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ABSTRACT Cerebrospinal fluid (CSF) analysis is an important diagnostic tool for many conditions affecting the central nervous system (CNS), especially CNS infectious diseases. Despite its low specificity, CSF white blood cell counts, CSF protein levels, CSF serum glucose ratio and CSF lactate measurement are useful in differentiating infections caused by distinct groups of pathogens. CSF direct examination and cultures can identify causative organisms and antibiotic sensitivities as well. Adjunctive tests such as latex agglutination, different immunological assays and molecular reactions have great specificities and increasing sensitivities. In this article, some recent diagnostic methods applied to CSF analysis for frequent CNS infections are presented.
RESUMO A análise do líquido cefalorraquiano (LCR) é uma importante ferramenta diagnóstica para muitas condições que afetam o sistema nervoso central (SNC), especialmente as doenças infecciosas. Apesar da baixa especificidade, a contagem de leucócitos no LCR, a determinação dos níveis de proteína, glicose e lactato podem ser úteis na diferenciação de infecções causadas por diferentes grupos de patógenos. O exame direto e as culturas podem identificar organismos causadores de infecções bem como suas sensibilidades a antibióticos. Testes adjuvantes como aglutinação em látex, diferentes ensaios imunológicos e reações moleculares têm taxas de sensibilidades e especificidades crescentes. Neste artigo, são apresentados alguns métodos diagnósticos mais recentemente aplicados à análise do LCR no diagnóstico das infecções do SNC.
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A case of suppurative meningitis caused by Streptococcus suis infection is reported. The patient was an elderly female with an atypical epidemiological history. The common symptoms included fever, headache and cervicodynia. According to the results of blood bacterial culture and next-generation sequencing of cerebrospinal fluid, the patient was considered purulent meningitis caused by Streptococcus suis. After treatment with the third generation cephalosporins, the symptoms improved significantly. One week after the onset of the disease, herpes labialis occurred, followed by hearing loss about 1 week later. The patient was treated with antiviral and hormone therapy, and was discharged after improvement.
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Aggregatibacter aphrophilus is a member of the normal flora of the human oral cavity and pharynx, a Gram-negative fastidous bacteria, belonging to agglomerates, which is a normal mixed oropharyngeal flora in humans, most commonly colonized on the surface of oral mucosa. This bacterial infection is rare in clinical practice, and it is difficult to culture and identify the bacteria, which is easy to be missed. A patient with intracranial infection was admitted to Huaihe Hospital, who showed fever and headache as the main clinical manifestations, and Aggregatibacter aphrophilus was detected by the metagenomic next-generation sequencing of cerebrospinal fluid. The patient′s symptoms were significantly improved after anti-infection treatment.
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Introducción: Las infecciones del sistema nervioso central constituyen un importante problema de salud en todas las regiones del planeta; representan un reto para el médico de asistencia, el microbiólogo y el epidemiólogo, en función de un precoz y correcto diagnóstico, elementos básicos para un pronóstico satisfactorio. Objetivo: Determinar el comportamiento de la meningoencefalitis bacteriana en la provincia Camagüey. Métodos: Se realizó un estudio observacional descriptivo, transversal y retrospectivo, sobre el comportamiento de la meningoencefalitis bacteriana en la provincia Camagüey en el periodo comprendido desde el 2016 hasta el 2020. El universo de estudio estuvo constituido por todos los casos (128) diagnosticados con meningoencefalitis bacteriana, atendidos en los hospitales de más de 100 camas durante el período del primero de enero de 2016 al 31 de diciembre de 2020. Resultados: El año 2017 resultó ser el mayor número de casos, el agente causal predominante fue el Streptococcus pneumoniae; las edades pediátricas fueron las de mayor incidencia en especial el menor de un año y sexo masculino. El síntoma cardinal en el estudio fue la fiebre y el neumococo fue el más letal agente causal. Conclusiones: El diagnóstico precoz de las meningoencefalitis bacterianas conlleva a una menor letalidad y por ende menos secuelas.
Introduction: Central nervous system infections are an important health problem in all regions of the planet; they represent a challenge for the attending physician, the microbiologist and the epidemiologist, based on an early and correct diagnosis, basic elements for a satisfactory prognosis. Objective: To determine the behavior of bacterial meningoencephalitis in the Province of Camagüey. Methods: A descriptive, cross-sectional and retrospective observational study was carried out on the behavior of bacterial meningoencephalitis in Camagüey province during the period 2016-2020. The study universe consisted of all cases (128) diagnosed with bacterial meningoencephalitis, attended in Hospitals with more than 100 beds during the period from January 1st, 2016 to December 31st, 2020. Results: The year 2017 turned out to be the one with the largest number of cases, the predominant causal agent was Streptococcus pneumoniae; pediatric ages were those with the highest incidence, especially those under 1 year of age and males. The cardinal symptom in the study was fever, and pneumococcus was the most lethal causative agent. Conclusions: The early diagnosis of bacterial meningoencephalitis leads to less lethality and therefore fewer sequelae.
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Objective To investigate the distribution and antimicrobial resistance of Coagulase-negative staphylococci ( CoNS) isolated from cerebrospinal fluids in neurosurgical patients.Methods CoNS strains isolated from cerebrospinal fluids of neurosurgical patients were collected from Beijing Tiantan Hospital of Capital Medical University during January 2013 and December 2015.CoNS infection was diagnosed according to the standards of US Centers for Disease Control and Prevention, and the distribution and antimicrobial resistance of pathogenic CoNS strains were analyzed. Results A total of 19 756 cerebrospinal fluid specimens were collected and 1 386 bacterial strains were isolated, in which 650 (46.9%) were CoNS.Among 650 CoNS strains, 130 were diagnosed as the pathogen, and the top 4 CoNS species were Staphylococcus epidermidis (77/130, 59.2%), Staphylococcus hominis (18/130, 13.8%), Staphylococcus haemolyticus (11/130, 8.5%) and Staphylococcus capitis (9/130, 6.9%).The rest 520 CoNS strains were contaminating strains.According to antimicrobial susceptibility test, there were 103 strains of methicillin-resistant CoNS (MR-CoNS) accounting for 79.1% (103/130).And among 77 Staphylococcus epidermidis isolates, 67 were MR-CoNS strains (87.0%) .More than 90.0%Staphylococcus epidermidis isolates were sensitive to vancomycin and linezolid, and the rest CoNS strains were also highly sensitive to these two antibacterial agents.Conclusions CoNS plays an important role in post-surgery infection in neurosurgical patients, and Staphylococcus epidermidis is the dominant CoNS species.Most CoNS strains are methicillin-resistant, but are highly sensitive to vancomycin and linezolid.
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Objective To explore the clinical features,laboratory tests,imaging characteristics of neurobrucellosis,and to improve the understanding of the disease.Methods A retrospective analysis was performed in seven patients with neurobrucellosis in our hospital from January 2002 to May 2013.Results The proportion of men and women was 6∶ 1,and the average age was 46 years.One case was attacked with the symptoms of cerebrovascular disease,another one with the symptoms of myelitis,and the other five with the symptoms of meningoencephalitis.Six had positive results of serum agglutination test,and the other one had a positive result of blood culture instead.Imaging findings lacked of specificity.There were two patients whose lesions were in the hemisphere cortex,subcortical,basal ganglia and other parts,four patients whose lesions were in the frontal lobe,one in the chest pulp,and one in both sides of cerebellum and pons.After systematical treatment,one case died,the other 6 cases recovered,and no one relapsed or got functional disability during the one-year follow-up.Conclusions Neurobrucellosis is a rare type of brucellosis,and its clinical manifestations lack of specificity,and imaging and serological detections are important for diagnosis.It is beneficial for patients if diagnosed early and treated systematically,so good understanding of this disease,early diagnosis and treatment are of great value.
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CONTEXT: Solitary brainstem abscesses are rare and they are usually associated with other infections. They are severe conditions with high morbidity and mortality. The surgical options are stereotactic aspiration and microsurgical drainage. Systemic antibiotic therapy is used for more than six weeks. CASE REPORT: We present the case of a young man with a solitary abscess at the pons, without other systemic infections. The patient was treated by means of microsurgical drainage and antibiotic therapy for three weeks. His postoperative recovery was good. CONCLUSIONS: A microsurgical approach may be considered to be an important option for large abscesses that are multiloculated, close to the surface or contain thick fluid. Complete emptying of the purulent accumulation may diminish the required duration of antibiotic therapy. .
CONTEXTO: Abscessos isolados do tronco encefálico são raros e geralmente associados a outras infecções. Trata-se de condição grave, com grande morbidade e mortalidade. Opções cirúrgicas são aspiração com estereotaxia e drenagem microcirúrgica. Antibioticoterapia sistêmica tem sido usada por mais de seis semanas. RELATO DE CASO: Apresentamos o caso de um jovem com abscesso pontino sem outras infecções sistêmicas. O paciente foi tratado com drenagem microcirúrgica e antibioticoterapia por três semanas. Houve boa evolução pós-operatória. CONCLUSÕES: Acesso microcirúrgico pode ser considerado uma opção importante no tratamento de grandes abscessos do tronco encefálico, que são multiloculados, próximos da superfície ou que contenham líquido espesso. Drenagem completa do material purulento pode diminuir o período de antibioticoterapia. .
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Adult , Humans , Male , Anti-Bacterial Agents/administration & dosage , Brain Abscess/drug therapy , Brain Abscess/surgery , Brain Stem/surgery , Microsurgery/methods , Ceftriaxone/administration & dosage , Magnetic Resonance Imaging , Metronidazole/administration & dosage , Oxacillin/administration & dosage , Suction/methods , Time FactorsABSTRACT
ObjectiveTo assess gene chip application value in detecting pathogenic bacteria in intracranial infection cases.MethodsPrimers and probes aiming at the specific DNA sequences of 4 kinds of common pathogenic bacteria and 6 kinds of common drug resistance genes (DRGs) were designed and used to identify the bacteria and DRGs among 30 cerebrospinal fluid (CSF) specimens (12 positive,18negative in CSF culture) from patients with intracranial infection using multiplex polymerase chain reaction (mPCR) and gene chip.The results of gene detection were compared with those of CSF culture and drug sensitivity testing.ResultsBacteria were identified and DRGs were detected in 15 specimens; DRGs and 16S gene were detected in 8 specimens; neither bacterium nor DRG was detected in 7 specimens.ConclusionGene chip technique is characterized by its relative sensitivity and rapidity of detecting the pathogenic bacteria in CSF of intraeranial infection cases.