Accuracy of heparin binding protein: as a new marker in prediction of acute bacterial meningitis

ABSTRACT Background: Cerebrospinal fluid bacterial culture is the gold-standard for confirmation of acute bacterial meningitis, but many cases are not culture confirmed. Antibiotics reduce the chance of a microbiological diagnosis. Objective to evaluate efficacy of Heparin-binding protein in diagnosis of bacterial meningitis. Patients: 30 patients diagnosed with acute bacterial meningitis, 30 viral meningitis, and 30 subjects with normal CSF findings. Design: Diagnosis was based on history, clinical criteria, CSF examination, latex agglutination & culture, and sensitivities and response to therapy. HBP was measured using enzyme-linked immunosorbent technique in both serum & CSF. Results: Cerebrospinal fluid HBP levels averaged 0.82 ± 0.3 ng/mL in controls, 3.3 ± 1.7 ng/mL in viral and 174.8 ± 46.7 ng/mL in bacterial meningitis. Mean serum level was 0.84 ± 0.3 ng/mL in the controls, 3.7 ± 1.9 ng/mL in viral, and 192.2 ± 56.6 ng/mL in bacterial meningitis. Both HBP levels were significantly higher in patients with bacterial meningitis. Cut-offs of 56.7 ng/ml and 45.3 ng/ml in cerebrospinal fluid & serum showed 100% overall accuracy. Even in patients who received prior antibiotics, remained elevated. Conclusion: Serum Heparin-binding protein serves as a non-invasive potential marker of acute bacterial meningitis even in partially treated cases.

Sepsis and Meningitis due to Listeria Monocytogenes

PURPOSE: This study focused on the effect of immuno-compromising conditions on the clinical presentation of severe listerial infection. PATIENTS AND METHODS: Nine human listeriosis cases seen from 1991-2002 were reviewed. All adult patients, from whose blood, peritoneal fluid or cerebrospinal fluid (CSF) the L. monocytogenes was isolated, were included in this retrospective study. RESULTS: Listeriosis presented as primary sepsis with positive blood cultures in 5 cases and meningitis with positive CSF cultures in 4 cases. All of these patients had at least one underlying disease, most commonly, hematologic malignancy, diabetes mellitus, amyloidosis and hepatic cirrhosis; 55.6% had received immunosuppressive or corticosteroid therapy within a week before the onset of listeriosis. The patients were adults with a mean age of 60 years. Fever, night sweats, chills and lethargy were the most common symptoms; high temperature (> 38 degrees C), tachycardia, meningeal signs and poor conditions in general were the most common findings on admission. The mortality rate was 33.3% and was strictly associated with the severity of the underlying disease. Mortality differences were significant between sepsis (20%) and meningitis (50%) patients. CONCLUSION: Listeriosis as an uncommon infection in our region and that immuno- suppressive therapy is an important pre-disposing factor of listeriosis. Sepsis and meningitis were more common in this group of patients and had the highest case-fatality rate for food-borne illnesses.

Serum concentrations of interleukin-1 alpha, interleukin-6 and tumor necrosis factor-alpha in neonatal sepsis and meningitis

To investigate whether serum levels of interleukin-1alpha [IL-1alpha], IL-6, tumor necrosis factor alpha [TNF-alpha], C-reactive protein [CRP] are useful in the diagnosis of neonatal sepsis and meningitis and differentiate them. Blood samples were collected from 35 full term neonates with suspected infection who admitted to the Neonatology Unit, Pediatric Department, King Abdul-Aziz University Hospital, Jeddah, Saudi Arabia during January 2002 - June 2003. On the basis of laboratory and bacteriological results, newborns were classified into: sepsis [n=28], meningitis [n=7], and healthy controls [n=16]. Sepsis groups were further subdivided according to culture results into: group 1 = proven sepsis [n=6], group 2 = clinical sepsis [n=14], and group 3 = possible-infected [n=8]. Serum levels of IL-1alpha, IL-6, TNF-alpha were measured using Enzyme-Linked Immunosorbent Assay while CRP by nephelometer. In sepsis and meningitis patients, serum levels of CRP [p<0.01, p<0.05,] and IL-1alpha [p<0.001, p<0.05] were elevated than controls. C-reactive protein levels elevated in proven sepsis [p<0.001] and IL-1alpha elevated in all subgroups of sepsis [groups 1, 2, 3] compared with [p<0.05, p<0.001, p<0.01] controls. Interleukin-6, TNF-alpha showed no significant differences between studied groups. In sepsis and meningitis, IL-1alpha had a highest sensitivity [89%, 86%], and negative predictive values [89% and 93%]. Interleukin-1alpha and CRP increased in neonatal sepsis and meningitis, but cannot differentiate between them. Interleukin-1alpha had a highest sensitivity in prediction of neonatal infection and its assessment may improve accuracy of diagnosis

C reactive protein for differentiating bacterial from aseptic meningitis in Thai patients.

OBJECTIVES: To evaluate the efficacy of serum CRP level differentiating between bacterial and aseptic meningitis in Thai patients. MATERIAL AND METHOD: The authors measured the serum CRP level in patients who were diagnosed clinically as bacterial and aseptic meningitis. RESULTS: The authors evaluated 32 subjects, 12 with bacterial meningitis (all males) and 20 with aseptic meningitis (13 males, 7 females). The mean serum CRP level in the bacterial meningitis and aseptic meningitis group was 209.25 +/- 105.34 (range, 65 to 420) and 67.05 +/- 40.81 (range, 10 to 169) mg/L, respectively (p < 0.001). CONCLUSIONS: Serum CRP can help differentiate between bacterial and aseptic meningitis.

Staphylococcus aureus meningitis in children: a review of 30 community-acquired cases

In spite of the steady increase in the incidence of Staphylococcus aureus infections, it remains a relatively uncommon cause of meningitis. To our knowledge, no series of community-acquired S. aureus meningitis (CASAM) restricted to children has been published. So far in this retrospective study we report our experience with CASAM in children, hospitalized from 1983 to 1998 at Nossa Senhora da Glória Children's Hospital (HINSG). During the sixteen-year study period, 2,319 new cases of acute pyogenic meningitis were diagnosed at HINSG. Community-acquired S. aureus was identified as the causative agent in 30 patients (1.3 percent). The predominantly spinal localization of the agent is stressed. In contrast with publications which analyze adults, it has a better prognosis

Meningitis bacteriana neonatal en una institución de tercer nivel de atención / Neonatal bacterial meningitis in a third level care unit

Objetivo. Conocer la incidencia, etiología, características clínicas y mortalidad de los pacientes con meningitis neonatal de la unidad de cuidados intensivos neonatales (UCIN) del Hospital Infantil de México Federico Gómez y analizar la incidencia de meningitis en recién nacidos (RN) con síndrome de dificultad respiratoria (SDR); asimismo, determinar la frecuencia de meningitis bacteriana neonatal con hemocultivos negativos. Material y métodos. Revisión retrospectiva de los expedientes clínicos de todos los RN que tenían el dianóstico de meningitis y que fueron admitidos a la UCIN de enero de 1990 a julio de 1995. Se compararon variables entre recién nacidos pretérmino (RNPT) y recién nacidos de término (RNT). Resultados. Se detectaton 31 pacientes (21 RNT y 10 RNPT) con meningitis neonatal (incidencia de 32.2 X 1000 egresos en UCIN); asimismo, se encontró un caso de meningitis neonatal en 170 pacientes con SDR (5.9/1000 RN con SDR). Los gérmenes más frecuentes aislados en LCR fueron bacilos gramnegativos (n: 19;61 por ciento). Los hallazgos clínicos de meningitis fueron inespecíficos no hubo diferencias en RNPT y RNT. Del total de pacientes con meningitis, 19(61 por ciento) tuvieron hemocultivos negativos al momento del diagnóstico. La mortalidad asociada a meningitis en RNPT y RNT fue del 40 y 24 por ciento, respectivamente (P=NS). Conclusiones. La incidencia de meningitis neonatal fue alta. Los gérmenes predominantes en meningitis fueron bacilos gramnegativos. Las manifestaciones clínicas de meningitis fueron inespecíficas y no hubo diferencia entre RNT y RNPT. El 61 por ciento de los pacientes con meningitis tuvo hemocultivos periféricos negativos. Debido a esto, en nuestra población es recomendable realizar la punción lumbar en pacientes con probable sepsis aun con hemocultivo negativo

Variáveis clínicas e laboratoriais para diagnóstico diferencial entre meningites asséptica e piogênica em crianças / Laboratorial and clinical variables to the differential diagnosis between aseptic and pyogenic meningitis in children

Foram estudadas informaçöes obtidas do prontuário de 573 crianças com idade entre 1 mês e 15 anos e diagnóstico de meningite, internadas no Hospital Couto Maia, na cidade de Salvador-Bahia, no período de janeiro-1990 a dezembro-1992. Crises epilépticas, diminuiçäo do nível de consciência e rigidez de nuca foram mais frequentes no grupo com meningite bacteriana. Glicorraquia menor que 45 mg/dL, proteinorraquia igual ou superior a 140 mg/Dl e celularidade liquórica superior a 600 cels/mm3 mostraram-se preditores de meningite piogênica. A análise de curva ROC foi utilizada para estabelecer o melhor ponto de corte nas medidas liquóricas de celularidade, proteínas e glicose capaz de predizer meningite bacteriana. Os resultados encontrados enfatizam que informaçöes clínicas, obtidas com a anamnese e o exame neurológico, e liquóricas simples, definidas pelos níveis de proteína, glicose e análise da celularidade, podem ser utilizadas como medidas de grande acurácia para diferenciar meningite piogênica de asséptica em crianças.

Plasma fibronectin in bacterial meningitis

Twenty-two cases of bacterial meningitis with age ranged between 1-12 years were examined and 20 healthy children matched for age and sex served as controls. All cases and controls were investigated for plasma fibronectin, total leucocytic count [WBC] and erythrocytic sedimentation rate [ESR]. Cerebrospinal fluid [CSF] glucose and protein had returned to normal levels in all cases after treatment, while CSF cell count remained abnormally high in 32% of cases. Plasma fibronectin, WBC and ESR did not significantly differ regarding the bacterial isolates from CSF

Diagnosis of bacterial meningitis and septicemia by serum counterimmunoelectrophoresis

We compare the results obtained by counterimmunoelectrophoresis in samples of serum and cerebrospinal fluid with microbiologic methods for 3,298 patients suspected of bacterial meningitis and/or septicemia at Instituto Adolfo Lutz, Säo Paulo, in a retrospective study of the period from July 1988 to July 1994. Of the 415 patients (12.6 percent of the total cases studied) who were positive by the serum test, only 249 (7.6 percent of the total cases studied) were also positive when cerebrospinal fluid was assayed. Thus, 40 percent of the positives (5.6 percent of the total) were identifiable by analysis of serum but not of cerebrospinal fluid. Neisseria meningitidis accounted for 77.7 percent (129) and Haemophilus influenzae for 22.3 percent (37) of the positive results obtained only when serum was examined. These...

level of Interleukin 6 in septic and aseptic meningitis

In this study the level of interleukin-6 [IL[6]] was evaluated in cerebrospinal fluid [CSF] and serum of septic [n=14] and aseptic meningitis [n=16] patients, in addition to its evaluation in 10 controls. CSF IL6 was elevated in 85.7% of patients with septic meningitis [SM] [mean 1471. 4 pg/ml] and in 43.7% of aseptic meningitis [AM] patients [mean 192.8 pg/ml], the difference in between was significant [P< 0. 0001]. Elevation of serum IL[6] was found in 28. 6% of the SM group [means 192.8 pg/ml] and none of the AM group [mean 122.5]. CRP was elevated in CSF and serum of SM and Am groups. Positive correlation was found between IL[6] and CRP in CSF and serum but not with other inflammatory parameters. It is concluded that marked elevation of IL[6] in patients with meningitis suggest a septic aetiology. It is also claimed that IL[6] plays a role in aseptic meningitis which is believed to be dependant on the causative agent