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American Family Physician Sep 2017The etiologies of meningitis range in severity from benign and self-limited to life-threatening with potentially severe morbidity. Bacterial meningitis is a medical...
The etiologies of meningitis range in severity from benign and self-limited to life-threatening with potentially severe morbidity. Bacterial meningitis is a medical emergency that requires prompt recognition and treatment. Mortality remains high despite the introduction of vaccinations for common pathogens that have reduced the incidence of meningitis worldwide. Aseptic meningitis is the most common form of meningitis with an annual incidence of 7.6 per 100,000 adults. Most cases of aseptic meningitis are viral and require supportive care. Viral meningitis is generally self-limited with a good prognosis. Examination maneuvers such as Kernig sign or Brudzinski sign may not be useful to differentiate bacterial from aseptic meningitis because of variable sensitivity and specificity. Because clinical findings are also unreliable, the diagnosis relies on the examination of cerebrospinal fluid obtained from lumbar puncture. Delayed initiation of antibiotics can worsen mortality. Treatment should be started promptly in cases where transfer, imaging, or lumbar puncture may slow a definitive diagnosis. Empiric antibiotics should be directed toward the most likely pathogens and should be adjusted by patient age and risk factors. Dexamethasone should be administered to children and adults with suspected bacterial meningitis before or at the time of initiation of antibiotics. Vaccination against the most common pathogens that cause bacterial meningitis is recommended. Chemoprophylaxis of close contacts is helpful in preventing additional infections.
Topics: Algorithms; Anti-Infective Agents; Bacterial Vaccines; C-Reactive Protein; Calcitonin; Cerebrospinal Fluid; Chemoprevention; Diagnosis, Differential; Glucocorticoids; Humans; Lactic Acid; Meningitis, Aseptic; Meningitis, Bacterial; Prognosis; Spinal Puncture
PubMed: 28925647
DOI: No ID Found -
Journal of Clinical Virology : the... Sep 2017Aseptic meningitis represents a common diagnostic and management dilemma to clinicians.
BACKGROUND
Aseptic meningitis represents a common diagnostic and management dilemma to clinicians.
OBJECTIVES
To compare the clinical epidemiology, diagnostic evaluations, management, and outcomes between adults and children with aseptic meningitis.
STUDY DESIGN
We conducted a retrospective study from January 2005 through September 2010 at 9 Memorial Hermann Hospitals in Houston, TX. Patients age≥2months who presented with community-acquired aseptic meningitis with a CSF white blood cell count >5cells/mm and a negative Gram stain and cultures were enrolled. Patients with a positive cryptococcal antigen, positive blood cultures, intracranial masses, brain abscesses, or encephalitis were excluded.
RESULTS
A total of 509 patients were included; 404 were adults and 105 were children. Adults were most likely to be female, Caucasian, immunosuppressed, have meningeal symptoms (headache, nausea, stiff neck, photophobia) and have a higher CSF protein (P <0.05). In contrast, children were more likely to have respiratory symptoms, fever, and leukocytosis (P <0.05). In 410 (81%) patients, the etiologies remained unknown. Adults were more likely to be tested for and to have Herpes simplex virus and West Nile virus while children were more likely to be tested for and to have Enterovirus (P <0.001). The majority of patients were admitted (96.5%) with children receiving antibiotic therapy more frequently (P <0.001) and adults receiving more antiviral therapy (P=0.001). A total of 384 patients (75%) underwent head CT scans and 125 (25%) MRI scans; all were normal except for meningeal enhancement. All patients had a good clinical outcome at discharge.
DISCUSSION
Aseptic meningitis in adults and children represent a management challenge as etiologies remained unknown for the majority of patients due to underutilization of currently available diagnostic techniques.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Female; Hospitalization; Humans; Infant; Infant, Newborn; Male; Meningitis, Aseptic; Middle Aged; Retrospective Studies; Texas; Young Adult
PubMed: 28806629
DOI: 10.1016/j.jcv.2017.07.016 -
International Journal of Environmental... Mar 2020Mumps is an important childhood infectious disease caused by mumps virus (MuV). We reviewed the epidemiology, pathogenesis, and vaccine development of mumps. Previous... (Review)
Review
Mumps is an important childhood infectious disease caused by mumps virus (MuV). We reviewed the epidemiology, pathogenesis, and vaccine development of mumps. Previous studies were identified using the key words "mumps" and "epidemiology", "pathogenesis" or "vaccine" in MEDLINE, PubMed, Embase, Web of Science, and Google Scholar. We excluded the articles that were not published in the English language, manuscripts without abstracts, and opinion articles from the review. The number of cases caused by MuV decreased steeply after the introduction of the mumps vaccine worldwide. In recent years, a global resurgence of mumps cases in developed countries and cases of aseptic meningitis caused by some mumps vaccine strains have renewed the importance of MuV infection worldwide. The performance of mumps vaccination has become an important issue for controlling mumps infections. Vaccine development and routine vaccination are still effective measures to globally reduce the incidence of mumps infections. During outbreaks, a third of MMR vaccine is recommended for groups of persons determined by public authorities.
Topics: Child; Disease Outbreaks; Humans; Measles-Mumps-Rubella Vaccine; Meningitis, Aseptic; Mumps; Mumps virus
PubMed: 32150969
DOI: 10.3390/ijerph17051686 -
Genome Research May 2019Metagenomic next-generation sequencing (mNGS) for pan-pathogen detection has been successfully tested in proof-of-concept case studies in patients with acute illness of...
Metagenomic next-generation sequencing (mNGS) for pan-pathogen detection has been successfully tested in proof-of-concept case studies in patients with acute illness of unknown etiology but to date has been largely confined to research settings. Here, we developed and validated a clinical mNGS assay for diagnosis of infectious causes of meningitis and encephalitis from cerebrospinal fluid (CSF) in a licensed microbiology laboratory. A customized bioinformatics pipeline, SURPI+, was developed to rapidly analyze mNGS data, generate an automated summary of detected pathogens, and provide a graphical user interface for evaluating and interpreting results. We established quality metrics, threshold values, and limits of detection of 0.2-313 genomic copies or colony forming units per milliliter for each representative organism type. Gross hemolysis and excess host nucleic acid reduced assay sensitivity; however, spiked phages used as internal controls were reliable indicators of sensitivity loss. Diagnostic test accuracy was evaluated by blinded mNGS testing of 95 patient samples, revealing 73% sensitivity and 99% specificity compared to original clinical test results, and 81% positive percent agreement and 99% negative percent agreement after discrepancy analysis. Subsequent mNGS challenge testing of 20 positive CSF samples prospectively collected from a cohort of pediatric patients hospitalized with meningitis, encephalitis, and/or myelitis showed 92% sensitivity and 96% specificity relative to conventional microbiological testing of CSF in identifying the causative pathogen. These results demonstrate the analytic performance of a laboratory-validated mNGS assay for pan-pathogen detection, to be used clinically for diagnosis of neurological infections from CSF.
Topics: Child; Computational Biology; Encephalitis; High-Throughput Nucleotide Sequencing; Humans; Meningitis, Aseptic; Metagenomics; Myelitis; Sensitivity and Specificity; Viruses
PubMed: 30992304
DOI: 10.1101/gr.238170.118 -
Nature Neuroscience Sep 2018Innate immune cells recruited to inflammatory sites have short life spans and originate from the marrow, which is distributed throughout the long and flat bones. While...
Innate immune cells recruited to inflammatory sites have short life spans and originate from the marrow, which is distributed throughout the long and flat bones. While bone marrow production and release of leukocyte increases after stroke, it is currently unknown whether its activity rises homogeneously throughout the entire hematopoietic system. To address this question, we employed spectrally resolved in vivo cell labeling in the murine skull and tibia. We show that in murine models of stroke and aseptic meningitis, skull bone marrow-derived neutrophils are more likely to migrate to the adjacent brain tissue than cells that reside in the tibia. Confocal microscopy of the skull-dura interface revealed myeloid cell migration through microscopic vascular channels crossing the inner skull cortex. These observations point to a direct local interaction between the brain and the skull bone marrow through the meninges.
Topics: Adult; Animals; Bone Marrow; Cell Movement; Female; Humans; Inflammation; Male; Meningitis, Aseptic; Mice; Mice, Inbred C57BL; Middle Aged; Myeloid Cells; Neutrophils; Skull; Stroke; Tibia; Tomography, X-Ray Computed
PubMed: 30150661
DOI: 10.1038/s41593-018-0213-2 -
Tidsskrift For Den Norske Laegeforening... Jan 2023Drug-induced aseptic meningitis is a rare but serious condition that should be suspected in patients with meningitis who test negative for a microbiological agent. The...
Drug-induced aseptic meningitis is a rare but serious condition that should be suspected in patients with meningitis who test negative for a microbiological agent. The medical history is presented here of a woman with recurrent urinary tract infections where meningitis symptoms arose after repeated exposure to a frequently prescribed drug.
Topics: Female; Humans; Meningitis, Aseptic; Urinary Tract Infections
PubMed: 36655954
DOI: 10.4045/tidsskr.22.0286 -
Arquivos de Neuro-psiquiatria Sep 2013Iatrogenic meningitis can be caused by a number of mechanisms. The recent case reports of fungal meningitis after application of epidural methylprednisolone caused... (Review)
Review
Iatrogenic meningitis can be caused by a number of mechanisms. The recent case reports of fungal meningitis after application of epidural methylprednisolone caused warning in the medical community. Cases were caused by contaminated lots of methylprednisolone from a single compounding pharmacy. Several medications can cause meningitis by probable hypersensitivity mechanism. Neurologists should be alert to the recent description of the use of lamotrigine and development of aseptic meningitis.
Topics: Drug Contamination; Humans; Iatrogenic Disease; Meningitis, Aseptic; Meningitis, Fungal; Methylprednisolone; Neuroprotective Agents
PubMed: 24141499
DOI: 10.1590/0004-282X20130145 -
European Neurology 2008Pierre Mollaret is mainly known for his contributions to infectious diseases and their prevention. He also described benign, recurrent endothelio-leukocytic meningitis...
Pierre Mollaret is mainly known for his contributions to infectious diseases and their prevention. He also described benign, recurrent endothelio-leukocytic meningitis in three patients who had short-lived recurrent attacks of fever, headache and vomiting caused by sterile meningitis, with 'fantomes cellulaires' (cell ghosts) in the cerebrospinal fluid. Identical symptoms are caused by Herpes simplex virus-2 and other viruses. The term Mollaret's meningitis should be restricted to idiopathic recurrent aseptic meningitis. This paper briefly outlines the syndrome and its discoverer.
Topics: History, 19th Century; History, 20th Century; Humans; Meningitis, Aseptic; Neurology
PubMed: 18832846
DOI: 10.1159/000159930 -
Clinical and Experimental Rheumatology 2018Autoinflammatory diseases (AIDs) are a distinct group of diseases characterised by a dysregulation of the innate immune response leading to systemic inflammation. The... (Review)
Review
Autoinflammatory diseases (AIDs) are a distinct group of diseases characterised by a dysregulation of the innate immune response leading to systemic inflammation. The clinical spectrum of these conditions is extremely variable and possibly every system and tissue can be involved, including the central nervous system (CNS). Indeed, neurological manifestations may dominate the clinical picture from disease onset in some rare conditions. However, the involvement of the CNS in AIDs is not a disease in itself, but represents a rare complication which is consequent to a systemic or local immune response, mainly involving cells of the innate immunity. This review will describe neurological manifestations associated with AIDs, including: chronic aseptic meningitis and brain atrophy, sensori-neural hearing loss, early-onset haemorrhagic and ischaemic strokes, mental retardation, cerebellitis, and ataxia, and severe encephalopathy with brain calcifications.
Topics: Ataxia; Atrophy; Brain Diseases; Calcinosis; Cerebellar Diseases; Encephalitis; Hearing Loss, Sensorineural; Hereditary Autoinflammatory Diseases; Humans; Intellectual Disability; Intracranial Hemorrhages; Meningitis, Aseptic; Nervous System Diseases; Stroke
PubMed: 29742058
DOI: No ID Found -
European Journal of Medical Research Aug 2023The clinical features of aseptic meningitis associated with amoxicillin are unknown. The main objective of this study was to investigate the clinical characteristics of...
OBJECTIVES
The clinical features of aseptic meningitis associated with amoxicillin are unknown. The main objective of this study was to investigate the clinical characteristics of amoxicillin-induced aseptic meningitis (AIAM) and provide a reference for clinical diagnosis and treatment.
METHODS
AIAM-related studies were collected by searching the relevant databases from inception to October 31, 2022.
RESULTS
AIAM usually occurred 3 h to 7 days after amoxicillin administration in 13 males and 9 females. Twenty-one patients (95.5%) had recurrent AIAM with a total of 62 episodes. Fever (19 cases, 86.4%) and headache (18 cases, 81.8%) were the most common symptoms. Typical cerebrospinal fluid (CSF) findings were leukocytosis (100%) with lymphocytic predominance (14 cases, 63.6%), elevated protein (20 cases, 90.1%), normal glucose (21 cases, 95.5%) and negative culture (21 cases, 100%). Brain magnetic resonance imaging showed mild meningeal enhancement in one patient. The symptoms resolved mainly within 1-4 days after drug discontinuation in all patients.
CONCLUSION
Clinical attention should be given to the adverse effects of AIAM. The medication history of patients with suspected meningitis should be investigated to avoid unnecessary examination and antibiotic treatment.
Topics: Humans; Meningitis, Aseptic; Male; Female; Adult; Middle Aged; Aged; Aged, 80 and over; Amoxicillin; Case Reports as Topic
PubMed: 37635233
DOI: 10.1186/s40001-023-01251-y