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The Lancet. Infectious Diseases Sep 2018Viral meningitis is increasingly recognised, but little is known about the frequency with which it occurs, or the causes and outcomes in the UK. We aimed to determine... (Observational Study)
Observational Study
BACKGROUND
Viral meningitis is increasingly recognised, but little is known about the frequency with which it occurs, or the causes and outcomes in the UK. We aimed to determine the incidence, causes, and sequelae in UK adults to improve the management of patients and assist in health service planning.
METHODS
We did a multicentre prospective observational cohort study of adults with suspected meningitis at 42 hospitals across England. Nested within this study, in the National Health Service (NHS) northwest region (now part of NHS England North), was an epidemiological study. Patients were eligible if they were aged 16 years or older, had clinically suspected meningitis, and either underwent a lumbar puncture or, if lumbar puncture was contraindicated, had clinically suspected meningitis and an appropriate pathogen identified either in blood culture or on blood PCR. Individuals with ventricular devices were excluded. We calculated the incidence of viral meningitis using data from patients from the northwest region only and used these data to estimate the population-standardised number of cases in the UK. Patients self-reported quality-of-life and neuropsychological outcomes, using the EuroQol EQ-5D-3L, the 36-Item Short Form Health Survey (SF-36), and the Aldenkamp and Baker neuropsychological assessment schedule, for 1 year after admission.
FINDINGS
1126 patients were enrolled between Sept 30, 2011, and Sept 30, 2014. 638 (57%) patients had meningitis: 231 (36%) cases were viral, 99 (16%) were bacterial, and 267 (42%) had an unknown cause. 41 (6%) cases had other causes. The estimated annual incidence of viral meningitis was 2·73 per 100 000 and that of bacterial meningitis was 1·24 per 100 000. The median length of hospital stay for patients with viral meningitis was 4 days (IQR 3-7), increasing to 9 days (6-12) in those treated with antivirals. Earlier lumbar puncture resulted in more patients having a specific cause identified than did those who had a delayed lumbar puncture. Compared with the age-matched UK population, patients with viral meningitis had a mean loss of 0·2 quality-adjusted life-years (SD 0·04) in that first year.
INTERPRETATION
Viruses are the most commonly identified cause of meningitis in UK adults, and lead to substantial long-term morbidity. Delays in getting a lumbar puncture and unnecessary treatment with antivirals were associated with longer hospital stays. Rapid diagnostics and rationalising treatments might reduce the burden of meningitis on health services.
FUNDING
Meningitis Research Foundation and UK National Institute for Health Research.
Topics: Adult; Aged; Aged, 80 and over; Cohort Studies; Female; Humans; Incidence; Male; Meningitis, Viral; Middle Aged; Population Surveillance; Prospective Studies; United Kingdom
PubMed: 30153934
DOI: 10.1016/S1473-3099(18)30245-7 -
Frontiers in Cellular and Infection... 2019Tuberculous meningitis (TBM) is the most common and severe form of central nervous system tuberculosis. Due to the non-specific clinical presentation and lack of...
Tuberculous meningitis (TBM) is the most common and severe form of central nervous system tuberculosis. Due to the non-specific clinical presentation and lack of efficient diagnosis methods, it is difficult to discriminate TBM from other frequent types of meningitis, especially viral meningitis (VM). In order to identify the potential biomarkers for discriminating TBM and VM and to reveal the different pathophysiological processes between TBM and VM, a genome-wide miRNA screening of PBMCs from TBM, VM, and healthy controls (HCs) using microarray assay was performed (12 samples). Twenty-eight differentially expressed miRNAs were identified between TBM and VM, and 11 differentially expressed miRNAs were identified between TBM and HCs. The 6 overlapping miRNAs detected in both TBM vs. VM and TBM vs. HCs were verified by qPCR analysis and showed a 100% consistent expression patterns with that in microarray test. Statistically significant differences of 4 miRNAs (miR-126-3p, miR-130a-3p, miR-151a-3p, and miR-199a-5p) were further confirmed in TBM compared with VM and HCs in independent PBMCs sample set ( = 96, < 0.01). Three of which were also showed significantly different between TBM and VM in CSF samples ( = 70, < 0.05). The receiver operating characteristic curve (ROC) analysis showed that the area under the ROC curve (AUC) of these 4 miRNAs in PBMCs were more than 0.70 in discriminating TBM from VM. Combination of these 4 miRNAs could achieve better discriminative capacity [AUC = 0.893 (0.788-0.957)], with a sensitivity of 90.6% (75.0-98.0%), and a specificity of 86.7% (69.3-96.2%). Additional validation was performed to evaluate the diagnostic panel in another independent sample set ( = 49), which yielded a sensitivity of 81.8% (9/11), and specificity of 90.0% (9/10) in distinguishing TBM and VM, and a sensitivity of 81.8% (9/11), and a specificity of 84.6% (11/13) in discriminating TBM from other non-TBM patients. This study uncovered the miRNA profiles of TBM and VM patients, which can facilitate better understanding of the pathogenesis involved in these two diseases and identified 4 novel miRNAs in distinguishing TBM and VM.
Topics: Adolescent; Adult; Aged; Biomarkers; Diagnosis, Differential; Female; Gene Expression Profiling; Humans; Leukocytes, Mononuclear; Male; Meningitis, Viral; MicroRNAs; Microarray Analysis; Middle Aged; ROC Curve; Real-Time Polymerase Chain Reaction; Sensitivity and Specificity; Tuberculosis, Meningeal; Young Adult
PubMed: 31572691
DOI: 10.3389/fcimb.2019.00323 -
Folia Medica Cracoviensia 2019Parechovirus and enterovirus belong to a family of Picornaviridae, non- enveloped, small-sized RNA viruses, responsible for multiple human diseases. Recent introduction...
BACKGROUND
Parechovirus and enterovirus belong to a family of Picornaviridae, non- enveloped, small-sized RNA viruses, responsible for multiple human diseases. Recent introduction of molecular tests enabled the identi cation of parechovirus and enterovirus infections. Our aim was a retrospective analysis of signs and symptoms associated with confirmed parechovirus or enterovirus infections among children treated in the Department of Neonatology, St. Louis Regional Children's Hospital in Kraków, Poland.
METHODS
Based on laboratory records, we identified all cases of parecho- or enterovirus infections confirmed by identification of viral RNA in nasal swab or cerebrospinal fluid samples. Hospital records and laboratory tests results of selected patients were then analyzed, and selected data were summarized, with emphasis on clinical and laboratory findings at admission.
RESULTS
We identified 11 cases of parechovirus and three of enterovirus infections. All cases were neonates admitted to hospital with fever and irritability. Except for leukopenia in 50% of patients, no significant abnormalities were noted in blood counts and serum biochemistry, including low C-reactive protein and procalcitonin. In nine cases, cerebrospinal fluid was collected, the fluid protein concentrations and cell counts were moderately increased. Final diagnosis was meningitis in 12 children, and other viral infections in two.
CONCLUSIONS
Viral infection, including parecho- and enteroviruses, should be considered in the etiology of fever and meningitis in neonates. The available molecular tests allow for detection of viral genetic material even in a scant biological specimen collected from neonates.
Topics: Enterovirus Infections; Female; Fever; Hospitals, Pediatric; Humans; Infant, Newborn; Leukopenia; Male; Meningitis, Viral; Nasal Cavity; Parechovirus; Picornaviridae Infections; RNA, Viral; Retrospective Studies
PubMed: 31180074
DOI: No ID Found -
Journal of Paediatrics and Child Health Nov 2022Aseptic meningitis, including culture negative and viral meningitis, contributes a significant health-care burden, including unnecessary antibiotic use and...
AIM
Aseptic meningitis, including culture negative and viral meningitis, contributes a significant health-care burden, including unnecessary antibiotic use and hospitalisation to treat possible bacterial meningitis. This study analysed aseptic meningitis hospitalisations in New Zealand (NZ) children over 29 years.
METHODS
In this population-based study, aseptic meningitis hospitalisations in NZ children <15 years old were analysed from 1991 to 2020. Incident rate ratios were calculated using Poisson regression models. Variations in hospitalisations by age, year, sex, ethnicity, geographical region and socio-economic deprivation were analysed.
RESULTS
There were 5142 paediatric aseptic meningitis hospitalisations from 1991 to 2020. Most were unspecified viral meningitis (64%), followed by enterovirus (29%). Hospitalisation rates varied annually with a median of 18.4/100 000 children including a peak in 2001 of 56.4/100 000 (51.7-61.6). From 2002 to 2019, rates increased by 8.4%/year (7.2-9.5%) in infants <90 days old but decreased in all other age groups. In 2020, a reduction in hospitalisations to 9.6/100 000 (7.9-11.8) occurred, and in infants <90 days old were 0.37 times expected. Hospitalisations were 1.50 times (1.49-1.68) higher in males than females; higher in children of Māori (P < 0.001) and Pacific (P < 0.001) versus European ethnicity; and higher for children living in the most (2.44 times, (2.16-2.75)) versus least deprived households; and in northern versus southern NZ.
CONCLUSIONS
Aseptic meningitis hospitalisations increased in young infants during 29 years of surveillance, apart from 2020 when admissions reduced during the COVID-19 pandemic. In contrast, hospitalisations decreased in children aged >1 year. Further investigation into reasons for higher admissions by ethnic group, geographical location and increased deprivation are required.
Topics: Infant; Male; Female; Child; Humans; Adolescent; Meningitis, Aseptic; New Zealand; Pandemics; COVID-19; Hospitalization; Meningitis, Viral
PubMed: 35861029
DOI: 10.1111/jpc.16131 -
Anaesthesia Oct 1979Pseudotetanus is a syndrome which is produced by a variety of non-Clostridial factors. It is usually not difficult to distinguish from tetanus but is must always be...
Pseudotetanus is a syndrome which is produced by a variety of non-Clostridial factors. It is usually not difficult to distinguish from tetanus but is must always be considered in the differential diagnosis. Six cases are reported in which tetanus was considered and in one of them the full treatment for the disease was started. It is hoped that by increasing the awareness of clinicians of this relatively common problem the risk of making an incorrect disagnosis will be reduced.
Topics: Adolescent; Adult; Child; Diagnosis, Differential; Drug Hypersensitivity; Female; Humans; Male; Meningitis, Viral; Metoclopramide; Middle Aged; Muscle Hypertonia; Prochlorperazine; Tetanus
PubMed: 532925
DOI: 10.1111/j.1365-2044.1979.tb08539.x -
Journal of Neurology, Neurosurgery, and... Apr 2006Many bacterial meningitis patients experience neurological or neuropsychological sequelae, predominantly deficits in short-term memory, learning, and attention....
BACKGROUND
Many bacterial meningitis patients experience neurological or neuropsychological sequelae, predominantly deficits in short-term memory, learning, and attention. Neuropsychological symptoms after viral meningitis are observed less frequently. Sleep disturbance has been reported after both viral and bacterial meningitis.
OBJECTIVES
To examine systematically the frequency and extent of sleep disturbance in meningitis patients.
METHODS
Eighty six viral or bacterial meningitis (onset of acute disease at least 1 year previously) patients were examined using two standardised questionnaires (Schlaffragebogen B and the Pittsburgh Sleep Quality Index, PSQI) in conjunction with a standardised neurological examination, and compared to a control group of 42 healthy age-matched volunteers.
RESULTS
Patients after both viral and bacterial meningitis described their sleep as reduced in quality and less restful than that of healthy control subjects; both patient groups had a pathological mean PSQI total score. Impaired sleep scores after meningitis were not correlated to either the Glasgow Coma Scale or the Glasgow Outcome Scale. Moreover, no relationship between residual neurological dysfunction or depressivity and sleep quality was observed.
CONCLUSIONS
Impaired sleep is a long-term consequence of meningitis. Additional, so far undetermined, factors other than the severity of concomitant neurological deficits are responsible for the development of this sequela.
Topics: Acute Disease; Adult; Female; Glasgow Coma Scale; Humans; Male; Meningitis, Bacterial; Meningitis, Viral; Severity of Illness Index; Sleep Wake Disorders; Surveys and Questionnaires; Time
PubMed: 16543543
DOI: 10.1136/jnnp.2005.071142 -
Acta Neurologica Taiwanica Mar 2022Meningitis is one of the most dangerous infection affecting children. The need for rapid and accurate diagnosis is mandatory for improving the outcome.
Accuracy of Cerebrospinal Fluid C-Reactive Protein and Multiplex Polymerase Chain Reaction and Serum Procalcitonin in Diagnosis of Bacterial and Viral Meningitis in Children.
BACKGROUND
Meningitis is one of the most dangerous infection affecting children. The need for rapid and accurate diagnosis is mandatory for improving the outcome.
AIM OF THE WORK
to evaluate the role of multiplex polymerase chain reaction (PCR), cerebrospinal fluid (CSF)-C-reactive protein (CRP) and serum procalcitonin (PCT) in diagnosis of meningitis and to detect its accuracy.
PATIENTS AND METHODS
A cross-sectional study was carried out in University Children hospital, Faculty of Medicine, between November 2019 and September 2020. The study was approved by the Ethics Review Board of Faculty of Medicine, Assiut University, and informed written consent was obtained. The committee's reference number is 17200161.
CLINICALTRIALS
gov ID: NCT03387969. 48 Children aged 2 to 18 years with meningitis were included. Detailed history and examination. Blood glucose level at time of admission prior to lumbar puncture, serum CRP level, serum PCT, CSF-CRP level and Multiplex PCR were evaluated.
FUNDING
The study was supported by Grant Office of Faculty of Medicine, Assiut University with grant NO. 2018-01-04-006-R2.
RESULTS
The mean age of children was 3.27 plus or minus 1.27 years. 35 (72.9%) cases were bacterial meningitis, while 13 (27.1%) cases were viral meningitis. Patients with bacterial meningitis had significantly higher serum CRP, serum PCT and higher CSF-CRP and significantly lower CSF/blood glucose compared to viral meningitis. Multiplex PCR had 94% sensitivity and 100% specificity for diagnosis of bacterial and viral meningitis.
CONCLUSION
CSF-CRP, CSF/blood glucose, PCT and Multiplex-PCR may help in diagnosis and differentiation of bacterial and viral meningitis.
Topics: Adolescent; C-Reactive Protein; Calcitonin; Child; Child, Preschool; Cross-Sectional Studies; Humans; Infant; Meningitis, Bacterial; Meningitis, Viral; Multiplex Polymerase Chain Reaction; Procalcitonin
PubMed: 35266132
DOI: No ID Found -
Przeglad Epidemiologiczny 2014The aim of this study was to assess the epidemiology of meningitis and/or encephalitis in Poland in 2012. (Comparative Study)
Comparative Study
AIM OF THE STUDY
The aim of this study was to assess the epidemiology of meningitis and/or encephalitis in Poland in 2012.
INTRODUCTION
About 2 500-3 000 cases of meningitis and/or encephalitis of viral or bacterial etiology are recorded in Poland every year.
MATERIALS AND METHODS
Assessment of the epidemiological situation of meningitis and/or encephalitis in Poland in 2012, was based on the results of analysis of epidemiological reports sent to the NIZP-PZH by the Regional Sanitary-Epidemiological Stations published in the annual bulletin "Infectious diseases and poisonings in Poland in 2012" and "Preventive immunizations in Poland in 2012" (Czarkowski MP. et al., Warsaw, 2013, NIZP-PZH, GIS).
RESULTS
In 2012 in Poland 3 088 cases of meningitis and/or encephalitis were recorded. More than 50% of these were viral infections.
SUMMARY AND CONCLUSIONS
The epidemiological situation of inflammatory meningitis and encephalitis in Poland in 2012 compared to 2011 did not change significantly.
Topics: Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Child; Child, Preschool; Disease Outbreaks; Encephalitis, Tick-Borne; Encephalitis, Viral; Female; Humans; Incidence; Infant; Infant, Newborn; Male; Meningitis, Bacterial; Meningitis, Viral; Middle Aged; Neisseria meningitidis; Poland; Prevalence; Rural Population; Seasons; Serotyping; Sex Factors; Urban Population; Young Adult
PubMed: 25135502
DOI: No ID Found -
Biomedical Papers of the Medical... Dec 2019Enteroviruses (EVs) are the most common agents of aseptic meningitis. Some serotypes can cause serious neuroinfection leading to death. The aim of this study was to...
AIMS
Enteroviruses (EVs) are the most common agents of aseptic meningitis. Some serotypes can cause serious neuroinfection leading to death. The aim of this study was to determine the representation of EVs in the etiology of aseptic meningitis in children and to analyze the demographic, clinical, laboratory, and epidemiological characteristics of patients with EV meningitis.
PATIENTS AND METHODS
This was a prospective study including 147 patients in three groups: EV meningitis, tick-borne encephalitis, and aseptic meningitis with unidentified agent.
RESULTS
Boys with EV meningitis predominated over girls. The average patient age was 11 years. Compared to the control group, these patients suffered more from stiff back (P=0.010), vomiting and nausea (P=0.009). They had shorter symptom duration (P<0.001), higher C-reactive protein in blood (P<0.001), higher predominance of polynuclears (P=0.026), and greater lactate (P=0.003) in cerebrospinal fluid (CSF). The serotype seen most frequently (68%) was ECHO virus (ECV) 30.
CONCLUSIONS
Enteroviruses play the most important role in the differential diagnosis of aseptic meningitis. Short symptom duration, slightly higher inflammatory parameters in blood, predominance of polynuclears, and elevated CSF lactate have predictive value in diagnosing this disease. ECV 30 (frequently the agent of epidemics in the Czech Republic) was the aseptic meningitis agent most often seen.
Topics: Adolescent; Child; Child, Preschool; Czech Republic; Enterovirus; Enterovirus Infections; Female; Humans; Male; Meningitis, Aseptic; Meningitis, Viral; Prospective Studies; Reverse Transcriptase Polymerase Chain Reaction; Sequence Analysis
PubMed: 30631207
DOI: 10.5507/bp.2018.082 -
Viruses Sep 2020Varicella vaccine is a live attenuated varicella-zoster virus (VZV). Like its parental strain called VZV pOka, the vaccine virus vOka retains some neurotropic... (Review)
Review
Varicella vaccine is a live attenuated varicella-zoster virus (VZV). Like its parental strain called VZV pOka, the vaccine virus vOka retains some neurotropic properties. To better understand vOka neuropathogenesis, we reassessed 12 published cases of vOka meningitis that occurred in once-immunized and twice-immunized children, all of whom had bouts of herpes zoster preceding the central nervous system infection. Eight of the 12 meningitis cases occurred in children who had received only one immunization. There was no pattern to the time interval between varicella vaccination and the onset of herpes zoster with meningitis. Four of the meningitis cases occurred in children who had received two immunizations. Since all four children were 14 years old when meningitis was diagnosed, there was a strong pattern to the interval between the first vaccination at age 1 year and onset of meningitis, namely, 13 years. Knowledge of pathogenesis requires knowledge of the location of herpes zoster; the majority of dermatomal rashes occurred at sites of primary immunization on the arm or thigh, while herpes zoster ophthalmicus was uncommon. Based on this literature review, currently there is no consensus as to the cause of varicella vaccine meningitis in twice-immunized children.
Topics: Adolescent; Chickenpox Vaccine; Child; Child, Preschool; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Infant; Male; Meningitis, Viral; Trigeminal Ganglion; Vaccines, Attenuated; Virus Activation; Virus Latency
PubMed: 32992805
DOI: 10.3390/v12101078