Several problems in the diagnosis and treatment of neonatal bacterial meningitis / 中华实用儿科临床杂志

Neonatal bacterial meningitis remains a common and life-threatening disease in newborns, with high mortality and morbidity.Despite its declining incidence in recent years, the rate of severe sequelae shows slight changes.The clinical manifestation of neonatal bacterial meningitis is atypical, and thus its diagnosis requires cerebrospinal fluid examination.Early detection and effective antibiotic treatment are the key to improve the survival rate.In addition, neonatal bacterial meningitis is often complicated with brain edema and intracranial hypertension, which would result in cerebral ischemia and hypoxia, and further aggravate brain injury.Therefore, more attention should be paid to the prevention and treatment of brain edema and intracranial hypertension while adopting antibiotic therapy in the treatment of neonatal bacterial meningitis.

Progress of group B streptococcus meningitis in children / 国际儿科学杂志

Group B streptococcus(GBS), also known as streptococcus agalactis, is a Gram-positive conditionally causative coccus that can colonize healthy humans.GBS is a common pathogen of bacterial meningitis in infants under 3 months of age.GBS serotype Ⅲ and sequence type 17(ST 17)are the most common and virulent, and there is a significant correlation between serotype Ⅲ and ST 17, and erythromycin resistance is high.Penicillin or ampicillin is the first-line drug in China.Children with GBS meningitis are at high risk of poor prognosis.Intrapartum antibiotic prophylaxis(IAP)may be given in the presence of specific risk factors for GBS invasion in newborns. IAP reduced the incidence of early-onset GBS, but did not significantly reduce early-onset mortality and late-onset morbidity.

Sepsis precoz, osteoartritis y meningitis: a propósito de un caso clínico / Early sepsis, osteoarthritis and meningitis: a clinical case / Sepse precoce, osteoartrite e meningite: relato de caso

Se expone el caso de un recién nacido que desarrolló sepsis connatal precoz a Streptococcus agalactiae, con meningitis aguda supurada y osteoartritis de rodilla izquierda. Como factor de riesgo la madre no tenía realizado el exudado rectovaginal, pesquisa que detecta la colonización por estreptococo del grupo B (EGB). Se aisló el germen en hemocultivo y en líquido de punción articular. Recibió tratamiento antibiótico adecuado a la sensibilidad del microorganismo y según pauta de sepsis con meningitis, evolucionando favorablemente. En este trabajo se describe la epidemiología de la sepsis neonatal y los cambios ocurridos luego de la implementación de la profilaxis antibiótica en el preparto.

We hereby present the case of a newborn with early connatal sepsis due to Streptococcus agalactiae, with acute suppurative meningitis and left knee osteoarthritis. As a risk factor, the mother had not performed the rectus vaginal exudate screening that detects colonization by Group B Streptococcus (GBS). The germ was isolated in blood culture and in joint puncture fluid. The patient received germ-sensitive antibiotic treatment for meningitis sepsis and evolved favorably. This paper describes the epidemiology of neonatal sepsis and the changes that have occurred after the administration of the antibiotic prophylaxis during pregnancy.

Apresentamos o caso de um recém-nascido com sepse neonatal precoce por Streptococcus agalactiae, com meningite supurativa aguda e osteoartrite de joelho esquerdo. Como fator de risco, a mãe não realizou teste de exsudato vaginal do reto que detecta a colonização por estreptococos do grupo B (SGB). O germe foi isolado em hemocultura e líquido de punção articular. A paciente recebeu tratamento com antibióticos germinativos para padrão meningite sepse e evoluiu favoravelmente. Este artigo descreve a epidemiologia da sepse neonatal e as mudanças ocorridas após a administração da profilaxia antibiótica durante a gravidez.

Predictive value of amplitude integrated electroencephalography in neurological prognosis of neonatal bacterial meningitis / 中国小儿急救医学

Objective:To explore the predictive value of amplitude integrated electroencephalography(aEEG)in the neurological prognosis of children with neonatal bacterial meningitis(NBM).Methods:The clinical data and aEEG results from 148 children diagnosed with NBM who completed aEEG examinations in the Department of Neonatology at Kunming Children′s Hospital from January 2018 to December 2019 were retrospectively analyzed.According to whether aEEG is abnormal, the children were divided into aEEG abnormal group and aEEG non-abnormal group.According to the degree of aEEG abnormality, children with aEEG abnormality were divided into aEEG mild abnormal group and aEEG severe abnormal group.The abnormal rate and abnormal characteristics of aEEG were analyzed; The clinical data of two groups were compared.Results:(1)Among the 148 children with NBM, 49 children had abnormal aEEG, 99 children had no abnormality, and the aEEG abnormal rate was 33.1%.The abnormal aEEG was manifested as delayed sleep-wake cycle maturation in 39 (26.3%) cases, abnormal discharge in eight (5.4%) cases, and abnormal background activity in one (0.6%) case.(2)The proportion of children with convulsive seizures and refractory NBM in aEEG abnormal group were significantly higher than those in aEEG non-abnormal group ( P<0.05). In the routine and biochemical abnormal indexes of cerebrospinal fluid, the proportion of protein >3 g/L, cerebrospinal fluid leukocyte>500×10 6/L, cerebrospinal fluid glucose<1.5 mmol/L, positive cerebrospinal fluid culture, positive blood and cerebrospinal fluid culture, abnormal head MRI in aEEG abnormal group significantly increased ( P<0.05); While there was no significant difference regarding blood routine leukocyte abnormality, CRP increase, and positive blood culture ratio between two groups ( P>0.05). (3) 148 cases of NBM children were followed up to 15 months old, 119 (80.4%) cases completed the follow-up, the loss rate was 19.6%, three cases died, and 11 cases had psychomotor retardation.Compared with the children with abnormal aEEG, the prognosis of children with NBM was significantly different, the Spearman rank correlation coefficient r was 0.315 ( P<0.05). COX regression was used to analyze the predictive value of each index for adverse outcomes. Abnormal aEEG was an independent risk factor for adverse outcomes in children with NBM ( OR=7.452, 95% CI 1.605-34.591, P<0.05). Conclusion:The aEEG monitoring of children with NBM, if abnormal, may indicate severe NBM, which is likely to be transformed into refractory NBM or has a poor prognosis.

Clinical diagnostic value of cerebrospinal fluid lactate in bacterial meningitis of newborn / 中国新生儿科杂志

Objective:To study the diagnostic value of cerebrospinal fluid (CSF) lactate level in infants with bacterial meningitis.Methods:From March 2018 to March 2020, infants admitted to the neonatal intensive care unit of our hospital and received lumber puncture were studied retrospectively. According to the diagnostic criteria of neonatal bacterial meningitis, the infants were assigned into bacterial meningitis group and non-bacterial meningitis group. CSF lactic acid, protein and glucose levels of the two groups were compared. JMP10.0 software was used for statistical analysis.Results:A total of 305 infants received lumbar puncture for CSF, 2 cases of intraventricular hemorrhage (grade Ⅲ~Ⅳ), 1 case of viral encephalitis and 1 case of neurosyphilis were excluded. 63 cases were in the bacterial meningitis group and 238 cases were in the non-bacterial meningitis group. The CSF cultures were positive in 5 cases and the blood cultures were all negative. The median levels of CSF lactic acid, protein and CSF lactic acid/CSF glucose in the bacterial meningitis group were 1.41 mmol/L, 2.1 g/L and 0.60, both significantly higher than the non-bacterial meningitis group (1.11 mmol/L, 1.2 g/L and 0.40) ( P<0.05). The median CSF glucose level in the bacterial meningitis group was 2.3 mmol/L, significantly lower than the non-bacterial meningitis group (2.5 mmol/L). When the cut-off value of CSF lactic acid was 1.47 mmol/L, the sensitivity and specificity of the diagnosis of bacterial meningitis were 49.2% and 79.9%. When the cut-off value of CSF protein was 2.26 g/L, the sensitivity and specificity of the diagnosis of bacterial meningitis were 49.2% and 91.2%. When the cut-off value of CSF lactic acid/CSF glucose ratio was 0.48, the sensitivity and specificity of the diagnosis of bacterial meningitis were 73.0% and 62.4%. Conclusions:CSF lactic acid is helpful in the diagnosis of neonatal bacterial meningitis. The combination of CSF protein and CSF lactic acid/CSF glucose ratio can improve the specificity and sensitivity of the diagnosis.

Clinical characteristics, pathogen distributions and outcomes of bacterial meningitis in preterm and term infants / 中国小儿急救医学

Objective:To investigate and compare the clinical characteristics, pathogen distributions and outcomes of bacterial meningitis in preterm and term infants.Methods:The data of 252 cases of neonatal bacterial meningitis hospitalized in Guangzhou Women and Children′s Medical Center from January 2013 to December 2018 were retrospectively analyzed and divided into two groups according to gestational age: preterm group( n=64)and term group( n=188). The clinical manifestations, laboratory examinations, pathogen distributions and clinical outcomes of the children in two groups were compared. Results:Fever was the most common clinical manifestation in both groups, but the incidences of lethargy, apnea and feeding intolerance in preterm group were significantly higher than those in term group( P<0.05). There was no significant difference in the rate of the first hemogram/cerebrospinal fluid abnormality between two groups( P>0.05). Sepsis, subdural effusion and hydrocephalus were the main complications in both groups.The incidence of complications in premature infants was 60.9%(39/64), which was significantly higher than that in full-term infants(44.7%, 84 /188) , with a statistically significant difference ( P<0.05). Escherichia coli and Streptococcus agalactiae were the most common pathogens in the preterm infants, whereas Klebsiella pneumoniae and Streptococcus agalactiae were the most common pathogens in the term infants.There was no statistical difference in the time of positive bacteria turning negative between two groups, but the course of antibiotics in preterm group was significantly longer than that in term group( P<0.05). The clinical cure/improvement rates in the two groups was about 95%, and the difference between two groups was not statistically significant( P>0.05). Conclusion:Early clinical manifestations of bacterial meningitis in preterm infants are atypical and relatively easy to be missed.The incidence of complications is significantly higher than that of full-term infants, and the duration of antibiotic use is longer.However, the clinical cure/improvement rate of premature infants is not worse than that of full-term infants after reasonable and standardized early treatment.

Meningitis tras técnica combinada raquídea-epidural para analgesia del parto: reporte de un caso / Case report of meningitis after combined spinal-epidural analgesia for labor

La meningitis pospunción es una complicación importante y poco frecuente de la anestesia neuroaxial. Describimos el caso de una paciente que ingresa para inducción del parto. Se realiza técnica espinal-epidural para analgesia del parto. Cursando 48 h de puerperio instala cefalea intensa, fotofobia y fiebre. No focalidad neurológica. Sin rigidez de nuca. Al examen, restos cavitarios que impresionan fétidos. Se plantea endometritis puerperal iniciando tratamiento antibiótico. Dado la persistencia del cuadro clínico se plantea punción lumbar para confirmación diagnóstica mediante análisis de líquido cefalorraquídeo; siendo éste turbio, por lo cual ingresa a cuidados intensivos con diagnóstico de meningitis aguda. Bacterióloga informa a los 10 días que el cultivo desarrolla estreptococo mitis oralis. La importancia esta dada porque la meningitis puede ser potencialmente devastadora si no se realiza un diagnóstico y tratamiento tempranos, existiendo medidas que se pueden adoptar para prevenir esta complicación.

Post-puncture meningitis is an important and rare complication of neuraxial anesthesia. We describe case of patient who is admitted for induction of labor. A spinal-epidural technique is performed for labor analgesia. During 48 hours of puerperium, she installed intense headache, photophobia and fever. No neurological focus. No stiff neck. On physical exam, cavitary remains that appear fetid. Puerperal endometritis arises starting antibiotic treatment. Given the persistence of the clinical picture, lumbar puncture is considered for diagnostic confirmation by analysis of cerebrospinal fluid; This being cloudy, for which he was admitted to Intensive Care with a diagnosis of acute meningitis. Bacteriologist reports 10 days later develops streptococcus mitis oralis. The importance is given because meningitis can be potentially devastating if early diagnosis and treatment is not performed, and there are measures that can be taken to prevent this complication.

Case report of bacterial meningitis complicated with posterior fossa subdural empyema in a newborn / 中华实用儿科临床杂志

The clinical data of a case of neonatal bacterial meningitis complicated with posterior fossa subdural empyema in the West China Second University Hospital in December 2019 were retrospectively analyzed.The 3-day-old male newborn was admitted for jaundice with decreased intake for 1 day.Examinations on admission showed increased C-reactive protein.The count of karyocytes in cerebrospinal fluid (CSF) significantly increased, which were mainly neutrophils, and pyocytes could be found.The protein content in CSF increased, while that of glucose decreased.Both CSF culture and blood culture detected the presence of Escherichia coli.Enhanced magnetic resonance imaging (MRI) of the head indicated large abnormal signals in bilateral occipital extra-cerebellar spaces.T1-weighted images presented mixed low and high signals, and T2-weighted images presented high signals, and marginal enhancement was observed after enhancement.After 6 weeks of antibiotic treatment using Meropenem combined with Ceftazidime, the CSF index of the newborn patient returned to normal, and the subdural empyema of the posterior fossae subsided.Bacterial meningitis complicated with subdural empyema of posterior fossa is a rare and critical disease of the central nervous system.It is easily misdiagnosed due to the atypical clinical manifestations and early imaging features.The disease requires an adequate course of anti-infective treatment.Surgical removal of the empyema should be performed if the anti-infective treatment is unresponsive.

Clinical application of metagenomics sequencing in children with acute bacterial meningitis / 中华实用儿科临床杂志

Objective:To explore the application value of metagenomics sequencing in the etiological diagnosis of bacterial meningitis(BM) in children and improve the diagnosis and treatment effect of BM in children.Methods:All BM cases were collected from Jiangxi Provincial Children′s Hospital from February 1, 2018 to January 31, 2020.Meanwhile, such biological samples as blood and cerebrospinal fluid were collected for traditional etiological testing and metagenomics sequencing.The results of traditional etiological testing were regarded as the gold standard, and the specificity and sensitivity of metagenomics sequencing in the diagnosis of BM in children were confirmed.Results:A total of 45 cases were collected in this study, including 31 males and 14 females, with the age between (74.74 ± 58.67) months.Twenty-six cases were identified by metagenomics sequencing, with the positive rate being 57.78%.Among them, there were 8 cases of Streptococcus pneumoniae, 2 cases of Escherichia coli, 2 cases of Neisseria meningitidis, 2 cases of Staphylococcus, 2 cases of Salmonella, 2 cases of Mycobacterium multiplex, 1 case of Streptococcus intermedius, 1 case of Streptococcus pyogenes, 1 case of Streptococcus paris, 1 case of Streptococcus salivarius, 1 case of Haemophilus influenzae, 1 case of Pseudomonas aeruginosa, 1 case of Acinetobacter baumannii, and 1 case of Aspergillus.The traditional etiological positive rate was 17.78%, and the metagenomic next-generation sequencing (mNGS) positive rate was 57.78% ( P=0.014, kappa=0.273). As per the comparison results, the sensitivity, specificity, positive predictive value, negative predictive value, Youden index and misdiagnosis rate were 100.00%, 51.35%, 30.76%, 100.00%, 51.36%, 48.64% and 0, respectively. Conclusions:Metagenomics examination had high sensitivity, which can improve the etiological diagnosis rate of acute BM in children, especially in case of high clinical suspicion of infection.Therefore, metagenomics examination should be selected as early as possible when the etiology cannot be determined by traditional approaches.

Treatment analysis and pharmaceutical care for one child with bacterial meningitis / 药学实践杂志

Objective To explore the strategies of drug treatment and pharmaceutical care for children with bacterial meningitis. Methods The anti-infective therapy, therapeutic drug monitoring and dose adjustment of vancomycin in children with bacterial meningitis were analyzed and discussed according to relevant guidelines and literatures. Results Clinical pharmacists analyzed therapeutic regimen. According to the results of etiology and drug sensitivity, meropenem was discontinued and rifampicin was added. Based on drug monitoring of vancomycin, it is suggested to extend the infusion time of vancomycin to reach the target concentration. The child was discharged from hospital. Conclusion Recommendations of the relevant drug treatment guidelines and the latest medical research evidence should be provided by clinical pharmacists in order to promote reasonable and effective clinical uses of medicine.

Utility of urine reagent strips in rapid bedside diagnosis of bacterial meningitis

Background: Bacterial meningitis is a medical emergency and late diagnosis and treatment can lead to neurological damage and death. For definitive diagnosis of meningitis, laboratory based CSF analysis is required which is based on microscopy, protein and sugar estimation. This requires laboratory set up with experienced pathologist and long turn around time. Hence urinary reagent strips as a semiquantitative method can be applied for CSF analysis. This method can be used where laboratory set up is not available as well as bedside test for early diagnosis of bacterial meningitis. The present prospective study was undertaken to evaluate the utility of urine reagent strips in rapid diagnosis of bacterial meningitis. The aim of the present was to evaluate the role of urine reagent strips in the analysis of cerebrospinal fluid in suspected cases of meningitis.Methods: The prospective study was carried out in the department of pathology in a tertiary care centre for a period of 6 months from September 2018 to February 2019. CSF analysis of suspected cases of meningitis was done with urine reagent strip as well as with standard laboratory method. The results of both were compared.Results: Out of 79 cases of meningitis, 68.35% cases were of bacterial meningitis. The specificity and sensitivity of CSF analysis with reagent strip was 93.33% and 82.35% respectively, for cell count, 94.4% and 88.2% respectively for proteins and 91.3% and 60.2% respectively for glucose.Conclusions: Semiquantitative analysis of CSF sample with urine reagent strips helps in rapid diagnosis of bacterial meningitis and can be useful to facilitate therapeutic decisions in resource constrained settings.

Serum procalcitonin in pediatric bacterial meningitis versus pediatric non bacterial meningitis: open label prospective study

Background: Several studies have shown potential value of serum Procalcitonin level (SPCT) for diagnosing and differentiating bacterial meningitis (BME) from other, but the results were inconsistent.Methods: Children from birth to 12 years, with clinical suspicion of meningitis were enrolled. Clinical and laboratory information was collected and cases were classified according to pre decided case definition (based on clinical and laboratory) as bacterial or non-bacterial meningitis (NBME).Results: Out of 4393 admission (2016-17) 60 patients were selected for final study (on basis of case definition) which were equally distributed in both group (BME and NBME) in terms of age and sex (p 0.97). 29/41 (70%) patients of pyogenic meningitis had high level of SPCT which was significant, whereas only 2/19 (10.5%) patients of NBME had high level of SPCT. Although SPCT seems to be the good marker in differentiating between BME and NBME, SPCT level specificity (89%) in the diagnosis of BME was not higher than CSF protein level (94%) and CSF glucose level (94%).Conclusions: Measurement of plasma SPCT levels are of value in differentiating BME & NBME in children. However, SPCT should not be used as single sole diagnostic marker of BME if CSF protein and glucose are available. CSF WBC Count alone should not to be used in diagnosis of BME as specificity is low. This study needs to be validated with a larger sample size and microbiological confirmation of bacterial disease.

Bacterial meningitis in patients with sickle cell anemia in Salvador, Bahia, Brazil: a report on ten cases

ABSTRACT Sickle cell anemia (SCA) is a common genetic blood disorder, affecting millions worldwide. According to current evidence, individuals with SCA have more than 300 times greater risk to develop bacterial meningitis (BM) than the general population. Herein we have described the characteristics of a series of BM cases in SCA patients in Salvador, Brazil, during 13 years of hospital-based surveillance. Data on clinical presentation, laboratory parameters and outcomes were collected retrospectively by reviewing medical records. From 1999 to 2011, ten SCA patients were identified among the 2511 cases of BM (10/2511; 0.40%). These patients were more likely to be male (90%) and to be younger (median age 8.5 years). The causative agents were Streptococcus pneumoniae (n = 5) and Haemophilus influenzae (n = 1). The most frequent pneumococcal serotypes were 23 F (2 cases), 14, 18 F, 23B (one case each). Common medical complications were stroke (n = 3); heart failure (n = 2), respiratory problems (n = 2), renal dysfunctions (n = 2) and leg ulcers (n = 1). This study highlights the importance of S. pneumoniae as a causative agent of meningitis in individuals with SCA and shows the diversity of comorbidities associated with this condition.

Vacuna cubana antimeningocócica VA-MENGOC-BC®: Treinta años de uso y potencialidades vigentes / Cuban Meningococcal Vaccine VA-MENGOC-BC®: 30 Years of Use and Future Potential

La enfermedad meningocócica provoca cada año más de 500.000 casos y 85.000 muertes en el mundo y un 20 por ciento de los sobrevivientes sufre secuelas. En Cuba, en 1980, la incidencia llegó a 14,4 por 100.000 habitantes para todas las edades y fue declarada como el principal problema de salud del país. En niños menores de 1 año se reportaron más de 120 casos por 100.000 habitantes en algunas provincias. En 1989, investigadores en La Habana, Cuba desarrollaron una vacuna contra meningococo B y C; VA-MENGOC-BC®, la primera en el mundo eficaz contra el meningococo del serogrupo B. Su eficacia de 83 por ciento se demostró en un estudio de campo prospectivo a doble ciegas, aleatorizado, contra placebo. En su producción se empleó por primera vez la tecnología vesicular o proteoliposómica. Esta vacuna se usó en una campaña de vacunación masiva y posteriormente fue incluida en el Programa Ampliado de Inmunización en Cuba y tuvo un impacto acumulado sobre la incidencia de la enfermedad meningocócica del serogrupo B superior a 95 por ciento (93 por ciento-98 por ciento). La vacunación masiva y sistemática cambió el espectro de cepas del meningococo en los portadores asintomáticos sanos y la circulación de cepas en las poblaciones hacia fenotipos no virulentos. La enfermedad dejó de ser un problema de salud en el país. VA-MENGOC-BC® es la vacuna contra la enfermedad meningocócica del serogrupo B que se aplicó en el mayor número de susceptibles en el mundo. En América Latina se administraron más de 60 millones de dosis. En varios países donde se ha usado VA-MENGOC-BC®, circulan cepas diferentes a la vacunal y contra todas ellas se demostró un elevado porcentaje de efectividad (55%-98 por ciento en menores de 4 años y 73 por ciento-100 por ciento en mayores de 4 años). VA-MENGOC-BC® y su tecnología proteoliposómica han tenido impacto y mantienen su potencialidad, no solo en la enfermedad meningocócica, sino en el desarrollo de otras vacunas y adyuvantes(AU)

Every year, meningococcal infection by Neisseria meningitidis causes over 500,000 cases and 85,000 deaths in the world, with 20 percent of survivors suffering sequelae. In Cuba its incidence in 1980 reached 5.9 cases per 100,000 population; about 80 percent of cases were serogroup B, prompting health authorities to declare meningococcal disease the country's main public health problem. Several provinces reported over 120 cases per 100,000 children aged <1 year, overwhelmingly serogroup B. At that time, no vaccines existed with proven efficacy against N. meningitidis serogroup B, nor was there a vaccine candidate that could be successful in the short term. By 1989, researchers in Havana had developed a Cuban meningococcal B and C vaccine, VA-MENGOC-BC®, the world's first against serogroup B meningococcal disease. Its efficacy of 83 percent was demonstrated in a prospective, randomized, double-blind, placebo-controlled field study. Vaccine production used vesicle or proteoliposome technology for the first time. The same year, the World Intellectual Property Organization awarded its gold medal to the main authors of the VA-MENGOC-BC® patent. The vaccine was used in a mass vaccination campaign and later included in Cuba's National Immunization Program, with a cumulative impact on incidence of serogroup B meningococcal disease greater than 95 percent (93 percent-98 percent). Mass, systematic vaccination shifted the spectrum of meningococcal strains in healthy asymptomatic carriers and strains circulating among population groups toward nonvirulent phenotypes. The disease ceased to be a public health problem in the country. VA-MENGOC-BC® is the most widely applied vaccine against serogroup B meningococcal disease in the world. Over 60 million doses have been administered in Latin America. In several countries where it has been applied, in which strains other than the vaccine-targeted strains circulate, VA-MENGOC-BC® has demonstrated effectiveness against all (55 percent-98 percent in children aged ≥4 years and 73 percent-100 percent in children aged >4 years). The vaccine and its proteoliposome technology have had an impact and continue to have potential, not only for meningococcal disease, but also for development of other vaccines and adjuvants(AU)

Application of Cervical Vestibular-Evoked Myogenic Potentials in Adults with Moderate to Profound Sensorineural Hearing Loss: A Preliminary Study

Abstract Introduction The cochlea and the vestibular receptors are closely related in terms of anatomy and phylogeny. Patients with moderate to profound sensorineural hearing loss (MPSHL) should have their vestibular organ functions tested. Objective To evaluate the incidence of vestibular abnormalities in patients with MPSHL and to study the correlation between the etiology of hearing loss (HL) and a possible damage to the labyrinth. Methods A case-control retrospective study was performed. In the case group, 20 adults with MPSHL of known etiology were included. The control group was composed of 15 adults with normal hearing. The case group was divided into 4 subgroups based on the etiology (bacterial meningitis, virus, vascular disease, congenital). Cervical vestibular-evoked myogenic potentials (cVEMPs) were used to rate the saccular function and lower vestibular nerve. Results The study was performed in 70 ears, and it highlighted the presence of early biphasic P1-N1 complex in 29 (71.5%) out of 40 ears in the study group, and in all of the 30 ears in the control group (p = 0.001). Regarding the presence or absence of cVEMPs among the four subgroups of patients with MPSHL, the data were statistically significant (p < 0.001). The comparison between the latencies and amplitude of P1-N1 in case and control groups from other studies and in the four subgroups of cases in the present study did not detect statistically significant differences. Conclusion The present study demonstrates that patients with MPSHL have a high incidence of damage to the labyrinthine organs, and it increases the current knowledge about the etiopathogenesis of sensorineural HL, which is often of unknown nature.

Studies on Phytochemical, Nutraceutical Profiles and Potential Medicinal Values of Allium sativumLinn (Lilliaceae) on Bacterial Meningitis

The studies on phytochemical, nutraceutical profiles and potential medicinal values of Allium sativumlinn (lilliaceae) on bacterial meningitis were evaluated against bacterial meningitis pathogens. The methods employed in this study were validation of phytochemical screening which was done according to standard methods, determination of nutritional composition was carried out using analytical automated instruments (Atomic Absorption Spectrometers) and evaluation of in vitro antibacterial activities of the extracts against clinical isolates using agar-well diffusion and broth dilution methods. The clinical isolates of meningitis pathogens, Streptococcus pneumoniae, Neisseria meningitides, Klebsiella pneumoniae, Haemophilus influenzaeand Escherichia coliwere obtained from Ahmadu Bello University Teaching Hospital (ABUTH), Shika-Zaria. The collected bulbs of A. sativum(600g) were washed and air dried under shade for 2 hours and the dry scaly outer covering was peeled-off to obtain the fresh garlic cloves which were then divided into three parts of 200 g each. These three portions were crushed separately for cold extraction. The first portion was homogenized and poured into a muslin cloth to squeeze out the juice, while second and third portions were homogenized and submerged into 500 ml of 96% ethanol and 500 ml of distilled water respectively for 24 hours and both filteredafter thorough shaking. The first and second portions were freeze dried, while the third portion was evaporated over water bath at 50°C to obtain the powdered yield. The phytochemical screening of A. sativum extracts (JEAS, EEAS and AEAS) revealed the presence of alkaloids, carbohydrates, cardiac glycosides, fats & oils, flavonoids, saponins and steroidal terpenoids. The results obtained as nutritional profiles from analytical automated machines analysis showed that A. sativumcontained all classes of foodnutrients such as carbohydrate, protein, fat and oils, dietary fibres, and vitamins together with zeolite herbominerals (nanopharmacologic effects). JEAS and EEAS extracts were potent in (0.94 ± 0.01 minutes), (0.99±0.04) and antibacterial activities while and AEAS (1.20±0.04) showed low activity, inhibiting the clinical bacterial isolates Neisseria meningitides, Streptococcus pneumoniae, Haemophilus influenzaeand Escherichia coliwith diameter of zone of inhibition ranging from 15-36 mm at concentrationsof 10, 15, 20 and 25 mg/ml. It produced significant (p<0.05) antibacterial activity while EEAS and AEAS showed low activities, except Klebsiella pneumoniaewhich was resistant to the three extracts concentrations used. The extracts inhibited the growth ofthe bacterial isolates in a concentration dependent manner with MICs ranging between 0.04-1.56 mg/ml while MBCs was 0.10-2.50 mg/ml respectively the findings from this study could be of interest and suggest the need for further investigations with a view to use the plant in novel drug development for BM therapy. The outcome of this study could therefore justify the ethnomedical and folkloric usage of A. sativumto treat bacterial meningitis locally

Historia de la meningitis bacteriana en Cuba: siglo XIX al XXI

Introducción: La meningitis bacteriana aún constituye un importante problema de salud mundial. En Cuba hay limitadas investigaciones con una perspectiva histórica de esta temática. Objetivo: Describir el comportamiento de la meningitis bacteriana en Cuba (siglo XIX-XXI). Material y Métodos: Estudio descriptivo (corte histórico) entre finales de 1800 y 2017, utilizando el método histórico-lógico y un análisis deductivo-inductivo de múltiples fuentes bibliográficas. Desarrollo: La primera alusión a la meningitis bacteriana en Cuba data de 1877. También se sugiere su probable importación por el ejército de ocupación norteamericano en 1899. En 1901 se aisló el meningococo de Weichselbaum del líquido cefalorraquídeo, lo que constituye, probablemente, su primera notificación en Cuba. Iniciado el siglo XX, se reportan casos aislados y brotes hasta 1976 cuando inicia la mayor epidemia de Enfermedad Meningocócica (serogrupos C y B). En 1979 se vacuna contra el C. En 1980 se implementa una vigilancia epidemiológica especial. Se desarrolla la vacuna cubana VA-MENGOC-BC® (1984) que se usa masivamente (1987) y se contribuye al control, incluyéndose en el Programa Nacional de Inmunizaciones (1991). Haemophilus Influenzae pasa a ser la principal bacteria causante de meningitis bacteriana hasta 1999 en que se aplican vacunas (Vaxem-Hib® y QuimiHib®) y se controla. Su nicho ecológico es ocupado por neumococo hasta ahora. Conclusiones: Desde fines del siglo XIX hasta la segunda mitad del XX la meningitis bacteriana en Cuba se manifestaba como casos aislados y brotes. Durante y después de una gran epidemia, se implementan estrategias preventivas efectivas, incluidas dos vacunas cubanas contra estas enfermedades, que revierten el comportamiento a endemia muy baja hasta la actualidad.

Introduction: Bacterial meningitis remains an important health problem worldwide. In Cuba, there are limited research studies about this issue from a historical perspective. Objective: To describe the behavior of this disease in Cuba (19th - 21st centuries). Material and Methods: A descriptive historical study was carried out between the ends of 1800-2017, using the historical-logical method and a deductive-inductive analysis of multiple bibliographical sources. Development: The first reference to bacterial meningitis in Cuba was made in 1877. The probable introduction of the disease by the US occupation army in 1899 is also considered. In 1901, the meningococci of Weichselbaum was isolated from cerebrospinal fluid, which was probably it first report in Cuba. At the beginning of the 20th century, isolated cases and outbreaks were reported until 1976, when the biggest and larger invasive meningococcal disease began (serogroups C, B). Vaccination against serogroup C started in 1979. In 1980, a special epidemiological surveillance was implemented. The Cuban vaccine VA-MENGOC-BC® against the disease was developed in 1984, which was massively used in 1987. The vaccine contributed to the control of the disease and was included in the National Immunization Program in 1991. Haemophilus Influenzae became the main causative bacterial agent of meningitis until 1999, when the implementation of massive vaccination (Vaxem-Hib® and QuimiHib®) controlled disease. Up to the present, its ecological niche is occupied by pneumococci. Conclusions: From the end of the 19th century to the second half of the 20th century, bacterial meningitis in Cuba behaved as isolated cases and outbreaks. Effective preventive strategies were implemented during and after a huge epidemic, including Cuban vaccines against the disease, that pass on its behavior to a very low endemic disease up to the moment.

A Five Years Retrospective Study on Etiology and Clinical Analysis of Meningitis in St. Paul’s Hospital Millennium Medical College Pediatric Ward from 2012-2016

Meningitis is the sever CNS pyogenicinfections which primarily affectsinfants and children. Ethiopia isone of the countries where meningitis isendemic and frequentepisodes of meningococcal epidemics are very common in the dry season (December to June). The main purpose of thisstudy was toidentify determinantsand clinical analysis of meningitis in pediatrics ward admitted to St.Paul’s hospital millennium medical college pediatrics wards from2012-2016. retrospective study on etiology and clinical analysis of meningitis was conducted at the pediatric unit. The study population was all pediatric patients admitted with meningitis that were presented in ward during the study period. Those fulfilling the mentioned inclusion criteria wereincluded. The data were collected using a structured format in September /2016. From the study population 95 cases fulfilled the inclusion criteriaand 64 & 31 of them were males and females, respectivelymaking a male to female ratio of 2:1. The most significant seasonalvariation was observed for N. meningitidishaving highincidence in the 2ndquarter (April to June). Inthe dry season 18 cases were diagnosed using the culture results. Culturefindings alsorevealed that S.pneumonia was one of the commonest causes of bacterialmeningitis. Themost common symptom was fever with high grade fever (>38oC) recorded in 84(88.4%) of cases. Most (65.5 %). of clients were recovered from meningitis at the end of the treatmentwhere as death was the second outcome with 17(20.2 %) cases ended up with death. Neurological or other complications were seen in 9(10.7 %) cases.

Cerebral vein thrombosis due to meningococcal meningitis

Bacterial meningitis is a life-threatening condition and Neisseria meningitidis is a major cause. Cerebrovascular complications can occur. Cerebral venous and sinus thrombosis (CVST) is an uncommon type of these complications, especially in meningococcal meningitis. The initiation of anticoagulant in septic thrombosis is controversial. A 35-year-old man was admitted to a hospital with fever and confusion. The diagnosis of N. meningitidis meningitis was established. Antimicrobial regimen (ceftriaxone) was continued. On the 3rd day, the patient's consciousness was improved; however, according to the patient's headache on day 7, brain imaging was performed which revealed a cerebral thrombosis in transverse and sigmoid sinuses. Although initiation of anticoagulant is controversial in septic thrombosis, the anticoagulant treatment also was started. Control brain magnetic resonance venogram done revealed complete resolution of cerebral CVST after 2 weeks. CVST as a complication of meningococcal meningitis should be considered. Anticoagulant treatment may be considered in the management of septic cerebral thrombosis if there are no contraindications. The use of anticoagulant needs further studies.

Asociación entre meningitis y punción dural en ratas bacterémicas. Un análisis crítico / The Association between meningitis and dural puncture in bacteremic rats. A critical análisis

INTRODUCTION: The presence of an active bacteremia has been considered a relative contraindication to perform an intrathecal puncture due to the risk of causing meningitis or epidural abscess. However, a clear and definite causal relationship has not yet been demonstrated. OBJECTIVES: To determine the relationship between intrathecal puncture and the development of meningitis in sub-jects with bacteremia. MATERIALS AND METHODS: Experimental study in rats with chronic bacteremia to which dural puncture was performed. Meningitis was then evaluated by direct drainage of the cisterna magna and histopathological studies of brain tissue. RESULTS AND CONCLUSION: 12 of 40 bacteremic rats that underwent intrathecal puncture developed meningitis. Previous administration of antibiotics seems to reduce this risk.

INTRODUCCIÓN: Se ha considerado la presencia de una bacteremia activa como contraindicación relativa para realizar una punción intratecal por el riesgo de provocar meningitis o absceso peridural. Sin embargo, aún no se ha podido demostrar una relación causal clara y definida. OBJETIVOS: Determinar la relación entre punción intratecal y el desarrollo de meningitis en sujetos con bacteremia. MATERIALES Y MÉTODOS: Estudio experimental en ratas con bacteremia crónica a las que se les realizó punción dural, luego se evaluó la presencia o no de meningitis mediante drenaje directo de la cisterna magna y estudios histopatológicos de tejido cerebral. RESULTADOS Y CONCLUSIÓN: 12 de 40 ratas bacterémicas a las que se le realizó punción intratecal desarrollaron meningitis. La adminis-tración previa de antibiótico parece disminuir este riesgo.