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Brain : a Journal of Neurology Sep 2023Clinical features applicable to the entire spectrum of viral meningitis are limited, and prognostic factors for adverse outcomes are undetermined. This nationwide...
Clinical features applicable to the entire spectrum of viral meningitis are limited, and prognostic factors for adverse outcomes are undetermined. This nationwide population-based prospective cohort study included all adults with presumed and microbiologically confirmed viral meningitis in Denmark from 2015 until 2020. Prognostic factors for an unfavourable outcome (Glasgow Outcome Scale score of 1-4) 30 days after discharge were examined by modified Poisson regression. In total, 1066 episodes of viral meningitis were included, yielding a mean annual incidence of 4.7 episodes per 100 000 persons. Pathogens were enteroviruses in 419/1066 (39%), herpes simplex virus type 2 in 171/1066 (16%), varicella-zoster virus in 162/1066 (15%), miscellaneous viruses in 31/1066 (3%) and remained unidentified in 283/1066 (27%). The median age was 33 years (IQR 27-44), and 576/1066 (54%) were females. In herpes simplex virus type 2 meningitis, 131/171 (77%) were females. Immunosuppression [32/162 (20%)] and shingles [90/149 (60%)] were frequent in varicella-zoster virus meningitis. The triad of headache, neck stiffness and hyperacusis or photophobia was present in 264/960 (28%). The median time until lumbar puncture was 3.0 h (IQR 1.3-7.1), and the median CSF leucocyte count was 160 cells/µl (IQR 60-358). The outcome was unfavourable in 216/1055 (20%) 30 days after discharge. Using unidentified pathogen as the reference, the adjusted relative risk of an unfavourable outcome was 1.34 (95% CI 0.95-1.88) for enteroviruses, 1.55 (95% CI 1.00-2.41) for herpes simplex virus type 2, 1.51 (95% CI 0.98-2.33) for varicella-zoster virus and 1.37 (95% CI 0.61-3.05) for miscellaneous viruses. The adjusted relative risk of an unfavourable outcome was 1.34 (95% CI 1.03-1.75) for females. Timing of acyclovir or valacyclovir was not associated with the outcome in meningitis caused by herpes simplex virus type 2 or varicella-zoster virus. In summary, the outcome of viral meningitis was similar among patients with different aetiologies, including those with presumed viral meningitis but without an identified pathogen. Females had an increased risk of an unfavourable outcome. Early antiviral treatment was not associated with an improved outcome in meningitis caused by herpes simplex virus type 2 or varicella-zoster virus.
Topics: Female; Humans; Adult; Male; Prospective Studies; Prognosis; Meningitis, Viral; Herpesvirus 3, Human
PubMed: 36929167
DOI: 10.1093/brain/awad089 -
Przeglad Epidemiologiczny 2021The most common form of infectious diseases of the nervous system is meningitis and encephalitis. This study discusses in detail bacterial meningitis and/or encephalitis...
INTRODUCTION
The most common form of infectious diseases of the nervous system is meningitis and encephalitis. This study discusses in detail bacterial meningitis and/or encephalitis in which the etiological factors are: Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae and viral - in Poland, most often caused by tick-borne encephalitis virus. In addition to routine epidemiological surveillance of diseases caused by these etiological factors, mandatory and recommended vaccinations are carried out in Poland aimed at reducing the number of cases caused by N. meningitidis, S. pneumoniae, H. influenzae and TBEV.
AIM OF THE STUDY
The aim of the study is to assess the epidemiological situation of meningitis and encephalitis in Poland in 2019.
MATERIAL AND METHODS
The epidemiological situation of meningitis and encephalitis in Poland was assessed on data sent to NIPH NIH - NRI by voivodeship sanitary-epidemiological stations and published in the annual bulletin "Infectious diseases and poisoning in Poland in 2019" and "Vaccinations in Poland in 2019".
RESULTS
In 2019, a total of 2,239 cases of meningitis and encephalitis were registered in Poland. This is a decrease by approximately 19,9% compared to 2018. In the case of bacterial infections, including neuroborreliosis, the number of cases decreased by 27%, from 1265 to 921 cases. In the group of viral infections, a decrease by 14% (from 1,533 to 1,318 cases) was recorded. In 31% of all the cases of bacterial etiology, the etiological factor was one of three: Neisseria meningitidis, Streptococcus pneumoniae and Haemophilus influenzae. Infections of viral etiology accounted for 58.9% of all registered cases. Compared to 2018, the number of S. pneumoniae cases decreased by 14.6%, and in the case of N. meningitidis by 6.9%. In the case of H. influenzae, there was an increase in the number of cases, compared to the previous year. In addition, there was a slight increase in the number of cases of tick-borne encephalitis - from 197 cases in 2018 to 265 cases in 2019 (an increase of 34.5%).
SUMMARY AND CONCLUSION
The analysis showed a generally declining disease trend, both in bacterial and viral meningitis and encephalitis. Only in cases caused by H. influenzae and tick-borne encephalitis virus, an increase was observed compared to the previous year. Meningitis and encephalitis continues to be a challenge for the healthcare system, with particular emphasis on the correct differentiation of the etiology at an early stage of infection detection.
Topics: Age Distribution; Encephalitis; Humans; Incidence; Infant; Meningitis, Bacterial; Neisseria meningitidis; Poland; Rural Population; Urban Population
PubMed: 34696559
DOI: 10.32394/pe.75.20 -
Clinica Chimica Acta; International... Aug 2023Meningitis is defined as the inflammation of the meninges that is most often caused by various bacterial and viral pathogens, and is associated with high rates of... (Review)
Review
Meningitis is defined as the inflammation of the meninges that is most often caused by various bacterial and viral pathogens, and is associated with high rates of mortality and morbidity. Early detection of bacterial meningitis is essential to appropriate antibiotic therapy. Alterations in immunologic biomarkers levels have been considered the diagnostic approach in medical laboratories for the identifying of infections. The early increasing immunologic mediators such as cytokines and acute phase proteins (APPs) during bacterial meningitis have made they significant indicators for laboratory diagnosis. Immunology biomarkers showed wide variable sensitivity and specificity values that influenced by different reference values, selected a certain cutoff point, methods of detection, patient characterization and inclusion criteria, as well as etiology of meningitis and time of CSF or blood specimens' collection. This study provides an overview of different immunologic biomarkers as diagnostic markers for the identification of bacterial meningitis and their efficiencies in the differentiating of bacterial from viral meningitis.
Topics: Humans; Meningitis, Bacterial; Biomarkers; Meningitis, Viral; Inflammation; Cytokines; Bacteria
PubMed: 37419301
DOI: 10.1016/j.cca.2023.117470 -
Immunity Apr 2023T cell factor 1 (Tcf-1) expressing CD8 T cells exhibit stem-like self-renewing capacity, rendering them key for immune defense against chronic viral infection and...
T cell factor 1 (Tcf-1) expressing CD8 T cells exhibit stem-like self-renewing capacity, rendering them key for immune defense against chronic viral infection and cancer. Yet, the signals that promote the formation and maintenance of these stem-like CD8 T cells (CD8SL) remain poorly defined. Studying CD8 T cell differentiation in mice with chronic viral infection, we identified the alarmin interleukin-33 (IL-33) as pivotal for the expansion and stem-like functioning of CD8SL as well as for virus control. IL-33 receptor (ST2)-deficient CD8 T cells exhibited biased end differentiation and premature loss of Tcf-1. ST2-deficient CD8SL responses were restored by blockade of type I interferon signaling, suggesting that IL-33 balances IFN-I effects to control CD8SL formation in chronic infection. IL-33 signals broadly augmented chromatin accessibility in CD8SL and determined these cells' re-expansion potential. Our study identifies the IL-33-ST2 axis as an important CD8SL-promoting pathway in the context of chronic viral infection.
Topics: Animals; Mice; Alarmins; CD8-Positive T-Lymphocytes; Interleukin-1 Receptor-Like 1 Protein; Interleukin-33; Lymphocytic Choriomeningitis; Lymphocytic choriomeningitis virus; Mice, Inbred C57BL; Persistent Infection; T Cell Transcription Factor 1
PubMed: 36809763
DOI: 10.1016/j.immuni.2023.01.029 -
Frontiers in Neurology 2023In recent years, with the rapid development of molecular biology techniques such as polymerase chain reaction and molecular biochip, the etiological diagnosis of viral... (Review)
Review
In recent years, with the rapid development of molecular biology techniques such as polymerase chain reaction and molecular biochip, the etiological diagnosis of viral encephalitis has a very big step forward. At present, the etiological examination of viral meningitis mainly includes virus isolation, serological detection and molecular biological nucleic acid detection. This article reviews the progress in etiological diagnosis of viral meningitis.
PubMed: 37583954
DOI: 10.3389/fneur.2023.1193834 -
Practical Neurology Aug 2020Lactate is produced from anaerobic glycolysis, which occurs in most tissues in the human body. Blood lactate is tested in most physiologically unwell patients in the... (Review)
Review
Lactate is produced from anaerobic glycolysis, which occurs in most tissues in the human body. Blood lactate is tested in most physiologically unwell patients in the Emergency Department and helps to guide treatment and prognosis. Cerebrospinal fluid (CSF) lactate, however, is not often measured. Various central nervous system (CNS) conditions lead to a rise in CSF lactate, including acute neurological infection, stroke, seizures and mitochondrial pathologies. This article discusses the utility and limitations of CSF lactate, highlighting specific clinical situations where it can help in the diagnosis of CNS infections and unexplained encephalopathy.
Topics: Adult; Biomarkers; Brain Diseases; Central Nervous System Infections; Enterovirus; Female; Humans; Lactic Acid; Male; Meningitis, Bacterial; Meningitis, Viral; Middle Aged; Mitochondrial Encephalomyopathies; Staphylococcal Infections
PubMed: 32404406
DOI: 10.1136/practneurol-2019-002191 -
The Journal of Infection Mar 2024Diagnostic tools to differentiate between community-acquired bacterial and viral meningitis are essential to target the potentially lifesaving antibiotic treatment to... (Review)
Review
Diagnostic tools to differentiate between community-acquired bacterial and viral meningitis are essential to target the potentially lifesaving antibiotic treatment to those at greatest risk and concurrently spare patients with viral meningitis from the disadvantages of antibiotics. In addition, excluding bacterial meningitis and thus decreasing antibiotic consumption would be important to help reduce antimicrobial resistance and healthcare expenses. The available diagnostic laboratory tests for differentiating bacterial and viral meningitis can be divided microbiological pathogen-focussed methods and biomarkers of the host response. Bacterial culture-independent microbiological methods, such as highly multiplexed nucleic acid amplification tests, are rapidly making their way into the clinical practice. At the same time, more conventional host protein biomarkers, such as procalcitonin and C-reactive protein, are supplemented by newer proteomic and transcriptomic signatures. This review aims to summarise the current state and the recent advances in diagnostic methods to differentiate bacterial from viral meningitis.
Topics: Humans; Proteomics; Diagnosis, Differential; Meningitis, Viral; Biomarkers; Meningitis, Bacterial; Anti-Bacterial Agents
PubMed: 38307149
DOI: 10.1016/j.jinf.2024.01.010 -
Medicine Nov 2022Diagnosis of viral meningitis (VM) is uncommon practice in Sudan and there is no local viral etiological map. We therefore intended to differentiate VM using... (Review)
Review
Diagnosis of viral meningitis (VM) is uncommon practice in Sudan and there is no local viral etiological map. We therefore intended to differentiate VM using standardized clinical codes and determine the involvement of herpes simplex virus types-1 and 2 (HSV-1/2), varicella zoster virus, non-polio human enteroviruses (HEVs), and human parechoviruses in meningeal infections in children in Sudan. This is a cross-sectional hospital-based study. Viral meningitis was differentiated in 503 suspected febrile attendee of Omdurman Hospital for Children following the criteria listed in the Clinical Case Definition for Aseptic/Viral Meningitis. Patients were children age 0 to 15 years. Viral nucleic acids (DNA/RNA) were extracted from cerebrospinal fluid (CSF) specimens using QIAamp® UltraSens Virus Technology. Complementary DNA was prepared from viral RNA using GoScriptTM Reverse Transcription System. Viral nucleic acids were amplified and detected using quantitative TaqMan® Real-Time and conventional polymerase chain reactions (PCRs). Hospital diagnosis of VM was assigned to 0%, when clinical codes were applied; we considered 3.2% as having VM among the total study population and as 40% among those with proven infectious meningitis. Two (0.4%) out of total 503 CSF specimens were positive for HSV-1; Ct values were 37.05 and 39.10 and virus copies were 652/PCR run (261 × 103/mL CSF) and 123/PCR run (49.3 × 103/mL CSF), respectively. Other 2 (0.4%) CSF specimens were positive for non-polio HEVs; Ct values were 37.70 and 38.30, and the approximate virus copies were 5E2/PCR run (~2E5/mL CSF) and 2E2/PCR run (~8E4/mL CSF), respectively. No genetic materials were detected for HSV-2, varicella zoster virus, and human parechoviruses. The diagnosis of VM was never assigned by the hospital despite fulfilling the clinical case definition. Virus detection rate was 10% among cases with proven infectious meningitis. Detected viruses were HSV-1 and non-polio HEVs. Positive virus PCRs in CSFs with normal cellular counts were seen.
Topics: Humans; Child; Infant, Newborn; Infant; Child, Preschool; Adolescent; Cross-Sectional Studies; Meningitis, Viral; Herpesvirus 2, Human; Herpesvirus 1, Human; Herpesvirus 3, Human; Enterovirus; Viruses; Parechovirus; Nucleic Acids
PubMed: 36401437
DOI: 10.1097/MD.0000000000031588 -
Pediatrics Jul 2022To evaluate the hypothesis that viral meningitis may mimic abusive head trauma (AHT) by comparing the history of present illness (HPI) and clinical presentation of young...
OBJECTIVES
To evaluate the hypothesis that viral meningitis may mimic abusive head trauma (AHT) by comparing the history of present illness (HPI) and clinical presentation of young children with proven viral meningitis to those with AHT and those with subdural hemorrhage (SDH) only. We hypothesized that significant differences would exist between viral meningitis and the comparison groups.
METHODS
We performed a 5-year retrospective case-control study of subjects aged <2 years, comparing those with confirmed viral meningitis (controls) to those with SDH evaluated by the hospital child abuse pediatrics team (cases). Cases were classified as SDH with concomitant suspicious injuries (AHT) and without concomitant suspicious injuries (SDH-only). Groups were compared across demographic (5 measures), HPI (11 measures), and clinical (9 measures) domains. Odds ratios were calculated for measures within each domain.
RESULTS
Of 550 subjects, there were 397 viral meningitis, 118 AHT, and 35 SDH-only subjects. Viral meningitis differed significantly from AHT subjects on all demographic measures, and from SDH-only subjects on age. Viral meningitis differed significantly from AHT subjects in all HPI measures with odds ratios ranging from 2.7 to 322.5, and from SDH-only subjects in 9 HPI measures with odds ratios ranging from 4.6 to 485.2. In the clinical domain, viral meningitis differed significantly from AHT subjects in all measures, with odds ratios ranging from 2.5 to 74.0, and from SDH-only subjects in 5 measures with odds ratios ranging from 2.9 to 16.8.
CONCLUSIONS
Viral meningitis is not supported as a mimic of AHT.
Topics: Case-Control Studies; Child; Child Abuse; Child, Preschool; Craniocerebral Trauma; Hematoma, Subdural; Humans; Infant; Meningitis, Viral; Retrospective Studies
PubMed: 35673951
DOI: 10.1542/peds.2021-054544 -
Frontiers in Cellular and Infection... 2023Early and accurate identification of pathogens is essential for improved outcomes in patients with viral encephalitis (VE) and/or viral meningitis (VM).
INTRODUCTION
Early and accurate identification of pathogens is essential for improved outcomes in patients with viral encephalitis (VE) and/or viral meningitis (VM).
METHODS
In our research, Metagenomic next-generation sequencing (mNGS) which can identify viral pathogens unbiasedly was performed on RNA and DNA to identify potential pathogens in cerebrospinal fluid (CSF) samples from 50 pediatric patients with suspected VEs and/or VMs. Then we performed proteomics analysis on the 14 HEV-positive CSF samples and another 12 CSF samples from health controls (HCs). A supervised partial least squaresdiscriminant analysis (PLS-DA) and orthogonal PLS-DA (O-PLS-DA) model was performed using proteomics data.
RESULTS
Ten viruses in 48% patients were identified and the most common pathogen was human enterovirus (HEV) Echo18. 11 proteins overlapping between the top 20 DEPs in terms of P value and FC and the top 20 proteins in PLS-DA VIP lists were acquired.
DISCUSSION
Our result showed mNGS has certain advantages on pathogens identification in VE and VM and our research established a foundation to identify diagnosis biomarker candidates of HEV-positive meningitis based on MS-based proteomics analysis, which could also contribute toward investigating the HEV-specific host response patterns.
Topics: Humans; Child; Proteomics; Encephalitis, Viral; Viruses; Meningitis, Viral; Enterovirus; High-Throughput Nucleotide Sequencing; Metagenomics; Sensitivity and Specificity
PubMed: 37153144
DOI: 10.3389/fcimb.2023.1104858