Causes and Presentation of Meningitis in a Baltimore Community Hospital 1997–2006

Wiberg, Kjell; Birnbaum, Anitra; Gradon, Jeremy D.

doi:10.1097/smj.0b013e31817e3544

Cited by 11 publications

(10 citation statements)

References 21 publications

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“…Viruses are by far the most common cause of childhood meningitis and their incidence is close to 20 times greater than bacterial meningitis, although because of mild and self-limited clinical signs and symptoms they are under-reported in most health statics ( 2 ). The reported rate of bacterial meningitis (BM) to all cases of meningitis in children, which was 5.1% in our study, varies from 4.9% (in a cohort of 12,000 children) in Finland to 50% in the UK, and was 21.2% according to a report from the US (Baltimore) ( 2 - 4 ). The rate of BM was 6.9% and 4.5% in Mashhad and Shiraz, respectively, in (non-neonates) children who underwent LP with suspicion of meningitis, yet among children with confirmed meningitis (who had CSF pleocytosis) this rate was 16.3% and 12.3%.…”

Section: Discussionmentioning

confidence: 44%

Enteroviral Meningitis in Neonates and Children of Mashhad, Iran

Vahedian-Shahroodi

Ghazvini

Sadeghi

et al. 2016

Jundishapur J Microbiol

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BackgroundThe highest incidence of meningitis occurs during the neonatal period and (then) infancy. Although Bacterial agents are the most dangerous cause of neonatal and childhood meningitis yet viruses especially, enteroviruses (EV), are by far the most common cause of meningitis in this age group.ObjectivesThe aim of the current study was to evaluate the role of EVs in neonatal and childhood meningitis in the Mashhad city of Iran.Materials and MethodsThis was a descriptive study that was performed at Imam Reza hospital in a period of six months (March to September 2007), during which all of the cerebral spinal fluid (CSF) samples from the neonatal intensive care unit (NICU) and pediatrics ward were collected and real time-polymerase chain reaction (RT-PCR) for EVs was done on these samples. Clinical data were collected retrospectively from hospital files.ResultsWe collected 58 CSF samples (35 neonates and 23 children) during six months. Pleocytosis of CSF was seen in 51.1% of the subjects (28% of neonates, and 66.6% of infants and children). Enteroviruses PCR was positive in 37.1% (13) of neonates and 34.7% (8) of children. Pleocytosis of CSF was seen in 23% and 75% of EV positive neonates and children, respectively. Polymorphonuclear (PMN) dominance (PMN > 50%) of CSF was seen in 50% and 33% of EV positive neonates and children, respectively. There were three cases of bacterial meningitis in our group; EV PCR result was positive for one of these subjects. Concomitant bacterial infection (meningitis and sepsis) was seen in 9.5% (two cases) of EV positive CSFs in our study. Almost half of the available neonates (four of nine) with pure enteroviral meningitis (EVM) were discharged (in good condition) with final diagnosis of culture negative sepsis (CNS) and mean length of hospital stay (MLOS) of 4.3 days. One (12.5%) of the neonates with EVM, who had a very low birth weight (< 1500 mg), was expired, and two (25%) cases were discharged with brain damage and final diagnosis of severe asphyxia. The MLOS for children with pure EVM was 1.6 days (one to four days); they didn't have any sign of brain damage or mortality. Qualitative c-reactive protein (CRP) of serum was negative in 72.7% and 37.5% of EV positive neonates and children, respectively. The mean white blood cell count and PMN percentage in the peripheral blood was 11416/mm3 and 60.8% for EV positive neonates, and 14500/mm3 and 77.1% for EV positive children, respectively. Hyponatremia, due to possible syndrome of inappropriate antidiuretic hormone (SIADH), was seen in 30% of neonates and 57% of children with EVM.ConclusionsEnteroviruses were a common cause (> 30%) of meningitis in our study group. Concomitant bacterial infection is not rare in neonates and children with EVM. Many of the neonates (50%) and almost all of the children with EVM did not require prolonged hospitalization. Both normal CSF and PMN dominancy of CSF was common in neonates and children with EVM. Positive qualitative CRP of serum (up to two plus) was common especially in children with ...

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Section: Discussionmentioning

confidence: 44%

Enteroviral Meningitis in Neonates and Children of Mashhad, Iran

Vahedian-Shahroodi

Ghazvini

Sadeghi

et al. 2016

Jundishapur J Microbiol

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“…Fever and peripheral leukocytosis are also classic findings in meningitis, but there may be many other causes of these findings in a hospitalized patient [51]. Signs of meningeal irritation, including nuchal rigidity, are seen in only 20%-30% of patients [52,53]. A history of a device placed into the CSF, a craniotomy or trauma resulting in contamination of the CSF, and the absence of another cause for fevers or seizures makes this diagnosis more likely.…”

Section: Evidence Summarymentioning

confidence: 99%

2017 Infectious Diseases Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis*

Tunkel

Hasbun

Bhimraj

et al. 2017

Clinical Infectious Diseases

703

671

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The Infectious Diseases Society of America (IDSA) Standards and Practice Guidelines Committee collaborated with partner organizations to convene a panel of 10 experts on healthcare-associated ventriculitis and meningitis. The panel represented pediatric and adult specialists in the field of infectious diseases and represented other organizations whose members care for patients with healthcare-associated ventriculitis and meningitis (American Academy of Neurology, American Association of Neurological Surgeons, and Neurocritical Care Society). The panel reviewed articles based on literature reviews, review articles and book chapters, evaluated the evidence and drafted recommendations. Questions were reviewed and approved by panel members. Subcategories were included for some questions based on specific populations of patients who may develop healthcare-associated ventriculitis and meningitis after the following procedures or situations: cerebrospinal fluid shunts, cerebrospinal fluid drains, implantation of intrathecal infusion pumps, implantation of deep brain stimulation hardware, and general neurosurgery and head trauma. Recommendations were followed by the strength of the recommendation and the quality of the evidence supporting the recommendation. Many recommendations, however, were based on expert opinion because rigorous clinical data are not available. These guidelines represent a practical and useful approach to assist practicing clinicians in the management of these challenging infections.

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“…The diagnosis of meningitis and meningococcal sepsis may seem relatively straightforward in patients with classical features of fever, headache, neck stiffness and altered mental status in the case of meningitis or fever, purpuric rash and shock in meningococcal sepsis but in many patients some of these signs will be absent. 9,24,25 The problem for general practitioners and acute physicians is to identify, from the large number of patients who present with symptoms consistent with meningitis or meningococcal sepsis, the small minority of patients who do in fact have these conditions and require urgent investigation and management.…”

Section: Rationalementioning

confidence: 99%

The UK joint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults

McGill

Heyderman

Michael

et al. 2016

Journal of Infection

159

167

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Bacterial meningitis and meningococcal sepsis are rare conditions with high case fatality rates. Early recognition and prompt treatment saves lives. In 1999 the British Infection Society produced a consensus statement for the management of immunocompetent adults with meningitis and meningococcal sepsis. Since 1999 there have been many changes. We therefore set out to produce revised guidelines which provide a standardised evidence-based approach to the management of acute community acquired meningitis and meningococcal sepsis in adults. A working party consisting of infectious diseases physicians, neurologists, acute physicians, intensivists, microbiologists, public health experts and patient group representatives was formed. Key questions were identified and the literature reviewed. All recommendations were graded and agreed upon by the working party. The guidelines, which for the first time include viral meningitis, are written in accordance with the AGREE 2 tool and recommendations graded according to the GRADE system. Main changes from the original statement include the indications for pre-hospital antibiotics, timing of the lumbar puncture and the indications for neuroimaging. The list of investigations has been updated and more emphasis is placed on molecular diagnosis. Approaches to both antibiotic and steroid therapy have been revised. Several recommendations have been given regarding the follow-up of patients.

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Causes and Presentation of Meningitis in a Baltimore Community Hospital 1997–2006

Abstract: Meningitis should be suspected with any suggestion of central nervous system complaint, even in the absence of the classic triad of symptoms and signs.

Cited by 11 publications

References 21 publications

Enteroviral Meningitis in Neonates and Children of Mashhad, Iran

Enteroviral Meningitis in Neonates and Children of Mashhad, Iran

2017 Infectious Diseases Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis*

The UK joint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults

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