Accuracy of Clinical and Cerebrospinal Fluid Indicators in the Diagnosis of Bacterial Meningitis in Infants &lt;90 Days of Age in Luanda, Angola

Pelkonen, Tuula; Urtti, Suvi; Cardoso, Ondina; Roine, Irmeli; Kyaw, Moe H.; Peltola, Heikki

doi:10.1097/inf.0000000000003305

Cited by 3 publications

(2 citation statements)

References 27 publications

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“…This lack of prioritisation causes delays in time-to-antibiotics for febrile infants who are at high risk for SBIs (14). Researchers continue to pursue predictive models for SBIs using clinical and biochemical predictors (15)(16)(17).…”

Section: Introductionmentioning

confidence: 99%

Adding heart rate n-variability (HRnV) to clinical assessment potentially improves prediction of serious bacterial infections in young febrile infants at the emergency department: a prospective observational study

Chong¹,

Niu²,

Piragasam³

et al. 2023

Ann Transl Med

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Background: We aim to investigate the utility of heart rate variability (HRV) and heart rate n-variability (HRnV) in addition to vital signs and blood biomarkers, among febrile young infants at risk of serious bacterial infections (SBIs). Methods:We performed a prospective observational study between December 2017 and November 2021 in a tertiary paediatric emergency department (ED). We included febrile infants <90 days old with a temperature ≥38 ℃. We obtained HRV and HRnV parameters via a single lead electrocardiogram. HRV measures beat-to-beat (R-R) oscillation and reflects autonomic nervous system (ANS) regulation. HRnV includes overlapping and non-overlapping R-R intervals and provides additional physiological information.We defined SBIs as meningitis, bacteraemia and urinary tract infections (UTIs). We performed area under curve (AUC) analysis to assess predictive performance.Results: We recruited 330 and analysed 312 infants. The median age was 35.5 days (interquartile range 13.0-61.0); 74/312 infants (23.7%) had SBIs with the most common being UTIs (66/72, 91.7%); 2 infants had co-infections. No patients died and 32/312 (10.3%) received fluid resuscitation. Adding HRV and HRnV to demographics and vital signs at ED triage successively improved the AUC from 0.765 [95% confidence interval (

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Section: Introductionmentioning

confidence: 99%

Adding heart rate n-variability (HRnV) to clinical assessment potentially improves prediction of serious bacterial infections in young febrile infants at the emergency department: a prospective observational study

Chong¹,

Niu²,

Piragasam³

et al. 2023

Ann Transl Med

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“… 8 The diagnosis of neonatal meningitis relies on clinical symptoms and cerebrospinal fluid (CSF), leukocyte count, glucose, and protein levels in the CSF aid in diagnosis. 9 Streptococcus gallolyticus subsp. pasteurianus is a subspecies within the broader category of Lancefield group D streptococci.…”

Section: Introductionmentioning

confidence: 99%

Late-Onset Meningitis in a Preterm Infant Caused by Streptococcus gallolyticus Subsp. Pasteurianus in Saudi Arabia: A Case Report and Literature Review

Al-shehri

2023

IMCRJ

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This report describes the progression of meningitis in a 24-day-old preterm male infant infected with Streptococcus gallolyticus subsp. pasteurianus (SGSP) and its medical care, pathogen detection, antibiotic treatment, and monitoring, ultimately leading to a positive outcome of successful recovery. Neonatal meningitis (NM) is a serious and potentially life-threatening condition, particularly in immunocompromised preterm infants. This report from Saudi Arabia presents a rare case of late-onset neonatal meningitis caused by SGSP in a preterm male infant. The 24-day-old preterm neonate presented with fever, lethargy, poor feeding, and respiratory distress. SGSP was confirmed by cerebral spinal fluid analysis showing the presence of pleocytosis and a low glucose ratio. Prompt antibiotic therapy with intravenous Ampicillin and Cefotaxime led to decreased pleocytosis, and the infant was discharged after 21 days. This report highlights the importance of vigilance, diagnosis, and management of neonatal infections caused by uncommon pathogens such as SGSP. The rarity of SGSP-caused meningitis emphasizes the need to monitor pregnant women for potential transmission and to implement early diagnostic and management strategies. This case report also encompasses a review of recent globally reported cases of neonatal S. gallolyticus infection, highlighting the distinctiveness of this report as the first of its type in Saudi Arabia.

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Diagnostic prediction models for bacterial meningitis in children with a suspected central nervous system infection: a systematic review and prospective validation study

Groeneveld,

Bijlsma,

van Zeggeren

et al. 2024

BMJ Open

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ObjectivesDiagnostic prediction models exist to assess the probability of bacterial meningitis (BM) in paediatric patients with suspected meningitis. To evaluate the diagnostic accuracy of these models in a broad population of children suspected of a central nervous system (CNS) infection, we performed external validation.MethodsWe performed a systematic literature review in Medline to identify articles on the development, refinement or validation of a prediction model for BM, and validated these models in a prospective cohort of children aged 0–18 years old suspected of a CNS infection.Primary and secondary outcome measuresWe calculated sensitivity, specificity, predictive values, the area under the receiver operating characteristic curve (AUC) and evaluated calibration of the models for diagnosis of BM.ResultsIn total, 23 prediction models were validated in a cohort of 450 patients suspected of a CNS infection included between 2012 and 2015. In 75 patients (17%), the final diagnosis was a CNS infection including 30 with BM (7%). AUCs ranged from 0.69 to 0.94 (median 0.83, interquartile range [IQR] 0.79–0.87) overall, from 0.74 to 0.96 (median 0.89, IQR 0.82–0.92) in children aged ≥28 days and from 0.58 to 0.91 (median 0.79, IQR 0.75–0.82) in neonates.ConclusionsPrediction models show good to excellent test characteristics for excluding BM in children and can be of help in the diagnostic workup of paediatric patients with a suspected CNS infection, but cannot replace a thorough history, physical examination and ancillary testing.

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Accuracy of Clinical and Cerebrospinal Fluid Indicators in the Diagnosis of Bacterial Meningitis in Infants <90 Days of Age in Luanda, Angola

Cited by 3 publications

References 27 publications

Adding heart rate n-variability (HRnV) to clinical assessment potentially improves prediction of serious bacterial infections in young febrile infants at the emergency department: a prospective observational study

Adding heart rate n-variability (HRnV) to clinical assessment potentially improves prediction of serious bacterial infections in young febrile infants at the emergency department: a prospective observational study

Late-Onset Meningitis in a Preterm Infant Caused by Streptococcus gallolyticus Subsp. Pasteurianus in Saudi Arabia: A Case Report and Literature Review

Diagnostic prediction models for bacterial meningitis in children with a suspected central nervous system infection: a systematic review and prospective validation study

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