasgow Outcome Scale). Results Older adults had more comorbidities and CSF abnormalities [pleocytosis, high cerebrospinal fluid (CSF) protein, low CSF glucose) and were more likely to have altered mental status than younger adults (P < .05). An adverse clinical outcome was seen in 142 participants (89%) (death (n = 18, 11%), persistent vegetative state (n = 26, 16%), severe disability (n = 68, 43%), moderate disability (n = 30, 19%). There was no difference in adverse outcomes between older (97%) and younger (86%) adults (P = .13). On logistic regression analysis, abnormal neurological examination (adjusted odds ratio (aOR) = 7.13, 95% confidence interval (CI) = 2.15–23.63, P = .001) and mechanical ventilation (aOR = 11.03, 95% CI = 1.35–90.51, P = .02) were associated with adverse clinical outcomes. Conclusion Older adults with HCAMV have more comorbidities and CSF abnormalities and are more likely to have altered mental status than younger adults but have similar high rates of adverse clinical outcomes.

Clinical and imaging characteristics in neonatal refractory purulent meningitis

Objective To identify the clinical and imaging characteristics in neonatal refractory purulent meningitis. Methods Clinical data of 70 cases of neonatal purulent meningitis admitted to the neonatal intensive care unit at Children's Hospital of Fudan University from January, 2009 to December, 2014 were reviewed retrospectively. The patients were divided into refractory group (n=28) and non-refractory group (n=42) according to the course of antimicrobial therapy. The clinical and brain MRI characteristics of neonatal refractory purulent meningitis were analyzed. Parameters were compared between the two groups using Chi-square or Fisher's exact tests, and Wilcoxon tests where appropriate. Risk factors of neonatal refractory purulent meningitis were investigated by univariate and multivariate Logistic regression analysis. Results Among the 70 cases, 31(44.3%) were positive for cerebrospinal fluid (CSF)/blood culture. The positive rate was higher in the refractory group than in the non-refractory group [75.0% (21/28) vs 23.8% (10/42), χ2=17.843, P<0.01]. The most common pathogenic bacteria isolated in the refractory group were Escherichia coli [8 cases (38.1%)] and group B streptococci [5 cases (23.8%)]. Compared to the non-refractory group, patients in the refractory group were more likely to have seizure, higher CSF white blood cell count, higher CSF protein concentration and lower CSF glucose concentration [53.6%(15/28) vs 7.1% (3/42), 965.0 (463.0-2 200.0)×106/L vs 116.5 (61.0-327.5)×106/L, 3 221.1(2 354.3-4 633.5) mg/L vs 1 487.6(988.2-1 924.1) mg/L, and 0.2 (0.1-0.8) mmol/L vs 1.5 (1.2-1.8) mmol/L; all P<0.01]. Multivariate Logistic regression analysis showed that seizure, low CSF glucose concentration on admission, and a positive CSF/blood culture result neonatal refractory purulent meningitis (OR=9.6, 95%CI: 1.2-76.0; OR=15.0, 95%CI: 5.6-63.3; and OR=7.3, 95%CI: 1.5-36.0, respectively). Abnormal brain MRI findings, including intracranial extracerebral space abnormality, ventricular dilatation and periventricular white matter injury, were more common in the refractory group [100.0%(28/28) vs 61.9%(26/42), χ2=13.827 totally; 64.3%(18/28) vs 21.4%(9/42), χ2=13.023 for intracranial extracerebral space abnormality; 60.7%(17/28) vs 19.0%(8/42), χ2=12.704 for ventricular dilation and 28.6%(8/28) vs 2.4%(1/42) for periventricular white matter injury; all P <0.01]. Compared with the non-refractory group, the refractory group had a longer hospital stay [(48.0±17.4) d vs (26.0±10.2) d, t=6.016, P<0.01] and more adverse events [67.9%(19/28) vs 31.0%(13/42), χ2=9.220, P=0.002], including hearing impairment and requirement of neurosurgical intervention [14/18 ears vs 10/46 ears (21.7%), χ2=4.292, P=0.038]. There was no death in both groups during hospitalization. Conclusions Neonates with seizure, low CSF glucose concentration and positive CSF/blood culture results are more likely to have refractory purulent meningitis. Brain MRI abnormalities are more common in neonatal refractory purulent meningitis. Key words: Meningitis, bacterial; Magnetic resonance imaging

Adenosine Deaminase (ADA) in Tuberculous Meningitis

Abstract not availableBangladesh J Medicine Jul 2014; 25 (2) : 61-71