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The Pediatric Infectious Disease Journal Jun 2019Introduction of conjugate vaccines against Haemophilus influenzae type b, Streptococcus pneumoniae, and Neisseria meningitidis has led to a substantial reduction in...
Introduction of conjugate vaccines against Haemophilus influenzae type b, Streptococcus pneumoniae, and Neisseria meningitidis has led to a substantial reduction in cases of acute bacterial meningitis in countries with high routine childhood immunization coverage. The majority of children hospitalized with meningitis in high-income countries have viral or aseptic meningitis and do not require antibiotic treatment. Cerebrospinal fluid analysis is irreplaceable in appropriately diagnosing and treating bacterial meningitis and avoiding unnecessary antibiotics and prolonged hospitalizations in children with viral meningitis. New diagnostic tests have improved detection of bacterial and viral pathogens in cerebrospinal fluid, underscoring the importance of promptly performing lumbar puncture when meningitis is suspected. This article provides an overview of acute bacterial and viral meningitis in children, focusing on the changing epidemiology, the advantages and limitations of conventional and newer diagnostic methods, and considerations for clinical practice.
Topics: Anti-Bacterial Agents; Bacteria; Bacterial Infections; Child; Child, Preschool; Clinical Decision Rules; Humans; Infant; Meningitis, Bacterial; Meningitis, Viral; Molecular Diagnostic Techniques; Spinal Puncture; Viruses
PubMed: 31205243
DOI: 10.1097/INF.0000000000002313 -
Journal of Neurovirology Aug 2019Human adenovirus (HAdV) has been recognized as a significant viral pathogen implicated in neurological diseases, particularly in immunocompromised patients. However, its... (Observational Study)
Observational Study
Human adenovirus (HAdV) has been recognized as a significant viral pathogen implicated in neurological diseases, particularly in immunocompromised patients. However, its involvement in meningoencephalitis remains unclear. The aim of this study was to investigate HAdV and other viral co-infections in the cerebrospinal fluid (CSF) of patients suspected of having either meningoencephalitis or encephalitis. A total of 373 CSF samples from patients under clinical suspicion of neurological viral infection were included in this study. HAdV was investigated by conventional or multiplex real-time PCR, for different time periods. The frequency of HAdV central nervous system (CNS) infection was 1.08%, predominating in female patients with a predisposing condition, and presented with HAdV encephalitis. HAdV CNS infection was found to occur during the months of autumn and winter. The frequency of HAdV detected in CSF positive samples increased after the change in the diagnostic method from conventional to multiplex real-time PCR. There were no specific NMRI or EEG characteristics and two CSF samples with HAdV encephalitis had normal CSF WBC count. There were two cases of co-infection with HIV; no other co-infections with enterovirus or herpes family viruses were detected. All patients had good outcome. Although HAdV is rarely observable in CNS infectious syndromes, it must be investigated particularly in immunocompromised patients.
Topics: Adenoviruses, Human; Aged; Aged, 80 and over; Cross-Sectional Studies; DNA, Viral; Encephalitis, Viral; Female; Humans; Leukocyte Count; Leukocytes; Male; Meningitis, Viral; Meningoencephalitis; Middle Aged; Prospective Studies; Seasons; Viral Load
PubMed: 31102186
DOI: 10.1007/s13365-019-00758-7 -
European Journal of Pediatrics Apr 2019This multicenter prospective cohort study describes the impact of human parechovirus meningitis on gross-motor neurodevelopment of young children. Gross-motor function...
This multicenter prospective cohort study describes the impact of human parechovirus meningitis on gross-motor neurodevelopment of young children. Gross-motor function was measured using Alberta Infant Motor Scale. Of a total of 38 eligible children < 10 months of age at onset, nine cases had clinical evidence of meningitis and polymerase chain reaction positive for human parechovirus in cerebrospinal fluid; 11 had no meningitis and polymerase chain reaction positive for human parechovirus in nasopharyngeal aspirate, blood, urine, or feces; and in 18, no pathogen was identified (reference group).The children with human parechovirus meningitis showed more frequent albeit not statistically significant suspect gross-motor function delay (mean Z-score (standard deviation) - 1.69 (1.05)) than children with human parechovirus infection-elsewhere (- 1.38 (1.51)). The reference group did not fall in the range of suspect gross-motor function delay (- 0.96 (1.07)). Adjustment for age at onset and maternal education did not alter the results.Conclusion: Six months after infection, children with human parechovirus meningitis showed more frequent albeit not statistically significant suspect gross-motor function delay compared to the population norm and other two groups. Longitudinal studies in larger samples and longer follow-up periods are needed to confirm the impact and persistence of human parechovirus meningitis on neurodevelopment in young children. What is Known: • Human parechovirus is progressively becoming a major viral cause of meningitis in children. • There is keen interest in the development of affected infants with human parechovirus meningitis. What is New: • This study describes prospectively gross-motor functional delay in children with both clinical evidence of meningitis and polymerase chain reaction positive for human parechovirus in cerebrospinal fluid. • It shows the importance of screening young children for developmental delay in order to refer those with delay for early intervention to maximize their developmental potential.
Topics: Case-Control Studies; Developmental Disabilities; Humans; Infant; Meningitis, Viral; Parechovirus; Picornaviridae Infections; Prospective Studies; Reverse Transcriptase Polymerase Chain Reaction
PubMed: 30637468
DOI: 10.1007/s00431-019-03319-6 -
Clinica Chimica Acta; International... Mar 2017Tuberculous meningitis (TBM) is the most severe and frequent form of central nervous system tuberculosis. The current lack of efficient diagnostic tests makes it...
BACKGROUND
Tuberculous meningitis (TBM) is the most severe and frequent form of central nervous system tuberculosis. The current lack of efficient diagnostic tests makes it difficult to differentiate TBM from other common types of meningitis, especially viral meningitis (VM). Metabolomics is an important tool to identify disease-specific biomarkers. However, little metabolomic information is available on adult TBM.
METHODS
We used H nuclear magnetic resonance-based metabolomics to investigate the metabolic features of the CSF from 18 TBM and 20 VM patients. Principal component analysis and orthogonal signal correction-partial least squares-discriminant analysis (OSC-PLS-DA) were applied to analyze profiling data. Metabolites were identified using the Human Metabolome Database and pathway analysis was performed with MetaboAnalyst 3.0.
RESULTS
The OSC-PLS-DA model could distinguish TBM from VM with high reliability. A total of 25 key metabolites that contributed to their discrimination were identified, including some, such as betaine and cyclohexane, rarely reported before in TBM. Pathway analysis indicated that amino acid and energy metabolism was significantly different in the CSF of TBM compared with VM.
CONCLUSIONS
Twenty-five key metabolites identified in our study may be potential biomarkers for TBM differential diagnosis and are worthy of further investigation.
Topics: Adult; Biomarkers; Cerebrospinal Fluid; Diagnosis, Differential; Humans; Magnetic Resonance Spectroscopy; Meningitis, Viral; Metabolic Networks and Pathways; Metabolomics; Principal Component Analysis; Tuberculosis, Meningeal
PubMed: 28063937
DOI: 10.1016/j.cca.2017.01.002 -
Cells Sep 2020Neutrophils are first responders of antimicrobial host defense and sterile inflammation, and therefore, play important roles during health and disease [...].
Neutrophils are first responders of antimicrobial host defense and sterile inflammation, and therefore, play important roles during health and disease [...].
Topics: Animals; Humans; Anti-Inflammatory Agents; Clinical Trials as Topic; COVID-19; Deoxyribonuclease I; Diabetes Mellitus; Extracellular Traps; Immunity, Innate; Inflammation; Lyme Neuroborreliosis; Malaria, Falciparum; Meningitis, Viral; Myocardial Infarction; Neutrophils; Obesity; Recombinant Proteins
PubMed: 32962213
DOI: 10.3390/cells9092130 -
Minerva Pediatrica Apr 2019Enterovirus (EV) and Parechovirus (HPeV) are a frequent cause of infection in children. This review gives an overview of possible causes for differences in clinical... (Review)
Review
Enterovirus and parechovirus infections in children: differences in clinical presentation, mechanisms for meningitis without pleocytosis and mechanisms involved in the neurological outcome.
Enterovirus (EV) and Parechovirus (HPeV) are a frequent cause of infection in children. This review gives an overview of possible causes for differences in clinical presentation. EV and HPeV can cause a meningitis with or without pleocytosis. Different possible mechanisms for meningitis without pleocytosis are given. Little is known about the prognosis and long-term effects of EV and HPeV meningitis in children. Only some studies with a small number of children with EV or HPeV meningitis are reported. The different possible mechanisms involved in the neurological outcome after EV or HPeV meningitis will be discussed.
Topics: Child; Enterovirus Infections; Humans; Leukocytosis; Meningitis, Viral; Picornaviridae Infections; Prognosis
PubMed: 30511561
DOI: 10.23736/S0026-4946.18.05449-X -
Science Immunology Oct 2023High neonatal susceptibility to meningitis has been attributed to the anatomical barriers that act to protect the central nervous system (CNS) from infection being...
High neonatal susceptibility to meningitis has been attributed to the anatomical barriers that act to protect the central nervous system (CNS) from infection being immature and not fully developed. However, the mechanisms by which pathogens breach CNS barriers are poorly understood. Using the Armstrong strain of lymphocytic choriomeningitis virus (LCMV) to study virus propagation into the CNS during systemic infection, we demonstrate that mortality in neonatal, but not adult, mice is high after infection. Virus propagated extensively from the perivenous sinus region of the dura mater to the leptomeninges, choroid plexus, and cerebral cortex. Although the structural barrier of CNS border tissues is comparable between neonates and adults, immunofluorescence staining and single-cell RNA sequencing analyses revealed that the neonatal dural immune cells are immature and predominantly composed of CD206 macrophages, with major histocompatibility complex class II (MHCII) macrophages being rare. In adults, however, perivenous sinus immune cells were enriched in MHCII macrophages that are specialized for producing antiviral molecules and chemokines compared with CD206 macrophages and protected the CNS against systemic virus invasion. Our findings clarify how systemic pathogens enter the CNS through its border tissues and how the immune barrier at the perivenous sinus region of the dura blocks pathogen access to the CNS.
Topics: Mice; Animals; Central Nervous System; Meningoencephalitis; Lymphocytic Choriomeningitis; Meninges; Lymphocytic choriomeningitis virus; Meningitis, Viral; Encephalitis, Viral
PubMed: 37801517
DOI: 10.1126/sciimmunol.adg6155 -
BMC Infectious Diseases Nov 2019Aseptic meningitis epidemics may pose various health care challenges.
BACKGROUND
Aseptic meningitis epidemics may pose various health care challenges.
METHODS
We describe the German enterovirus meningitis epidemics in the university hospital centers of Düsseldorf, Cologne and Berlin between January 1st and December 31st, 2013 in order to scrutinize clinical differences from other aseptic meningitis cases.
RESULTS
A total of 72 enterovirus (EV-positive) meningitis cases were detected in our multicenter cohort, corresponding to 5.8% of all EV-positive cases which were voluntarily reported within the National Enterovirus surveillance (EVSurv, based on investigation of patients with suspected aseptic meningitis/encephalitis and/or acute flaccid paralysis) by physicians within this period of time. Among these 72 patients, 38 (52.8%) were enterovirus positive and typed as echovirus (18 pediatric and 20 adult cases, median age 18.5 years; echovirus 18 (1), echovirus 2 (1), echovirus 30 (31), echovirus 33 (1), echovirus 9 (4)). At the same time, 45 aseptic meningitis cases in our cohort were excluded to be due to enteroviral infection (EV-negative). Three EV-negative patients were tested positive for varicella zoster virus (VZV) and 1 EV-negative patient for herpes simplex virus 2. Hospitalization was significantly longer in EV-negative cases. Cerebrospinal fluid analysis did not reveal significant differences between the two groups. After discharge, EV-meningitis resulted in significant burden of sick leave in our pediatric cohort as parents had to care for the children at home.
CONCLUSIONS
Voluntary syndromic surveillance, such as provided by the EVSurv in our study may be a valuable tool for epidemiological research. Our analyses suggest that EV-positive meningitis predominantly affects younger patients and may be associated with a rather benign clinical course, compared to EV-negative cases.
Topics: Adolescent; Adult; Child; Child, Preschool; Enterovirus B, Human; Enterovirus Infections; Female; Germany; Herpesvirus 2, Human; Herpesvirus 3, Human; Humans; Length of Stay; Male; Meningitis, Viral; Middle Aged; Seasons; Young Adult
PubMed: 31783807
DOI: 10.1186/s12879-019-4635-6 -
Journal of Neurology Jul 2022In 2020, a wide range of hygiene measures was implemented to mitigate infections caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In...
BACKGROUND AND OBJECTIVES
In 2020, a wide range of hygiene measures was implemented to mitigate infections caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In consequence, pulmonary infections due to other respiratory pathogens also decreased. Here, we evaluated the number of bacterial and viral meningitis and encephalitis cases during the coronavirus disease 2019 (COVID-19) pandemic.
METHODS
In a multicentre retrospective analysis of data from January 2016 until December 2020, numbers of patients diagnosed with bacterial meningitis and other types of CNS infections (such as viral meningitis and encephalitis) at 26 German hospitals were studied. Furthermore, the number of common meningitis-preceding ear-nose-throat infections (sinusitis, mastoiditis and otitis media) was evaluated.
RESULTS
Compared to the previous years, the total number of patients diagnosed with pneumococcal meningitis was reduced (n = 64 patients/year in 2020 vs. n = 87 to 120 patients/year between 2016 and 2019, all p < 0.05). Additionally, the total number of patients diagnosed with otolaryngological infections was significantly lower (n = 1181 patients/year in 2020 vs. n = 1525 to 1754 patients/year between 2016 and 2019, all p < 0.001). We also observed a decline in viral meningitis and especially enterovirus meningitis (n = 25 patients/year in 2020 vs. n = 97 to 181 patients/year between 2016 and 2019, all p < 0.001).
DISCUSSION
This multicentre retrospective analysis demonstrates a decline in the number of patients treated for viral and pneumococcal meningitis as well as otolaryngological infections in 2020 compared to previous years. Since the latter often precedes pneumococcal meningitis, this may point to the significance of the direct spread of pneumococci from an otolaryngological focus such as mastoiditis to the brain as one important pathophysiological route in the development of pneumococcal meningitis.
Topics: COVID-19; Encephalitis; Hospitals; Humans; Mastoiditis; Meningitis, Pneumococcal; Meningitis, Viral; Pandemics; Retrospective Studies; SARS-CoV-2
PubMed: 35316388
DOI: 10.1007/s00415-022-11034-w -
Emerging Infectious Diseases Mar 2023Lymphocytic choriomeningitis mammarenavirus (LCMV) is a globally distributed zoonotic pathogen transmitted by house mice (Mus musculus). We report the reemergence of...
Lymphocytic choriomeningitis mammarenavirus (LCMV) is a globally distributed zoonotic pathogen transmitted by house mice (Mus musculus). We report the reemergence of LCMV (lineages I and II) in wild house mice (Mus musculus domesticus) and LCMV lineage I in a diseased golden lion tamarin (Leontopithecus rosalia) from a zoo in Germany.
Topics: Animals; Mice; Lymphocytic choriomeningitis virus; Lymphocytic Choriomeningitis; Rodent Diseases; Germany
PubMed: 36823667
DOI: 10.3201/eid2903.221822