Effect of Staphylococcal Decolonization Regimen and Change in Antibiotic Prophylaxis Regimen on Incidence of Postcraniotomy Aseptic Meningitis.

OBJECTIVE: To study the effect of a staphylococcal decolonization regimen (SDR) and change in antibiotic prophylaxis regimen on postoperative meningitis (bacterial and aseptic) rates in patients undergoing elective cranial surgery. METHODS: Data on elective craniotomy (supratentorial and infratentorial) were collected retrospectively for a total of 4 years-2 years before (2011-2012; group A) and 2 years after (2014-2015; group B) initiation of a SDR and a change in the antibiotic prophylaxis regimen (from chloramphenicol to ceftriaxone) in a neurosurgical unit of a tertiary care hospital. The SDR consisted of a 4% chlorhexidine scrub bath once a day and 10% betadine ointment application intranasally twice daily for ≥2 days before surgery. RESULTS: A total of 1349 patients (GROUP A, n = 622; group B, n = 727) were included in the present study, of whom 806 (59.7%) were males. Of the 1349 patients, 43 (3.2%) developed postoperative meningitis. Of these 43 patients, 8 (0.6%) had bacterial meningitis (BM) and 35 (2.6%) had aseptic meningitis (AM). A reduction occurred in the incidence of both BM and AM in group B; however, the reduction was statistically significant only for AM (P = 0.48 for BM; P = 0.019 for AM). Multivariate analysis showed that the initiation of an SDR conferred a significant protective effect against developing postoperative AM (relative risk, 0.31; 95% confidence interval, 0.14-0.70; P = 0.005). CONCLUSIONS: Our data showed that the incidence of AM can be reduced with an SDR and appropriate antibiotic prophylaxis. These findings lend support to the suspicion that AM might be a form of low-grade BM possibly due to a staphylococcal infection.

Impacto de la implantación de la reacción en cadena de la polimerasa a enterovirus en el manejo de la meningitis aséptica / Impact of introducing an enterovirus polymerase chain reaction in the management of aseptic meningitis

INTRODUCCIÓN: El diagnóstico de meningitis aséptica basado en la reacción en cadena de la polimerasa (PCR) frente a enterovirus en líquido cefalorraquídeo es un método rápido y sensible. OBJETIVO: Valorar la influencia de la implantación de la PCR a enterovirus en el uso de antibióticos y la estancia hospitalaria en meningitis aséptica. MATERIAL Y MÉTODOS: Estudio prospectivo de ni˜nos con meningitis aséptica durante un a˜no, utilizando como grupo control a pacientes previos a la implantación de la técnica. RESULTADOS: La realización de la PCR se asoció a un menor uso de antibióticos respecto al grupo control (16,2% vs. 41,4%; p = 0,029), a un menor tiempo de administración (0,54 vs. 2 días; p = 0,014) y a una disminución no significativa de la duración del ingreso (3,57 vs. 4,21 días; p = 0,376). CONCLUSIÓN: La implantación de la PCR a enterovirus disminuye la utilización de antibióticos y la estancia hospitalaria

INTRODUCTION: The diagnosis of aseptic meningitis, based on an enterovirus PCR (EV-PCR) in cerebrospinal fluid, is a rapid and sensitive test. OBJECTIVE: To assess the impact of introducing EV-PCR on the use of antibiotics and hospital length of stay in aseptic meningitis. MATERIAL AND METHODS: A prospective study that included children with aseptic meningitis during one year. The patients prior to the introduction of the test formed the control group. RESULTS: The performance of the PCR test was associated with less use of antibiotics compared to the control group (16.2% vs 41.4%, P = .029) and with fewer days of administration (.54 vs. 2 days, P=.014). A non-significant decrease in length of stay (3.57 vs. 4.21 days, P=.376) was also observed in the study group. CONCLUSION: The introduction of the EV-PCR test decreases the use of antibiotics and hospital length of stay

Adverse effects of IgG therapy.

IgG is widely used for patients with immune deficiencies and in a broad range of autoimmune and inflammatory disorders. Up to 40% of intravenous infusions of IgG may be associated with adverse effects (AEs), which are mostly uncomfortable or unpleasant but often are not serious. The most common infusion-related AE is headache. More serious reactions, including true anaphylaxis and anaphylactoid reactions, occur less frequently. Most reactions are related to the rate of infusion and can be prevented or treated just by slowing the infusion rate. Medications such as nonsteroidal anti-inflammatory drugs, antihistamines, or corticosteroids also may be helpful in preventing or treating these common AEs. IgA deficiency with the potential of IgG or IgE antibodies against IgA increases the risk of some AEs but should not be viewed as a contraindication if IgG therapy is needed. Potentially serious AEs include renal dysfunction and/or failure, thromboembolic events, and acute hemolysis. These events usually are multifactorial, related to combinations of constituents in the IgG product as well as risk factors for the recipient. Awareness of these factors should allow minimization of the risks and consequences of these AEs. Subcutaneous IgG is absorbed more slowly into the circulation and has a lower incidence of AEs, but awareness and diligence are necessary whenever IgG is administered.

Mollaret's meningitis and herpes simplex virus type 2 infections.

Benign recurrent aseptic meningitis is a rare disorder described by Mollaret in 1944. When initially described, this form of aseptic meningitis had no identifiable infecting agent. New sophisticated diagnostic tools have now identified herpes simplex type 2 virus as the most commonly isolated agent. Antiviral treatment has been used successfully for prophylaxis and treatment.

Ongoing outbreak of aseptic meningitis in South-Eastern Latvia, June - August 2010.

An outbreak of aseptic meningitis has been ongoing in several areas of Latgale region, in the south-eastern part of Latvia since the end of June 2010. By 9 August 2010, 114 cases had been notified. Most of the cases were registered in the city and amalgamated municipality of Daugavpils and neighbouring territories. According to current evidence, two types of enteroviruses, coxsackie A-9 virus and echovirus 30, are the causative agents of the outbreak.

Recurrent HSV-2 meningitis in a 9-year-old girl.

While HSV-2 meningitis has been described in prepubertal children in the context of sexual abuse, to the best of our knowledge recurrent episodes have not been described in this population. We report a 9-y-old girl with recurrent HSV-2 meningitis presenting as aseptic meningitis without any evidence of genital herpes. A high index of suspicion for this condition would be needed to make a diagnosis in this age group, which in turn would guide further therapeutic decisions.

[Enteroviruses in the XX and XXI centuries].

The modern view of the role of enteroviruses in the eradication of poliomyelitis is presented. Enteroviruses were discovered in the XX century. In the 1950s they caused great epidemics of poliomyelitis and serous meningitis in many countries of the world. The introduction of oral poliomyelitis vaccine (OPV) into medical practice made it possible to eliminate the epidemics of poliomyelitis in a short time. Poliomyelitis morbidity was reduced to sporadic cases and in a number of regions disappeared. OPV produced non-specific influence also on the epidemics of serous meningitis, as well as on a case incidence. The eradication of poliomyelitis viruses and the cessation of immunization with OPV will not result in eradication of paralytic diseases. Paralytogenic viruses of 20 serotypes circulate in nature, and some of these viruses are capable of causing the outbreaks of severe paralytic diseases. The authors propose either to retain immunization with OVP as tour immunizations with monovaccine of type 2, or to create new live enterovirus vaccines on the basis of avirulent enterovirus strains.

[Summer 1997 viral meningitis in children Frankfurt/Main--a discussion of the revised communicable disease control regulation]. / Virale Meningitiden bei Kindern in Frankfurt/M. im Sommer 1997--ein Diskussionsbeitrag zum Referentenentwurf des Infektionsschutzgesetzes.

According to the current law of preventing infectious diseases in Germany, bacterial as well as aseptic meningitis have to be reported to the health authorities, whereas according to the amendment aseptic meningitis will no longer be notifiable. In Summer 1997, 63 children with aseptic meningitis were reported to the local health authorities of Frankfurt compared with 4 or 5 per year during the preceding years. In 40% enterovirus, resp. ECHO-30 virus could be detected. The local health authorities gave detailed information on the medical relevance as well as necessary hygienic measures to the families and kindergartens. During the same time reports on aseptic meningitis increased to double compared with 1996, with hot spots in 4 defined regions in Bavaria, Hesse and in Northern Germany. According to these data the duty of notification of aseptic meningitis should be maintained, so that health authorities can inform the population and ensure good hygiene methods.

The aseptic meningitis syndrome: a complication of posterior fossa surgery.

The syndrome of aseptic meningitis is characterized by spiking fever and meningismus. CSF analysis generally shows increased pleocytosis, hypoglycorrhachia, elevated protein and negative cultures. In an earlier series, 70% of children with posterior fossa operations developed the syndrome. In a new review the incidence was slightly more than 30%. The incidence of aseptic meningitis following operation for structural lesions was 44%, which was higher than the tumor group, where the meningitic syndrome was seen in 25% of the children. It is the purpose of this paper to reexamine the impact that steroids have made on the prevalence of the aseptic meningitis syndrome, and to review recent studies that have attempted to distinguish between aseptic and bacterial meningitis.