Septic Meningitis Research Articles

Characterization of clinical infection and drug resistance of group B streptococcus in Chengdu, China

ObjectiveTo investigate the clinical infection characteristics and antibiotic resistance of Group B Streptococcus (Streptococcus agalactiae, GBS) in Chengdu, China, from 2019 to 2021, as well as to provide data to support rational clinical drug use. MethodsThis was a retrospective study to collect 203 culture-positive GBS strains isolated from January 2019 to December 2021 in Chengdu, China, all of which were identified by the VITEK 2 Compact automated microbial Bacterial identification instrument. Data were derived using WHONET 5.6 software. The sample type and ward distribution were counted. Pregnant women and newborns were screened from the original data and their pregnancy outcomes were calculated respectively. ResultsGBS strains were mainly concentrated in obstetrics and neonatology departments, accounting for 40.9 % and 33.5 %. The types of specimens were mainly vaginal secretions, amniotic fluid and sputum, accounting for 25.6 %, 26.1 % and 18.7 %, respectively. Chorioamnionitis, premature rupture of membranes and preterm delivery occurred mainly in pregnant women after infection, accounting for 44.4 %, 31.5 % and 24.1 %. Neonates, on the other hand, were mainly diagnosed with neonatal pneumonia, neonatal sepsis, respiratory failure and septic meningitis, accounting for 91.8 %, 61.2 %, 44.9 % and 16.3 % of all positive neonates. 840 pregnant women were screened for GBS colonization from 2019 to 2021, and a total of 108 GBS positive pregnant women were identified, with a GBS colonization rate of 12.9 %. A total of 9 neonates from 108 GBS positive pregnant women developed early-onset disease. The morbidity in neonates was 8.3 %. No strains resistant to penicillin and ampicillin were found, while the resistance rates of tetracycline and clindamycin were higher than 50 %, respectively 60.1 % and 53.2 %. ConclusionGBS infection mainly affected pregnant women and newborns in Chengdu, China, which can lead to adverse maternal and infant outcomes. Attention should be paid to strengthening general screening of GBS in perinatal urogenital secretions and the prevention strategy of IAP (intrapartum antibiotic prophylaxis). Antimicrobial therapy should be administered with appropriate antibiotics. Penicillin was still the first line drug for the treatment of GBS. These initiatives were important to reduce mother-to-child transmission and neonatal infections.

Rare case of septic shock combined with meningitis caused by Pasteurella multocida without a history of cat and dog bites

BackgroundPasteurella multocida is a zoonotic pathogen that mainly causes local skin and soft tissue infections in the human body through cat and dog bites. It rarely causes bacteraemia (or sepsis) and meningitis. We reported a case of septic shock and meningitis caused by P. multocida in a patient without a history of cat and dog bites.Case presentationAn 84-year-old male patient was urgently sent to the emergency department after he was found with unclear consciousness for 8 h, accompanied by limb tremors and urinary incontinence. In the subsequent examination, P. multocida was detected in the blood culture and wound secretion samples of the patient. However, it was not detected in the cerebrospinal fluid culture, but its DNA sequence was detected. Therefore, the patient was clearly diagnosed with septic shock and meningitis caused by P. multocida. The patient had no history of cat or dog contact or bite. The patient was subsequently treated with a combination of penicillin G, doxycycline, and ceftriaxone, and he was discharged after 35 days of hospitalisation.ConclusionThis report presented a rare case of septic shock and meningitis caused by P. multocida, which was not related to a cat or dog bite. Clinical doctors should consider P. multocida as a possible cause of sepsis or meningitis and should be aware of its potential seriousness even in the absence of animal bites.

Unmasking the invisible enemy: A case report of metagenomics-guided diagnosis and treatment of neonatal septic meningitis caused by Corynebacterium aurimucosum in a preterm infant with neonatal lupus erythematosus.

Neonatal septic meningitis is a serious condition that can be caused by various pathogens, including Corynebacterium aurimucosum, a rare and opportunistic bacterium. We reports a case of infectious meningitis in a premature infant with neonatal lupus erythematosus caused by C aurimucosum. The purpose of this study is to explore the occurrence of meningitis caused by C aurimucosum in preterm infants with neonatal lupus erythematosus. We found that early diagnosis and treatment are crucial for this type of meningitis, especially for infants with impaired immunity or mothers receiving immunosuppressive therapy. This bacterium is rare in clinical practice, but it needs to be taken seriously. The infant was born to a mother with systemic lupus erythematosus who had a history of long-term immunosuppressive therapy. The infant presented with preterm birth, purplish-red skin, fever, and widespread scarlet dermatitis. He also had positive anti-Ro/SSA and anti-La/SSB antibodies. The infant was diagnosed with neonatal lupus erythematosus based on clinical and serological features. A lumbar puncture revealed septic meningitis with high levels of total nucleated cells, protein, and Pan's test in the CSF. The macrogenic examination identified C aurimucosum as the causative agent. The culture of the mother's vaginal secretion also revealed the same bacterium. The infant was treated with anti-infective therapy with ceftriaxone, ampicillin, vancomycin, and meropenem. He also received prednisone and gammaglobulin infusion for neonatal lupus erythematosus. The infant's temperature returned to normal, and his general condition and responsiveness improved. The CSF cytology and biochemistry normalized, and the culture was negative. The cranial MRI examination showed no abnormalities. The red rash disappeared, and the follow-ups after discharge revealed no complications. This case highlights the importance of early diagnosis and treatment of neonatal septic meningitis caused by C aurimucosum, especially in infants with immunocompromised conditions or maternal history of immunosuppressive therapy. C aurimucosum should not be overlooked as a potential pathogen in neonatal septic meningitis.

The granulocyte colony-stimulating factor produced during Streptococcus suis infection controls neutrophil recruitment in the blood without affecting bacterial clearance.

Streptococcus suis causes diseases in pigs and has emerged as a zoonotic agent. When infected, the host develops an exacerbated inflammation that can lead to septic shock and meningitis. Although neutrophils greatly infiltrate the lesions, their dynamics during S. suis infection remain poorly described. Moreover, very few studies reported on the production and role of a key factor in the regulation of neutrophils: the colony-stimulating granulocyte factor (G-CSF). In this study, we characterized the G-CSF-neutrophil axis in the pathogenesis of S. suis induced disease. Using a mouse model of S. suis infection, we first evaluated the recruitment of neutrophils and their activation profile by flow cytometry. We found that infection provokes a massive neutrophil recruitment from the bone marrow to the blood and spleen. In both compartments, neutrophils displayed multiple activation markers. In parallel, we observed high systemic levels of G-CSF, with a peak of production coinciding with that of neutrophil recruitment. We then neutralized the effects of G-CSF and highlighted its role in the release of neutrophils from the bone marrow to the blood. However, it did not affect bacteremia nor the cytokine storm induced by S. suis. In conclusion, systemic G-CSF induces the release of neutrophils from the bone marrow to the blood, but its role in inflammation or bacterial clearance seems to be compensated by unknown factors. A better understanding of the role of neutrophils and inflammatory mediators could lead to better strategies for controlling the infection caused by S. suis.

Pattern and Epidemiological Characters of Meningitis Infections, Cairo Egypt. 2016–2019

Background and study aim Egypt is an endemic area with meningitis infections, which is associated with high complications and death rates making it a medical emergency. The World Health Organization (WHO) estimates that there are around 1 million of cases per year worldwide with 135–200,000 fatal cases. The aim of the study is to describe the socio demographic, economic and clinical pattern of meningitis, to determine the outcomes of the disease in term of complications and fatality, to identify the causative organisms, and potential factors associated with either complications or mortality. Patients and Methods All patients presents with symptoms of meningitis according to the standardized case definition of CDC and confirmed with either cerebrospinal fluid analysis or brain imaging were recruited from Ain Shams University Hospitals by retrospective reviewing of medical records along the period from 2016 to the end of 2019. Socioedemographic, clinical and outcome data were also collected (extracted from the records) Results One thousand three hundred twenty-four (1324) patients were enrolled in the current study. males were more infected than females, children were the most vulnerable group. The main cause of septic meningitis was streptococcus meningitis, mainly among children after Haemophilic influenza due to the introducing the HIB vaccine in vaccination program November 2014. Bacterial meningitis was the leading cause of death among studied patient and deafness was the main neurological complication. Conclusion Early clinical suspicion of CNS infection and immediate management are crucial factors in reduction of the still high morbidity and mortality rates. The changes in the pattern of causative organisms must be considered when starting empiric antibiotic.

A study on the correlation between serumProcalcitonin level and the resistant bacterial strains isolated from meningitispatients in Bani- Suief governorate

Absract Meningitis is an inflammation of the membranes surrounding the brain, spinal cord and the intervening cerebrospinal fluid. Bacterial Meningitis can be quite severe and may result in brain damage, hearing loss, or learning disabilities. Viral Meningitis is less severe and will clear up with specific treatment. N.meningitides, S. pneumonia, H. influenza , M. tuberculosis are among the commonest bacterial causes.This study aimed to assess the diagnostic role of cerebrospinal LDH and serum procalcitonin (PCT-Q) in meningitis in Bani- suef governorate and to differentiate bacterial from viral meningitis. Patients were classified cases into three groups; group (I) for septic meningitis, group (II) for aseptic meningitis and group (III) for meningism along with 100 control patients. After clinical examination, CBC, ESR, CRP, blood sugar level, renal and hepatic functions. CSF LDH, serum PCT were assessed in some patients. CSF LDH was higher than normal in 100% of patients suffering from septic meningitis and in 98% of patients suffering from aseptic meningitis. Serum PCT was positive in all patients with septic meningitis whereas it was negative in 69(66%) patients. There is a correlation between elevated serum levels of PCT and presence of bacterial resistant strains in cases of septic meningitis.

Unique presentation of rat-bite fever: Polyarthritis with petechial lesion on palms and soles

Abstract Rat-bite fever is a rare disease because of its challenging diagnosis and propensity to mimic other conditions that present with symptoms, such as rash and polyarthritis. However, when left untreated, this illness can persist for weeks or even months and has been associated with a reported mortality rate of approximately 10%. Furthermore, rat-bite fever can lead to severe complications including septic arthritis, endocarditis, pericarditis, pneumonia, and meningitis. In this case report, we present the clinical findings of a 36-year-old male patient who presented to our department with intermittent fever and polyarthritis persisting for 1 week. After a thorough evaluation, the patient was ultimately diagnosed with rat-bite fever through blood culture analysis.

Varicella Zoster Virus Aseptic Meningitis: A Misleading Clinical And Laboratory Presentation: Three Case Reports

Background: A septic meningitis caused by varicella zoster virus (VZV) reactivation was less described in the literature, Varicella-zoster virus is a neurotropic virus that remain dormant in dorsal root ganglion after primary infection, usually manifested as chickenpox which gets reactivated in immunocompromized state presented usually with vesicular rash complicated with multi-organ affection such as central nervous system. Rarely this characteristic skin rash can be absent initially requiring high clinical suspicion for diagnosis. When no skin lesions are present, a high clinical suspicion is required to reach the diagnosis. In this report we described three clinical of varicella-zoster virus reactivation presented in atypical way in terms of clinical presentation and cerebrospinal fluid analysis. Case presentation: Three patients otherwise healthy were admitted to the hospital with a chief complaint of headache, nausea, vomiting and symptoms suggestive of increased intracranial pressure (IIH). Resembling IIH but due to acute presentation and positive meningeal signs this was unlikely. The clinical examination did not show any neurological deficits or rash except lately in the first case. Lumbar puncture unexpectedly showed high opening pressure with markedly elevated CSF total and high total cell count with lymphocytic predominance which was misleading raising suspicion of tuberculous meningitis. Further CSF analysis, including polymerase chain reaction (PCR) and detection of intrathecal synthesis of antibodies, showed a VZV infection. Clinical follow-up examinations later on proved successful antiviral treatment. Conclusion: In conclusion, absence of typical vesicular rash of varicella zoster initially as well as high opening CSF pressure with high CSF protein even young and previously healthy patients should not rule out consideration of varicella zoster meningitis.

Varicella Zoster Virus Aseptic Meningitis: A Misleading Clinical and Laboratory Presentation: Three Cases Reports

A septic meningitis caused by varicella zoster virus (VZV) reactivation was less described in the literature, Varicella-zoster virus is a neurotropic virus that remain dormant in dorsal root ganglion after primary infection, usually manifested as chickenpox which gets reactivated in immunocompromized state presented usually with vesicular rash complicated with multi-organ affection such as central nervous system. Rarely this characteristic skin rash can be absent initially requiring high clinical suspicion for diagnosis. When no skin lesions are present, a high clinical suspicion is required to reach the diagnosis. In this report we described three clinical of varicella- zoster virus reactivation presented in atypical way in terms of clinical presentation and cerebrospinal fluid analysis.

Varicella Zoster Virus Aseptic Meningitis: A Misleading Clinical and Laboratory Presentation: Three Cases Reports

Background: A septic meningitis caused by varicella zoster virus (VZV) reactivation was less described in the literature, Varicella-zoster virus is a neurotropic virus that remain dormant in dorsal root ganglion after primary infection, usually manifested as chickenpox which gets reactivated in immunocompromized state presented usually with vesicular rash complicated with multi-organ affection such as central nervous system. Rarely this characteristic skin rash can be absent initially requiring high clinical suspicion for diagnosis. When no skin lesions are present, a high clinical suspicion is required to reach the diagnosis. In this report we described three clinical of varicella- zoster virus reactivation presented in atypical way in terms of clinical presentation and cerebrospinal fluid analysis. Case presentation: Three patients otherwise healthy were admitted to the hospital with a chief complaint of headache, nausea, vomiting and symptoms suggestive of increased intracranial pressure (IIH). Resembling IIH but due to acute presentation and positive meningeal signs this was unlikely. The clinical examination did not show any neurological deficits or rash except lately in the first case. Lumbar puncture unexpectedly showed high opening pressure with markedly elevated CSF total and high total cell count with lymphocytic predominance which was misleading raising suspicion of tuberculous meningitis. Further CSF analysis, including polymerase chain reaction (PCR) and detection of intrathecal synthesis of antibodies, showed a VZV infection. Clinical follow-up examinations later on proved successful antiviral treatment.

Analysis of the main biological properties of <em>Kocuria</em>

Representatives of the genus Kocuria are found in soil, marine sediments, water, on the skin and oropharynx of mammals. This paper presents the results of a study to determine the biological properties of Kocuria sp. isolated from goat milk. There is evidence of association of opportunistic Kocuria spp. with the development of severe septic conditions, meningitis, endocarditis, cholecystitis, and osteomyelitis.

A Patient With Rheumatoid Arthritis Who Developed Pasteurella Multocida Arthritis Without Animal Contact; Case Report

Pasteurella species are immobile, non-sporeless, gram-negative coccobacilli that can be found in the respiratory tract and gastrointestinal tract flora of pets and can cause various infections with cat-dog bites. While it usually causes cellulitis and abscesses, clinical pictures such as septic arthritis, osteomyelitis, pneumonia, endocarditis, sepsis and meningitis can also be seen in immunosuppressed patients. Here, a case of septic arthritis due to Pasteurella multocida, which developed in the left shoulder joint of a 70-year-old female patient with a history of rheumatoid arthritis, diabetes mellitus, and hypertension, without animal contact or trauma, is presented in the light of the literature.

The Host-Pathogen Interactions and Epicellular Lifestyle of Neisseria meningitidis.

Neisseria meningitidis is a gram-negative diplococcus and a transient commensal of the human nasopharynx. It shares and competes for this niche with a number of other Neisseria species including N. lactamica, N. cinerea and N. mucosa. Unlike these other members of the genus, N. meningitidis may become invasive, crossing the epithelium of the nasopharynx and entering the bloodstream, where it rapidly proliferates causing a syndrome known as Invasive Meningococcal Disease (IMD). IMD progresses rapidly to cause septic shock and meningitis and is often fatal despite aggressive antibiotic therapy. While many of the ways in which meningococci survive in the host environment have been well studied, recent insights into the interactions between N. meningitidis and the epithelial, serum, and endothelial environments have expanded our understanding of how IMD develops. This review seeks to incorporate recent work into the established model of pathogenesis. In particular, we focus on the competition that N. meningitidis faces in the nasopharynx from other Neisseria species, and how the genetic diversity of the meningococcus contributes to the wide range of inflammatory and pathogenic potentials observed among different lineages.

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

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

Utility of Urine Reagent Strips for Analysis of Cerebrospinal Fluid in Emergency Settings: A Cross-sectional Study

Introduction: Meningitis is the inflammation of the meninges which covers brain and spinal cord, which if not identified on time will result in permanent neurological deficit or death. Mainly divided into septic and aseptic meningitis, differentiating these two and timely intervention would prevent neurological damage. Cerebrospinal Fluid (CSF) analysis helps to arrive at a diagnosis of meningitis which requires relevant trained staff and adequately equipped laboratory These are not available in most of the healthcare centers in rural settings. Aim: To evaluate the role of urinary reagent strip method in rapid analysis of CSF to assist the clinician in the bedside diagnosis or exclusion of meningitis. To compare the values obtained by rapid method with that of results obtained by automated analyser. Materials and Methods: This is a cross sectional study done in Pathology lab of Mandya Institute of Medical Sciences, district hospital, Karnataka, Mandya, India. A total of 30 samples evaluated during the period of two months in 2019. (15th Aug- 15th Oct).Cerebrospinal fluid analysis were tested using combur- 10 urinary reagent strip and microscopy examination as reference standards. Automated analysers were used for the analysis of protein and glucose; and neubauer’s counting chamber was used for leucocytes count. Results: The sensitivity and specificity of urinary strips in the analysis of cerebrospinal fluid for glucose, protein, leucocytes is 50.00%, 41.67%, 78.57% and 92.31%, 88.89%, 68.75% respectively. Diagnostic accuracy of urinary strip tests for glucose, protein and leucocytes are 83.33% 93.34% 86.67% respectively. Conclusion: The study shows the reliable sensitivity and specificity in some parameters hence can be used in remote settings.

Peripheral arterial embolization and limb ischemia complicating septic internal jugular vein thrombosis: a case report of Lemierre’s syndrome

Purpose: Septic thrombophlebitis of the internal jugular vein is a life-threatening complication of venous thrombosis. While heparin is frequently added to antimicrobial therapy, its usefulness in patients with Lemierre’s syndrome is controversial. In this case report, we demonstrate that delayed use of intravenous heparin may be associated with septic embolization of peripheral arteries. Limb ischemia has rarely been reported in patients with Lemierre’s syndrome.
 Case presentation: Lemierre’s syndrome is a complex and unusual clinical entity, characterized by septic thrombophlebitis of the internal jugular vein and accompanied by sepsis. We present an unusual case of a young female with Lemierre’s syndrome who developed peripheral arterial embolization and Streptococcus pyogenes sepsis, complicating septic internal jugular vein thrombosis. The patient was initially treated with antibiotics without therapeutic heparin. The patient developed digital gangrene in all four extremities, septic meningitis, and a severe fungal infection; she died 6 weeks after admission secondary to multisystem organ failure. We discuss the importance of rapid diagnosis of disease extent in directing heparin treatment in patients with Lemierre’s syndrome.
 Conclusion: It may be advisable to treat Lemierre’s syndrome with anticoagulation in the acute setting.

Достовірні і сумнівні діагностичні критерії раннього неонатального сепсису

Neonatal sepsis is a significant cause of mortality among newborns, especially in low and middle income countries with poor economic development. It is important to start the appropriate treatment as soon as possible, as this prevents most deaths from sepsis and reduces the occurrence of residual neurological lesions due to septic meningitis. The article provides an overview of modern literature data on the principles of diagnosis of early neonatal sepsis; mentions the main etiological factors and ways of infection by potential pathogens. Diagnostic criteria for early neonatal sepsis have been analyzed and have been classified as doubt-ful or credible. An important role is given to the assessment of potential risk factors for the development of the septic process, including data on history of pregnancy and childbirth, clinical and laboratory indicators of the baby after birth. The nonspecificity of most clinical signs of sepsis and their comparison with clinical manifestations in meningitis was carried out. The importance of the bacteriological method of detecting the pathogen in the blood, urine and cerebrospinal fluid was analyzed, which remains the «gold» standard diagnosis of neonatal sepsis, and the method of multiplex polymerase chain reaction. There is a need to detect sepsis through visual examination, such as chest radiography, computed tomography, magnetic resonance imaging and ltrasonography of the head. The diagnostic value of indicators is described with the complete blood cell count and differential, including some of its components, and markers of inflammatory process, especially the immature-to-total (I/T) neutrophil ratio, C-reactive protein, procalcitonin. The article mentions a method of determining the concentration of immunoglobulin M in the serum, the elevated level of which indicates intrauterine infection. The diagnostic value of glutathione is considered, which is a marker of the functioning of the immune system. Emphasis is placed on the expediency of using Kaiser Permanente calculator to detect signs of sepsis in the first days of a newborn's life and the choice of optimal tactics management in such patients. No conflict of interest was declared by the authors. Key words: sepsis, newborn, diagnosis of infection, neonatal.

Evaluation of IL-8 level in cerebrospinal fluid in acute bacterial meningitis in adults

Background: Interleukin 8 increases in various types of meningitis, specifically acute bacterial meningitis inflammation, and it is important in the distinction between types of meningitis. The present paper aims at evaluation of the level of interleukin 8 in cerebrospinal fluid in acute adult bacterial meningitis. Methods: All adult patients’ with diagnosis of suspected meningitis with symptoms of fever, headache, neck stiffness, and consciousness disorder. Lumbar puncture was taken in between the third and fourth vertebra by a specialist physician for all patients suspected with meningitis. To determine the level of consciousness, the GCS of the patients was determined and the cerebrospinal fluid was cultured and sent to the laboratory for the analyses of cell count, diffraction, CSF fluid glucose, CSF fluid protein, LDH, or lactate dehydrogenase, and the level of interleukin 8. Results: The mean of IL-8 protein was 296.17±48.57Pg/ml in patients with aseptic meningitis and 1088.96±526.55Pg/ml in the group of patients with septic meningitis. There was a significant difference between the two groups in terms of the amount of interleukin 8 (p = 0.009). Cutoff was 297.6 Pg/ml for the detection of positive bacterial meningitis with a sensitivity of 92% and the specificity of 83.1% was 297.6 pg/ml. Conclusion: Interleukin 8 has a high sensitivity and specificity in the diagnosis of bacterial meningitis from aseptic meningitis, and along with the measurement of cerebrospinal fluid protein, it can be a good criterion for differentiation of bacterial from aseptic meningitis.

Role of urine reagent strips in diagnosis of childhood meningitis

ObjectiveThe aim was to evaluate the role of urine reagent strips in the diagnosis of childhood meningitis and differentiating between septic and aseptic types.BackgroundPrevious research studies have declared that clinical manifestations of acute bacterial meningitis can be very subtle, nonspecific, or even absent, especially in neonates and infants. Urine reagent strips have been used to test urine, ascetic fluid, and pleural aspirate to evaluate infection in these biologic fluids.Patients and methodsTo reach the goal of this research, a prospective study was designed. The study sample included 50 participants divided into two groups. The first group was selected from clinically diagnosed patients with septic meningitis, whereas the second group was selected from clinically diagnosed patients with aseptic meningitis. All participants were subjected to detailed medical history taking, age, sex, vital signs, complete blood count with differential white blood cell count, blood culture, C-reactive protein, random blood sugar, urea, creatinine, alanine aminotransferase, aspartate aminotransferase, and cerebrospinal fluid analysis.ResultsThe authors found that there was a significant difference between septic and aseptic groups regarding presence of fever, which was more prevalent in septic group (P = 0.029). There were highly significant differences between both groups regarding cerebrospinal fluid reagent strip results with respect to cytology count, protein, and glucose (P < 0.001).ConclusionThe study supports the association of urine reagent strips and early diagnosis of childhood meningitis and differentiating between septic and aseptic types.

Characteristics of patients with invasive pneumococcal disease requiring admission to intensive care units

Patients with invasive pneumococcal disease (IPD) may require admission into paediatric intensive care units (PICU). The aim of this study is to analyse the epidemiological, clinical, and microbiological characteristics associated with IPD that may require admission to the PICU. A prospective study was conducted on cases of IPD diagnosed in three Paediatric Hospitals in Barcelona between January 2012 and June 2016. An analysis was made of the associations between the admission to PICU and the epidemiological, clinical, and microbiological variables. A total of 263 cases with IPD were included, of which 19% (n = 50) required admission to PICU. Patients with septic shock (7; 100%), meningitis (16; 84.2%), and those with complicated pneumonia (23; 15.2%) were admitted to the PICU. The most frequent complications were pulmonary (35.2%) and neurological (39.5%). The ratio between admission and non-admission to PICU was 4.7 times higher in subjects with an underlying disease. The serotypes associated with PICU admission were 19A (23% of the total of this serotype), serotype 14 (20%), serotype 3 (17%), and serotype 1 (12.5%). IPD required PICU admission in cases of septic shock and meningitis, and less so with complicated pneumonia. The percentage of admissions is greater in children with an underlying disease. Admission into the PICU involves a longer stay, complications during the acute phase, as well as sequelae, particularly neurological ones. The serotypes of the patients that were admitted to PICU were predominantly vaccine serotypes.