ABSTRACT
PURPOSE: This study was performed to investigate clinical findings of acute neurologic complications and risk factors for chronic neurologic complications of bacterial meningitis in children. METHODS: Pediatric patients with community acquired bacterial meningitis diagnosed at Seoul National University Children's Hospital and Bundang Seoul National University Hospital were included. We investigated the relative frequency of neurologic complications and distribution of causative organisms. Chronic neurologic complication was defined as persistent neurologic deficit including recurrent seizures 6 months from the diagnosis. Multiple logistic regression analysis was used to identify risk factors for epilepsy and motor deficits, which were the most frequently reported chronic neurologic complications. RESULTS: A total of 90 cases were included in the study. Thirteen cases with less than 6 months follow-up duration were excluded from the analysis of risk factors for chronic neurologic complications. The mean age at diagnosis was 15.6 months. Streptococcus agalactiae was the most common pathogen accounting for 27 cases, followed by Streptococcus pneumoniae (19 cases), Hemophilus influenzae type b (13 cases), and Neisseria meningitidis (12 cases). Acute neurologic complications were found in 28 cases (31%): cerebral infarction in 16 cases, subdural effusion in 15 cases, and hydrocephalus in 9 cases. Chronic neurologic complications were found in 41 (53%) cases: epilepsy in 28 cases, motor deficit in 16 cases, hearing loss in 6 cases, and cognitive impairment in 4 cases. Cerebral infarction and S. pneumoniae infection were identified as risk factors for epilepsy. Cerebral infarction was a unique risk factor for motor deficit. CONCLUSION: Cerebral infarction is the important risk factor for the development of chronic neurologic complications including epilepsy and motor deficit in pediatric patients with bacterial meningitis.
Subject(s)
Child , Humans , Accounting , Cerebral Infarction , Epilepsy , Follow-Up Studies , Haemophilus influenzae type b , Hearing Loss , Hydrocephalus , Logistic Models , Meningitis, Bacterial , Neisseria meningitidis , Neurologic Manifestations , Pneumonia , Risk Factors , Seizures , Streptococcus agalactiae , Streptococcus pneumoniae , Subdural EffusionABSTRACT
PURPOSE: The aim of this study was to determine the prevalence of asymptomatic nasopharyngeal carriages in children using a multiplex reverse transcriptase-polymerase chain reaction (mRT-PCR) assay kit. METHODS: We obtained nasopharyngeal swabs from 33 children without any underlying disease from July 25 to July 28, 2008. The children were free from the signs of respiratory tract infections at the time of sampling. DNA was extracted from the swabs and subjected to multiplex RT-PCR using a primer set for the detection of pneumococci (Seeplex(R) PneumoBacter ACE Detection Seegene, Seoul, Korea). The amplified PCR products were separated on 2% agarose gels and stained with either ethidium bromide or screen tape system (Lab901 Scotland, UK). RESULTS: A total of 33 children (male, 15 female, 18) aged between 3.2 and 16.3 (median, 8.2) years were included in this study. The mRT-PCR detected colonized bacteria (Streptococcus pneumoniae, Hemophilus influenzae, Chlamydia pneumoniae, and Bordetella pertussis) in 30 children (90.9%). Of these, 13 children (39.4%) showed more than 2 bacteria: 12 children were positive for 2 bacteria (S. pneumoniae and H. influenzae) and 1 child was positive for 3 bacteria (S. pneumoniae, H. influenzae, and C. pneumoniae). CONCLUSION: mRT-PCR was found to be a sensitive tool for the detection of asymptomatic nasopharyngeal carriages. Clinical significances of the bacteria detected by mRT-PCR will have to be evaluated in the future.
Subject(s)
Aged , Child , Female , Humans , Bacteria , Bordetella , Chlamydophila pneumoniae , Colon , DNA , Ethidium , Gels , Haemophilus influenzae , Influenza, Human , Nasopharynx , Pneumonia , Polymerase Chain Reaction , Prevalence , Respiratory Tract Infections , Scotland , Sepharose , Streptococcus pneumoniaeABSTRACT
Background: Acute bacterial meningitis (ABM) is a serious disease that needs rapid diagnosis for an accurate treatment. The most important etiological agents are: Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae type b. Overall pathogen detection rate in patients with ABM in Chile is 83 percent. Aim: To evaluate a Polymerase Chain Reaction (PCR) protocol for simultaneous detection of several pathogens in patients with ABM. Material and methods: We designed and evaluated a multiplex PCR protocol for simultaneous specific genes identifications of S pneumoniae (¡ytA and ply genes), N meningitidis (ctrA, crgA) and H influenzae (bexA) in cerebrospinal fluid (CSF) samples from pediatric patients with suspected diagnosis of ABM. Sensitivity, specificity and minimum detection levels of DNA were determined. Amplifications ofrDNA 16S gene was done to confirm extraction of bacterial DNA. Results: Ninety nine CSF samples were studied, 90 from children with fever and negative CSF culture, and 9 from ABM and positive culture patients. The PCR protocol had a sensitivity of 89 percent, specificity of 100 percent, positive predictive value 100 percent and negative predictive value 99 percent. Conclusions: We observed a high concordance (89 percent) between bacteriological cultures and the PCR protocol results. This diagnostic tool could increase identification of agents in specific settings such as patients previously treated with antibiotics.
Subject(s)
Child , Humans , Meningitis, Bacterial/cerebrospinal fluid , Polymerase Chain Reaction/methods , Acute Disease , Chile , DNA, Bacterial/cerebrospinal fluid , DNA, Bacterial/genetics , Haemophilus influenzae type b/genetics , Haemophilus influenzae type b/isolation & purification , Meningitis, Bacterial/microbiology , Meningitis, Haemophilus/cerebrospinal fluid , Meningitis, Haemophilus/microbiology , Meningitis, Meningococcal/cerebrospinal fluid , Meningitis, Meningococcal/microbiology , Neisseria meningitidis/genetics , Neisseria meningitidis/isolation & purification , Pneumococcal Infections/cerebrospinal fluid , Pneumococcal Infections/microbiology , Sensitivity and Specificity , Streptococcus pneumoniae/genetics , Streptococcus pneumoniae/isolation & purificationABSTRACT
There are various microbial agents which causing meningitis in children. It is well known that Haemophilus influenzae (HI) are the most frequent bacterial agents. In Korea, it is hard to find studies detecting HI in cerebrospinal fluid (CSF) from pediatric patients with aseptic meningitis by PCR. It has been also reported that human herpes virus-6 (HHV-6) causes meningitis, meningoencephalitis, neuroinvasion and persistent infection of the central nervous system in children. In this study we also detected HHV-6 in the same CSF by EIA and PCR. We used 85 CSF specimens from 85 aseptic meningitis patients (mean age 6.6 years) taken from the Department of pediatrics at Ewha Womans University MokDong Hospital from June 2001 to August 2002. Detection rate of HI by EIA method was 12.9% (11/85) and by PCR was 16.5% (14/85). Detection rate of HHV-6 by EIA and by PCR was 18.8% (16/85) and 21.2% (18/85), respectively. Co-detection rate of HI and HHV-6 was 7.1% (6/85) by EIA and 12.9% (11/85) by PCR. In conclusion, by PCR in combination with EIA, HI infection could be proved in the aseptic meningitis CSF from which no bacterium was cultivated.