Purulent Bacterial Meningitis Research Articles

AUSTRIAN SYNDROME: A RARE CASE REPORT.

Austrian syndrome is a rare and fatal triad of pneumonia, meningitis and endocarditis caused by Streptococcus pneumoniae, with a mortality rate of 60%. We report a case of Austrian syndrome in a 59-year-old patient, with a history of arterial hypertension on angiotensin 2 receptor antagonist therapy for five years, chronic smoking at 20 packs per year and occasional enolism for fifteen years, presenting with prolonged fever associated with loss of consciousness with no respiratory or cardiac signs, in whom purulent bacterial meningitis with positive Gram stain, infective endocarditis with mitral and aortic localization and interstitial pneumopathy have been demonstrated with negative blood cultures. Although the mortality rate is very high, early management of Austrian syndrome can improve the patient's quality of life.

Epidemiological Features of Purulent Bacterial Meningitis in the Russian Federation at the Present Stage

Relevance. The decrease in the number of cases of invasive diseases caused by N. meningitidis, S. pneumoniae, H. influenzae and in the world has been associated with measures against the spread of the 2019 coronavirus disease (COVID-19).Aim. Presentation of the epidemiological features of purulent bacterial meningitis (PBM) in the Russian Federation at the present stage.Materials and methods. On the basis of the Russian Reference Center for Monitoring Bacterial Meningitis (RCMC), an in-depth personalized system for recording PBM cases has been established. Since 2010, all territories of the Russian Federation have been included in the monitoring system. In 2022, the RCMC received information on 1596 cases of PBM. The descriptive-evaluative epidemiological method was used in the work: a retrospective analysis.Results. The increase in the incidence of a generalized form of meningococcal infection (GFMI), which began in 2017, was recorded in 2018 and 2019, but in 2020–2021 growth was interrupted: the indicator dropped sharply, amounting to 0.26–0.21 per 100 thousand of the population, which is most likely due to the disunity of the population as a result of measures aimed at combating the new coronavirus infection. Measures to combat COVID-19 were canceled in 2021, and already in 2022 the incidence rate of GBM increased by 1.4 times, while the GFMI by 2 times, amounting to 0.44 per 100 thousand of the population. A sharp decrease in the incidence of PBM caused by S. pneumoniae and H. influenzae in 2020-2021 was replaced in 2022 by an increase in the incidence of pneumococcal meningitis, however, the incidence of meningitis caused by H. influenzae remained at the same level.Conclusion. Continued monitoring of the incidence of PBM and the properties of the pathogen are extremely important tasks in order to identify risk groups and areas for the timely optimization of vaccination measures, given that the three infections that cause bacterial meningitis are vaccine-controlled, and vaccination is recognized as the most effective measure to combat meningococcal, pneumococcal and hemophilic infections.

Purulent Bacterial Meningitis in the Russian Federation: Epidemiology and Immunization

Relevance: Purulent bacterial meningitis and invasive meningococcal disease remain relevant throughout the world and are of particular concern due to high mortality and disability rates, as well as regular outbreaks of meningococcal infections. Objective: To establish epidemiological features of purulent bacterial meningitis and meningococcal disease in the Russian Federation and to highlight the problem of immunization. Materials and methods: Data were collected at the Russian Reference Center for Bacterial Meningitis Monitoring of the Central Research Institute of Epidemiology in the personified system for registering cases of purulent bacterial meningitis, including meningococcal disease, meningitis of non-meningococcal and unknown etiology. We examined 28,440 registered cases. Results: We established that three pathogens, that is, meningococcus, pneumococcus and Haemophilus influenzae, accounted for 84 % of all cases of bacterial meningitis, the most vulnerable age group being children under 5 years of age. Despite a general decrease in the incidence of purulent bacterial meningitis in the Russian Federation in 2010–2019, we noted an increasing incidence of pneumococcal meningitis and invasive meningococcal disease by the end of the study period. In terms of age, the 10-year observation period demonstrated a decrease in the incidence of invasive meningococcal disease in children and its rise among adolescents and young adults; an increase in the incidence of pneumococcal meningitis in adults and a null decrease in children; and the absence of a downward trend in the incidence of Haemophilus meningitis in children. Discussion: Organization of epidemiological monitoring of bacterial meningitis within the system of epidemiological surveillance in the Russian Federation in 2010, its testing and 12-year implementation has enabled us to trace changes in the incidence, mortality, and fatality of the disease and to establish age groups at risk. To reduce the burden of the disease, it is expedient to further improve the existing immunization programs in the Russian Federation.

Indirect Obstetrics Causes of Maternal Death: A-20 Year Retrospective Autopsy Study at the Korle-Bu Teaching Hospital

Background: The pattern and contributions of indirect causes of maternal deaths in Ghana from autopsy data have not been studied. The aim of this study was to estimate the proportions, the spectrum and demographic characteristics of maternal deaths that resulted from indirect obstetrics causes, and to offer recommendations.Material and methods: This was a retrospective study of the above stated parameters from autopsy records in the department of pathology of Korle-Bu Teaching Hospital (KBTH).Results: Approximately 15.2%, of all maternal deaths during the period of study were indirect obstetric causes with a mean age of 28.0 years. About 32.5% of the deaths were recorded in women within 25 – 29 year age group. A little more than a third (35.9%) of the deaths occurred in a health facility. The common underlying indirect causes of death were: infections 99 (39.4%), SCD 73 (29.1%), anaemia in pregnancy 32 (12.7%), chronic liver disease (CLD) 15 (6.0%), cardiovascular disorders (CVS) 10 (4.0%), pulmonarythromboembolism (PE) 8 (3.2%) and neoplastic lesions 5 (2.0%). The common infections were: HIV/AIDS 24 (24.2%), pneumonia 19 (19.1%), purulent bacterial meningitis 17 (17.2%), malaria 9 (9.1%) and tuberculosis 8 (8.1%). The common complications of SCD leading to death were: anaemia 40 (54.8%), haemolytic crisis 10 (13.7%) and acute chest syndrome 9 (12.3%). The major complications of anaemia and CLD in pregnancy leading to death were congestive cardiac failure 28 (87.7%) and septicaemia 7 (46.7%). Deaths due to CLD 3 (37.5%) CVS 6(40.0%) and neoplastic lesions 3 (60.0%) were commoner within the age group of 30 – 34 years. Deaths due to CVS disorders 6 (60.0%) and neoplastic lesions 3 (60.0%) occurred commonly in health facilities.Conclusion: The study found that 15.2% of all maternal deaths were due to indirect causes. These commonly occurred in the community and in the 25 -29 year age group. Infections were the commonest cause of death. The authors conclude that indirect causes of maternal deaths cannot be ignored and that efforts should be focused on their reduction. Research is needed in thisarea of maternal death including the mechanisms by which these cause death and what programme could reduce it.

Impact of Nonspecific Antipidemic Measures against COVID-19 on the INCIDENCE of Acute Purulent Meningitis during the Pandemic

Relevance. Nonspecific anti-epidemic measures against СOVID-19 (mask-wearing, social distancing, lockdowns, homework, quarantines, school closures, tourism bans, etc.) resulted in a significant decrease in the incidence of many respiratory infections. Scientific publications have reported a decrease in the incidence of bacterial purulent meningitis (BMP) during the development of the COVID-19 pandemic.Aims. To review the scientific publications on the decline in the incidence of BMP during the СOVID-19 pandemic.Conclusions.Undoubtedly non-specific anti-epidemic measures taken during the COVID-19 pandemic helped to reduce the incidence of respiratory infections regardless of their etiology and could serve as an indirect indicator of the activity of these measures.

Quantitative Electroencephalography Indicators in Children with Acute Purulent Meningitis.

The aim of the present work was to assess the state of brain bioelectrical activity in children during the acute period of bacterial purulent meningitis, with quantitative mathematical analysis of the changes found. The studies included 31 children on days 1 and 6 from onset of illness: 16 children (8.9 ± 2.4 years) admitted to the Pediatric Scientific Clinical Center for Infectious Diseases with laboratory confirmation of diagnoses of purulent meningitis (due to Neisseria meningitidis) (n = 11) or Streptomyces pneumoniae (n = 2) or unidentified pathogen (n = 3)), along with 15 healthy children. Electroencephalogram (EEG) traces were recorded from all these children in the state of calm waking using a Neuron-Spectrum 4/VP 16-channel electroencephalograph. Clinical assessment of the EEG included analysis of background rhythms, zonal differences, and detection of pathological types of activity. Quantitative analysis consisted of the mean power (μV2) and amplitude (μV) of the α, θ, and δ rhythms, along with mean power ratios – α/θ and α/δ. Visual analysis of the EEG in 100% of children in the acute period of purulent meningitis showed diffuse slowing with detection of δ and θ waves. Focal changes in the form of sharp waves were seen in 18.8% of cases (three patients). No cases displayed periodic activity. Meningitis patients showed significant reductions in the α/δ (p = 0.001) and α/θ (p = 0.048) spectral ratios. ROC analysis showed that the α/θ value was <0.18 and the α/δ value was <0.02 (sensitivity 100% and specificity 80%, AUROC 0.9), which may be evidence of the likely development of cerebral edema. Thus, pediatric patients with acute purulent meningitis showed significant impairments to the normal α/θ and α/δ rhythm power ratios on the EEG, which is presumptively explained by suppression of the functional activity of the thalamus and thalamocortical pathways, as well as the reticular formation of the brain.

Bacterial purulent meningitis in children: is there a light at the end of the tunnel?

Bacterial purulent meningitis is a life-threatening disease characterized by high mortality and severe consequences in survivors. Despite the modern possibilities of medicine, the disease continues to be a heavy burden on health care, the economy and society everywhere.Aim. To draw the attention of doctors to the problems associated with modern features of epidemiology, the consequences and possibilities of preventing bacterial purulent meningitis, especially in children, who constitute the main risk group for the development of this pathology.Literature review of Russian and foreign publications on the problem under consideration presented.Vaccination is recognized as one of the main tools for reducing morbidity and mortality from meningitis. Prophylactic vaccinations against N. meningitidis, Str.pneumoniae, H. influenzae, along with strict adherence to anti-epidemic measures in hospitals providing care to newborns, can help reduce the incidence of purulent meningitis in children and improve outcomes if they develop.

Epidemiological characteristics of staphylococcal meningitis in Russian Federation

Staphylococcal meningitis (SM) ranks fourth in the etiological structure of purulent bacterial meningitis in the Russian Federation. The most common cause of staphylococcal meningitis is Staphylococcus aureus, which accounts for 68 % of all cases. This meningitis is characterized by a higher mortality rate (30 %) than staphylococcal meningitis of other types of Staphylococcus (13 %) and mainly affects people over 25 years of age. With increasing age, the probability of death increases, and among people over 65 years of age, the mortality rate reaches 44 %.

The effect of new derivatives of 3-hydroxypyridine on the development of brain edema in bacterial purulent meningitis in experimental conditions

Bacterial purulent meningitis (BPM) is one of the most severe infectious and inflammatory diseases of the nervous system, which is characterized by high mortality and frequent development of residual neurological deficits. Edema and swelling of the brain is the most common cause of death in patients with neuroinfections. Most often, brain edema develops in pneumococcal meningitis (PM), which has the highest mortality rate among all bacterial meningitis. The aim of our work was to study the effect of new derivatives of 3-hydroxypyridine, 2-ethyl-6-methyl-3-hydroxypyridinium 2.6-dichlorophenyl (amino)phenylethanoic acid (EMHDA) and bis(2-ethyl-6-methyl-3-hydroxypyridinium) 2.6-dichlo-rophenyl (amino)phenylethanoic acid (B-EMHDA), on the degree of brain edema in the simulation of BPM in experimental conditions.Material and methods. BPM was modeled by injecting a suspension containing Streptococcus pneumoniae at a concentration of 5 x 109 CFU/ml into the subarachnoid space of the brain. The degree of severity of cerebral edema in rats was assessed by determining the content of total water, free and bound fractions in the brain tissue, as well as the hydration coefficient. The lower the hydration coefficient, the more pronounced the cerebral edema. Determination of the content of water fractions in brain tissue and blood was carried out by the thermogravimetric method.Results and discussion. 24 hours after the induction of meningitis, the free water content increases and the amount of bound water decreases. That testifies to the development of cerebral edema. Hydration coefficient in the group treated with EMHDA at a dose of 50 mg/kg, increased by 11.5 % relative to the control group; in the group receiving EMHDA at a dose of 25 mg/kg, increased by 15.3 % compared to the control group (p&lt;0.05). Hydration coefficient in the group treated with B-EMHDA at a dose of 50 mg/kg, increased by 23 % relative to the control group; in the group receiving B-EMHDA at a dose of 25 mg/kg, increased by 26.9 % compared to the control group; and the group receiving B-EM-HDA at a dose of 12.5 mg/kg was 19.2 % higher relative to the control group (p&lt;0.05).Conclusion. Brain edema is least pronounced when using B-EMHDA at all three studied dosages - 50, 25 and 12.5 mg/kg. Injection of EMHDA at doses of 50 mg/kg and 25 mg/kg also helped to reduce the degree of brain edema when modeling BPM in experimental conditions.

Бактериальные гнойные менингиты: проблемы диагностики и лечения на догоспитальном этапе

Бактериальные гнойные менингиты: проблемы диагностики и лечения на догоспитальном этапе

Bacterial meningitis imaging in children

In this review, we provide the data on the modern use of different MRI modalities and computer tomography (CT) as diagnostic and prognostic tools for meningitis of various etiology, first of all, bacterial purulent meningitis. Each of these techniques has its own field of application depending on the stage of the disease and the patients condition (necessity of intensive care procedures, ventilation support). The opinions on the diagnostic value of CT and structural MRI data differ and depend on the etiology and phase of the inflammatory process. In the recent years, the techniques of multiparametric MRI are widely implemented in the practice. Beside structural MRI, they include diffusion-weighted imaging (DWI), diffusion tensor imaging (DTI) and MR spectroscopy (MRS), as well as studies with artificial contrast; there are some reports that these modalities are more effective as a diagnostic tool in meningitis. Thus, the use of multiparametric MRI techniques and CT with contrast is promising and justified for the diagnostics of patients with bacterial purulent meningitis from the viewpoint of enhanced sensitivity.

Cerebroprotective Effects of 2-Ethyl-6-methyl-3-hydroxypyridine-2,6-dichlorophenyl(amino)phenylethanoic Acid in the Treatment of Purulent Meningitis.

Purulent meningitis (PM) is a severe disease, characterized by high mortality and a formation of a residual neurological deficit. Loss of treatment of PM leads to the lethal outcome in 100% of cases. In addition, death and the development of residual neurological complications are possible despite adequate therapy. The aim of the study was to evaluate the cerebroprotective effects of a new pharmacological compound 2-ethyl-6-methyl-3-hydroxypyridine-2,6-dichlorophenyl(amino)phenylethanoic acid (EMHDPA) on the bacterial purulent meningitis in a model of experimental pneumococcal meningitis. Meningitis was simulated by intrathecal injection of the suspension containing Streptococcus pneumoniae at the concentration of 5 × 109 CFU/mL. The cerebroprotective effect was evaluated by survival rates, the severity of neurological deficit, investigatory behaviors, and results of short-term and long-term memory tests. The group administered with EMHDPA showed high survival rates, 80%. Animals treated with the studied compound showed a higher clinical assessment of the rat health status and specific force, and a lesser intensity of neurological deficit compared to the control group (p < 0.05). Locomotor activity of the animals treated with EMHDPA was significantly higher compared to the control group (p < 0.05). There is a decrease in the activity of all estimated indicators of oxidative stress in the group administered with 2-ethyl-6-methyl-3-hydroxypyridine-2,6-dichlorophenyl(amino)phenylethanoic acid relative to the control group: a decrease in the activity of catalase—17%, superoxide dismutase—34%, malondialdehyde and acetylhydroperoxides—50%, and nitric oxide—85% (p < 0.05). Analysis of the data obtained during the experiment leads to the conclusion about the effectiveness of 2-ethyl-6-methyl-3-hydroxypyridine-2,6-dichlorophenyl(amino)phenylethanoic acid in the treatment of the experimental PM.

Cortisol and laboratory indicators of systemic inflammation in case of bacterial purulent meningitis and viral encephalitis in children

Pediatric bacterial purulent meningitis (BPM) and viral encephalitis (VE) are significant medical and social problems due to their course severity, high frequency of death cases, and formation of neurologic deficiency at the disease outcome. Activation of hormonal regulation and severity syndrome of systemic inflammatory response are important factors to evaluate the character of BPM and VE course.Objective.To study the level of cortisol and laboratory indicators of systemic inflammation in children with various variants of BPM and VE course depending on the period of the disease (acute period, reconvalescence) to specify their role in the pathogenesis of acute neuroinfections.Object and methods.There were investigated hematological indicators, the level of cortisol, C-reactive protein in blood serum of 60 children, 39 of them had BPM and 21 ones VE. The comparison group included 14 children aged from 1 to 14 years old who were undergoing rehabilitation care due to neurologic problems at the Federal State-Financed Institution Pediatric Research and Clinical Center for Infectious Diseasesunder the Federal Medical Biological Agency.Results.The patients were divided into some subgroups according to the severity of their condition at the moment of hospitalization, i.e. urgent condition or critical condition requiring organ replacement therapy. The maximum increase of cortisol level and laboratory markers of systemic inflammation during the acute period was revealed in case of BPM in comparison with VE with a subsequent normalization to the stage of reconvalescence. Thelevel of cortisol during the acute period of BPM was reliably higher in the subgroup with urgent conditions, whereas in case of VE in the subgroup with critical conditions. There were no significant differences in the laboratory indicators of systemic inflammation response among the subgroups. There was established a correlation interrelation of cortisol level and the content of granulocytes and blood lymphocytes.Conclusion.There were identified characteristic features of cortisol content in children with bacterial and viral neuroinfections depending on the course of the disease.

Major and minor lymphocytes subpopulations in peripheral blood and cerebrospinal fluid of children with meningitis

Introduction. The analysis of current publications indicates at our insufficient understanding of subpopulation composition of lymphocytes in peripheral blood and cerebrospinal fluid (CSF) during pediatric neuroinfectious diseases. It has been found that the main lymphocyte populations are divided into many small (minor) subpopulations.The purpose of this research was to assess percentage of major and minor blood and CSF lymphocyte subsets in children with aseptic viral meningitis (AM) or bacterial purulent meningitis (BM).Materials and methods. Phenotyping of blood and CSF lymphocytes of children aged from 4 months to 17 years diagnosed with AM (n = 86) and BM (n = 39) was carried out by using flow cytometry. As a comparison group, we analyzed peripheral blood and CSF samples collected from children with acute respiratory viral infections (ARVIs) associated with syndrome of meningism (n = 27). There was evaluated percentage of the major cell subpopulations (CD3+ T-lymphocytes, T-helpers — CD3+CD4+ Th, cytotoxic T-lymphocytes — CD3+CD8+ CTL, natural killer cells — CD3-CD16+CD56+ NK, B-cells — CD3-CD19+), as well as minor lymphocyte subsets (double positive (DP) (CD3+CD4+CD8+), double negative (DN) (CD3+CD4-CD8-) T-cells, NKT (CD3+CD16+CD56+), CD3-CD8+ NK, CD3+CD8dim and CD3+CD8 8bright).Results. It was found that the acute period of BM and AM vs. the comparison group (ARVI) was characterized by significant differences in the blood and CSF composition of major and minor lymphocyte subsets. In particular, blood T-cells, Th, CTL, NK, NKT, DN, CD3-CD8+ NK, CD3+CD8bright and CD3+CD8dim dominated in parallel with significantly lowered B-cell frequency in AM vs. BM. In the CSF of children with AM, T-cells and Th prevailed, whereas count of B-cells and CD3-CD8+ NK was lower compared to those in BM. In addition, further differences were revealed in CSF and blood cell subset composition depending on nosological entity, while maintaining differences in some major and minor lymphocyte subpopulations lacked in the comparison group. Calculating the CSF/blood ratio for the major and minor lymphocyte subsets uncovered the prevalence for the majority of cell subpopulations (the coefficients ranged from 1.2 to 16.4) in the CSF of the comparison group (ARVI), except B-cells, NK and CD3-CD8+ NK (coefficients ranged from 0.07 to 0.31). AM and BM were featured with various changes in the CSF/blood ratio found for most of the studied subpopulations in the acute period as well as the recovery phase highlighted with characteristic traits for each nosological form.Conclusion. The data obtained indicate about finding specific features in the activation of systemic and intrathecal immune response during viral and bacterial meningitis in children, which may be used as an additional differential diagnostic criterion.

Etiological role and molecular-genetic features of &lt;i&gt;Streptococcus pneumoniae&lt;/i&gt; in children’s infectious diseases

Objective: To study the etiological role, serotype distribution and prevalent Streptococcus pneumoniae genotypes (sequence types) in 459 children hospitalized with acute purulent otitis media, acute tonsillitis, community-acquired pneumonia, and purulent bacterial meningitis. Pneumococcal cultures isolated from patients were tested for sensitivity to antimicrobials, and presence of resistance genes. Materials and Methods: The cultural and molecular methods (PCR, sequencing) were used. Statistical analysis was carried out using Microsoft Excel 2007 and Statistica 6.0. Results: S. pneumoniae was detected in 16,8%. The prevalent serotypes were 19F (39.7%) and 19A (13.2%) — representatives of multidrug-resistant clonal com-plex 320. Isolates of serogroup 6 (6AB, 8.82%) belonged to clonal complex 315, and characterized by resistance to macrolides, clindamycin and tetracycline. From 70.6% to 88.2% of S. pneumoniae serotypes isolated from patients corresponded to «vaccine»-types.

Study of Behavioural Activity and Cognitive Impairment in Rats in the Simulation of Pneumococcal Meningitis

Aim. To study neurological disorders in rats when modeling purulent bacterial meningitis (PBM) on the example of pneumococcal meningitis under experimental conditions.Materials and methods. Pneumococcal meningitis was modeled by injecting a suspension containing Streptococcus pneumoniae at a concentration of 5×109 CFU/ml into the subarachnoid space. The degree of neurological disorders was determined by clinical assessment of rat health status, the degree of neurological defi cit, specifi c strength, “Infrared activity monitor”, “Object recognition task” tests.Results. When modeling pneumococcal meningitis in rats, the sum of points of clinical assessment of their health in the 1st day after modeling the pathology is 34.2 % less than the initial, on the 5th — less than 3.4 %, on the 8th day returns to the primary indicator, 5 points. The maximum degree of severity of neurological defi cit was observed in the fi rst four days after meningitis modeling; it was in the 1st day 34 % less than the same indicator in the group of intact animals, on the 2nd day 32.7 % less, on the 3rd day — 30.7 % and on the 4th day — 30.1 %. In the meningitis group on day 10, the distribution of neurological defi cit by severity was as follows: mild — 32 %, medium — 20 %, severe — 16 %, without residual neurological defi cit — 32 %. The specifi c strength of rats in the group of meningitis on the 1st, 5th and 10th day after the development of the pathology was 48.7, 64, and 67.4 % of the baseline specifi c strength. In relation to intact animals, the index of recognition of short-term memory in rats of the meningitis group is 2.3 times greater, and the index of recognition of long-term memory is 1.7 times greater.Conclusion. The dynamics of neurological disorders in rats in the simulation of PBM can be determined using the methods of assessing behavioural and cognitive status. In rats, when modeling pneumococcal meningitis, neurological disorders are maximally expressed on the 1st day of the disease. Then there is a distinct positive dynamic up to 5 days of the disease. From 6 to 10 days positive dynamics is present, but insignifi cant.

Listeriosis of the Central nervous system

To study the main causes of severe course and high mortality in patients with nervous form of listeriosis. The analysis of the course of Listeria meningoencephalitis (LM) in 36 patients aged from 9 to 85 years, who were treated in the Infectious clinical hospital No. 2 DZM (IKB No. 2 DZM). Along with standard examination methods, blood and cerebrospinal fluid (CSF) polymerase chain reaction tests were performed to identify Listeria monocytogenes. The sensitivity of the pathogen to antibiotics was determined by serial dilutions on the WalkAway 96 Plus device of Siemens, USA. LM in 84% of cases developed in patients with disorders in the immune system, in particular, with infection with the human immunodeficiency virus - in 25% of cases. The clinical picture of the disease, changes in CSF were not typical for bacterial purulent meningitis of another etiology. It is noted that LM is characterized by early involvement of the substance and ventricles of the brain in the process. Severe course and high mortality are due to atypical picture of the disease, late diagnosis, low bioavailability of the pathogen for antibiotics (intracellular persistence of the pathogen) and frequent resistance to them. The mortality from the nervous form of listeriosis was 33.3%.

Efficacy of laboratory methods of diagnostic of purulent bacterial meningitis.

According to the World Health Organization, every year about 1 million cases of purulent bacterial meningitis (PBM) are registered in the world, of which 200 thousand cases end in death. Bacterial meningitis is polyethiologic, which makes the task of determining the pathogen the main in the organization of epidemiological surveillance, treatment regimens, planning of preventive and anti-epidemic measures. The quality of laboratory diagnostics has a key influence on this. The true incidence of meningitis of different etiology can be altered at low-efficiency laboratory diagnostics. This work was carried out to assess the effectiveness of existing laboratory methods for the detection of PBM pathogens: Haemophilus influenzae, Streptococcus pneumoniae and Neisseria meningitidis; as a part of the programme on sentinel surveillance of invasive bacterial diseases (IBD) carried out by the WHO regional office for Europe in a number of countries in Europe (Ukraine, Belarus), Transcaucasia (Azerbaijan, Armenia, Georgia), Asia (Uzbekistan, Kyrgyzstan, Kazakhstan) in the period 2010-2017. 2893 samples of clinical material (CSF and blood) obtained from patients with the meningeal syndrome were studied by four diagnostic methods: cultural method, latex-agglutination test, immunochromatographic test (BinaxNOW), PCR (conventional and real-time), used to identify the following pathogens: Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae. When identifying the causative agents of BM, PCR more effective than culture method is 5 times in detecting N. meningitidis; 3 times in the detection of S. pneumoniae; 4 times the detection of H. influenzae b. Latex-agglutination test and immunochromatographic test allow to increase the identification of pathogens of BM for N. meningitidis - by 35.6%; S. pneumoniae - by 67%; H. influenzae b - by 19.2%, it is possible to set them in the field and at the epidpoint if necessary. When working with clinical material from patients diagnosed with GBM, it is advisable for bacteriological laboratories to complement the culture method of microbiological diagnosis of latex-agglutination test, immunochromatographic test or PCR.

EPIDEMIOLOGICAL AND CLINICAL FEATURES OF BACTERIAL PURULENT MENINGITIS IN CHILDREN OF MOSCOW

Data on etiology, epidemiology, clinical course and consequences of bacterial purulent meningitis in children of the city of Moscow are presented. The analysis of the dynamics of morbidity for the last 5 years is presented depending on etiology. In Moscow in recent years, there has been a change in serovars of meningococcus with an increase in W135, an increase in the proportion of pneumococcus and a decrease in the proportion of haemophilic type b. The modern aspects of the clinic, diagnosis, therapy and prevention of meningitis in children are considered.

Application of GIS for Optimization of Epidemiological Monitoring

IntroductionTechnology that combines traditional manipulations with databasesand complete visualization of geographic (spatial) analysis employingmaps has been developed in order to explore the possibilities forGeographical Information Systems (GIS) to be used in sanitaryand epidemiological surveillance system based on the analysis ofmorbidity and identification of influence of hazardous chemicalenvironmental factors on human health.MethodsGraphical analytic method of information processing allowedvisual establishing of mathematically determined cause-and-effectrelationships between levels of air chemical pollution and morbiditylevels for purulent bacterial meningitis.ResultsCalculated average annual contaminations of atmosphere of 20administrative rayons and seven cities of Lviv oblast with carbonoxide, lead, sulfur dioxide, and dust during the period 2006-2014were the objects of the study. During a year, 1,920 air samples werecollected per each ingredient for each rayon and city according tolaboratory data of facilities of the State Sanitary and EpidemiologicalService in Lviv oblast. Average annual levels of the chemicalsubstances were determined within the M.A.C. in all rayons and cities.However, 4-6% of individual samples in the rayons and 8-10% ofindividual samples in the cities exceeded the allowed concentrations,which imposed a real ecological danger.Fig. 1.Levels of carbon oxide air contamination within rayons ofLviv oblastMorbidity intensity rates for purulent bacterial meningitis weredetermined for the same period according to statistical reports oninfectious disease morbidity in Lviv oblast. In different years, humanmorbidity fluctuated from 0.7 to 2.3 per 100 thousand of populationin the oblast.The study found the correlation between the concentrations ofcarbon monoxide, lead, sulfur dioxide, and dust in the air and levels ofincidence of bacterial meningitis in people in the cities of Lviv oblastwith 1,092 thousand inhabitants, which compose 42.3% of all oblastpopulation. Correlation coefficients are r = 0.78 (p&lt;0.001), r = 0.70(p&lt;0.001), r = 0.51 (p&lt;0.005), and r =0.68 (p&lt;0.02), respectively.Fig. 2.Correlation dependencies between air contamination andpopulation morbidity rates for purulent bacterial meningitis withinrayons of Lviv oblast.The search for a correlation between chemical contaminationof atmosphere and the morbidity level the rayon population of theoblast for purulent bacterial meningitis testified the existence of astatistically significant dependence between the level of morbidityfor all population layers and atmosphere contamination with sulfurdioxide, lead, carbon monoxide, and dust. The correlation coefficientsare r = 0.62 (p&lt;0.002), r = 0.52 (p&lt;0.005), r = 0.63 (p&lt;0.005), r = 0.56(p&lt;0.05), correspondingly.The study found the correlation between the concentrationsof sulfur dioxide, and lead in the air of Lviv oblast and levels ofincidence of purulent bacterial meningitis in children. Correlationcoefficients are r = 0.55 (p&lt;0.05) and r = 0.57 (p&lt;0.001), respectively.ConclusionsUsing GIS approach, the study resulted in the development ofmedical-geographical maps of administrative rayons of Lviv oblast.The maps include peculiarities for each year of surveillance. Cause-and-effect relationships between the levels of the anthropogenicpollution of the air basin of Lviv oblast and morbidity levels forpurulent bacterial meningitis for the oblast population have beenspatially and temporally visualized as a study result.