Meningitis in Yemen

The Ministry of Health in Yemen, in collaboration with WHO, are closely monitoring the epidemiological pattern of the ongoing reported cases of menin-gitis in Yemen. Since the beginning of the year up to 8 July 2017 [Epidemiological week 27], a total of 2,146 suspected cases have been reported through the electronic early warning surveillance system [eDEWS] in the country

Analysis of cerebrospinal fluid in racemose form of neurocysticercosis / Análise do líquido cefalorraquidiano na forma racemosa da neurocisticercose

The present work aimed to evaluate the pattern of CSF alterations in patients diagnosed with neurocysticercosis (NCC) in racemose form.Method This is a retrospective cohort study of patients with diagnosis of NCC in racemose form. CSF samples from 26 patients were analyzed. After patient-chart analysis was performed descriptive analysis of case studies and comparison between sexes in relation to variables were obtained with CSF by Mann-Whitney and Student’s t-tests.Results The sexes did not differ statistically when compared to pleocytosis in CSF. Eosinophils were present in 31% in samples while the ELISA test presented 80% sensitivity in this case series. Of the patient total, 24 presented a meningitis pattern with lymphocytic predominance.Conclusion There was no difference in inflammatory pattern between the sexes, with predominance of lymphocytic meningitis and 80% sensitivity by ELISA test of CSF patients with racemose form of NCC.

O objetivo deste trabalho foi avaliar o padrão de alterações do LCR de pacientes com diagnóstico de neurocisticercose (NCC) na forma racemosa.Método Trata-se de estudo de coorte retrospectiva, de pacientes com diagnóstico de forma racemosa da NCC. Foram analisadas amostras de LCR de 26 pacientes. Após análise de prontuário foi realizada análise descritiva da casuística e comparação entre sexos em relação às variáveis obtidas com o LCR por meio dos testes de Mann-Whitney e t-Student.Resultados Não houve diferença estatisticamente significante quando comparado à pleocitose no LCR entre os sexos. Houve presença de eosinofilorraquia em 31% das amostras e o teste ELISA apresentou sensibilidade de 80% nesta casuística. Do total de paciente, 24 apresentaram padrão de meningite com predomínio linfocítico.Conclusão Não houve diferença no padrão inflamatório entre os sexos, com predomínio de meningite linfocítica e sensibilidade de 80% ao teste ELISA do LCR de pacientes da forma racemosa de NCC.

Serum procalcitonin in Egyptian patients with acute meningitis and a negative direct cerebrospinal fluid examination

To reduce the morbidity and mortality related to bacterial meningitis, it is important to discriminate bacterial meningitis from aseptic meningitis during the acute phase of the disease, when the clinical symptoms are often similar. To test the reliability of serum procalcitonin [PCT] to discriminate bacterial meningitis from aseptic meningitis in patients who have a negative direct cerebrospinal fluid [CSF] examination, and to evaluate the role of serum PCT to assess treatment efficacy compared with the total leukocyte count [TLC], erythrocyte sedimentation rate [ESR] and C-reactive protein [CRP]. Forty patients with suspected acute meningitis and negative gram stains were included, and ten healthy persons were included as controls. According to the clinical examination and the CSF cytochemical analysis and cultures, the patients were divided into bacterial and aseptic groups. The measurements of serum PCT, ESR, CRP and TLC were performed. Patients in the bacterial group had a higher value of serum PCT at admission and at 3 days post-treatment than those in the aseptic group, with a highly significant difference between them. Serum PCT and, to a lesser extent, TLC had prognostic value in patients with acute meningitis, and PCT is more useful because it can be frequently measured for the diagnosis and follow-up of bacterial meningitis.

Molecular diagnosis of eosinophilic meningitis due to Angiostrongylus cantonensis (Nematoda: Metastrongyloidea) by polymerase chain reaction-DNA sequencing of cerebrospinal fluids of patients

Cerebrospinal fluid (CSF) samples from clinically diagnosed patients with detectable Angiostrongylus canto-nensis-specific antibodies (n = 10), patients with clinically suspected cases that tested negative for A. cantonensis-an-tibodies (n = 5) and patients with cerebral gnathostomiasis (n = 2) and neurocysticercosis (n = 2) were examined by a single-step polymerase chain reaction (PCR) method using the AC primers for the 66-kDa native protein gene. The PCR method detected A. cantonensis DNA in CSF samples from four of 10 serologically confirmed angiostrongyliasis cases. The PCR results were negative for the remaining CSF samples. The nucleotide sequences of three positive CSF-PCR samples shared 98.8-99.2% similarity with the reference sequence of A. cantonensis. These results indicate the potential application of this PCR assay with clinical CSF samples for additional support in the confirmation of eosinophilic meningitis due to A. cantonensis.

Is cerebrospinal fluid C-reactive protein a better tool than blood C-reactive protein in laboratory diagnosis of meningitis in children?

This study aimed to test whether C-reactive protein [CRP] measurement could differentiate between different types of meningitis and become a routine test. A prospective study included 140 children admitted to Manipal Teaching Hospital, Pokhara, Nepal, between July 2009 and June 2011. The subjects had a blood test and detailed cerebrospinal fluid [CSF] analysis, including blood and CSF CRP levels. Of those admitted, 31.1% had pyogenic meningitis [PM], 26.2% partially treated meningitis [PPM], 33% viral meningitis [VM], and 9.7% tubercular meningitis [TBM], with 26.4% controls. Organisms were isolated in 12.5% of the cases by blood culture and 25% of cases through CSF culture. Blood CRP was positive in all groups, with the highest values in PM [53.12 +/- 28.88 mg/dl] and PPM [47.55 +/- 34.34 mg/dl]; this was not statistically significant [P = 0.08]. The CSF CRP levels were significantly higher [P <0.001] in PM [45.75 +/- 28.50 mg/dl] and PPM [23.11 +/- 23.98 mg/dl]. The sensitivity and specificity of blood CRP was 90.62%, 88.88%, 64.7%, 70% and 32.4%, 30.97%, 24.52%, 26.12% and that of CSF CRP was 96.87%, 66.66%, 20.58%, 10% and 74.73%, 63.71%, 50.94%, 55.35% for PM, PPM, VM and TBM, respectively. Because of its high sensitivity, both CSF CRP and blood CRP can be used to screen for bacterial meningitis [both PM and PPM]. CSF CRP screening yielded results with a higher specificity than blood CRP; hence, it can be a supportive test along with CSF cytology, biochemistry, and microbiology for diagnosing meningitis

[Evaluation of epidemiological, clinical and laboratory findings of admitted patients with meningitis in infectious diseases ward of Razi hospital, Ahvaz]

Familiarity with the epidemiological, clinical and laboratory features of bacterial meningitis [BM] is important for rapid diagnosis and initiation of antibacterial therapy. This study aimed at evaluating these patients based on their epidemiological, clinical and laboratory findings and comparing these variables with patients with aseptic meningitis [ASM]. Admitted patients aged 18 years or more who were hospitalized because of meningitis, were studied between 2003 and 2007. Cases were grouped as BM and ASM and compared for their epidemiological, clinical and cerebrospinal fluid [CSF] laboratory aspects. Among 312 patients with meningitis, 215 [68.9%] had BM [42 definite, 156 probable and 17 partially treated] and 97 [31.1.%] had ASM. The mean age of patients with BM was 44.7 +/- 26.7 years and for ASM was 37.3 +/- 15.5 years [P>0.05]. Twelve percent of cases had triad of fever, neck stiffness and low level of consciousness. The means for CSF-WBC, CSF- glucose and CSF-protein in BM compared with ASM patients were 4021.6 +/- 1035.2 and 163.2 +/- 116.4 cell/microl of CSF; 27.5 +/- 17.3 and 68.7 +/- 16.lmg/dl and 689.8 +/- 476.8 and 132.6 +/- 107.7mg/dl, respectively [P<0.05]. The prevalence of BM was higher than that of ASM. Tuberculous meningitis had a considerable frequency among ASM patients. Confirmed BM based on CSF culture was lower than other studies. The number of performed LP procedures was not in accordance with the total meningitis cases. Similarly, WBC and glucose in CSF were helpful in differential diagnosis of BM vs. ASM

Epidemiology of meningitis in Oman, 2000-2005

We reviewed the epidemiologic features and trends for 771 cases of meningitis in Oman from January 2000 to December 2005. We found 69% were bacterial in origin and 13% were viral. Leading bacterial pathogens included Haemophilus influenzae [15%], Streptococcus pneumoniae [14%] and Nesseria meningitidis [12%]. For 56% of patients with suspected pyogenic meningitis, no specific bacterial pathogen could be identified. Peak occurrence was in children under 2 years old. The incidence of H. influenzae type b decreased by almost 100% after implementation of the national immunization programme in 2001, while the incidence of cases caused by S. pneumoniae and N. meningitidis remained steady

Pattern of sepsis and meningitis in a university hospital

To define the clinical and cerebrospinal fluid [CSF] criteria that establishes a diagnosis of sepsis and meningitis immediately on admission. One thousand children, aged one day to 13 years, presenting with acute onset of vomiting, fever, convulsion, and diarrhea to the Pediatrics Department, King Abdul-Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia from January 1997 to December 2000 were evaluated. Cases were subjected to history, clinical examination, and lumbar puncture [LP]. On admission, chemical, cytological, and bacteriological examinations of blood and CSF were carried out. Patients were divided into sepsis [n=94] and meningitis [n=26] groups. The most common age liable for LP was in the neonatal period [35.8%]. Septic cases were more than meningitis [78.3% versus 21.7%]. Neonates were the most commonly affected age in sepsis and meningitis; and the predominant symptom in all groups was vomiting. In meningitis, hemoglobin was less [p<0.05] while, blood white blood cell counts [WBCs] [p<0.05], blood neutrophils [p<0.05], CSF-chloride [p<0.000] and CSF-WBCs [p<0.001] were more than sepsis. In meningitis, a positive correlation was found between CSF-glucose with WBCs [r=0.52, p<0.05], neutrophils [r=0.49, p<0.05], and blood-glucose [r=0.56, p<0.01]; and between CSF-WBCs and CSF-protein [r=0.55, p<0.01]. In sepsis, a positive correlation was found between CSF-lymphocyte and CSF-red blood cell count [r=0.37, p<0.001]. More septic cases were admitted to the Pediatric Department through Emergency than meningitis cases. The most common pediatric patients liable to LP were neonates, and the most common presenting symptom was vomiting. Children with vomiting and convulsion and no organism in CSF must be carefully examined, and urine and blood culture must be collected. These children must be closely observed in hospital and re-evaluated by a pediatrician

Detection of Cysticercus antigens and antibodies in cerbrospinal fluid of patients with chronic meningitis

Chronic meningitism is a less frequent manifestation of neurocysticercosis caused by Taenia solium cysticerci. In the present study we used Co-agglutination (Co-A), a simple and rapid slide agglutination test to detect specific Cysticercus antigen in the 67 cerebrospinal fluid (CSF) samples from patients with chronic meningitis of unknown etiology. The results were compared with that of ELISA for detection of antibodies. Among these samples four (5.97 percent) were positive for Cysticercus antigen by Co-A test and six (8.95 percent) were positive for antibodies by ELISA. Two samples were positive by both Co-A and ELISA, two were positive only by Co-A and four were positive only by ELISA. In the present study, although Cysticercus antigen and antibodies were present in CSF samples from eight (11.94 percent) patients, we cannot affirm that all the cases of chronic meningitis are due to cysticercosis, but for any case of chronic meningitis of unknown origin, it would be useful to consider the possibility of cysticercal meningitis.

Meningite crônica é manifestação pouco freqüente de neurocisticercose causada por cisticerco de Taenia solium. No presente estudo utilizamos co-aglutinação (Co-A) um teste simples e rápido de aglutinação para detectar antígeno específico de Cysticercus nas 67 amostras de fluido cerebrospinal (CSF) de pacientes com meningite crônica de etiologia desconhecida. Os resultados foram comparados com os de ELISA para detecção de anticorpos. Dentre estas amostras quatro (5,97 por cento) foram positivas para antígenos de Cysticercus pelo teste Co-A e seis (8,95 por cento) foram positivas para anticorpos por ELISA. Duas amostras foram positivas por ambos Co-A e ELISA, duas foram positivas somente por Co-A e quatro foram positivas somente por ELISA. No presente estudo embora antígenos e anticorpos de Cysticercus estivessem presentes nas amostras de CSF de oito pacientes (11,94 por cento), não podemos afirmar que todos os casos de meningite crônica sejam devidos à cisticercose, mas para qualquer caso de meningite crônica de origem desconhecida seria útil considerar a possibilidade de meningite por cisticerco.

lumbar puncture always necessary in the febrile child with convulsion?

Febrile convulsion is the most common benign convulsive disorder in children. Meningitis is one of the most important causes of fever and convulsions, diagnosed by lumbar puncture [LP], a painful and invasive procedure much debated regarding its necessity. This study evaluates the frequency of abnormal LP findings in a group of patients, to determine whether or not unnecessary LP can be prevented without missing patients with serious problems such as meningitis. The study was a descriptive, cross sectional study, conducted on 200 children suffering from fever and convulsions. Medical files of patients were taken from the hospital records and relevant data were collected to complete the appropriate forms. Of 200 patients included in the study, 116 [58%] children were male, and 84 [42%] were female. 47 cases [23.5%] underwent LP, of whom just one [0.5%] had abnormal LP and meningitis. Regarding Considering the low prevalence of meningitis in children with convulsion and fever, we conclude that by means of precise clinical examination and monitoring, it is possible to prevent unnecessary LP in these patients

C-reactive protien and lactate dehydrogenase in serum and cerebrospinal fluid in rapid and early diagnosis of childhood meningitis

Bacterial meningitis is still a life threatening epidemiological problem especially in many developing countries; considering its dire consequences, its prompt and accurate diagnosis has become a priority for clinicians. Because of the various limitations of conventionally used laboratory techniques, we evaluated and compared the diagnostic utility of C-reactive protein and lactate dehydrogenase in serum and cerebrospinal fluid in the diagnosis of bacterial meningitis and its effectivity in distinguishing it from aseptic meningitis. A total of 125 pediatric cases, aged between 1 month and 12 years, including patients with bacterial meningitis [n=45], aseptic meningitis [n=42] and a control group [n=38], were retrospectively analyzed on the basis of data from the initial clinical examinations. Cultures, smears and other common serum and CSF indices were compared with serum and CSF CRP levels and LDH activity. Compared with each of the other variables, there were significant differences in the mean values of serum-CRP, CSF-glucose, CSF-LDH and CSF/serum LDH ratio between the bacterial and aseptic meningitis groups [p<0.001]. Of all the tests applied, the highest sensitivity [95%] and negative predictive value [95%] belonged to CSF-LDH activity and the most specific [100%] test with the highest positive predictive value [100%] was CSF-CRP titration as well as smear and culture. Combination of CSF-CRP serum-CRP, and CSF-LDH yielded the highest sensitivity [100%] and negative predictive value but the combined application of CSF-LDH and CSF-CRP proved to be the most specific and efficient. In the presence of a normal CRP titration and low glucose level in CSF, bacterial meningitis is excluded, whereas elevated level of CSF-LDH activity is a valid confirmatory predictor of BM. In addition, combination of these three tests with serum CRP is far more effective than the separate determination of any of these parameters

Clinical and laboratory findings in neurobrucellosis: a study of 43 cases

Brucellosis is a common zoonotic infection that is endemic in many parts of the world. Neurological involvement is a rare entity, occurs in 2-5% of cases. Neurobrucellosis comprises a variety of complications, including meningitis, meningoencephalitis, myelitis and myelopaties, peripheral and cranial neuropathies, and psychiatric manifestations. The aim of the present study was to evaluate neurological manifestations and cerebrospinal fluid [CSF] findings in a group of Iranian patients with neurobrucellosis. During a 10-year period [1996-2005], medical records of 43 hospitalized patients with definite diagnosis of neurobrucellosis were studied. Inclusion criteria were a minimum titer of 1/160 for Wright and abnormal CSF findings. Age, gender, neurological manifestations, CSF analysis and its changes were investigated. Neurological manifestations include meningitis [64.9%], meningoencephalitis [11.6%], cranial nerve palsy [11.6%], brain abscess [2.4%], myelitis [2.4%] and psychiatric disorders [6.9%]. Pleocytosis [100%], high protein [40%] and low glucose levels [40%] were noted in CSF analysis clinical manifestations and CSF abnormality of nearobrucellosis is similar to tuberculosis an nearobrucellosis must be kept in mind in approach of patients with acute or chronic lymphocytic meningitis with increased protein and low glucose level in CSF and risk factors of brucellosis

Avaliação dos exames laboratoriais para o diagnóstico das meningites infecciosas no Estado de Sergipe, durante o período de 1977 a 2003 / Assessment of the laboratorial examinations for diagnosing infectious meningitis performed in the Sergipe state, during the period from 1997 to 2003

As meningites infecciosas continuam a ocorrer no país com alta incidência e elevados índices de mortalidade, apesar da existência de programas de prevenção da doença e dos avanços na tecnologia empregada na detecção dos microrganismos envolvidos. O exame laboratorial do líquido céfalorraquidiano (LCR) é a base para efetuar o diagnóstico e para introdução de tratamento eficaz ao paciente. Na rotina laboratorial, são utilizados para o diagnóstico: exame microscópico, cultura e pesquisa de antígeno. Visando conhecer a eficiência e a capacidade de resposta, bem como para efetuar a correlação das referidas técnicas laboratoriais com os dados clínicos, este trabalho investigou 510 fichas de registros de pacientes com suspeita de meningite, atendidos pelo Serviço Único de Saúde, que deram entrada no período de 1997 a 2003, no Laboratório Central de Saúde Pública no estado de Sergipe, no Instituto Parreiras Horta. Foi realizada a análise de freqüências absolutas dos testes utilizados no diagnóstico das meningites infecciosas. Os dados mostram uma diminuição, nos últimos anos, da porcentagem de confirmação de diagnóstico de meningite por meio de cultura, fato que pode ser observado em pesquisas realizadas em outros laboratórios do Brasil. Em contrapartida, verifica-se um aumento expressivo no número de paciente com meningites confirmado por meio de bacterioscopia, utilizando-se a coloraçãode Gram. Os resultados apresentados confirmam a importância do diagnóstico rápido e preciso que ofereça vantagens clínicas significativas para o emprego da terapia antimicrobiana adequada e acompanhamento da evolução da doença.

study comparing cerebrospinal fluid lactate levels in childhood culture positive and culture negative meningitis

Despite recent innovations in the laboratory diagnosis of bacterial from nonbacterial meningitis, solid data-necessary for early determination of bacterial meningitis [BM] before organism growth in the culture medium-are missing. Therefore cerebrospinal fluid [CSF] lactate levels were evaluated as a possible means of differentiating the two clinical entities. This was a retrospective study. Patients were studied in one year. They were divided into three groups: Group one included 10 patients with culture positive meningitis; Group two included 10 patients with culture negative meningitis compatible with a viral etiology; Group three consisted of 10 febrile children without any biochemical or cytological CSF abnormality as the normal controls. CSF lactate level determinations were made enzymatically with Boehringer Mannheim reagents in addition to the formal biochemical and cytological investigations, consisting of cell counts and differential plus glucose and protein levels and CSF/blood glucose ratio in all three groups. Group one had a mean CSF lactate level of 12.90 [ +/- 3.08] mmol/L, while in groups 2 and 3 the level was 1.89 [ +/- 0.52] mmoL/l and 1.63 [ +/- 0.31] mmol/L respectively. Lactate levels were significantly higher in patients from group one with respect to the control group [p= 0.001] whereas there were no significant differences between group 2 and the control group. Regarding temporal profile of CSF markers and considering the rapid rise in CSF lactate levels in bacterial meningitis, its measurement seems appealing to confirm a bacterial etiology instead of awaiting the results of CSF culture

Características clínicas e laboratoriais da meningite asséptica associada à vacina tríplice viral / Clinical and laboratory features of aseptic meningitis associated with measles-mumps-rubella vaccine

Objetivos. Descrever os achados epidemiológicos, clínicos e liquóricos dos casos de meningite asséptica associada à vacina tríplice viral (sarampo, caxumba e rubéola), ocorridos no Estado da Bahia após campanha de vacinaçäo em massa promovida pelo Ministério da Saúde do Brasil em agosto de 1997, e comparar esses casos aos de meningite asséptica näo associada à vacina ocorridos no mesmo ano. Métodos. Entre março e outubro de 1997, foi realizado acompanhamento prospectivo de todos os indivíduos com idade de 1 a 12 anos admitidos no Hospital Couto Maia com diagnóstico clínico e laboratorial de meningite asséptica. A populaçäo do estudo foi dividida em dois grupos, representando indivíduos vacinados e näo vacinados. Foram coletadas informaçöes demográficas, clínicas e laboratoriais para ambos os grupos. Resultados. No mês de setembro, logo após a campanha de vacinaçäo, 74 casos de meningite asséptica foram atendidos no Hospital Couto Maia, em comparaçäo com a média mensal de 7,5 casos. Verificamos maior freqüência de rigidez de nuca e níveis mais altos de celularidade liquórica nas crianças cuja meningite foi associada à vacina. Por outro lado, houve maior número de casos com comprometimento encefálico no grupo de meningites näo associadas à vacinaçäo. Conclusöes. Embora a meningite pós-vacinal tenha curso mais benigno, seu tratamento continua gerando custos com exames complementares e internaçöes. As campanhas de vacinaçäo em larga escala devem utilizar vacinas contendo cepas menos reatogênicas

C-reactive protein follow-up of children with acute bacterial meningitis

Twenty-two children with bacterial meningitis were prospectively studied to follow serum levels of C-reactive protein (CRP) at admission, and the 2nd, 5th and 7th days of treatment, and in the cerebrospinal fluid (CSF) at admission, to investigate whether there is any relationship of its levels with the clinical evolution. CRP was measured by latex agglutination and/or ELISA techniques with detection limits of 0.15mg/L and 0.9mg/L, respectively. Patients were classified according to clinical evolution in two groups: uneventful recovery (n=12) and complicated evolution (n=10). Clinical complications observed were: relapse of fever (8), persistent fever (4), arthritis (4), ventricle enlargement (2), subdural effusion (1), subdural empyema (1), ataxia (1), cervical hypotonia (1), deafness (1), endophthalmitis (1), accute otitis media (1), secondary skin infection (1) and treatment change due to poor clinical response (1). A significant decrease in CRP levels was observed among the uneventful recovery group after admission. In contrast, in the group with complicated evolution, CRP levels showed either secondary elevation or remained high continously. Mean serum CRP levels were significantly lower in the uneventful recovery group than in the complicated evolution group on the 5th and 7th days. CRP levels below 20mg/L on the 5th and 7th days were associated with an uneventful recovery, and CRP levels higher than 20mg/L on those same days were associated with a complicated clinical evolution (p=0.01* and p=0.0015*, respectively). We conclude that serumm CRP level monitoring in children with bacterial meningitis provides useful and objective information about their clinical evolution. This procedure is inexpensive and suitable for use in endemic areas lacking sophisticated laboratories.