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Tropical Medicine & International... Sep 2017Diagnosis of bacterial meningitis often requires cytometry, chemistry and/or microbiologic culture capabilities. Unfortunately, laboratory resources in low-resource... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Diagnosis of bacterial meningitis often requires cytometry, chemistry and/or microbiologic culture capabilities. Unfortunately, laboratory resources in low-resource settings (LRS) often lack the capacity to perform these studies. We sought to determine whether the presence of white blood cells in CSF detected by commercially available urine reagent strips could aid in the diagnosis of bacterial meningitis.
METHODS
We searched PubMed for studies published between 1980 and 2016 that investigated the use of urine reagent strips to identify cerebrospinal fluid (CSF) pleocytosis. We assessed studies in any language that enrolled subjects who underwent lumbar puncture and had cerebrospinal fluid testing by both standard laboratory assays and urine reagent strips. We abstracted true-positive, false-negative, false-positive and true-negative counts for each study using a diagnostic threshold of ≥10 white blood cells per microlitre for suspected bacterial meningitis and performed mixed regression modelling with random effects to estimate pooled diagnostic accuracy across studies.
RESULTS
Our search returned 13 studies including 2235 participants. Urine reagent strips detected CSF pleocytosis with a pooled sensitivity of 92% (95% CI: 84-96), a pooled specificity of 98% (95% CI: 94-99) and a negative predictive value of 99% when the bacterial meningitis prevalence is 10%.
CONCLUSIONS
Urine reagent strips could provide a rapid and accurate tool to detect CSF pleocytosis, which, if negative, can be used to exclude diagnosis of bacterial meningitis in settings without laboratory infrastructure. Further investigation of the diagnostic value of using protein, glucose and bacteria components of these strips is warranted.
Topics: Adolescent; Adult; Aged; Bacteria; Carboxylic Ester Hydrolases; Child; Child, Preschool; Health Resources; Humans; Infant; Infant, Newborn; Leukocyte Count; Leukocytes; Leukocytosis; Meningitis, Bacterial; Middle Aged; Reagent Strips; Sensitivity and Specificity; Spinal Puncture; Young Adult
PubMed: 28627004
DOI: 10.1111/tmi.12913 -
Medicina (Kaunas, Lithuania) Feb 2022: Secondary cerebral vasospasm (CV) with subsequent delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH) remains an unpredictable pathology....
: Secondary cerebral vasospasm (CV) with subsequent delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH) remains an unpredictable pathology. The aim of this retrospective study was to investigate the association between inflammatory parameters, white blood cell (WBC) count, and C-reactive protein plasma levels (CRP) and the occurrence of secondary CV in patients with aSAH. : The medical records of 201 Intensive Care Unit patients in Riga East University Hospital with aSAH were retrospectively reviewed in a 24-month period. WBC count and CRP values were observed at admission to the hospital and on the third day. According to the inclusion criteria, 117 (48 males) participants were enrolled for further analysis, with average age of 56 ± 15 years (mean ± SD). In total, secondary CV was diagnosed in 21.4% of cases, and DCI in 22.4% of cases. The patients were classified into three groups: SAH-CV group ( = 25), SAH-DCI group ( = 12), and SAH or control group ( = 80), for comparative analysis. : We found that SAH-CV patients demonstrated notably higher inflammatory parameters compared to controls: WBC 13.2 ± 3.3 × 10/L vs. 11.2 ± 3.7 × 10/L; = 0.01 and CRP median 9.3 mg/L vs. 1.9 mg/L; < 0.001, respectively. We found that the odds of developing CV increased by 5% for each CRP increase of 1 mg/L at admission (OR, 1.05; CI, 1.014-1.087; = 0.006). Concomitantly, the odds increased by 16% for every rise in WBC count of 1 × 10/L (OR, 1.16; CI, 1.02-1.32; = 0.02). WBC count was associated with the occurrence of CV with 96% sensitivity and 40% specificity, with a cut off level of 10.015 × 10/L and AUC 0.683; = 0.006. CRP displayed 54% sensitivity and 90% specificity with a cut off value of 8.9 mg/L and AUC 0.751; < 0.001. Moreover, higher values of inflammatory parameters at admission correlated with a longer stay in ICU (r = 0.3, = 0.002 for WBC count and r = 0.305, = 0.002 for CRP values), and poor outcome (death) was significantly associated with higher CRP values at admission and on the third day (16.1. vs. 2.2. and 57.4. vs. 11.1, < 0.001, respectively). Higher mortality was detected in SAH-CV patients (32%) compared to controls (6.3%; < 0.001). : Inflammatory parameters such as WBC count and CRP values at admission might be helpful to predict the development of secondary CV.
Topics: Adult; Aged; C-Reactive Protein; Female; Humans; Leukocytosis; Male; Middle Aged; Retrospective Studies; Subarachnoid Hemorrhage; Vasospasm, Intracranial
PubMed: 35208646
DOI: 10.3390/medicina58020323 -
Anaerobe Jun 2017Clostridium difficile is the leading cause of healthcare-associated infections in the United States. Clinically, C. difficile-associated disease can present as... (Review)
Review
Clostridium difficile is the leading cause of healthcare-associated infections in the United States. Clinically, C. difficile-associated disease can present as asymptomatic colonization, self-limited diarrheal illness or severe colitis (that may result in death). This variability in disease course and outcomes suggests that host factors play an important role as key determinants of disease severity. Currently, there are several scoring indices to estimate severity of C. difficile-associated disease. Leukocytosis and renal failure are considered to be the most important predictors of C. difficile disease severity in hosts with a normal immune system. The degree of leukocytosis which is considered significant for severe disease and how it is scored vary amongst scoring indices. None of the scores have been prospectively validated, and while total WBC count is useful to estimate the magnitude of the host response in most patient populations, in immune-compromised patients like those receiving chemotherapy, solid organ transplant patients or hematopoietic stem cell transplants the WBC response can be variable or even absent making this marker of severity difficult to interpret. Other cellular subsets like neutrophils, eosinophils and lymphocytes provide important information about the host immune status and play an important role in the immune response against C. difficile infection. However, under the current scoring systems the role of these cellular subsets have been underestimated and only total white blood cell counts are taken into account. In this review we highlight the role of host leukocyte response to C. difficile challenge in the normal and immunocompromised host, and propose possible ways that would allow for a better representation of the different immune cell subsets (neutrophils, lymphocytes and eosinophils) in the current scoring indices.
Topics: Clostridium Infections; Humans; Immunocompromised Host; Leukocytes; Leukocytosis; Prospective Studies
PubMed: 28223256
DOI: 10.1016/j.anaerobe.2017.02.014 -
Hemoglobin Jan 2021Venous thromboembolism (VTE) in individuals with sickle cell disease is common and portends a poor prognosis. The role of leukocyte count and its subsets on risk of VTE...
Venous thromboembolism (VTE) in individuals with sickle cell disease is common and portends a poor prognosis. The role of leukocyte count and its subsets on risk of VTE in sickle cell disease are not known. We conducted a retrospective case-control study and analyzed for leukocyte count at the time of VTE and 3 months prior. Leukocyte and neutrophil counts were elevated at the time of VTE ( = 0.003 and = 0.0006, respectively) and 3 months prior ( = 0.001 and = 0.0096, respectively) when compared to controls. Baseline leukocytosis and neutrophilia may be associated with subsequent risk for thrombosis in sickle cell disease.
Topics: Anemia, Sickle Cell; Case-Control Studies; Humans; Leukocytosis; Retrospective Studies; Risk Factors; Venous Thromboembolism
PubMed: 33588667
DOI: 10.1080/03630269.2020.1869565 -
International Journal of Infectious... Jun 2017Viral central nervous system (CNS) infections are typically characterized by a cerebrospinal fluid (CSF) lymphocytic pleocytosis. A CSF neutrophilic pleocytosis... (Comparative Study)
Comparative Study
BACKGROUND
Viral central nervous system (CNS) infections are typically characterized by a cerebrospinal fluid (CSF) lymphocytic pleocytosis. A CSF neutrophilic pleocytosis presentation has been described, but its prognostic and clinical significance is unknown. The objectives of this study were to (1) compare the clinical and laboratory characteristics of viral CNS infections with a CSF neutrophilic pleocytosis to those with a lymphocytic pleocytosis, and (2) evaluate factors associated with an adverse clinical outcome.
METHODS
A retrospective study of patients with confirmed viral CNS infections was conducted. The patients were divided into those with CSF neutrophilic pleocytosis and those with CSF lymphocytic pleocytosis. Clinical findings and outcomes were compared between the two groups.
RESULTS
Of the 182 patients included in the study, 45 (24.7%) had CSF neutrophilic pleocytosis. Enterovirus infections were the cause of 64% of neutrophil-predominant CSF and 33% of lymphocyte-predominant CSF (p<0.001), while herpes infections were the cause of 46% of lymphocytic pleocytosis and 20% of neutrophilic pleocytosis (p=0.003). Moreover, neutrophilic pleocytosis was seen more commonly in younger patients (p=0.001), patients with respiratory symptoms (p=0.04), and patients with higher CSF white cell counts (p=0.004). Twenty-nine patients had an adverse clinical outcome (15.9%); the only predictor independently associated with an adverse clinical outcome on multivariable logistic regression analysis was an encephalitis presentation (p=0.01).
CONCLUSIONS
The results of a study exploring the association between CSF neutrophilic pleocytosis and clinical and prognostic significance are presented here. This study suggests that CSF neutrophilic pleocytosis is not associated with higher adverse clinical outcomes.
Topics: Adolescent; Adult; Central Nervous System Infections; Enterovirus Infections; Female; Humans; Leukocytosis; Lymphocytes; Male; Middle Aged; Neutrophils; Prognosis; Retrospective Studies
PubMed: 28435023
DOI: 10.1016/j.ijid.2017.04.010 -
BMC Neurology Feb 2023Gadolinium enhancement of spinal nerve roots on magnetic resonance imaging (MRI) has rarely been reported in spinal dural arteriovenous fistula (SDAVF). Nerve root... (Review)
Review
BACKGROUND
Gadolinium enhancement of spinal nerve roots on magnetic resonance imaging (MRI) has rarely been reported in spinal dural arteriovenous fistula (SDAVF). Nerve root enhancement and cerebrospinal fluid (CSF) pleocytosis can be deceptive and lead to a misdiagnosis of myeloradiculitis. We report a patient who was initially diagnosed with neurosarcoid myeloradiculitis due to spinal nerve root enhancement, mildly inflammatory cerebrospinal fluid, and pulmonary granulomas, who ultimately was found to have an extensive symptomatic SDAVF.
CASE PRESENTATION
A 52-year-old woman presented with a longitudinally extensive spinal cord lesion with associated gadolinium enhancement of the cord and cauda equina nerve roots, and mild lymphocytic pleocytosis. Pulmonary lymph node biopsy revealed non-caseating granulomas and neurosarcoid myeloradiculitis was suspected. She had rapid and profound clinical deterioration after a single dose of steroids. Further work-up with spinal angiography revealed a thoracic SDAVF, which was surgically ligated leading to clinical improvement.
CONCLUSIONS
This case highlights an unexpected presentation of SDAVF with nerve root enhancement and concurrent pulmonary non-caseating granulomas, leading to an initial misdiagnosis with neurosarcoidosis. Nerve root enhancement has only rarely been described in cases of SDAVF; however, as this case highlights, it is an important consideration in the differential diagnosis of non-inflammatory causes of longitudinally extensive myeloradiculopathy with nerve root enhancement. This point is highly salient due to the importance of avoiding misdiagnosis of SDAVF, as interventions such as steroids or epidural injections used to treat inflammatory or infiltrative mimics may worsen symptoms in SDAVF. We review the presentation, diagnosis, and management of SDAVF as well as a proposed diagnostic approach to differentiating SDAVF from inflammatory myeloradiculitis.
Topics: Female; Humans; Middle Aged; Spinal Cord; Contrast Media; Leukocytosis; Gadolinium; Spinal Cord Diseases; Magnetic Resonance Imaging; Central Nervous System Vascular Malformations; Arteriovenous Fistula
PubMed: 36750779
DOI: 10.1186/s12883-023-03097-7 -
Blood Nov 2021
Topics: Aged; B-Lymphocytes; Cytogenetic Analysis; Flow Cytometry; Gene Rearrangement, B-Lymphocyte; Humans; Immunophenotyping; Lymphocytosis; Male; Mutation
PubMed: 34792570
DOI: 10.1182/blood.2021012832 -
American Family Physician Apr 2021
Topics: Acute Disease; Anti-Bacterial Agents; Child, Preschool; Edema; Humans; Infections; Leukocytosis; Neck; Thyroglossal Cyst; Ultrasonography
PubMed: 33788515
DOI: No ID Found -
Journal of Korean Medical Science Apr 2016Enterovirus 71 frequently involves the central nervous system and may present with a variety of neurologic manifestations. Here, we aimed to describe the clinical...
Enterovirus 71 frequently involves the central nervous system and may present with a variety of neurologic manifestations. Here, we aimed to describe the clinical features, magnetic resonance imaging (MRI) findings, and cerebrospinal fluid (CSF) profiles of patients presenting with neurologic complications of enterovirus 71 infection. We retrospectively reviewed the records of 31 pediatric patients hospitalized with acute neurologic manifestations accompanied by confirmed enterovirus 71 infection at Ulsan University Hospital between 2010 and 2014. The patients' mean age was 2.9 ± 5.5 years (range, 18 days to 12 years), and 80.6% of patients were less than 4 years old. Based on their clinical features, the patients were classified into 4 clinical groups: brainstem encephalitis (n = 21), meningitis (n = 7), encephalitis (n = 2), and acute flaccid paralysis (n = 1). The common neurologic symptoms included myoclonus (58.1%), lethargy (54.8%), irritability (54.8%), vomiting (48.4%), ataxia (38.7%), and tremor (35.5%). Twenty-five patients underwent an MRI scan; of these, 14 (56.0%) revealed the characteristic increased T2 signal intensity in the posterior region of the brainstem and bilateral cerebellar dentate nuclei. Twenty-six of 30 patients (86.7%) showed CSF pleocytosis. Thirty patients (96.8%) recovered completely without any neurologic deficits; one patient (3.2%) died due to pulmonary hemorrhage and shock. In the present study, brainstem encephalitis was the most common neurologic manifestation of enterovirus 71 infection. The characteristic clinical symptoms such as myoclonus, ataxia, and tremor in conjunction with CSF pleocytosis and brainstem lesions on MR images are pathognomonic for diagnosis of neurologic involvement by enterovirus 71 infection.
Topics: Acute Disease; Brain; Central Nervous System Diseases; Child; Child, Preschool; Encephalitis; Enterovirus A, Human; Enterovirus Infections; Feces; Female; Humans; Immunoglobulins; Infant; Injections, Intravenous; Leukocytes; Leukocytosis; Magnetic Resonance Imaging; Male; RNA, Viral; Real-Time Polymerase Chain Reaction; Republic of Korea; Retrospective Studies; Seasons
PubMed: 27051240
DOI: 10.3346/jkms.2016.31.4.561 -
Medicina (Kaunas, Lithuania) Aug 2021Clozapine is the only antipsychotic approved for treatment-resistant schizophrenia. Despite its superior efficacy profile as compared with other antipsychotics,... (Review)
Review
BACKGROUND AND OBJECTIVES
Clozapine is the only antipsychotic approved for treatment-resistant schizophrenia. Despite its superior efficacy profile as compared with other antipsychotics, clozapine remains underutilized. Clozapine monitoring systems clearly describe the proposed management of clozapine-induced neutropenia; however, no specific mention is made of how to interpret neutrophilic leukocytosis, despite that being a relatively frequent finding. Prescribers unfamiliar with this molecule may misjudge its clinical significance, potentially leading to untimely treatment interruption. Here, we systematically review the literature on the risk of neutrophilic leukocytosis during clozapine treatment, and describe eight additional cases among our patient cohort.
MATERIALS AND METHODS
We performed a systematic review of the literature on PubMed and Embase using the PRISMA 2020 guidelines, and selected all original reports describing either (1) the prevalence of neutrophilic leukocytosis during clozapine treatment, or (2) the clinical significance of neutrophilic leukocytosis. We described eight additional cases of neutrophilic leukocytosis during clozapine treatment while attending an outpatient psychiatric clinic.
RESULTS
Our research ultimately yielded the selection of 13 articles included in this systematic review. The case series highlighted the presence of stable and clinically unremarkable neutrophilia during a follow-up ranging from one to ten years.
CONCLUSIONS
Existing evidence indicates that leukocytosis associated with clozapine treatment can be considered as an asymptomatic and benign condition, suggesting that no change in clozapine treatment is needed upon its detection.
Topics: Antipsychotic Agents; Clozapine; Humans; Leukocytosis; Prevalence; Schizophrenia
PubMed: 34441022
DOI: 10.3390/medicina57080816