Role of cerebrospinal fluid il-8 as a marker for differentiation between acute bacterial and aseptic meningitis

No doubt, the distinguishing between bacterial and aseptic meningitis in the emergency department could help to limit unnecessary antibiotic use and hospital admissions. This study evaluated the role of cerebrospinal fluid IL-8 in differentiating acute bacterial meningitis [ABM] from aseptic meningitis [AM]. A total of 80 hospitalized patients with clinical presentations of suspected acute meningitis were subjected to estimation of IL-8 CSF concentrations. The results showed that CSF IL-8 levels were higher in acute bacterial meningitis than in aseptic ones [p <0.05]. The best cut-off value of CSF IL8 for early diagnosis of bacterial meningitis was 3.6ng/ml with a sensitivity of 82.5% and a specificity of 85.0%

Meningite asséptica e doença autoimune / Aseptic meningitis and autoimmune disease

A meningite asséptica (MA) é uma entidade anatomoclínica aguda, benigna, de ocorrência rara na população geral, com manifestações clínicas variáveis e ausência de patógenos identificáveis no líquido cefalorraquidiano. Sua prevalência é maior associada a administração ou presença de algum medicamento e/ou doença autoimune, respectivamente. Seu diagnóstico é dificultado devido à inespecificidade das manifestações clínicas e laboratoriais, o que resulta em hospitalizações, propedêutica invasiva e antibioticoterapia desnecessárias.

Aseptic meningitis (AM) is an acute and benign condition, rare in the general population, characterized by nonspecific clinical manifestations associated with changes on cerebrospinal fluid (CSF) sample analysis, including negative cultures. The subject of analysis is the relationship between medication intake and autoimmune diseases with the occurrence of AM. It has been concluded that this condition occurs more often in case both causes are associated. The diagnosis of AM is difficult because of the nonspecifity of the signs and symptoms and findings on CSF analysis, which results in unnecessary hospitalizations, invasive exams and antibiotic therapy.

Validación de una regla de predicción clínica para diferenciar meningitis bacteriana de meningitis aséptica / Validation of a clinical prediction rule to distinguish bacterial from aseptic meningitis

La mayoría de las meningitis en la infancia no son bacterianas, pero la dificultad en descartar tal etiología obliga con frecuencia a utilizar antibióticos inicialmente. El objetivo de este trabajo fue validar, en nuestro medio, una regla de predicción clínica para diferenciar la etiología de las meningitis en niños a su ingreso al hospital. Método. Estudio prospectivo que incluyó pacientes menores 19 años de edad con diagnósitco de meningitis. En todos se obtuvo líquido cefalorraquídeo (LCR) para análisis directo, citoquímico y cultivo, y hemograma. Se calculó el BMS (Bacterial Meningitis Score: puntaje de meningitis basteriana) descripto por Nigrovic (Pediatrics 2002; 110:712): tinción de Gram en LCR positiva = 2 puntos; proteinorraquia mayor o igual 80 mg/dl, neutrófilos en sangre periférica mayor o igual 10000/mn3, neutrofilos en LCR mayor o igual 1000/mm3, convulsiones, un punto cada uno. Se calculó sensibilidad (S), especificidad (E), valores predictivos positivo y negativo (VPP y VPN) y razones de verosimilitud positiva y negativa (RVP y RVN)del BMS para predecir meningitis bacteriana. Resultados. Se incluyeron 70 pacientes con meningitis (14 bacterianas) veinticinco pacientes presentaron BMS=0 puntos, 11 BMS=1 punto, y 34 BMS mayor o igual 2 puntos. Un BMS=0 evidenció S: 100 por ciento E: 44 por ciento, VPP; 31 por ciento, VPN: 100 por ciento, RVP: 1,81 RVN: 0 para predecir meningitis bacteriana. Un BMS mayor o igual 2 mostró S: 100 por ciento, E: 64 por ciento, VPP: 41 por ciento, VPN: 100 por ciento, RVP: 2,8 RVN: 0 para predecir meningitis bacteriana. Conclusión: La utilización del BMS fue simple y permitió identificar pacientes con bajo riesgo de meningitis bacteriana. Su empleo podría constituir una herramienta útil en la toma de decisiones clínicas.

Laboratorial diagnosis of lymphocytic meningitis

Meningitis is the main infectious central nervous system (CNS) syndrome. Viruses or bacteria can cause acute meningitis of infectious etiology. The term "Aseptic Meningitis" denotes a clinical syndrome with a predominance of lymphocytes in the cerebrospinal fluid (CSF), with no common bacterial agents identified in the CSF. Viral meningitis is considered the main cause of lymphocyte meningitis. There are other etiologies of an infectious nature. CSF examination is essential to establish the diagnosis and to identify the etiological agent of lymphocytic meningitis. We examined CSF characteristics and the differential diagnosis of the main types of meningitis.

Manifestaciones neurológicas de la granulomatosis de Wegener: Caso clínico / Neurological involvement in Wegener's granulomatosis: Report of one case

Wegener's granulomatosis is a systemic necrotizing vasculitis that affects medium size and small vessels. Neurological involvement occurs in 22 percent to 54 percent of patients, mainly in the form of mononeuritis multiplex. Central nervous system involvement is reported in only 2 percent to 8 percent of the cases. We report a 42-year-old male who presented with headache, diplopia, third and sixth cranial nerve palsies and íeft eye amaurosis associated to mass located in the íeft Meckel cavum and diffuse meningeal involvement. A biopsy of the mass disclosed a chronic granulomatous necrotizing inflammation with Langhans giant cells. A chest CAT scan showed three cavitated lung nodules and ANCA antibodies were positive in a titer of 1:80. Treatment with steroid and cyclophosphamide was started and cranial nerve palsies resolved and the number and size of lung nodules decreased. The patient was lost from follow up.

Relationship between aseptic meningitis and MMR vaccination

Mumps is a predominant disease of young children recognized by fever and parotitis. Meningitis and meningoencephalitis are the most frequent complications of the disease. Mumps live vaccine is available in many countries. In Iran routine 2 dose administration of MMR was launched in 2004. Vaccine produce a subclinical and noncommunicable infection but in part of Europes, Canada and Japan where different vaccines have been used, rates of vaccine-induced aseptic meningitis have been high. The purpose of this study is to survey the occurrence of Aseptic meningitis as an adverse effect of MMR vaccination and to determine its clinical and laborabry characteristics. In this prospective study during 2004-2005 cases of Aseptic meningitis who was admitted in Infection and neurology wards of Tabriz Pediatric Medical center were studied. Sex, age, clinical manifestations, lab data and duration between vaccination and appearance of symptoms were recorded and analyzed. In 44 cases of aseptic meningitis there was history of MMR vaccination within 30 days [average: 21.7 days]. Seventy five percent of patients were male. The mean age of patients was 31 months. 40.9% of cases were 13 months old. Febrile seizure [54.5%] and meningeal signs with parotid enlargement [29.5%] were the most clinical manifestation. The mean Total and lymphocyte cell count in cerebrospinal fluid were 674.43 and 550.2/mm[3], respectively. The mean glucose and protein levels were found to be 54.3 and 48.34 mg/dl, respectively. The results of our study shows the occurrence of aseptic meningitis after immunization with the MMR vaccine which is being used by the health services in our country. According to Presence of wild virus Strains within community and to rule out the role of other viruses, PCR is recommended despite of its complexity and limitations. This complication must be considered important and followed up precisely in spite of its complete cure without any Sequela, because all of these cases occurred within 30 days after vaccination

Manifestaciones neurológicas asociadas a infección por Mycoplasma pneumoniae / Neurological clinical manifestations associated to Mycoplasma pneumoniae infection

Mycoplasma pneumoniae, reconocido patógeno respiratorio, es también responsable de numerosas y variadas manifestaciones extrapulmonares, siendo las neurológicas las más frecuentes. Se presenta el caso de una escolar de 8 años, con un síndrome febril prolongado asociado a infección por M. pneumoniae que se complicó con encefalomielitis diseminada aguda. Se reportan otros seis casos con manifestaciones neurológicas: meningitis aséptica (1), meningoencefalitis (1), síndrome de Guillain Barré (1) y parálisis facial (3). La patogenia de las complicaciones neurológicas asociadas con infección por M. pneumoniae es aún desconocida, planteándose que algunas se deben a invasión directa del SNC y aquellas con pródromo prolongado, como encefalomielitis diseminada aguda, síndrome de Guillain Barré y mielitis transversa, obedecerían probablemente a fenómenos autoinmunes. En nuestro medio, en ausencia de RPC para confirmar el diagnóstico de esta infección, éste se fundamenta en la presencia de anticuerpos IgM o ascenso de IgG específica. La utilidad de los antimicrobianos en el control de estas manifestaciones neurológicas es discutida postulándose el uso de terapia inmunomoduladora.

Colagenopatia y meningitis recurrente en una paciente de 88 años / Collagen diseases and recurrent meningitis in an 88 year old patient

La meningitis aséptica recurrente (MAR) en ancianos es rara y generalmente es secundaria a drogas. Su asociación a colagenopatías en ancianos ha sido raramente informada. El Síndrome de Sjögren (SS) en ocasiones afecta el sistema nervioso central, pero la MAR asociada a SS es rara en este grupo etario. Se presenta una paciente de 88 años, autoválida, con antecedentes de xerostomía, xeroftalmos, Raynaud, disfagia y agrandamiento parotídeo recurrente autolimitado. En el año 2001 cursó una meningitis linfocítica y evolucionó con recuperación completa. Un año después volvió a presentar una meningitis linfocítica aséptica. Se descartaroncausas infecciosas. Se demostró FAN 1/160 con patrón nucleolar moteado, Ac anti Ro y anti RNP positivosy anticoagulante lúpico positivo. Se confirmó sequedad ocular y la biopsia de labio fue compatible con SS.Evolucionó con resolución completa en 10 días sin tratamiento. Se interpretó como una enfermedad mixta deltejido conectivo (EMTC) con síntomas predominantemente de SS, que cursó una MAR en su forma pura. La EMTC y el SS deberían ser considerados entre los diagnósticos diferenciales de la MAR, inclusive en ancianos.

Enfermedad mano-pie-boca: a propósito de un caso por enterovirus 71 / Hand-foot-mouth disease associated with enterovirus 71

Una niña de 10 meses fue derivada a la consulta dermatológica por exantema y enantema de 48 horas de evolución. Las vesículas de forma redondeada u ovalada asentaban sobre piel discretamente eritematosa y se extendían a muslos, manos, pies y boca tanto en labios como en lengua. El diagnóstico clínico e histopatológico de las lesiones resultó compatible con enfermedad mano-pie-boca y el diagnóstico virológico realizado en cultivo celular permitió identificar al agente etiológico como enterovirus 71 (EV71). Esta etiología ha sido asociada en epidermis de enfermedad mano-pie-boca con elevado compromiso neurológico. Nuestra paciente cursó sin complicaciones

Complicações neurológicas determinadas pela anestesia subaracnóidea / Spinal anesthesiaðinduced neurological complications

Justificativa e objetivos - Complicações neurológicas da anestesia subaracnóidea, apesar de raras, podem determinar seqüelas importantes. O objetivo deste estudo é apresentar estas complicações com a finalidade de esclarecer os fatores desencadeantes, o que facilita o diagnóstico das lesões. Conteúdo - Säo apresentadas as seguintes complicações: lesäo de nervo desencadeada pela agulha e cateter, cefaléia pós-punçäo, síndrome da artéria espinhal anterior, hematoma espinhal, meningite bacteriana, meningite asséptica, aracnoidite adesiva, síndrome da cauda eqüina e sintomas neurológicos transitórios. Conclusões - O conhecimento dos fatores desencadeantes de complicações neurológicas determinadas pela anestesia subaracnóidea pode prevenir as lesões, diagnosticar e tratar mais precocemente e, desse modo, mudar o prognóstico das mesmas

Polymerase chain reaction for the laboratory diagnosis of aseptic meningitis and encephalitis

A protocol for testing cerebrospinal fluid specimens using a range of PCR assays for the diagnosis of central nervous system infection was developed and used to test prospectively 383 specimens. PCR assays were used for the detection of adenovirus, Borrelia burgdorferi, enteroviruses, Epstein Barr virus, cytomegalovirus, herpes simplex virus, human herpes virus type 6, JC virus, Leptospira interrogans, Listeria monocytogenes, lymphocytic choriomeningitis virus, measles virus, mumps virus, Mycobacterium sp., Mycoplasma pneumoniae, Toxoplasma gondii and varicella zoster virus. Of the 383 specimens tested in this study, 46 (12.0 percent) were found to be positive. The microorganisms detected were CMV, enterovirus, Epstein Barr virus, herpes simplex virus, human herpes virus type 6, JC virus, L. monocytogenes, Mycobacterium genus, Toxoplasma gondii and varicella zoster virus. The introduction of the PCR protocol described has improved the diagnosis of a range of central nervous system infections in our laboratory. We believe however that further evaluation of these assays in immunocompromised patients is necessary to better determine the predictive value of positive PCR results in these patient groups

Magnetic resonance imaging in the evaluation of patients with aseptic meningoencephalitis and connective tissue disorders

OBJECTIVE: To describe the role of magnetic resonance imaging (MRI) in the evaluation of patients with chronic and recurrent aseptic meningitis.METHOD: A retrospective study of five patients with aseptic meningoencefalitis diagnosed by clinical and CSF findings. CT scans showed without no relevant findings. RESULTS: MRI showed small multifocal lesions hyperintense on T2 weighted images and FLAIR, with mild or no gadolinium enhancement, mainly in periventricular and subcortical regions. Meningoencephalitis preceded the diagnosis of the underlying disease in four patients (Behçet's disease or systemic lupus erythematosus). After the introduction of adequate treatment for the rheumatic disease, they did not present further symptoms of aseptic meningoencephalitis. CONCLUSION: Aseptic meningoencephalitis can be an early presentation of an autoimmune disease. It is important to emphasize the role of MRI in the diagnosis and follow-up of these patients.

Caracterización etiológica de las meningoencefalitis asépticas en la provincia Ciego de Avila, Cuba / Etiologic characterization of aseptic meningoencephalitis in the province of Ciego de Avila, Cuba

Se realiza análisis prospectivo aleatorio a 198 pacientes con meningoencefalitis aséptica (MEA) ingresados en el servicio de medicina del hospital provincial ®Dr. Antonio Luaces Iraola¼ de Ciego de Avila, Cuba. Se les efectuó estudios con sueros pareados para determinar anticuerpos neutralizantes a enterovirus, pruebas de hemoglutinación, neutralización viral para arbovirus, hemolítica para leptospira y estudio virológico de heces fecales buscando enterovirus. En 36.8 por ciento de los pacientes se encontró como agente etiológico un enterovirus. El segundo agente en frecuencia fue la leptospira en 14.6 por ciento. Se determinó el agente etiológico en 51.4 por ciento de los pacientes estudiados

Caxumba e infecçåo aguda do sistema nervoso central (SNC) / Mumps and infections of Central Nervous System (C.N.S.)

Dentre 916 casos de "Meningite Asséptica" internados no Hospital de Doenças Tropicais de Goiânia no período de 1982-1993, o vírus da caxumba foi o mais provável agente etiológico dde 157 (17,14 pôr cento) casos, pois havia concomitância de parotidite ou história recente de contágio intradomiciliar. Foram levantados dados sobre a idade dos pacientes, o tempo de permanência hospitalar, o tempo de duraçåo da doença e em que dia da caxumba surgiram os primeiros sinais do acometimento do S.N.C.. Os exames de rotina do L.C.R. foram solicitaddos e, no sangue a amilasemia. O tipo de acometimento nervoso, a concomitância de pancreatite e os anos e meses de maiores e menores incidências såo citados. O autor eenfatiza que o acometimento cerebral nåo deve ser considerado uma complicaçåo e sim forma clínica da parotidite epidêmica do mesmo modo que a pancreatite e a orquite

Brote epidémico de meningitis aséptica: experiencias en un hospital infantil privado / Epidemic of aseptic meningitis experience of private hospital

Se informa acerca de las experiencias obtenidas en 193 niños con meningitis aséptica, estudiados durante un brote epidémico registrado entre febrero y julio de 1992. Los cultivos de líquido cefalorraquídeo hechos en el Instituto de Referencia Epidemiológica permitieron identificar al virus Echo 30 como un agente a la meningitis en 48 niños

Central nervous system leptospirosis in the Philippines.

One hundred hospitalized patients in Manila, Philippines with aseptic meningoencephalitis were screened for leptospirosis. On the basis of a microscopic agglutination titer of 1:1,600 or greater, the diagnosis was made in five cases, yet in no instance had leptospirosis been included in the differential diagnosis on admission to the hospital. Four of the five patients first noted neurologic symptoms during the second week of illness; two patients presented with encephalitis, two with meningitis and the fifth with hemiparesis. No case was complicated by renal dysfunction or jaundice. By the time of discharge from the hospital, two patients had recovered completely and the other three had markedly improved. Our data show that leptospirosis is an important but overlooked cause of aseptic meningoencephalitis in the Philippines. This is probably also the case in other parts of the tropics where Leptospira interrogans infection remains a significant public health problem.