Dengue en paciente de 32 días de vida. Reporte de un caso poco habitual / Dengue fever in a 32-day-old patient. A rare case report

El dengue es una enfermedad viral transmitida por la picadura del mosquito Aedes aegypti. El comportamiento del dengue en Argentina es epidémico; la mayoría de los casos se observan en los meses de mayor temperatura. Hasta la semana epidemiológica (SE) 20/2023, se registraron en Argentina 106 672 casos; se vieron afectadas 18 de las 24 provincias que conforman el país. Dentro de los principales grupos de riesgo, se incluyen los menores de 2 años. Reconocer los signos, síntomas e identificar los factores de riesgo es fundamental para el manejo de casos con mayor riesgo de gravedad. Presentamos el caso de una paciente de 32 días de vida que se internó por síndrome febril sin foco, con diagnósticos diferenciales de meningitis viral y sepsis, evolucionó con leucocitosis, plaquetopenia, hipoalbuminemia, asociado a exantema y edemas. Se llegó al diagnóstico de dengue por la clínica, epidemiologia e IgM positiva.

Dengue fever is a viral disease transmitted by the Aedes aegypti mosquitoes. In Argentina, dengue fever is an epidemic disease; most cases are reported during the hot months.Until epidemiological week (EW) 20/2023, 106 672 cases were reported across 18 of the 24 provinces of Argentina. Children younger than 2 years are among the main groups at risk. Recognizing signs and symptoms and identifying risk factors is fundamental for the management of cases at a higher risk of severity. Here we describe the case of a 32-day-old female patient who was hospitalized due to febrile syndrome without a source, who had a differential diagnosis of viral meningitis and sepsis and progressed to leukocytosis, thrombocytopenia, hypoalbuminemia in association with rash and edema. The diagnosis of dengue fever was established based on clinical, epidemiological, and positive IgM data.

Study advances in biomarkers and technologies for diagnosis of bacterial meningitis / 中华实用儿科临床杂志

Bacterial meningitis (BM) is one of the most serious central nervous system diseases of childhood worldwide.However,for the patients who had received antibiotic pretreatment,the clinical symptoms,as well as cerebrospinal fluid (CSF) composition,are not typical,the diagnosis tests,such as CSF Gram staining and bacterial culture,often present high false negative rates.All above factors add difficulties in distinguishing BM from viral meningitis.Till now,more and more biomarkers and diagnostic technologies had been proposed,now,the focuses on the recent advances in biomarkers like C-reactive protein,procalcitonin,CSF lactic acid and technologies like immunochromatography tests,real-time polymerase chain reaction,next-generation sequencing in the aspect of differentiating BM from viral meningitis in children were reviewed,in order to provide clinical suggestions for early diagnosis of BM.

Study advances in biomarkers and technologies for diagnosis of bacterial meningitis / 中华实用儿科临床杂志

Bacterial meningitis (BM) is one of the most serious central nervous system diseases of childhood worldwide.However, for the patients who had received antibiotic pretreatment, the clinical symptoms, as well as cerebrospinal fluid (CSF) composition, are not typical, the diagnosis tests, such as CSF Gram staining and bacterial culture, often present high false negative rates.All above factors add difficulties in distinguishing BM from viral meningitis.Till now, more and more biomarkers and diagnostic technologies had been proposed, now, the focuses on the recent advances in biomarkers like C-reactive protein, procalcitonin, CSF lactic acid and technologies like immunochromatography tests, real-time polymerase chain reaction, next-generation sequencing in the aspect of differentiating BM from viral meningitis in children were reviewed, in order to provide clinical suggestions for early diagnosis of BM.

A New Scoring System for the Differential Diagnosis between Tuberculous Meningitis and Viral Meningitis

BACKGROUND: Tuberculous meningitis (TBM) is associated with high mortality and morbidity despite administering anti-tuberculous chemotherapy to the patients. Differential diagnosis between TBM and viral meningitis (VM) is difficult in some clinical situations. METHODS: We reviewed and analyzed records of adult patients who were admitted and diagnosed with TBM or VM at a tertiary hospital in Korea, between January 2006 and December 2015. Diagnostic criteria for TBM were categorized into three groups: definite, probable, and possible TBM. The VM group included patients with no evidence of other meningitis who achieved complete recovery with only conservative treatments. Clinical, laboratory and radiological findings, as well as outcomes, were compared between the TBM and VM groups. RESULTS: Ninety-eight patients were enrolled. Among the study patients, 47 had TBM and 51 had VM. Based on univariate analysis and multivariate logistic regression, sodium 70 (U/L) in cerebrospinal fluid (CSF), protein > 160 (mg/dL) in CSF, voiding difficulty, and symptoms of cranial nerve palsy were significant predictive factors for TBM in the final model. We constructed a weighted scoring system with predictive factors from multiple regression analyses. Receiver operating characteristic curve analyses and decision tree analyses were plotted to reveal an optimum cutoff point as 4 with this scoring system (range: 0–13). CONCLUSION: For differential diagnosis between TBM and VM, we created a new weighted scoring system. This scoring system and decision tree analysis are simple and easy to apply in clinical practice to differentiate TBM from VM.

Two Cases of Acute Retinal Necrosis after Viral Meningitis

PURPOSE: To report two cases of acute retinal necrosis following viral meningitis. CASE SUMMARY: A 52-year-old woman who has had viral meningitis presented with visual loss of right eye. Slit-lamp examination showed conjunctival injection and inflammatory cells (2+) in the anterior chamber of the right eye. Funduscopic examination showed multiple yellow-whitish spots in the peripheral retina. Fluorescein fundus angiography showed early hypofluorescence and the late vascular leak in the peripheral retina. After the patient was diagnosed with Acute retinal necrosis (ARN), intravenous acyclovir (2,100 mg/m²/day) was administered. During the treatment period, the retinal detachment of the right eye was found, so the authors performed pars plana vitrectomy. After the surgery, new retinal lesions weren't observed in both eyes during follow-up. A 57-year-old man previously treated with possible viral meningitis presented with visual loss of his right eye. Funduscopic examination showed multiple yellow-whitish spots in the peripheral retina. Fluorescein fundus angiography showed the late vascular leak in the peripheral retina. In the systemic evaluation, Herpes simplex virus and Cytomegalovirus immunoglobulin G were detected. With the impression of ARN, intravenous acyclovir (2,100 mg/m²/day) was administered. No new retinal lesions were observed in both eyes during follow-up. CONCLUSIONS: We report rare cases of ARN occurring after viral meningitis. Uveitis in patients with recent history of meningitis should be examined carefully under the suspicion of ARN.

Surveillance and genetic characteristics of echovirus 6 strains isolated from environmental sewage and aseptic encephalitis cases / 中华微生物学和免疫学杂志

Objective To analyze the genetic characteristics of echovirus 6 ( E-6) strains isolated from patients with acute meningitis/encephalitis syndrome ( AMES) in 2014 and sewage samples in 2013—2014 in Shandong province and to investigate their correlations.Methods Enterovirus strains were isolated from cerebrospinal fluid, stool and throat swab samples collected from 940 cases of AMES and 96 sewage samples used for environmental surveillance.The positive isolates were identified by molecular typing meth-od.Homologous and phylogenetic analyses based on the VP1 sequences of E-6 isolates were performed.Re-sults Altogether 47 E-6 strains were isolated from patients with AMES in 2014, accounting for 29.56%of all isolated enteroviruses ( EVs) strains.No E-6 strains were isolated from AMES cases in 2013.Data of the environmental surveillance showed that E-6 virus strains had been frequently detected in sewage samples since the summer of 2013 to the end of 2014.In total, 40 E-6 virus strains were isolated (7.87% of total isolated EVs strains) in 2013 and 139 E-6 virus strains (26.18%) in 2014.Phylogenetic analysis indicated that the E-6 isolates recruited in this study belonged to clusters A and C with high intracluster sequence iden-tities between AMES and environmental isolates.The nucleotide identities were 98.3%-100% among cluster A E-6 virus strains isolated from AMES cases in 2014 and 96.6%-100% among cluster A E-6 virus environ-mental isolates during the surveillance year 2013—2014.The cluster A E-6 virus strains shared 97.1%-100% nucleotide identities between the AMES and environmental isolates.For cluster C E-6 virus strains, the nucleotide identities were 100%, 98.7%-100% and 99.1%-100%, respectively.Conclusion The epidemic of viral encephalitis in Shandong province in 2014 was associated the transmission of two lineages of E-6 virus.Environmental surveillance revealed the potential epidemic of E-6 virus even before the epidemic of viral encephalitis in Shandong province, indicating the possibility of using environmental surveillance for early warning of related diseases.

Factors associated with mumps meningitis and the possible impact of vaccination / 소아과

PURPOSE: Mumps meningitis is a common complication of mumps infection; however, information on mumps meningitis in the postvaccine era is limited. The purpose of the present study was to determine factors associated with mumps meningitis and to discuss the effect of vaccination on this disease. METHODS: We retrospectively reviewed patients younger than 19 years with mumps, diagnosed at a university hospital in Korea between 2003 and 2013. Patients were divided into groups with and without meningitis, and the clinical features of the 2 groups were compared. RESULTS: The study enrolled 119 patients: 19 patients with meningitis and 100 patients without. Univariate analysis showed that older age (median: 15 years vs. 9.5 years, respectively), a longer interval from last vaccination (median: 10.2 years vs. 4.8 years, respectively), and febrile presentation (94.7% vs. 31.0%, respectively) were significantly associated with mumps meningitis. Sex, number of vaccination doses, bilateral parotitis, and the presence of complications other than meningitis did not differ between the 2 groups. In multivariate logistic regression analysis, age (odds ratio, 1.38; 95% confidence interval, 1.01-1.89; P=0.04) and fever (odds ratio, 30.46; 95% confidence interval, 3.27-283.61; P<0.01) remained independent factors for mumps meningitis. CONCLUSION: Clinicians in the postvaccine era should be aware of the possibility of mumps meningitis in febrile cases of mumps in adolescents, regardless of the number of vaccination doses. To establish the role of vaccination in mumps meningitis, further studies will be necessary.

Validez del Score de Boyer para el diagnóstico diferencial de meningitis bacteriana y no bacteriana en niños del Hospital Manuel Ascencio Villarroel. Cochabamba, Bolivia / Validity of Score Boyer, to differential diagnosis between bacterial and non-bacterial meningitis; in children of the Hospital Manuel Ascencio Villarroel. Cochabamba, Bolivia.

Introducción: la meningitis es un síndrome clínico que conlleva riesgos en la morbimortalidad sobre todo en edad pediátrica, la variabilidad de las manifestaciones clínicas dependientes de la edad, ha permitido el empleo de scores que permitan objetivar la toma de decisiones sobre posibilidades etiológicas y criterios terapéuticos, tal es el caso del "Score de Boyer". Objetivo: determinar la validez del Score de Boyer y la utilidad en el diagnóstico diferencial de meningitis bacteriana y no bacteriana. Material y métodos: el presente estudio es de tipo analítico, longitudinal, prospectivo, realizado en el periodo de marzo del 2014 a enero del 2015 en el Hospital del Niño Manuel Ascencio Villarroel. La muestra fue conformada por de 32 pacientes entre las edades de 1 mes a 15 años, los cuales fueron diagnosticados de meningitis por clínica, laboratorio, y por citoquímico de líquido cefalorraquídeo. Resultados: se encontró que el 25% de la población presento el diagnóstico de meningitis bacteriana confirmado con cultivo de LCR positivo. El score de Boyer en este estudio demostró una especificidad del 92% y una sensibilidad del 100% para el diagnóstico diferencial de meningitis bacteriana. Conclusión: el Score de Boyer es una herramienta útil, rápida, fácil para el diagnóstico diferencial de la etiología de la meningitis, en cuya asociación con otros marcadores biológicos aumenta su sensibilidad y especificidad.

Introduction: meningitis is a clinical syndrome that carries risks in morbidity and mortality especially in pediatric patients, the variability of the dependent clinical manifestations of age, has allowed the use of scores that allow objectify decisions on etiological possibilities and therapeutic criteria, as in the case of "Boyer Score". Objective: to determine the validity of Score Boyer and utility in the differential diagnosis of bacterial and non-bacterial meningitis. Methods: this study is analytical, longitudinal, prospective, conducted in the period from March 2014 to January 2015 in the Children's Hospital Manuel Ascencio Villarroel. The study group was made up of 32 patients between the ages of 1 month to 15 years who were diagnosed with meningitis by clinical, laboratory, and cytochemical CSF. Results: we found that 25% of the population presented the diagnosis of bacterial meningitis confirmed positive CSF culture. Boyer's score in this study showed a specificity of 92% and a sensitivity of 100 % for the differential diagnosis of bacterial meningitis. Conclusion: the Score Boyer is a useful, fast, easy for the differential diagnosis of the etiology of meningitis, whose association with other biological markers increases the sensitivity and specificity tool.

Effect of Acyclovir on the Neurological Function and Cytokines of Children with Viral Meningitis / 中国药房

OBJECTIVE:To observe the effect of acyclovir on neurological function and cytokines of children with viral menin-gitis. METHODS:Totally 70 children with viral meningitis were randomly divided into control group and observation group. All children were given routine treatment,including defervescence,reducing intracranial pressure and regulating water and electrolyte balance,etc. Based on it,the control group was treated by Ribavirin glucose injection 15 mg/kg,iv,bid;observation group was treated by Acyclovir glucose injection 5 mg/kg,iv,tid. The course for both was 7 d. The clinical data was compared,including the vascular endothelial growth factor (VEGF),matrix metalloproteinase-9 (MMP-9) in cerebrospinal fluid (CSF) and serum,insu-lin-like growth factor-Ⅱ(IGF-Ⅱ) and insulin like growth factor binding protein-3(IGFBP-3) in CSF before and after treatment and the incidence of adverse reactions. There were no obvious adverse reactions during the treatment. RESULTS:After treatment, the VEGF and MMP-9 in serum and the VEGF,MMP-9,IGF-Ⅱ and IGFBP-3 in CSF in 2 groups were significantly lower than before,and observation group was lower than control group,with significant differences(P<0.05). There was no adverse reactions in 2 groups during the treatment. CONCLUSIONS:Compared with ribavirin,acyclovir can more obviously improve the neurological function and cytokines of children with viral meningitis,with similar safety.

Parâmetros laboratoriais do líquido cefalorraquidiano em indivíduos com meningite por enterovírus / Laboratory parameters of cerebrospinal fluid in individuals with enterovirus meningitis

A meningite é a principal síndrome infecciosa que afeta o sistema nervoso central, e grande parte dos casos são ocasionados por infecções virais, principalmente por Enterovirus. O diagnóstico clínico para a verificação da etiologia da meningite ainda apresenta grandes desafios. O teste de Reação em Cadeia da Polimerase, leucócitos, hemácias, glicose, proteína e lactato no líquido cefalorraquidiano fornecem os primeiros indícios para o diagnóstico. No entanto, os valores de referência de alguns parâmetros podem sofrer alteraçõesOBJETIVO: Verificar parâmetros laboratoriais do líquido cefalorraquidiano em indivíduos com meningite por Enterovirus e, posteriormente, analisar suas relações por faixa etáriaMÉTODO: Foi realizado um estudo descritivo, com base nos dados do serviço de referência de coleta de líquido cefalorraquiano, localizado em São Paulo, Brasil. Totalizou-se em 202 indivíduos que apresentaram meningite por Enterovirus. Os dados foram analisados pelo teste de Shapiro-Wilk e Kruskal-Wallis (IC = 95%, p < 0,05) e representados pela mediana e percentil 25 e 75...

Meningitis is the leading infectious syndrome that affects the central nervous system, and most cases are caused by viral infections, mainly enterovirus. The clinical diagnosis for meningitis etiology still presents major challenges. The analysis of polymerase chain reaction (PCR), white blood cells, red blood cells, glucose, protein, and lactate in the cerebrospinal fluid (CSF) provides the first clues to the diagnosis. However, the reference values of some parameters can suffer changesOBJECTIVE: Analyze the laboratory parameters of CSF in patients with enterovirus meningitis, and then, theirrelationship by age groupMETHODS: A descriptive study was conducted based on data from a CSF reference service, located in São Paulo, Brazil, on 202 individuals who had enterovirus meningitis. Data was analysed by the Shapiro-Wilk and Kruskal-Wallis tests (CI = 95%, p < 0.05) and represented by the median and percentile 25 and 75, respectively...

Meningitis de Mollaret: reporte de caso / Mollaret´s meningitis: A case report

La meningitis de Mollaret es una enfermedad rara caracterizada por episodios recurrentes y autolimitados de meningitis linfocítica. Se presenta un caso de meningitis de Mollaret asociado a la infección por herpes simple tipo 2 en una mujer de 27 años con confirmación por reacción en cadena de la polimerasa (PCR) del líquido cefalorraquídeo y se hace una revisión del tema.

Mollaret´s meningitis is a rare disease characterized by recurrent and self-limited episodes of lymphocytic meningitis. We present a case of a 27-year-old woman with Mollaret´s meningitis related to viral infection with herpes simplex virus type 2 confirmed by cerebrospinal fluid polymerase chain reaction ( PCR ).

Changes of soluble triggering receptor expressed on myeloid cells-1 and lactate in children with purulent meningitis / 中华实用儿科临床杂志

Objective To discuss the diagnosis significance of soluble triggering receptor expressed on myeloid cells-1 (STREM-1) and lactate in children with purulent meningitis,and to investigate the changes of STREM-1,lactate in cerebrospinal fluid(CSF) of purulent meningitis before and after treatment.Methods Dry chemical method and enzyme linked immunosorbent assay(ELISA) were used to measure STREM-1 and lactate levels in CSF of purulent meningitis group (24 cases),viral meningitis group (27 cases),CSF normal group (25 cases) and purulent meningitis after treatment group(22 cases).Results 1.STREM-1 and lactate levels in CSF were higher in patients with purulent meningitis than in those with viral meningitis and CSF normal group(all P ＜ 0.05).2.STREM-1 and lactate levels in CSF were higher in patients with purulent meningitis before treatment than those after treatment(all P ＜ 0.05).3.The area under the curve(AUC) of STREM-1 in CSF was 0.891,and at a cutoff level of 27.86 ng/L STREM-1 yielded a sensitivity of 80.8％ and specificity of 75.0％ ;the AUC of CSF lactate was 0.940,and at a cutoff level of 1.75 mmol/ L lactate yielded a sensitivity of 90.4％ and specificity of 83.3％.Conclusions 1.STREM-1 and lactate were associated with bacterial infection,they have considerable diagnostic values in purulent meningitis.2.STREM-1 and lactate maybe worthless in differential diagnosis of purulent meningitis when treated by effective antibiotics.3.The decline of STREM-1 and lactate in CSF prompts the control of infection and good prognosis.

Conteo diferencial de leucocitos del líquido cefalorraquídeo y tiempo de evolución de la infección en recién nacidos con meningitis aséptica / Differential leukocyte count in cerebrospinal fluid and time of infection progression in children with aseptic meningitis

Objetivo: comprobar si un predominio de polimorfonucleares en el líquido cefalorraquídeo de pacientes neonatales con meningitis aséptica es frecuente y si tiene relación con el tiempo de evolución de la infección. Métodos: estudio retrospectivo de recién nacidos con meningitis aséptica, que ingresaron en el Servicio de Neonatología del Hospital Pediátrico Universitario "Juan M. Márquez", entre los años 1992-2007. Se analizaron las características de los leucocitos en el examen citoquímico del líquido cefalorraquídeo y su relación con el tiempo de evolución de la infección. Resultados: la mayoría de los 291 pacientes mostraron conteo de leucocitos del líquido cefalorraquídeo con valores en la mediana discretamente elevados. Los valores medios para el porcentaje de leucocitos polimorfonucleares estuvieron por debajo del 40 % para cualquiera de los intervalos de progresión de tiempo en la evolución de la infección. El análisis del tiempo de duración de la infección previa al diagnóstico de meningitis aséptica con el conteo de leucocitos y conteo absoluto y diferencial de polimorfonucleares en el líquido cefalorraquídeo, mostró que no hay relación estadística significativa, por lo que no dependen linealmente del tiempo de duración de la infección. Conclusiones: el predominio de polimorfonucleares en el líquido cefalorraquídeo no se circunscribe a las primeras horas de la infección y no depende del tiempo de duración de la infección.

Objective: to confirm whether polymorphonuclear leukocytes frequently predominate in the cerebrospinal fluid of neonates with aseptic meningitis and whether there is association between this predominance and time of the infection progression. Methods: a retrospective study of newborns with aseptic meningitis, who were admitted to the neonatology service of "Juan M. Marquez" university pediatric hospital from 1992 to 2007. The characteristics of leukocytes were analyzed in the cytochemical test and their association with the time of infection progression. Results: most of the 291 patients had slightly high median values in their leukocyte count. Regarding the percentage of polymorphonuclear leukocytes, the average values were below 40 % for any of the time intervals of the infection progression. The analysis of the infection duration prior to the diagnosis of aseptic meningitis with leukocyte count and with absolute and differential polymophonuclear count in the cerebrospinal fluid showed that there was neither significant statistical association nor linear dependence on the length of time of infection duration. Conclusions: the predominance of polymorphonuclears in the cerebrospinal fluid is not restricted to the first hours of infection and does not depend on the time of infection duration.

Características clínicas y epidemiológicas de la meningitis aséptica en recién nacidos / Clinical and epidemiological features of aseptic meningitis in newborns

Objetivo: exponer las características clínicas y epidemiológicas de la meningitis aséptica, probablemente enteroviral, en recién nacidos atendidos en nuestro servicio de neonatología. Métodos: estudio retrospectivo de 291 pacientes recién nacidos ingresados en el servicio de neonatología del Hospital Pediátrico Universitario "Juan M. Márquez", entre los años 1992-2009, con el diagnóstico de meningitis aséptica. La información se obtuvo de una base de datos creada para una investigación sobre meningitis neonatal. Se analizaron diversas variables clínicas y epidemiológicas de presentación de esta enfermedad. Resultados: ocurrieron picos de incremento de la incidencia de la meningitis aséptica, con una tendencia estadísticamente significativa a disminuir en el transcurso de los 18 años (p= 0,00027). La frecuencia de presentación mostró una agrupación de casos hacia los meses de junio a noviembre. La fiebre estuvo presente en todos los pacientes, seguida por la irritabilidad y la presencia de diversas manifestaciones del aparato respiratorio. La apariencia de niño enfermo y las convulsiones fueron manifestaciones poco frecuentes. Exceptuando la pleocitosis, los indicadores convencionales en el líquido cefalorraquídeo y la relación glucosa líquido cefalorraquídeo/sangre tuvieron una mediana dentro de los límites normales para el período neonatal, sin embargo, los rangos fueron amplios. Hubo pacientes con pleocitosis importante, otros con predominio de los polimorfonucleares en una proporción mayor del 50 % y también con relación glucosa líquido cefalorraquídeo/sangre baja. La evolución clínica de todos los pacientes fue favorable sin secuelas neurológicas inmediatas aparentes. Conclusiones: los episodios de meningitis aséptica ocurridos siguen un patrón característico de las infecciones enterovirales con agrupación de casos estacional y picos epidémicos periódicos. La expresión clínica de la infección y los resultados en los exámenes de biometría hemática y del examen citoquímico del líquido cefalorraquídeo, aunque característicos de una infección de esta índole, tienen amplia variabilidad, pues puede haber pacientes que presenten hallazgos que se asemejan a los observados en pacientes con meningitis bacteriana, lo cual puede crear incertidumbre clínica al médico que evalúa el paciente.

Objective: to show the clinical and epidemiological features of the aseptic meningitis, potentially by enterovirus in newborns seen in our service of Neonatology. Methods: a retrospective study was conducted in 291 neonatal patients admitted in the Neonatology service of the "Juan Manuel Márquez" Children Hospital from 1992 to 2009, diagnosed with aseptic meningitis. Information was collected from a database created for a research on neonatal meningitis. Different clinical and epidemiological variables of presentation of this disease were analyzed. Results: there were peaks of increase in the incidence of the aseptic meningitis with a statistically significant trend to decrease within the 18 years old (p= 0.00027). The frequency of presentation showed a grouping of cases towards June to November. The fever was present in all patients, followed by irritability and presence of different manifestations of respiratory tract. The appearance of the sick child and the convulsions were no more frequent manifestations. Excepting for the pleocytosis, the conventional indicators in the cerebrospinal fluid/blood had a mean within the normal limits for the neonatal period, however, the ranks were wide. There were patients presenting with a significant pleocytosis, other with predominance of polimorphonuclear ones in a ratio higher than 50 % and also a low relation of glucose-cerebrospinal fluid/blood. The natural history of all patients was favorable without neurological immediate obvious sequelae. Conclusions: the episodes of aseptic meningitis occurred have a pattern characteristic of the enterovirus infections with seasonal grouping of cases and periodical epidemic peaks. The clinical expression of the infection and the results in examinations of hematic biometry and the cytochemistry examination of the cerebrospinal fluid, although characteristic of a infection like this, have a wide variability, since could to be patients with findings resembling that observed in patients presenting with bacterial meningitis, creating a clinical uncertainty for physician assessing the patient.

Meningitis aséptica concurrente con infección del tracto urinario en recién nacidos / Aseptic meningitis concomitant with urinary tract infection in newborns

INTRODUCCIÓN. Trabajos publicados recientemente han destacado el hallazgo de meningitis aséptica (MA) en lactantes pequeños, concomitante con infección del tracto urinario (ITU). El objetivo de esta investigación fue determinar la frecuencia de tal presentación. MÉTODOS. Se realizó un estudio descriptivo, retrospectivo que incluyó a 626 recién nacidos con ITU, ingresados en el Hospital Pediátrico Universitario Juan Manuel Márquez entre febrero de 1992 y diciembre de 2008, y a quienes se les realizó una punción lumbar. Se comparó la frecuencia de MA e ITU con los informes documentados en la literatura médica. RESULTADOS. La frecuencia de MA concomitante con ITU fue del 7,0 por ciento (IC 95 por ciento: 4,9-9,1 por ciento). Los resultados promedio del examen citoquímico del líquido cefalorraquídeo mostraron que la pleocitosis fue el indicador más notable entre los que comúnmente se miden. La frecuencia encontrada fue similar a la de los informes internacionales. CONCLUSIONES. Es llamativa la incidencia de MA concomitante con ITU en los recién nacidos y en concordancia con lo reportado internacionalmente. La concomitancia de MA e ITU puede ser multifactorial, y es posible que se presenten factores causales en algunos pacientes, o casuales en otros casos

INTRODUCTION. Papers recently published have emphasized the finding of the aseptic meningitis (AM) in small infants, concomitant with a urinary tract infection (UTI). The aim of present research was to determine the frequency of this type of presentation. METHODS. A retrospective and descriptive study was conducted including 626 newborns presenting with UTI, admitted in the Juan Manuel Márquez University Children Hospital between February, 1992 and December, 2008 who underwent a lumbar puncture. The AM and UTI frequency was compared with informed reports in medical literature. RESULTS. The frequency of AM concomitant with UTI was of 7.0 percent (95 percent CI. 4,9-9,1 percent). The mean results of cytochemical examination of cerebrospinal fluid (CSF) showed that pleocytosis was the more remarkable indicator among those usually measured. The frequency found was similar to that of international reports. CONCLUSIONS. It is interesting the incidence of AM concomitant with UTI in newborns and in concordance with that reported at international level. The AM and UTI concomitant feature may be multifactor, and it is possible the presence of causal factors in some patients or casual in other cases.

Tratamiento sin antibióticos en recién nacidos febriles con pleocitosis del líquido cefalorraquídeo y presunta meningitis viral / Treatment without antibiotics in febrile infants presenting with cerebrospinal fluid pleocytosis and supposed viral meningitis

INTRODUCCIÓN. El objetivo de esta investigación fue presentar la experiencia en antibioticoterapia en recién nacidos (RN) febriles con pleocitosis del líquido cefalorraquídeo (LCR) y presunción médica de meningitis viral. MÉTODOS. Se realizó un estudio retrospectivo con 310 RN con diagnóstico de meningitis aséptica, ingresados en el Servicio de Neonatología del Hospital Pediátrico Universitario Juan Manuel Márquez entre 1992 y 2009. Se determinó, utilizando estadística descriptiva, la indicación o no de tratamiento antibiótico, momento y motivos de la indicación. RESULTADOS. Hubo 204 RN (65,8 por ciento) con meningitis aséptica que egresaron favorablemente sin haber recibido tratamiento antibiótico. En 106 RN (34,2 por ciento) se indicaron antibióticos (en 76 inmediatamente al diagnóstico de meningitis y en 30 casos, mediatamente por diversos motivos). Los motivos para tratamiento inmediato fueron principalmente los resultados del examen citoquímico del LCR muy semejantes a los de una meningitis de causa bacteriana y los antecedentes de fiebre elevada o persistente. En la indicación mediata el principal motivo fue la concurrencia de infección del tracto urinario. En los pacientes que nunca recibieron tratamiento antibiótico, la mediana de estadía hospitalaria fue de 4 días (intervalo intercuartil 3-5 días) y para los que sí lo recibieron fue de 5 días (intervalo intercuartil 4-7 días) (p < 0,0001). CONCLUSIONES. Es aconsejable revisar el enfoque de utilizar tratamiento antibiótico ante todo RN proveniente de la comunidad cuando se encuentra pleocitosis del LCR y se presume la existencia de una meningitis viral, siempre y cuando existan condiciones de vigilancia profesional calificada y continua, y un laboratorio de microbiología con recursos suficientes para respaldar una estrategia de tratamiento con uso racional de la antibioticoterapia

INTRODUCTION. The aim of present research was to present the antibiotic-therapy experience in febrile newborn (NB) presenting with cerebrospinal fluid pleocytosis (CSFP) and supposed viral meningitis. METHODS. A retrospective study was conducted in 310 NB diagnosed with aseptic meningitis admitted in the Neonatology Service of the Juan Manuel Márquez Children University Hospital between 1992 and 2009. Using the descriptive statistic method the indication or not of antibiotic treatment, moment and indication reasons were determined. RESULTS. There were 204 NB (65,8 percent) presenting with aseptic meningitis favorably discharged without antibiotic treatment. In 106 NB (34,2 percent) antibiotics were prescribed (in 76 immediately to be diagnosed with meningitis and in 30 cases, due to different reasons. The reasons for immediate treatment were mainly the results of cytochemical examination of CSF very similar to that of bacterial meningitis and backgrounds of a high or persistent fever. In mediate indication the main reason was the concurrence urinary tract infection. In patients that never were received antibiotic treatment, the hospital stay mean was of 4 days (inter-quartile interval 3-5 days), and for those that received treatment it was of 5 days (inter-quartile 3-7 days) (p < 0,0001). CONCLUSIONS. It is advisable to review the approach to use the antibiotic treatment in the case of a NB from the community when there is CSF pleocytosis and the supposed existence of viral meningitis provided that there are conditions of qualified and continuous professional surveillance and a laboratory with enough resources to support a treatment strategy with a rational use of the antibiotic therapy

Study on the pathological and molecular characteristics of viral meningitis outbreaks in Linhai county, Zhejiang province, 2004 / 中华流行病学杂志

Objective In order to confirm the causes of viral meningitis outbreaks in Linhai county,Zhejiang province in 2004,and to analyze the relationship between hereditary variation and evolution of the pathogen.Methods 60 cerebrospinal fluid(CSF)specimens were collected from the suspected patients.Virus strains from the specimens were isolated with RD and Hep-2 cell lines,and identified through neutralization test.VP1 and VP4/VP2 genes of the isolated viruses were sequenced.Both phylogcnetic and homological trees were also constructed.Results 19 Echovirus type 30(E30)strains were isolated from 60 CSFs,in which E30 accounted for 31.7％.All of the complete VP1 genes in 4 sequenced virus isolates of E30 were composed of 876 nt,encoding 292 amino acids(aa).The identity of nucleotide and amino acid in VP1 gene were 82.4％-84.1％ and 93.5％-94.2％ between the 4 Linhai strains and the prototype strain Bastianni of E30,were 87.1％-99.9％ and 97.9％-100.0％ among the 4 virus strains of E30 from Linhai,respectively.The 4 Linhai strains could be classified into two classes.The diversity of nt and aa was minimal in the same class but obvious between the two classes,with the range of diversities as 12.9％ and 2.1％,respectively.The Linhai E30 strains had maximum similarity with the Zhejiang E30 strains in 2002-2003.The 4 Linhai strains of E30 in the phylogenetic tree of the VP1 gene were attributed into two branches of the G and H genotype,respectively.The G branch also included the E30 strains from Zhejiang,Jiangsu and Shangdong in 2003,while the H branch including E30 strains from Zhuji,Zhejiang in 2002.The phylogenetic tree of VP4/VP2 genes was similar to that of VP1 gene.Conclusion The outbreak of viral meningitis in Linhai county in 2004 was caused by the two classes of E30 strains with G and H genotype existed simultaneously.The Linhai E30 strains had maximum genetic relations to the Zhejiang,Jiangsu and Shangdong strains of E30.The H genotype was inferred to be a new variant strain,which was first isolated in Zhejiang province in 2002.

Acute Central Horner Syndrome Diagnosed by 0.5% Apraclonidine Test: The Usefulness of the Apraclonidine Test

No abstract available.

Echovirus 30 associated with cases of aseptic meningitis in state of Pará, Northern Brazil

Investigation of the aetiology of viral meningitis in Brazil is most often restricted to cases that occur in the Southern and Southeastern Regions; therefore, the purpose of this study is to describe the viral meningitis cases that occurred in state of Pará, Northern Brazil, from January 2005-December 2006. The detection of enterovirus (EV) in cerebrospinal fluid was performed using cell culture techniques, RT-PCR, nested PCR and nucleotide sequencing. The ages of the 91 patients ranged from < one year old to > 60 years old (median age 15.90 years). Fever (87.1 percent), headache (77.0 percent), vomiting (61.5 percent) and stiffness (61.5 percent) were the most frequent symptoms. Of 91 samples analyzed, 18 (19.8 percent) were positive for EV. Twelve were detected only by RT- PCR followed by nested PCR, whereas six were found by both cell culture and RT-PCR. From the last group, five were sequenced and classified as echovirus 30 (Echo 30). Phylogenetic analyses revealed that Echo 30 detected in Northern Brazil clustered within a unique group with a bootstrap value of 100 percent and could constitute a new subgroup (4c) according to the phylogenetic tree described by Oberste et al. (1999). This study described the first molecular characterization of Echo 30 in Brazil and this will certainly contribute to future molecular analyses involving strains detected in other regions of Brazil.

Estudio de 312 niños con meningitis atendidos en un Hospital Universitario en el Sur de Brasil / Study of 312 children with meningitis treated at a University Hospital in the South of Brazil

El objetivo de este trabajo fue evaluar los aspectos clínicos, análisis de laboratorio, el perfil etiológico y las características evolutivas de los distintos tipos de meningitis aguda atendidos en un Servicio de Pediatría de un Hospital Público Universitario. Fueron evaluados a partir de un estudio descriptivo y retrospectivo de niños atendidos en el Servicio de Pediatría del Hospital de Clínicas de la Universidad Federal del Paraná, durante el periodo entre enero 2003 a enero 2007, con el diagnóstico probable de meningitis basado en manifestaciones clínicas y en alteraciones citológicas y bioquímicas del LCR. Se diagnosticó meningitis viral (MV) en 140 niños (45%), meningitis bacteriana (MB) en 58 (19%) y en 114 la etiología fue indeterminada (36%). Entre las MB el agente etiológico más frecuente fue Neisseria meningitidis (25 casos). Lo datos clínicos predominantes fueron fiebre, vómitos y cefalea. En el LCR de la MB hubo predominio de polimorfonucleares, proteína elevada y glucosa baja. En la MV predominaron los mononucleares. Las complicaciones neurológicas fueron más frecuentes en la MB, siendo la convulsión el hallazgo más común (6/58 pacientes). El óbito ocurrió en un caso en la MV y tres en la MB. Se llegó a la conclusión de que la clásica tríada fue la manifestación clínica más común, las anormalidades citológicas y bioquímicas fueron típicas auxiliando en la diferenciación entre las MB y MV, aunque un gran número de casos haya quedado sin definición etiológica; las complicaciones neurológicas inmediatas y los óbitos han sido pocos frecuentes en esta muestra.

The aim of this study is to evaluate the clinical and laboratorial aspects, as well as the etiological profile and the evolution characteristics, of the diverse types of severe meningitis treated at a Pediatric Clinic of a public university hospital. From a descriptive and retrospective study, 312 children at the Pediatric Clinic of the Hospital de Clínicas of the Federal University of Paraná were evaluated between January 2003 and January 2007. All of them had a probable diagnosis of meningitis based on clinical signs, and on the cytological and biochemical alterations in the cerebrospinal fluid routine examination. Viral meningitis (VM) was present in 140 children (45%), 58 had bacterial meningitis (BM - 19%) and etiology was undetermined in 114 (36%). In MB, Neisseria meningitidis was the most frequent etiological agent (25 cases). Predominant clinical symptoms were fever, sickness and headache. The cerebrospinal fluid test showed a high number of polymorphonuclear leukocytes, high protein and low glucose level in MB; mononuclear cells were predominant in VM. Neurological complications were more frequent in BM, and convulsion the most common symptom (6/58 patients). Death happened to one case in VM and 3 in BM. Our conclusions were that the classical triad (headache, vomiting and fever) was the most common clinical manifestation, the cytological and biochemical abnormalities were typical, helping in the differentiation of MB from VM, although a good number of cases ended up with no etiological definition and, finally, immediate neurological complications and death were rare.