Meningitis Research Articles

EPIDEMIOLOGICAL TRENDS OF MENINGITIS IN BRAZIL FROM 2001 TO 2022

Introduction: Meningitis is a worldwide pathology that has a high morbidity and mortality rate. Its pathophysiology consists of an inflammation that affects the meninges, especially in the subarachnoid space, cranial and spinal segments. Materials and methods: Descriptive study that used secondary data to examine the disease "meningitis" that occurred between 2001 and 2022. The data were obtained from the Database of the Department of Information and Informatics of the SUS (DATASUS), accessible at https:/ /datasus.saude.gov.br/informacoes-de-saude-tabnet/. Results: In the years 2001-2022, 452,392 cases were reported in Brazil. The prevalence in the North region reached a total of 18,836 cases, in the Northeast 82,106, Southeast = 236,345, South = 93,353 and Central-West = 21,752, highlighting the Southeast region with the highest prevalence of cases. Discussion: The Southeast region has a higher number of meningitis cases due to the local health infrastructure and population growth in this region. Viral meningitis is one of the most relevant causes as it affects individuals of all ages, being the cause of large epidemic outbreaks and bacterial is a condition of great importance, due to its high mortality and morbidity compared to viral meningitis, the main bacterial agent is Neisseria meningitidis. Conclusion: Meningitis is a serious public health problem due to its intensity of spread and its high morbidity and mortality rate, especially in children. Therefore, it is necessary to highlight the importance of prophylactic methods such as vaccination, which are extremely effective in controlling and eradicating diseases. Keywords: Viral meningitis; Bacterial meningitis; Nursing; Epidemiology

YKL-40 levels in cerebrospinal fluid serve as a diagnostic biomarker for post-neurosurgical bacterial meningitis in patients with stroke.

Previous studies have reported that YKL-40 can serve as a biomarker of infectious diseases and different stroke types. However, evidence supporting its role in diagnosing post-neurosurgical bacterial meningitis (PNBM) remains lacking METHODS: A total of 110 patients with stroke who underwent neurosurgical treatment were recruited. Among these, 36 were diagnosed with PNBM based on the results of bacterial culture/Gram staining or cerebrospinal fluid (CSF) characteristics. CSF levels of YKL-40 and other biomarkers with potential diagnostic utility for PNBM were statistically analysed using univariate and logistic regression models. Receiver operating characteristic (ROC) analysis was performed to investigate diagnostic efficiency. According to univariate analysis, CSF levels of glucose, total protein, white blood cells, polymorphocytes, and YKL-40, as well as the CSF-to-blood glucose ratio, were significantly different between the PNBM and non-PNBM groups. Logistic regression analysis revealed that glucose (p = 0.026), total protein (p = 0.028), and YKL-40 (p = 0.006) levels in the CSF may have independent diagnostic utility for PNBM. Among the three biomarkers, CSF-to-blood glucose (area under the receiver operating characteristic curve [AUC] 0.9208) and YKL-40 (AUC 0.9587) demonstrated strong diagnostic utility. CSF levels of YKL-40, glucose, and total protein played independent roles in the diagnosis of PNBM in patients with stroke.

Reducing the Risk: An Evidence-Based Approach to the Febrile Infant

Fever is the most common complaint for children of all ages who present to an emergency department (ED) for evaluation and treatment. Although most children with fever have a self-limiting viral illness, the infant less than 60 days of age with fever poses a higher risk for an underlying serious bacterial illness (SBI) including urinary tract infections, bacteremia and bacterial meningitis, or an invasive bacterial infection (IBI) including bacteremia. This case is a discussion of a high-risk febrile infant that was evaluated in the emergency department and was ultimately diagnosed with Streptococcus B meningitis. This case emphasizes the importance of heightened vigilance in this high-risk age group for the risk of infection. To prevent mortality and long term morbidities that may result from inadequate treatment or delayed diagnosis and treatment, it is critical to know and strictly adhere to the clinical practice guidelines.

Optimal control and cost-effectiveness analysis for bacterial meningitis disease

In this study, we developed an optimal control deterministic model for the dynamics of bacterial meningitis disease. The objective was to investigate the efficiency and cost-effectiveness of the three controls (prevention, treatment, and screening) in curtailing the spread of bacterial meningitis. To accomplish this, we applied Pontryagin's maximum principle to derive the optimality system. We examined different combination strategies to investigate the effect of the interventions on the spread of bacterial meningitis. We used an incremental cost-effectiveness ratio (ICER) to examine which control technique was the most successful. The simulation results show that combining prevention and screening is the most cost-effective strategy. The objective function and the incremental cost-effectiveness ratio further support this result, indicating that maximum utilization of prevention and screening is required for the entire period.

Chronic Neutrophilic Meningitis in Tuberculous Infection: A Rare Case Presentation and review of the literature

Persistent neutrophilic pleocytosis syndrome is a rare form of tuberculous meningitis that is defined as the persistence of neutrophils in cerebrospinal fluid for more than 7 days, in association with the clinical features of meningitis (headache, fever, and positive meningeal signs).1 The exact pathogenesis of this syndrome is not well known yet, and it has many diverse etiologies, including infectious and noninfectious ones. among infectious ones: bacteria such as Nocardia and Actinomyces, and systemic mycoses such as Aspergillus and the zygomycetes, as well as mycobacterium.2 This entity is very rare in immunocompetent patients, and most of the cases are due to infectious causes in those who are immunocompromised. The usual scenario in such cases is initiating broad-spectrum antimicrobial agents without any improvement, therefore the diagnosis is difficult initially and often delayed. Therefore, the epidemiologic features and clinical profile may offer clues to the etiologic agent, especially in the immunocompromised host.3

NF-κB, neutrophil extracellular traps, and microglial in mice with <em>Streptococcus suis</em> serotype 2 meningitis infection

BACKGROUND Streptococcus suis is the most frequent etiology of zoonotic bacterial meningitis, potentially initiating an outbreak. Acute bacterial meningitis caused by S. suis has various manifestations, often accompanied by sepsis with multiple organ involvement. This study aimed to evaluate the pattern of S. suis outgrowth in the brain, which is associated with nuclear factor-κappaB (NF-κB) activation, neutrophil extracellular traps (NETs) release (NETosis), and microglial activation as three crucial pathological mechanisms of bacterial meningitis. METHODS This study used 64 female BALB/c mice aged 6 weeks and weighed 18−20 g, grouped into infected and non-infected as the control group. Both groups were administered 1 ml of S. suis serotype 2 suspension (1 × 107 colony forming-unit/ml) and normal saline intraperitoneally. The bacterial colony count of S. suis was evaluated, along with NF-κB and NET levels in blood and brain, as well as meningeal inflammation and microglial activation in the brain at Days 1, 3, 5, and 7 post-infection. RESULTS The invasion of S. suis into the brain slightly induced NF-κB activation, leading to a burst of inflammatory responses, neutrophil infiltration with NET releases, and microglia activation that co-occurred, showing their peaks on Days 3 and 5 after onset. CONCLUSIONS The S. suis invasion into the mice’s brain increased NF-κB activation, NETosis, and microglia activation during S. suis meningitis infection.

Iron-chelating agent alleviates chronic hydrocephalus in an experimental model of subarachnoid hemorrhage

Background. The iron-chelating agent is being tested in this research to see whether or not it may aid rats with experimental communicating hydrocephalus caused by an intraventricular blood clot. Subarachnoid hemorrhage (SAH) causes chronic post-hemorrhagic hydrocephalus (CPHH) in one-third of patients, and up to 45 % of patients require permanent cerebrospinal fluid diversion during follow-up, with about 50 % shunt failures within a year. Hemoglobin degradation products induce subarachnoid fibrosis and consequent hydrocephalus, with iron as a critical factor. Iron-chelating agents reduce iron overload after SAH. ­Materials and methods. Our study used Wistar rats weighing 250–500 g. The first group (the controls) was without surgery. In the sham group, 0.15 ml of normal saline was administered into the cisterna magna, followed by a second injection 48 hours later. A 0.15 ml blood injection into cisterna magna was followed by a 0.15 ml blood injection 48 hours later, which was performed in the third treatment group, a blood group minus minocycline (BGMM). The fourth double hemorrhagic group (blood group plus minocycline — BGPM) received iron-chelating agent — minocycline. Transcranial ultrasonography was used in all groups, assessing the Levene index (LI) in the rats before and after surgery. CPHH was defined as a ventricular index above the 97th percentile of the pre-intervention LI (1.297). Morphological signs of SAH (blood in subarachnoid space and ventricular wall damage) were evaluated histologically. Results. Ninety-seven operations were done in 50 rats with a 15% posthemorrhagic postoperative mortality. Hydrocephalus in the BGMM group occurred in 56 % of rats, according to the ultrasonography, and all had SAH features with ependymal integrity disruption, according to histological investigations. The introduction of minocycline in the BGPM group prevented an increase in LI after autologous blood injection (similar values of preoperative mean LI = 1.079 ± 0.096 and postoperative mean LI = 1.034 ± 0.058). The difference between BGMM and BGPM groups was highly significant, with a mean of 0.179 ± 0.029, t(41) = 6.12, p < 0.00001. Conclusions. Based on the findings, minocycline alleviates ventriculomegaly in rats. The data suggests that iron-chelating agents may be utilized to treat and prevent CPHH. By illustrating vascular disorders, the technology may become more valuable.

Adult Work Ability Following Diagnosis of Bacterial Meningitis in Childhood

ImportanceA diagnosis of bacterial meningitis in childhood can lead to permanent neurological disabilities. Few studies have examined long-term consequences for work ability in adulthood.ObjectiveTo compare earnings, work loss, and educational attainment between adults diagnosed with bacterial meningitis in childhood and population comparators.Design, Setting, and ParticipantsThis nationwide registry-based matched cohort study included individuals in Sweden diagnosed with bacterial meningitis in childhood (aged <18 years) from January 1, 1987, to December 31, 2019, and general population comparators matched 1:9 on age, sex, and place of residence. Follow-up was completed December 31, 2020. Data were analyzed from February 7 to September 12, 2023.ExposureA diagnosis of bacterial meningitis in childhood recorded in the National Patient Register.Main Outcomes and MeasuresAnnual taxable earnings (in 2020 US dollars), work loss (sum of sick leave and disability insurance), and educational attainment.ResultsThe cohort included 2534 individuals diagnosed with bacterial meningitis in childhood (mean [SD] age at diagnosis, 4.7 [5.3] years) and 22 806 comparators (13 510 [53.3%] male). Among those with childhood bacterial meningitis, 812 (32.0%) were diagnosed at younger than 1 year and 1351 (53.3%) were male. From 18 to 34 years of age, those with childhood meningitis had lower adjusted earnings relative to comparators and higher adjusted work loss. When pooling observations for individuals 28 years or older, the annual mean reduction in earnings was −$1295 (95% CI, −$2587 to −$4), representing a 4.0% (95% CI, 0%-8.0%) reduction relative to comparators, and the annual increase in work loss was 13.5 (95% CI, 8.6-18.5) days. There was a larger reduction in earnings for those with childhood meningitis relative to comparators with pneumococcal (Streptococcus pneumoniae) vs meningococcal (Neisseria meningitidis) meningitis. For work loss, there was a difference among all 3 major causes of meningitis, with the largest increase for pneumococcal meningitis. Individuals diagnosed at a younger age (below the median) had lower earnings relative to comparators and higher work loss than individuals diagnosed at an older age (above the median). Fewer individuals with childhood meningitis relative to comparators had obtained a high school degree at age 30 years (adjusted odds ratio, 0.68 [95% CI, 0.56-0.81]).Conclusions and RelevanceIn this cohort study of adults diagnosed with bacterial meningitis in childhood, findings suggest that work ability decreases relative to population comparators, with lower earnings and higher work loss, especially among adults diagnosed with pneumococcal meningitis or diagnosed at a young age, with long-lasting costs for the individual patient and society at large.

Socioeconomic Outcomes Associated With Childhood Bacterial Meningitis—Long-Term Socioeconomic Outcomes Matter to Patients

Socioeconomic Outcomes Associated With Childhood Bacterial Meningitis—Long-Term Socioeconomic Outcomes Matter to Patients

Clinical Insights and Outcomes in Community-Acquired Acute Bacterial Meningitis versus Postoperative Bacterial Meningitis.

To compare the demographics, clinical characteristics, and in-hospital mortality rates between community-acquired bacterial meningitis cases and postoperative bacterial meningitis. Analytical study. Place and Duration of the Study: Department of Infectious Diseases and Clinical Microbiology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkiye, from 2016 to 2022. A total of 153 patients diagnosed with bacterial meningitis were included and categorised into two groups: 95 (62.1%) with community-acquired bacterial meningitis (CABM) and 58 (37.9%) with postoperative bacterial meningitis (POBM). Demographics, clinical features, laboratory, paraclinical findings, treatments, and outcomes of the cases were compared. Data were retrieved using a standard data collection form from the electronic medical records. A substantial portion (58.8%) of all patients had comorbidities. Fever was the common symptom in all groups. Headache, neck stiffness, nausea, and vomiting were more often observed in the CABM group (p <0.001). Upon admission, the CABM exhibited higher levels of white blood cell count, C-reactive protein, and procalcitonin (p = 0.017, p = 0.004, p = 0.007, respectively). Overall 33.1% had positive cerebrospinal fluid cultures. The overall mortality rate was 26.8%. POBM was associated with longer hospital and intensive care unit (ICU) stays (p <0.001). Shorter treatment durations, lower Glasgow coma scale scores (GCS), higher Charlson Comorbidity Index values, and elevated markers of inflammation were related to mortality. This study illuminates the differences in clinical presentations and outcomes between community-acquired and postoperative bacterial meningitis. It also suggests that factors such as lower GCS scores, comorbidities, and elevated inflammation markers at the last follow-up may be associated with unfavourable clinical outcomes in bacterial meningitis. Postoperative meningitis, Central nervous system infection, Cerebrospinal fluid, Antibiotics.

Daily functioning and (health-related) quality of life of young adult survivors of childhood bacterial meningitis.

Young adult survivors of childhood BM reported similar and even better levels of daily functioning, HRQoL, and overall QoL than age-matched Dutch reference scores. However, clinicians and healthcare workers should be mindful of poor mental and physical health of some survivors of childhood BM because these survivors also face problems with functioning in daily life. • Acute bacterial meningitis is a life-threatening infection which may lead to devastating lifelong disabilities. • Health-related quality of life is decreased in school-age survivors of bacterial meningitis. • The present study shows that HRQoL in survivors of childhood BM improves over time • However, especially poor mental health in adolescent and young adult survivors is associated with impaired functioning in daily life.

Advances in the pathogenesis and treatment of pneumococcal meningitis.

Streptococcus pneumoniae is a common pathogen associated with community-acquired bacterial meningitis, characterized by high morbidity and mortality rates. While vaccination reduces the incidence of meningitis, many survivors experience severe brain damage and corresponding sequelae. The pathogenesis of pneumococcal meningitis has not been fully elucidated. Currently, meningitis requires bacterial disruption of the blood - brain barrier, a process that involves the interaction of bacterial surface components with host cells and various inflammatory responses. This review delineates the global prevalence, pathogenesis, and treatment strategies of pneumococcal meningitis. The objective is to enhance the thorough comprehension of the clinical manifestations and biological mechanisms of the disease, thereby enabling more efficient prevention, diagnosis, and therapeutic interventions.

Modeling of the brain movement and cerebrospinal fluid flow within porous subarachnoid space under translational impacts

Modeling of the brain movement and cerebrospinal fluid flow within porous subarachnoid space under translational impacts

Protective Antimicrobial Effect of the Potential Vaccine Created on the Basis of the Structure of the IgA1 Protease from Neisseria meningitidis

Background/Objectives: IgA1 protease is one of the virulence factors of Neisseria meningitidis, Haemophilus influenzae and other pathogens causing bacterial meningitis. The aim of this research is to create recombinant proteins based on fragments of the mature IgA1 protease A28–P1004 from N. meningitidis serogroup B strain H44/76. These proteins are potential components of an antimeningococcal vaccine for protection against infections caused by pathogenic strains of N. meningitidis and other bacteria producing serine-type IgA1 proteases. Methods: To obtain promising antigens for creating a vaccine, we designed and obtained several recombinant proteins. These proteins consisted of single or directly connected fragments selected from various regions of the IgA1 protease A28–P1004. The choice of these fragments was based on our calculated data on the distribution of linear and conformational B-cell epitopes and MHC-II T-cell epitopes in the structure of IgA1 protease, taking into account the physicochemical properties of potential compounds and the results of a comparative analysis of the spatial structures of the original IgA1 protease and potential recombinant proteins. We studied the immunogenic and protective effects of the obtained proteins on the BALB/c mice against meningococci of serogroups A, B and C. Results: Proteins MA28–P1004-LEH6, MW140–K833-LEH6, MW329–P1004-LEH6, M(W140–H328)-(W412–D604)-(Y866–P1004)-LEH6 and M(W140–Q299)-(Y866–P1004)-LEH6 have shown the following antibody titers, 103/titer: 11 ± 1, 6 ± 2, 6 ± 1, 9 ± 1 and 22 ± 3, respectively. Also, the last two proteins have shown the best average degree of protection from N. meningitidis serogroups A, B and C, %: 62 ± 6, 63 ± 5, 67 ± 4 respectively for M(W140–H328)-(W412–D604)-(Y866–P1004)-LEH6 and 70 ± 5, 66 ± 6, 83 ± 3 respectively for M(W140–Q299)-(Y866–P1004)-LEH6. Conclusions: We selected two recombinant proteins consisting of two (M(W140–Q299)-(Y866–P1004)-LEH6) or three (M(W140–H328)-(W412–D604)-(Y866–P1004)-LEH6) linked fragments of IgA1 protease A28–P1004 as candidate active component for an antimeningococcal vaccine.

Can a Bayesian approach clarify if corticosteroids are beneficial for severe community-acquired pneumonia?

Despite advances in the antimicrobial treatment of sepsis and organ support in the intensive care unit (ICU), community-acquired pneumonia (CAP) remains a leading cause of mortality and disability-adjusted life years lost globally.1 Severe CAP, where CAP becomes complicated by acute hypoxaemic respiratory failure or shock, is also the most common cause of sepsis, where complex and heterogeneous biological mechanisms underlie a dysregulated inflammatory host response that ultimately leads to major organ dysfunction and death. Along with the emerging threats of respiratory pandemics, antimicrobial resistance, ageing populations and the rise of chronic diseases, much research has been conducted to improve the treatment outcomes of CAP via host immunomodulation. These efforts have focused almost exclusively on anti-inflammatory effects of corticosteroids, which have a proven track record of improving outcomes in other forms of sepsis, such as bacterial meningitis, Pneumocystis jirovecii pneumonia and severe COVID-19.

Integrating Diagnostic Approaches in Infant Bacterial Meningitis Caused by a Non-K1 Escherichia coli: A Case Report

Background: Infant meningitis, particularly caused by Escherichia coli, remains a life-threatening condition, especially in premature and low-weight infants. Infections of the central nervous system can be fatal, necessitating prompt diagnosis and appropriate treatment. Acute infections caused by various pathogens, including E. coli, often present with similar clinical symptoms. The rapid identification of pathogens and their antimicrobial resistance mechanisms is critical for timely and effective treatment. We report the case of an 8-month-old patient who presented with fever, diarrhea, and convulsive seizures and was subsequently diagnosed with meningitis. Despite initial empirical treatment with ceftriaxone, the patient’s condition worsened. Methods: At Bambino Gesù Children’s Hospital, molecular diagnostic tools, including the FilmArray Meningitis/Encephalitis and Blood Culture Identification panels, were employed. Results: Although the Meningitis panel did not detect any pathogens due to the lack of the specific bacterial target, the off-label use of the Blood Culture Identification panel identified a non-K1 Escherichia coli strain carrying the CTX-M resistance gene, an extended-spectrum beta-lactamase (ESBL). Despite the rapid diagnostic approach and adjustment of antibiotic therapy, the patient succumbed to the infection due to the strain’s high virulence and multidrug resistance. Whole-genome sequencing further characterized the strain, revealing that it belonged to the ST131 group, a highly resistant and virulent strain associated with sepsis. Conclusions: This case highlights the importance of integrating advanced molecular diagnostics, such as whole-genome sequencing, with traditional methods to improve pathogen detection, especially in cases of emerging resistant strains that are not covered by standard diagnostic panels. It also emphasizes the need for the continuous adaptation of diagnostic tools to include non-K1 E. coli strains for more comprehensive and timely meningitis diagnosis.

Post traumatic cerebrospinal fluid rhinorrhea: a descriptive study

Background: Post-traumatic CSF rhinorrhea occurs following head trauma or after intracranial surgery. Traumatic CSF rhinorrhea can be detrimental with complications such as bacterial meningitis. Methods: Retrospective review of hospital records of post-traumatic patients admitted under neurosurgery department from 2016-2021 was done. 66 patients with CSF rhinorrhea were identified. Their mode of trauma, management and radiological images were reviewed and recorded. Results: Out of the 66 patients, 87.8% were males and average age group 20-30years. 41 resolved with conservative management. Frontal bone was most common site of rhinorrhea. In 61.8% (n=41) patients, fracture was seen in more than one bone/anatomical site. Incidence of post-traumatic CSF rhinorrhea in this study in 6.6%. Conclusions: Early diagnosis and management are important to prevent complications. In majority of cases, the leak subsides with conservative management, hence early surgical intervention is not required.

THE ETIOLOGICAL PROFILE AND ALTERATIONS IN CEREBROSPINAL FLUID CHARACTERISTICS IN PATIENTS WITH BACTERIAL MENINGITIS

Currently, bacterial meningitis (BM) remains a form of life-threatening infectious pathology, with a mortality rate ranging from 4% to 35% and poor prognosis often accompanied by diverse specific and non-specific complications, including infectious toxic shock, cerebral edema, ventricular inflammation, hydrocephalus, acute cerebrovascular accidents, venous sinus thrombosis, disseminated intravascular coagulation (DIC) syndrome, respiratory distress syndrome (RDS) syndrome, inappropriate secretion of antidiuretic hormone, and systemic inflammatory response syndrome. In clinical practice, the early identification of the causative microorganism and the implementation of proper antibiotic treatment, as well as a comprehensive assessment of the patient's status and management, are crucial for minimizing a risk of related severe complications and mortality. The BM etiology is characterized by a highly variable nature, contingent upon a multitude of factors such as geographic location, temporal context, patient age, immunological status, and other variables. Over the past two to three decades, advancements in conjugate vaccines and the use implementation of antibiotic treatment have brought about alterations in the spectrum of pathogens responsible for meningitis. The objective of this study was to delve into the etiological profile and prognostic implications of cerebrospinal fluid (CSF) parameters among patients with diagnosed meningitis admitted to the Neuroinfectious Diseases Division of the Infectious Clinical Hospital №2 (Moscow) between 2022 and 2023. A retrospective analysis of medical records of meningitis patients admitted to the Infectious Clinical Hospital №2 during 2022–2023 was conducted. The data were analyzed using the k-means clustering algorithm implemented in the Loginom analytics software to create a scenario, as well as OLAP cubes. The study involved the analysis of medical records for 110 patients aged 18-89 years old. Among the BM pathogens identified, Neisseria meningitidis emerged as the most prevalent in this patient cohort, accounting for 68.2% of cases. Within the group of meningococcal meningitis cases, serovariants A and W135 were the most frequently detected, accounting for 49.3% and 33.3%, respectively. Significant alterations in cerebrospinal fluid parameters, characterized by elevated cell counts and lowered glucose levels, were observed among patients with purulent meningitis resulting from serogroup A Neisseria meningitidis infections. A combination of elevated baseline cell level along with high concentrations of proteins, and lactate, coupled with the presence of D-dimer in cerebrospinal fluid, has been associated with a severe disease progression and the emergence of critical and life-threatening sequelae.

Evaluation of children with acute central nervous system infections admitted to the pediatric intensive care unit and pediatric ward: a retrospective study

ObjectivesAcute central nervous system (CNS) infections in children can lead to neurological complications and mortality. This study aimed to identify the clinical manifestations, laboratory parameters, and cerebrospinal fluid characteristics indicative of CNS infections and define the risk factors that lead to pediatric intensive care unit (PICU) admission in the pediatric population of Şanlıurfa, a city in southeastern Turkey.MethodsThis retrospective analysis included patients aged 1 month to 18 years who were treated for acute CNS infections in the Şanlıurfa Training and Research Hospital between January 2020 and May 2023. Clinical data were obtained from the hospital electronic medical records.ResultsA total of 68 patients with acute CNS infections were included in this study. The median patient age was 3 (0.94–8.75) years. Fever was the most prevalent symptom in 92.6% of the patients. Of the total, 25% (n = 17) of the patients had an identified causative agent and 35.3% (n = 24) were admitted to the PICU. Serum C-reactive protein (CRP) levels were significantly higher in patients with bacterial meningitis than in those with viral meningitis (p = 0.007). Patients with impaired consciousness and seizure were significantly more likely to require admission to the PICU than patients without these conditions (both p < 0.001). Patients requiring PICU admission had significantly higher platelet counts (p = 0.01).ConclusionsImpaired consciousness, seizure, and thrombocytosis on admission were important risk factors for PICU admission. Serum CRP levels can serve as an indicator of bacterial meningitis. A combination of physical findings from clinical evaluations and laboratory data is necessary to accurately diagnose bacterial CNS infections.

Optic Nerve Sheath Dilation Is aPossible Marker of CSF Dyshomeostasis in Idiopathic Intracranial Hypertension.

Idiopathic intracranial hypertension (IIH) is acomplex neurological disease characterized by symptoms of raised intracranial pressure of unclear etiology. Although optic nerve sheath dilation is acommon MR neuroimaging feature of IIH, how and why it occurs remains poorly understood. The purpose of the presented analysis was to investigate if optic nerve sheath dilation might be associated with neuroimaging correlates of cerebrospinal and interstitial fluid homeostasis. IIH patients were retrospectively identified from 2016-2023 from our tertiary healthcare system. Brain MRIs were computationally segmented using FreeSurfer. Additionally, diffusion tensor imaging along the perivascular space (DTI-ALPS) was employed to assess cerebral glymphatic flow. The mean perioptic subarachnoid space (PSAS) to optic nerve sheath diameter (ONSD) ratio from both eyes was correlated with neuroimaging markers of CSF and interstitial fluid homeostasis (choroid plexus, ventricle, and gray and white matter volume) and glymphatic flow. All volumes of interest were normalized to total intracranial volume. Multiple linear regression was used to evaluate for associations between continuous variables accounting for covariates of patient age, sex, and body mass index. In total, 55 IIH patients (89% female; mean age: 30.3 years [SD: 7.6]) were included. Increasing PSAS/ONSD was found to be significantly associated with increasing normalized total choroid plexus volume (p = 0.001, R = 0.48) and total ventricle volume (P = 0.014, R = 0.39). Additionally, increasing PSAS/ONSD was associated with declining/worsening cerebral glymphatic clearance based on DTI-APLS (p = 0.043, R = 0.34). Additionally, there was asignificant association between increasing PSAS/ONSD and increasing normalized total gray matter volume (p = 0.025, R = 0.36) and declining normalized total white matter volume (p = 0.012, R = 0.40). These findings suggest that MR optic nerve sheath dilation in IIH might be associated with CSF dyshomeostasis with possible choroid plexus hyperplasia and impaired cerebral glymphatic flow based on DTI-ALPS. These findings encourage future research into the ocular glymphatic system in IIH patients.