Meningitis In Children Research Articles

Enterovirus and parechovirus infections in children: differences in clinical presentation, mechanisms for meningitis without pleocytosis and mechanisms involved in the neurological outcome.

Enterovirus (EV) and Parechovirus (HPeV) are a frequent cause of infection in children. This review gives an overview of possible causes for differences in clinical presentation. EV and HPeV can cause a meningitis with or without pleocytosis. Different possible mechanisms for meningitis without pleocytosis are given. Little is known about the prognosis and long-term effects of EV and HPeV meningitis in children. Only some studies with a small number of children with EV or HPeV meningitis are reported. The different possible mechanisms involved in the neurological outcome after EV or HPeV meningitis will be discussed.

Clinical Profile of Meningitis in Children

Meningitis is an emergency clinical problem in pediatrics. The mortality from meningitis is close to 100% in untreated individuals and can still be up to 40% in children who received appropriate antibiotic therapy in developing countries. A cross sectional study was done to address the common presentation of meningitis among the children. The study was conducted in the Pediatric unit of Rajshahi Medical College Hospital from March 2008 to July 2009. A total of 130 suspected case of meningitis patients were included in the study. Among them 102 were diagnosed as meningitis of 66 children with pyogenic meningitis, 36 children with aseptic meningitis and 28 children without meningitis were taken as non meningitis group. This study showed that all patients (100%) had fever. 97 (95.10%) had symptom of convulsion. Vomiting was present in 62 (60.78%), excessive cry or irritability present in 50(49%) cases. This study expressed that 75 (73.53%) patients had bulged fontanel. Neck rigidity was present in 67 (65.69%). Only 32.35% had kernig’s sign positive and 17.65% present with Brudginsky’s sign positive. The infancy was the most vulnerable age for pyogenic meningitis. H. influenzae were the leading pathogen (24.24%) in infancy followed by S. pneumoniae (21.21%). The result shows that among 66 pyogenic meningitis, 26 (39.39%) were completely cured and 24 (36.37%) were cured with sequelae. Out of 36 aseptic meningitis 27 (75.00%) were completely cure.TAJ 2015; 28(1): 6-11

338. The Use of Multiplex PCR Panel in the Diagnosis of Meningitis in Children

BackgroundCerebrospinal fluid (CSF) culture remains the gold standard for the diagnosis of bacterial meningitis, with viral PCR considered when clinically indicated. These tests can take 48–72 hours to result, during which patients receive empiric antimicrobial therapy and remain hospitalized. BioFire FilmArray™ Meningitis/Encephalitis panel (MEP) tests CSF for 14 bacterial, viral, and fungal pathogens with turnaround time of 1 hour. The objective of the study was to compare the results of the MEP to that of bacterial cultures, to evaluate the potential impact on length of stay (LOS) and antimicrobial use in our pediatric population.MethodsA retrospective review of data from MEP processed by Health Network Laboratories in children ≤18 years of age, from February 1, 2016 to December 31, 2017, at Lehigh Valley Children’s Hospital.ResultsA total of 220 MEP results were included in the study, with 46 positive samples. Of the positive samples, five were positive for bacterial organisms, four E. coli and 1 N. meningitidis. Four of the corresponding CSF cultures grew E. coli. The CSF culture corresponding to the MEP positive for N. meninigitidis, was negative, but both samples were collected after one dose of ceftriaxone. Of the positive MEPs, 89% were positive for a viral pathogen, with threesamples positive for Herpes Simplex Virus (HSV). MEPs had a lower average turnaround time of 6.9 hours when compared with CSF cultures of 48.8 hours. Average LOS was 5.7 days for those with a negative MEP compared with 3.8 days for those with a positive viral MEP other than HSV. Empiric antiviral treatment with acyclovir was initiated in 58 patients; patients with a negative MEP for HSV received an average of 3.13 doses.ConclusionThe study showed 100% concordance between MEP and CSF culture for E. coli meningitis. The discordance between CSF culture and MEP corresponding to N. meningitidis indicates that the increased sensitivity of MEP may play a role in the management of partially treated meningitis. The use of the BioFire MEP may be helpful in decreasing the average LOS in patients where a viral etiology other than HSV is identified. Faster turnaround time of MEP may decrease the number of antiviral doses in those with a negative MEP for HSV.Disclosures All authors: No reported disclosures.

326. Malaria vs. Bacterial Meningitis in Children With Spinal Tap in the Luanda Children’s Hospital, Angola

BackgroundIn Sub-Saharan Africa, both malaria (M), and bacterial meningitis (BM) cause fever and central nervous system (CNS) disturbance. We studied their prevalence, characteristics, outcome, and risk factors for poor outcome to better understand the clinical impact of suspected CNS infection in children.MethodsWe conducted a prospective study in the Children’s Hospital (HPDB) in the capital of Angola which attends 300 new patients daily. Spinal tap (ST) was performed for children presenting with altered consciousness, convulsions, prostration, or meningism. The analysis included children aged 3 month to 15 years with confirmed discharge diagnosis in 2016–2017.ResultsOf 941 children, the diagnosis was M in 56% (525), BM in 12% (116), epilepsy/convulsions in 9% (88), and other infections in 6% (60). Of all children, 16% (150/941) died, 6% (45/733) had severe, 14% (93/655) any neurological sequelae, and 27% (243/897) either died or had neurological sequelae. In children with M, the corresponding figures were 7% (35/525), 1.5% (7/476), 4% (19/443), and 11% (54/514). In children with BM, the figures were 41% (47/116), 15% (8/54), 33% (11/33), and 55% (58/105), respectively. Comparing with M, children with BM were younger (median age (IQR) 28 (61) vs. 60 (68) months, P < 0.0001), had an underlying illness (23/97 vs. 19/374, P < 0.0001), like sickle-cell disease (18/96 vs. 9/372, P < 0.0001), longer duration of illness (4 (4) vs. 3 (3) days, P < 0.0001, dyspnea (70/119 vs. 210/463, P = 0.009), were dehydrated (36/113 vs. 67/441, P < 0.0001), or malnourished (38/115 vs. 75/447, P = 0.0001). Multivariate analysis revealed as independent risk factors for death or neurological sequelae age <12 months (OR 1.71, 95% CI 1.02–2.88, P < 0.0001), duration of illness >3 days (2.48, 1.68–3.64, P < 0.0001), malnutrition (1.92, 1.20–3.05, P = 0.006), and dehydration (1.92, 1.16–3.14, P = 0.01). When BM vs. M was included in the analysis, BM appeared as the most important risk factor (OR 8.06, 4.44–14.65, P < 0.0001) and age lost its significance.ConclusionIn suspected CNS infection, M was the final diagnosis of most children. However, BM caused more deaths and neurological sequelae. Amendable factors, such as delay in treatment, dehydration, and malnutrition, appeared as risk factors for poor outcome.Disclosures T. Pelkonen, sanofi pasteur: Investigator, Sanofi Paster funded this study. Paediatric Research Foundation, Helsinki, Finland: Grant Investigator, Grant recipient. Päivikki and Sakari Sohlberg Foundation, Helsinki, Finland: Grant Investigator, Grant recipient

Sero-molecular epidemiology of enterovirus-associated encephalitis in Zhejiang Province, China, from 2014 to 2017

BackgroundRecently, both sporadic and outbreak aseptic meningitis caused by enteroviruses have been reported in Zhejiang Province based on a surveillance system. MethodsThis study analysed the epidemiologic features, phylogenetic characteristics and prevalence of enterovirus neutralizing antibodies (nAbs) from 2014 to 2017 in Zhejiang Province. ResultsA total of 584 samples were collected. Males accounted for 66.07% while females accounted for 33.93%. The median age was 6 years (range: 1–15 years). Cases peaked in May and August (81.17%) and 162 cases (28.93%) occurred in June. We detected 15 serotypes, some of which (E6, E9, E18 and E30) were the dominant serotypes prevalent in different years and geographical regions. Phylogenetic results revealed that all of the isolates from this study belonged to the human enterovirus B family. A total of 329 subjects sampled from a healthy population were tested for nAbs against B5, E6 and E30 in Rui’an county in 2015. The seropositive rate of E30 in each age group was significantly higher than that of the other serotypes. ConclusionEnterovirus-associated encephalitis pathogens circulating in Zhejiang caused sporadic aseptic meningitis in children. The level of nAbs against human enterovirus reflects the history of previous infections in different age groups. Therefore, additional surveillance sites and more precise seroprevalence studies based on these populations are required to gain better insight into the epidemiology of enterovirus-associated encephalitis in Zhejiang Province.

Serum procalcitonin in bacterial & non-bacterial meningitis in children

BackgroundBacterial meningitis is a paediatric emergency with high mortality and morbidity requiring prompt diagnosis and treatment. Clinically, it is often difficult to differentiate between bacterial and non-bacterial meningitis. Several studies have demonstrated the raised values of serum procalcitonin (PCT) in bacterial infections including meningitis but without definite cut-off guidelines. Hence, this study was done to evaluate serum PCT as a marker to differentiate bacterial and non-bacterial meningitis in children and assess its efficacy.MethodsIt was a cross-sectional study done over a period of 5 months (Aug 2016-Dec 2016) in the department of Paediatrics, B P Koirala Institute of Health Sciences (BPKIHS). Fifty children aged 3 months to 15 years with suspected meningitis were enrolled and investigated with relevant investigations like complete blood counts, and cerebrospinal fluid (CSF) analysis along with serum PCT. Patients were classified into bacterial (22) and non-bacterial meningitis (28) according to clinical & CSF findings and data analysed using SPSS software.ResultsSerum PCT levels were significantly higher in bacterial meningitis group (median = 2.04 (1.2–3.18) ng/ml) compared with non-bacterial meningitis (median = 0.35 (0.18–0.35) ng/ml); p < 0.001. The sensitivity and specificity of serum PCT in diagnosis of bacterial meningitis at cut-off level of 0.5 ng/ml were 95.45% and 84.61% respectively. Procalcitonin showed maximum area under receiver operating characteristics (ROC) curve 0.991 (0.974–1.00) (p < 0.001) compared to total leukocyte count and CSF cytochemistry.ConclusionSerum PCT has high sensitivity and specificity for early diagnosis of bacterial meningitis in children. Hence it can be a useful adjunct in differentiating bacterial and non-bacterial meningitis for prompt and better management of the children.

Uncomplicated Late-Onset Group B Streptococcal Bacteremia: Can We Do Less Than 10 Days IV?

* Abbreviations: GBS — : group B streptococcal IV — : intravenous LO-GBS — : late-onset group B streptococcal Late-onset group B streptococcal (LO-GBS) bacteremia remains a common serious infection in early infancy. It can be associated with meningitis, osteomyelitis, or other focal sites of infection but often occurs as uncomplicated bloodstream infection. Current authoritative sources recommend 10 days of intravenous (IV) antimicrobial therapy for uncomplicated LO-GBS bacteremia.1,2 In this issue of Pediatrics , Coon et al3 report an observational, comparative effectiveness study that revealed no difference in group B streptococcus (GBS) recurrence risk in young infants treated with shortened IV courses (≤8 days of IV therapy) versus prolonged courses (>8 days) for uncomplicated bacteremia. We know that 10 days IV works well for this infection and is effective and safe, right? So, why wrestle with questions about duration of therapy? With a growing literature on potential impacts of antimicrobial therapy on the infant microbiome that may matter later in life, risks of antimicrobial resistance, risks associated with hospitalization in general, financial and social burdens of hospitalizations on families, and well-described IV catheter-associated risks during home IV therapy, addressing this question is reasonable. A place to start is, “How did we come to recommendations of 10 days of IV therapy for this entity?” In his 1990 review of recommended durations of antimicrobial therapy for bacterial meningitis in children, Radetsky4 stated, “…the standards for … Address correspondence to Charles R. Woods, MD, MS, Department of Pediatrics, University of Tennessee College of Medicine–Chattanooga, Children's Hospital at Erlanger, 910 Blackford St, Chattanooga, TN 37403. E-mail: charles.woods{at}erlanger.org

Risk Classification for Enteroviral Infection in Children With Meningitis and Negative Gram Stain.

Enterovirus is the most common cause of aseptic meningitis in children. This study aimed at identifying baseline variables associated with a positive cerebrospinal fluid (CSF) Enterovirus polymerase chain reaction (PCR) to aid clinicians in targeting patients who could be tested and treated as outpatients. We performed a retrospective review of children (2 months to 17 years old) admitted to the Children's Memorial Hermann Hospital in Houston, TX, between January 2005 and December 2010 with symptoms of meningitis, CSF white cell count of greater than 5 cells/mm, and a negative CSF Gram stain, who had a CSF Enterovirus PCR. One hundred thirty-seven children were reviewed; median age was 4.7 (0.1-17.1) years, and 79 (58%) were male. Fifty patients (37%) had positive CSF Enterovirus PCR. Only 13 (15%) of the Enterovirus PCR-negative patients had an identifiable etiology. All patients were hospitalized. The mean hospital stay for patients with Enterovirus was 2.9 days; 88% received empiric antibiotics. Rates of antibiotic administration were not different between PCR-positive and PCR-negative groups (P > 0.05). All patients with Enterovirus had a favorable clinical outcome.A predictive model was created using 3 baseline variables independently associated with a positive Enterovirus PCR (P < 0.05): May to November presentation, CSF protein of less than 100 mg/dL, and absence of focal neurologic signs. The model classified patients into 2 risk categories for a positive Enterovirus PCR (low risk, 0% [0/17 patients]; high risk, 42% [50/120 patients]; P < 0.001). Our predictive model can be used to identify children for whom Enterovirus PCR testing is warranted. Such testing could avoid unnecessary hospitalization and antibiotic administration.

Neisseria meningitidis-mediates proinflammatory responses in PMN: Crosstalk TLR-2/c-JunN-Terminal

Neisseria meningitidis is a Gram-negative bacterium emerging the leading cause of bacterial meningitis in children and young adult wide world. The host innate immune response against meningitis is largely unknown. In this study, we show that N.meningitidis robustly activates mRNA and protein expression of tumor necrosis factor (TNF-α) and interleukin (IL-6) in murine bone marrow-derived PMN. Toll-like receptor (TLR-2) and myeloid differentiation primary response gene 88 (MyD88), N.meningitidis also activates the mitogen-activated protein kinase (MAPKs; c-Jun N-terminal kinase (JNK), ERK1/2 and p38 MAPK) pathway. N.meningitidis-induced TNF-α and IL-6 production was dependent on JNK activation. The intracellular reactive oxygen species (ROS), NADPH oxidase-2, and nuclear factor-κB are required for N.meningitides-induced proinflammatory cytokine generation in PMN. Together, we have demonstrated that N.meningitidis-induced activation of host proinflammatory cytokines is mediated through TLR2-dependent JNK signaling pathways.

Accuracy of cerebrospinal fluid and serum S100B protein in the diagnosis of bacterial meningitis in children

Background: The diagnosis of bacterial meningitis is very difficult because of the vague clinical presentation primarily in infants and children. The S100B protein is a brain neurochemistry that may a biomarkers of inflammatory process in the brain and it is thought to have relationship with neuron damage and oxidative stress in bacterial meningitis.Methods: In this study, we measured the levels of S100B protein in CSF and serum by using ELISA method, in children with suspected bacterial meningitis. The diagnosis of proven bacterial meningitis based on positive culture that confirmed the causing bacteria. We analyzed the data by using MedCalc-version 17.6 programe.Results: Eighty patients suspected bacterial meningitis included in this study, 47 (58.8%) male, and mean of age was 29.8 months (SD+32.1). Prevalence of proven bacterial meningitis were 21/80 (26.25%). The main clinical symptoms were seizures, decreased of consciousness, clinically sepsis, positive meningeal sign, vomiting and focal neurologic deficits. The comparison of S100BCSF levels between positive culture and negative culture were 31.4 (SD+32.81) and 29.2 (SD+27.13). A comparison of S100Bserum levels between positive culture and negative culture 114.1 (SD+95.67) dan 74.9 (SD+75.84). Area under curve (AUC) of S100BCSF dan S100Bserum were 0.523 and 0.655, respectively. Levels of S100BCSF protein &gt;54 ng/L and S100Bserum &gt;177 ng/L were optimal criteria for diagnosis bacterial meningitis with sensitivity 29% and 19%, specificity 98% and 98%, respectively.Conclusion:  Levels of S100BCSF and S100Bserum protein have prospective value with high specificity to confirm the diagnosis of bacterial meningitis in children. We can use S100Bserum as addition test for the diagnosis of bacterial meningitis in children if there is contraindication for lumbal puncture.

Catalytic mechanism of type C sialidase from Streptococcus pneumoniae: from covalent intermediate to final product.

Streptococcus pneumoniae is a Gram-positive human pathogenic bacterium, which is the main cause of pneumonia and meningitis in children and the elderly. Three sialidases (or neuraminidases) encoded from Streptococcus pneumoniae could catalyze the cleavage of sialic acid linkages. This mechanism is directly connected with infection, apoptosis, and signaling, and usually considered to be one of the critical virulence factors. Type C neuraminidase (NanC) is unique because its primary product of Neu5Ac2en is considered to be an inhibitor to the other two sialidases. Experimentally, there are two different pathways for the formation mechanism of Neu5Ac2en catalyzed by NanC. In this work, a combined quantum mechanical and molecular mechanical approach was employed in all calculations. Starting from the covalent sialylated intermediate, we first examined the reaction to Neu5Ac2en and found the reaction prefers a direct proton abstraction mechanism rather than the water mediated proton abstraction mechanism. Free energy profiles can confirm that Neu5Ac2en is the major product of NanC. Functional roles of some important residues were also investigated, e.g., D315 acts as the proton acceptor during the formation of Neu5Ac2en, while the general base for the hydrolytic reaction to Neu5Ac. This study can facilitate the understanding of the catalytic mechanism of NanC and has the potential to aid in future inhibitor design studies.

Use of Lumbar Puncture for First Episode of Febrile Seizure among Children 6 Months to 18 Months of Age: A Cross Sectional Study

Introduction: Febrile seizure accounts for the majority cases of the pediatric seizure. Fever with seizure can be either due to febrile seizure or underlying serious infection as meningitis. As seizure may be the only manifestation of meningitis it is important to rule out meningitis in children presenting with fever and seizure.Objective: The objective of this study was to determine the incidence of meningitis among children aged 6 to 18 months presenting with first episode of febrile seizure.Methodology: A prospective observational study was conducted among 94 children with first episode of febrile seizure presenting to the emergency and observation wards of Kanti Childrens' Hospital and subjected to lumbar puncture (LP) as per the American Academy of Pediatrics (AAP) recommendations. The proportion of children with meningitis and no meningitis among the study population was determined, clinical characteristics were compared among these groups and the incidence of meningitis in simple febrile seizure and complex febrile seizure was calculated. The collected data was analysed using SPSS.Results: Twenty (21.3%) cases were diagnosed with meningitis among 94 children enrolled in our study. Meningitis was detected in 38.1% of the cases of complex febrile seizure and 7.7% of cases of simple febrile seizure. In the age group 6 to 12 months, 11 (17.4%) had meningitis while in 12 to 18 months of age, 9 (29%) were detected with meningitis. Meningitis was 7.38 times more likely in cases presenting with complex febrile seizure than simple febrile seizure (OR=7.58; 95% CI 2.24-24.4; p&lt;0.001). Regarding the clinical characteristics, vomiting, fever of more than 48 hours duration prior to onset of seizure, impaired consciousness and complex features of seizure were found to be significantly associated with meningitis in our study.Conclusion: The probability of meningitis among children aged 6 to 18 months presenting with first episode of febrile seizure episode is high. In febrile convulsing children less than 18 months of age, meningitis should be considered even in the absence of signs of meningeal irritation. BJHS 2018;3(2)6:399-402.

Prevalence of Enterovirus Meningitis in Children: Report from a Tertiary Center.

Meningitis is the most frequent infection of the central nervous system and viruses aret he most common agents. Enteroviruses are among the most important causative agents. The goal of this study was to determine Coxsackievirus and echovirus infections in children referred to Bahrami Hospital with the diagnosis of meningitis. Forty children with the diagnosis of meningitis, who were referred betweeen January 2017 and February 2018, were evaluated. Forty cases were evaluated. Twenty two (55%) were males and 18 (45%) females (M/F=2.1). The most common age group was 0-4 years and the most cases were admitted in autumn and summer. Entroviruses are the causative agent of meningitis in 26 (65%) cases, including coxsackieviruse type B5 in 18(69%) and coxsackieviruse type B4 in 2(10%). Six meningitis cases were caused by echoviruses(30%). In both coxsackieviruus and echovirus groups, the most frequent age group was less than four year. Among the 26 cases with enterovirus infection, three were admitted in spring (11.5%), eight in summer (30.7%), 10 in autumn (38.4%) and fice (19.2%) in winter. The most common symptoms in cases with entroviruses infection were fever in 26 (100%) patients and nausea/vomiting in 18 (69.2%). Entroviruses are among the most common viral infections leading to meningitis in Iranian children. Rapid diagnosis will result in early and proper treatment.

Potential Coverage of the 4CMenB Vaccine against Invasive Serogroup B Neisseria meningitidis Isolated from 2009 to 2013 in the Republic of Ireland.

Neisseria meningitidis is a common cause of bacterial meningitis in children and young adults worldwide. The 4CMenB vaccine (Bexsero), developed to combat meningococcal serogroup B (MenB) disease, contains subcapsular antigens that may induce immunity against strains of N.meningitidis, regardless of serogroup. Owing to differential levels of expression and peptide diversity in vaccine antigens across meningococcal strains, the meningococcal antigen typing system (MATS) was developed to estimate the potential MenB strain coverage of 4CMenB. Prior to introducing the 4CMenB vaccine into routine use, we sought to estimate the potential 4CMenB coverage against invasive MenB strains isolated in the Republic of Ireland (RoI) over four consecutive epidemiological years. MATS was applied to a panel of 105 invasive MenB strains isolated during July 2009 to June 2013. Sequence data characterizing the multilocus sequence typing (MLST) alleles and the major 4CMenB target peptides were extracted from isolate genome sequence data, hosted in the Bacterial Isolate Sequencing database (BIGSdb). MATS data indicated that 4CMenB may induce protective immunity against 69.5% (95% confidence interval [CI95%], 64.8% to 84.8%) of circulating MenB strains. Estimated coverage was highest against the most prevalent disease-causing lineage, cc41/44, where the most frequently observed sequence types, ST-154 and ST-41 (21% of isolates, collectively), were typically covered by three antigens. No significant temporal trends were observed. Overall, these data provide a baseline of strain coverage prior to the introduction of 4CMenB and indicate that a decrease in invasive meningococcal disease (IMD) is predicted following the introduction of 4CMenB into the routine infant immunization schedule in the RoI.IMPORTANCE The meningococcal antigen typing system (MATS) is an enzyme-linked immunosorbent assay (ELISA) that measures both the levels of expression and the immune reactivity of the three recombinant 4CMenB antigens. Together with PorA variable-region sequence data, this system provides an estimation of how susceptible MenB isolates are to killing by 4CMenB vaccine-induced antibodies. Assays based on subcapsular antigen phenotype analyses, such as MATS, are important in situations where conventional vaccine coverage estimations are not possible. Subcapsular antigens are typically highly diverse across strains, and vaccine coverage estimations would require unfeasibly large efficacy trials and screening of an exhaustive strain panel for antibody functional activity. Here, MATS was applied to all invasive meningococcal serogroup B (MenB) strains isolated over four consecutive epidemiological years (n = 105) and predicted reasonably high 4CMenB vaccine coverage in the Republic of Ireland.

The value of serum procalcitonin in acute meningitis in children

Early diagnosis and initial therapy are important to reduce the complications of bacterial meningitis. We aimed to evaluate the diagnostic value of serum procalcitonin in children with acute meningitis. We included 40 children (4 months–14 years) suspected to have acute meningitis in our study. Based on the clinical scenario, physical examination and complete analysis of cerebrospinal fluid, patients were assigned into two groups: bacterial meningitis group (24 patients) and aseptic meningitis group (16 patients). Twenty-five apparently healthy children of matched age and sex served as a control group. Procalcitonin, C-reactive protein, and leukocyte count were measured initially at the time of admission and again after 72 h. Initially, patients with bacterial meningitis showed statistically significant higher values of serum procalcitonin than both patients with aseptic meningitis and the control groups (p < 0.001). After 72 h of treatment, patients of bacterial meningitis group showed statistically significant lower values of serum procalcitonin than their initial values (P < 0.05). The cutoff point of procalcitonin needed for early diagnosis of bacterial meningitis was >10 ng/ml at the time of admission. However, values of procalcitonin >2 ng/ml had 100% sensitivity. Whereas, the specificity, negative predictive value and positive predictive value of procalcitonin were 63%, 100%, and 67% respectively. Serum Procalcitonin can be used as an early diagnostic marker of acute bacterial meningitis and its differentiation from aseptic meningitis. In acute bacterial meningitis, it can be used to follow the response to antibiotic therapy.

Characterization of strains of Neisseria meningitidis causing meningococcal meningitis in Mozambique, 2014: Implications for vaccination against meningococcal meningitis.

IntroductionIn sub Saharan Africa, the epidemiology, including the distribution of serogroups of strains of N. meningitidis is poorly investigated in countries outside “the meningitis belt”. This study was conducted with the aim to determine the distribution of serogroups of strains of N. meningitidis causing meningococcal meningitis in children and adults in Mozambique.MethodsA total of 106 PCR confirmed Neisseria meningitidis Cerebrospinal Fluid (CSF) samples or isolates were obtained from the biobank of acute bacterial meningitis (ABM) surveillance being implemented by the National Institute of Health, at three central hospitals in Mozambique, from January to December 2014. Serogroups of N. meningitidis were determined using conventional PCR, targeting siaD gene for Neisseria meningitidis. Outer Membrane Proteins (OMP) Genotyping was performed by amplifying porA gene in nine samples.ResultsOf the 106 PCR confirmed Neisseria meningitidis samples, the most frequent serotype was A (50.0%, 53/106), followed by W/Y (18.9%, 20/106), C (8.5%, 9/106), X (7.5%, 8/106) and B (0.9%, 1/106). We found non-groupable strains in a total of 15 (14.2%) samples. PorA genotypes from nine strains showed expected patterns with the exception of two serogroup C strains with P1.19,15,36 and P1.19–36,15 and one serogroup X with P1.19,15,36, variants frequently associated to serogroup B.ConclusionOur data shows that the number of cases of meningococcal meningitis routinely reported in central hospitals in Mozambique is significant and the most dominant serogroup is A. In conclusion, although serogroup A has almost been eliminated from the “meningitis belt”, this serogroup remains a major concern in countries outside the belt such as Mozambique.

THE MAIN ASPECTS OF THE EFFECT OF MENINGITIS ON THE CENTRAL NERVOUS SYSTEM

The article is devoted to meningitis in children. The author touched upon such questions as a severe form of meningitis, meningococcal infection, effects on the central nervous system, meningoencephalitis, etc. Diagnostics, especially differential diagnosis of meningitis, were considered. Various foreign sources on this topic have been analyzed.

Incidence of paediatric pneumococcal meningitis and emergence of new serotypes: a time-series analysis of a 16-year French national survey

Successive implementation of seven-valent then 13-valent pneumococcal conjugate vaccines (PCVs) led to a marked decrease in pneumococcal disease burden, including pneumococcal meningitis. We assessed the long-term effect of implementation of PCVs on incidence of pneumococcal meningitis in children in France over a 16-year period. We did a quasi-experimental, population-based interrupted time-series analysis with a nationwide prospective survey over 16 years in France, recruiting children aged younger than 15 years from 227 paediatric wards from January, 2001, to December, 2016. The main outcome by the time-series model was the estimated incidence of pneumococcal meningitis per 100 000 children (of a population of 12·6 million children in 2017) before and after PCV7 and PCV13 implementation. The time-series model was based on segmented regression with autoregressive error. We enrolled 1778 children with pneumococcal meningitis. PCV13 implementation led to a significant reduction in monthly incidence of pneumococcal meningitis from 0·12 per 100 000 children before PCV13 to a nadir of 0·07 in December, 2014 (-38%, 95% CI -56·1 to -20·4; p<0·0001). A sharp increase occurred during 2015 and 2016, (+2·3% per month, incidence of 0·13 per 100 000 children at the end of the study period, p=0·0002), mainly related to an increase of serotype 24F, which was frequently penicillin resistant. The early effect of PCV13 implementation greatly reduced the incidence of pneumococcal meningitis in children less than 15 years old. However, a sharp rebound in incidence linked to the emergence of serotype 24F compromised the long-term PCV efficacy. If confirmed in future studies and in other countries, pneumococcal meningitis incidence rebound and 24F emergence should be considered when developing next-generation PCVs. The French Pediatric Infectious Diseases Group, Association Clinique et Thérapeutique Infantile du Val de Marne, Pfizer, and for the National Reference Centre for Pneumococci, the French National Health Agency.

A primary care physician’s approach to a child with meningitis

Background: Paediatric meningitis remains a common cause of childhood morbidity and mortality in developing countries. In children the peak age for meningitis is six to 12 months old, with 90% of cases occurring in children younger than five years. It is imperative that a primary healthcare physician be aware of and is capable of managing this life-threatening condition as most caregivers first present to a primary healthcare physician with their sick child.Discussion: Common symptoms are headaches, photophobia, drowsiness, fatigue, unexplained crying, convulsions, irritability, and lethargy. Signs include fever, vomiting, neck stiffness and signs of increased intracranial pressure. Acute bacterial meningitis, especially meningococcal meningitis can present with petechiae and/or purpura. Cranial nerve palsy occurs commonly in cryptococcal meningitis, which can occur as part of immune reconstitution inflammatory syndrome (IRIS) after initiation of antiretroviral therapy. Older children may present with behavioural changes and localising signs such as hemiparesis and coma.Conclusion: This paper discusses the lumbar puncture technique and findings, drug and non-drug management, information on chemoprophylaxis for bacterial meningitis, and the possible complications of meningitis in children. This is an important area for the primary care physician as they are usually the first port of call by caregivers.

Serotypes of human enteroviruses causing pediatric viral encephalitis and meningitis in Hebei province, China, from 2013 to 2015.

ImportanceViral encephalitis and meningitis are severe infectious diseases responsible for substantial morbidity and mortality in children. Enteroviruses are typically the most common causative agents of viral encephalitis and meningitis.ObjectiveThis study aimed to investigate the etiology of viral encephalitis and meningitis among children in Hebei province, China.MethodsCerebrospinal fluid samples from children with viral encephalitis (n=309) and meningitis (n=133) were collected between Nov 2013 and Dec 2015 and viral pathogens were identified by real‐time and multiplex PCR. Amplification and sequencing of partial VP1 genes was used to type enteroviruses.ResultsThe causative pathogen was successfully detected in 176 (57%) patients with viral encephalitis and 82 (61.7%) patients with viral meningitis. The most common causative agents of both viral encephalitis and meningitis were enteroviruses (55.7% and 64.6% of cases, respectively). The most common enterovirus serotypes identified were echovirus 18, echovirus 6 and echovirus 30. Echovirus 18 accounted for 74.4% of all typed enteroviruses and caused a viral encephalitis and meningitis outbreak in Hebei province in 2015. By contrast, the major enterovirus serotypes circulating in 2014 were echovirus 6 and echovirus 30.InterpretationEnteroviruses were the main causative agents of viral encephalitis and meningitis in children in Hebei province from Nov 2013 to Dec 2015. Echovirus 18 became the leading cause of viral encephalitis and meningitis for the first time in Hebei province in 2015.