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American Journal of Diseases of... Apr 1987Recent advances in cell culture techniques have made possible the rapid and accurate detection of enteroviruses, the most commonly identified cause of aseptic...
Recent advances in cell culture techniques have made possible the rapid and accurate detection of enteroviruses, the most commonly identified cause of aseptic meningitis. Between 1983 and 1985, 69 patients were diagnosed as having enteroviral meningitis by viral culture of cerebrospinal fluid, throat swab, and/or rectal swab or stool specimens. Half of the 49 patients in whom the diagnosis was based on positive cerebrospinal fluid culture benefited directly from viral culture results by early withdrawal of antibiotics, early discharge, or changing of the diagnosis and prognosis of the disease. Enteroviral cultures became positive in as early as 24 hours, and most of the cultures became positive within one week. The cost of viral culture is comparable with that of other microbiologic tests. The virology laboratory has proved useful in the diagnosis and management of patients with enteroviral meningitis.
Topics: Adolescent; Cerebrospinal Fluid; Child; Child, Preschool; Enterovirus; Enterovirus Infections; Female; Humans; Infant; Infant, Newborn; Laboratories; Male; Meningitis, Viral; Prognosis; Virology
PubMed: 3031978
DOI: 10.1001/archpedi.1987.04460040112030 -
Journal of Clinical Neuroscience :... Feb 2017We investigated the potential role of serum procalcitonin in differentiating bacterial meningitis from viral meningitis, and in predicting the prognosis in patients with...
We investigated the potential role of serum procalcitonin in differentiating bacterial meningitis from viral meningitis, and in predicting the prognosis in patients with bacterial meningitis. This was a retrospective study of 80 patients with bacterial meningitis (13 patients died). In addition, 58 patients with viral meningitis were included as the disease control groups for comparison. The serum procalcitonin level was measured in all patients at admission. Differences in demographic and laboratory data, including the procalcitonin level, were analyzed between the groups. We used the mortality rate during hospitalization as a marker of prognosis in patients with bacterial meningitis. Multiple logistic regression analysis showed that high serum levels of procalcitonin (>0.12ng/mL) were an independently significant variable for differentiating bacterial meningitis from viral meningitis. The risk of having bacterial meningitis with high serum levels of procalcitonin was at least 6 times higher than the risk of having viral meningitis (OR=6.76, 95% CI: 1.84-24.90, p=0.004). In addition, we found that high levels of procalcitonin (>7.26ng/mL) in the blood were an independently significant predictor for death in patients with bacterial meningitis. The risk of death in patients with bacterial meningitis with high serum levels of procalcitonin may be at least 9 times higher than those without death (OR=9.09, 95% CI: 1.74-47.12, p=0.016). We found that serum procalcitonin is a useful marker for differentiating bacterial meningitis from viral meningitis, and it is also a potential predicting factor for prognosis in patients with bacterial meningitis.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Biomarkers; Calcitonin; Diagnosis, Differential; Female; Hospital Mortality; Humans; Male; Meningitis, Bacterial; Meningitis, Viral; Middle Aged; Predictive Value of Tests; Prognosis; Retrospective Studies; Young Adult
PubMed: 28341167
DOI: 10.1016/j.jocn.2016.10.005 -
Revista Medico-chirurgicala a... 1995In order to differentiate bacterial meningitis versus viral meningitis, we have comparatively tested the efficacy of the following tests: C-reactive protein (CRP),...
In order to differentiate bacterial meningitis versus viral meningitis, we have comparatively tested the efficacy of the following tests: C-reactive protein (CRP), erythrocytes sedimentation rate (ESR), fever, level of glucose in cerebro-spinal fluid (CSF), glucose in CSF/glycemia ratio, number of white blood cells in peripheric blood, percentage of neutrophils in peripheric blood, level of proteins in CSF and number of nucleated cells in CSF for a group of 49 patients, both children and adults with central nervous system infection (37 patients with bacterial meningitis and 12 with viral meningitis) hospitalised between May 1993 and July 1994 in Clinical Hospital for Infectious Diseases in Iaşi. The mean value of CRP in bacterial meningitis patients was 8.78 mg%, contrasting with the mean value of CRP = 1.92 mg% recorded in patients with viral meningitis. Ten out of 37 bacterial meningitis patients presented a CRP concentration < 1.85 mg%. All these 10 patients have already had an antibiotic treatment at the moment of the assay. One out of 12 cases of viral meningitis had a value of CRP = 3.3 mg%, all the remainder cases having values under 1.85 mg%. We recorded highly significant differences between the two patient groups for CRP (p < 0.001), ESR (p < 0.01), protein concentration in CSF (p < 0.001) and number of nucleated cells in CSF (p < 0.001). Differences recorded for fever, concentration of glucose in CSF, glucose in CSF/glycemia ratio, number of leucocytes in peripheric blood and percentage of neutrophils in peripheric blood, were not significant (p > 0.5). Data were analysed also by box-plot method which facilitates the visual appraisal of the differences recorded between the two aetiological groups. In conclusion, assays of CRP and ESR may be used as differentiation tests for bacterial meningitis versus viral meningitis, when assay is done before the antibiotic treatment, being sufficient sensitive, and easy to perform.
Topics: Adolescent; Adult; Aged; C-Reactive Protein; Child; Child, Preschool; Diagnosis, Differential; Female; Humans; Infant; Male; Meningitis, Bacterial; Meningitis, Viral; Middle Aged; Predictive Value of Tests
PubMed: 9524672
DOI: No ID Found -
BMC Neurology Aug 2012Vertebral artery dissection (VAD) is often associated with trauma or occurs spontaneously, inevitably causing some neurological deficits. Even though acute infection can...
BACKGROUND
Vertebral artery dissection (VAD) is often associated with trauma or occurs spontaneously, inevitably causing some neurological deficits. Even though acute infection can be related to the development of spontaneous VAD (sVAD), VAD associated with viral meningitis has never been reported in the literature.
CASE PRESENTATION
A 42-year-old man with fever, sore throat, and runny nose developed sudden onset of occipital headache, vertigo, transient confusion, diplopia, and ataxia. Brain stem encephalitis was diagnosed initially because the cerebrospinal fluid (CSF) study showed inflammatory changes. However, subsequent diffusion-weighted (DWI) magnetic resonance imaging of his brain demonstrated left lateral medullary infarction, and the digital subtraction angiography (DSA) confirmed VAD involving left V4 segment of the artery. Consequently, the patient was diagnosed as VAD accompanied by viral meningitis.
CONCLUSION
This case suggests that viral meningitis might lead to inflammatory injury of the vertebral arterial wall, even sVAD with multiple neurological symptoms.
Topics: Adult; Diagnosis, Differential; Humans; Male; Meningitis, Viral; Vertebral Artery Dissection
PubMed: 22909191
DOI: 10.1186/1471-2377-12-79 -
Lancet (London, England) Jul 1982
Topics: Cerebrospinal Fluid; Enterovirus; Humans; Meningitis, Aseptic; Meningitis, Viral; Virus Cultivation; Viruses
PubMed: 6124677
DOI: No ID Found -
The Journal of Infection Apr 2007Although diagnostic performance has recently improved by using new diagnostic methodologies, acute patient management is usually initiated after considering only fairly...
OBJECTIVE
Although diagnostic performance has recently improved by using new diagnostic methodologies, acute patient management is usually initiated after considering only fairly elementary findings of CSF examination. Using these early findings it is often difficult to distinguish between bacterial and aseptic (viral) meningitis. In order to help distinguish these two categories, scoring tools have been proposed that are more or less complex and validated.
METHODS
The aim of this study was to establish a simple scoring tool and compare it to other available decision making systems. We retrospectively analysed all the meningitis cases from our patients at our institution and established a scoring tool for pediatric meningitis and for meningitis in adults by using categorized analysis tree methodology.
RESULTS
Main categories for bacterial etiology were, leucocytosis >15 giga, CSF leucocytes count >1700 per ml, CSF neutrophil percentage >80, CSF protein >2.3g/l and glucose CSF/blood ratio <0.33 for adults and CSF leucocytes count >1800, CSF neutrophil percentage >80, CSF protein >1.2g/l and glucose CSF/blood ratio <0.3 for children. Additionally, our new scoring tool and five published ones were compared using our data and two external data sets; from these scores, three, including ours, exhibited good sensitivity and specificity. We then performed several thousand Monte Carlo simulations of both bacterial and viral meningitis for children and adults. We found that our scoring tool (Meningitest) had very high performances with positive and negative predictive values of 97% and 94%, respectively.
CONCLUSION
Thus, from this analysis of five meningitis scoring systems, we believe that our new tool is simple, does not need any complex calculation and is effective in identifying bacterial vs viral meningitis in fully immunocompetent children and adults.
Topics: Adult; Child; Child, Preschool; Decision Support Techniques; Diagnosis, Differential; Humans; Leukocytosis; Meningitis, Aseptic; Meningitis, Bacterial; Meningitis, Viral; Middle Aged; Monte Carlo Method; Predictive Value of Tests; Sensitivity and Specificity
PubMed: 16887191
DOI: 10.1016/j.jinf.2006.06.009 -
Clinical Infectious Diseases : An... Sep 2008In this retrospective study, our objective was to review the epidemiology of viral meningitis and to compare clinical features associated with enterovirus, herpes...
Clinical features of viral meningitis in adults: significant differences in cerebrospinal fluid findings among herpes simplex virus, varicella zoster virus, and enterovirus infections.
BACKGROUND
In this retrospective study, our objective was to review the epidemiology of viral meningitis and to compare clinical features associated with enterovirus, herpes simplex virus (HSV), and varicella zoster virus (VZV) infections in immunocompetent adults.
METHODS
Data on cerebrospinal fluid (CSF) samples submitted to the Trust Virology Laboratory (Sheffield, UK) from April 2004 through April 2007 were reviewed. Notes on immunocompetent adults who were polymerase chain reaction (PCR) positive for enterovirus, HSV type 2, or VZV and who had presented to local clinical departments were scrutinized (4 patients were positive for HSV type 1 and did not meet the inclusion criteria).
RESULTS
A total of 2045 samples were analyzed for viral pathogens during the 3-year period. Of the 109 PCR-positive samples, 38 (35%) were from immunocompetent adults, of whom 22 were infected with enterovirus, 8 were infected with HSV type 2, and 8 were infected with VZV. The median ages were 32 years (range, 16-39 years), 39 years (range, 22-53 years), and 47.5 years (range, 26-80 years), respectively. Rash occurred after the meningitis symptoms in 5 patients infected with VZV (median time from meningitis symptoms to rash, 6 days). Protein levels were significantly higher in CSF samples from patients infected with HSV type 2 (median, 1205 mg/L) and in samples from those infected with VZV (median, 974 mg/L) than in samples from those infected with enterovirus (median, 640 mg/L; P = .001 and P = .01, respectively). White blood cell counts were significantly higher in CSF samples from patients infected with HSV type 2 (median, 240 x 10(6) cells/L) than in samples from those infected with enterovirus (median, 51 x 10(6) cells/L; P = .01).
CONCLUSIONS
Enterovirus infection was the most common cause of viral meningitis in immunocompetent adults in this study. White blood cell counts and protein levels were significantly higher in CSF samples from patients infected with HSV type 2 than in samples from patients with enterovirus infection. Zoster rash often occurs after meningitis. PCR testing provides a rapid and specific etiological diagnosis.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Enterovirus Infections; Female; Herpes Simplex; Herpes Zoster; Humans; Male; Meningitis, Viral; Middle Aged; Retrospective Studies; United Kingdom; Young Adult
PubMed: 18680414
DOI: 10.1086/591129 -
Internal and Emergency Medicine Aug 2012To analyze the clinical characteristics of acute meningitis and their relationship with age in adult patients presenting to the emergency department. We retrospectively...
To analyze the clinical characteristics of acute meningitis and their relationship with age in adult patients presenting to the emergency department. We retrospectively investigated consecutive adult patients admitted with a diagnosis of bacterial or viral meningitis from 2002 to 2006. Data about patient's history, symptoms and signs at presentation, etiology and clinical course were collected. To investigate the relationship of clinical presentation with age, we divided patients in four age quartiles (<30 years, between 30 and 36 years, between 37 and 56 years, >56 years). Among the 202 patients considered in the study (mean age 42.8 ± 18.7 years, range 14-90), 162 (80.2%) patients had viral and 40 (19.8%) bacterial meningitis. Specific signs, such as neck stiffness or Kernig or Brudzinski signs, were more common in the first than in the fourth quartile (73.1 vs. 45.7% P = 0.041). Conversely, altered consciousness expressed as Glasgow Coma Scale (GCS) <15 was more frequent in the fourth (80.4%) than in the first (9.6%) quartile (P < 0.001). The linear regression analysis confirmed a significant decrease of GCS with the increasing of patient's age (r = -0.69, P < 0.001). At multivariate analysis, aging was associated with altered level of consciousness (OR 16.7, P < 0.001) independent of viral or bacterial etiology of the presence of comorbidities and of clinical severity (presence of severe sepsis or septic shock). Meningitis presentation largely differs with aging in adult patients. Level of consciousness is frequently altered in the older patients, when other specific signs become more rare, independent of etiology, comorbidities and clinical severity.
Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Aging; Consciousness Disorders; Female; Glasgow Coma Scale; Humans; Male; Meningitis, Bacterial; Meningitis, Viral; Middle Aged; Retrospective Studies; Statistics as Topic; Young Adult
PubMed: 22419148
DOI: 10.1007/s11739-012-0765-1 -
Clinical Infectious Diseases : An... Oct 1998
Topics: Adolescent; Adult; Enterovirus; Enterovirus Infections; Female; Humans; Male; Meningitis, Viral; Prospective Studies
PubMed: 9798053
DOI: 10.1086/517162 -
Pediatrics International : Official... Oct 2017We encountered two cases of Herpes zoster (HZ) meningitis, a rarely occurring complication of HZ, in previously healthy children. One patient treated with i.v. acyclovir... (Review)
Review
We encountered two cases of Herpes zoster (HZ) meningitis, a rarely occurring complication of HZ, in previously healthy children. One patient treated with i.v. acyclovir (ACV, 31 mg/kg/day) did not recover. His symptoms were relieved somewhat by increased ACV dosage, but it caused transient renal dysfunction. Another patient treated with i.v. ACV (30 mg/kg/day) recovered. Treatment for HZ meningitis in immunocompetent children has not been established. In a literature review, 80% of 20 patients were treated with the usual dose of ACV 15-30 mg/kg/day. The present cases suggest that a high dosage of ACV up to 60 mg/kg/day should be considered (while monitoring for side-effects) unless symptoms improve. In the review, one of every three vaccine-strain Varicella zoster virus (VZV) cases was severe, whereas the present cases resulted from wild type. Further investigations must examine different clinical characteristics of HZ meningitis caused by wild-type and vaccine-strain VZV.
Topics: Acyclovir; Antiviral Agents; Child; Herpes Zoster; Humans; Immunocompetence; Male; Meningitis, Viral
PubMed: 29081071
DOI: 10.1111/ped.13362