Clinical Prognosis in Neonatal Bacterial Meningitis: The Role of Cerebrospinal Fluid Protein

Tan, Jintong; Liu, Jun; Qiu, Gang; Zhao, Deping; Ren, Fang; Luo, Zhong‐Cheng; Zhang, Yongjun

doi:10.1371/journal.pone.0141620

Cited by 39 publications

(52 citation statements)

References 31 publications

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“…Moreover, animal and human investigations have found that the use of dexamethasone improves the BBB damage and reduces neurological complications and CSF inflammation [1,2,14,17,19,22,25,30]. According to our data, the BBB damage is intensive during purulent meningitis and it constitutes a sensitive parameter in the outcome of the disease [6,14,21,25,29,31].…”

Section: Discussionsupporting

confidence: 52%

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Blood-brain barrier damage as a predictor of outcome in patients with purulent meningitis

Dreshaj¹,

Shala²,

Ponosheci³

et al. 2018

Arch Med Sci Civil Dis

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Introduction: Purulent meningitis is a severe infection of the central nervous system caused by different bacteria and very often causes severe complications and high lethality. Since the disease still has unclear pathogenesis and high mortality, researchers and clinicians are focused on the influence of damage of the blood-brain barrier (BBB) and its subsequent impact on the outcome of purulent meningitis. The aim of this study was to investigate the albumin concentration and the albumin coefficient as the best parameters of BBB damage, and their influence on the outcome of patients with purulent meningitis. Material and methods: The study was carried out by examining the hospitalized patients in the Clinic of Infective Diseases in Prishtina, Kosovo. Blood-brain barrier damage is evaluated by analyzing the dynamics of values of proteins, glucose and albumins, as well as by determining the BBB coefficient of damage. Results: The data consistent with BBB damage in patients with purulent meningitis corresponded with disease outcome. Consequently, 56.97% of the patients who developed complications or died had very severe BBB damage. Patients with the mean value of albumin coefficient X = 46.5 ±27.23 g/l were at higher risk of developing complications (relative risk (RR) = 2.63; p < 0.0001) or having a lethal outcome (RR = 5.20; p < 0.0001). Patients with longer duration of pathological mean values of albumin coefficient were at higher risk of developing complications (RR = 3.11; p < 0.0001). Conclusions: Our data suggest that BBB damage in patients with purulent meningitis correspond with disease outcome. The best predictors for outcome were albumin coefficient and albumin concentration in cerebrospinal fluid.

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Section: Discussionsupporting

confidence: 52%

“…Therefore, finding reliable predictors of this serious disease has been the aim of many studies that have used various clinical and laboratory parameters [28][29][30][31]. It is worth underlining that the addition of laboratory tests to a score has only marginally improved the accuracy of the results [29].…”

Section: Discussionmentioning

confidence: 99%

Blood-brain barrier damage as a predictor of outcome in patients with purulent meningitis

Dreshaj¹,

Shala²,

Ponosheci³

et al. 2018

Arch Med Sci Civil Dis

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“…Its sensitivity in diagnosis of neonatal infections is about 30% and the specificity is about 60% (40). In another study, 72% of neonates with meningitis showed CRP level higher than 8 mg/Dl (33). The result of a study showed that CRP level of cerebrospinal fluid in neonates with purulent meningitis was higher than aseptic meningitis.…”

Section: Discussionmentioning

confidence: 90%

“…In another retrospective study, thrombocytopenia was an important predictor for neonatal meningitis complications (35). In a study, anemia with hemoglobin less than 14.5 g/dL was observed in 151 (65%) neonates with meningitis (33).…”

Section: Discussionmentioning

confidence: 95%

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Etiology, clinical findings and laboratory parameters in neonates with acute bacterial meningitis

Boskabadi¹,

Heidari²,

Zakerihamidi³

2020

IJM

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Background and Objectives: Neonatal meningitis is one of the most important and serious neonatal infections with a high mortality and morbidity rate. The present study aimed to investigate the causes, clinical signs, laboratory parameters and mortality rates in newborns with bacterial meningitis. Materials and Methods: This cross-sectional study was performed on 468 neonates aged 2-28 days admitted to NICU in Ghaem Hospital Mashhad, Iran by available sampling method during 2009-2018. Meningitis was confirmed according to positive results of CSF culture and clinical feature. By using researcher-made questionnaire, neonate's individual data in- cluding cardiopulmonary resuscitation, the Apgar score of the first and fifth minutes, gestational age, birth weight, clinical symptoms and laboratory data such as ESR, WBC and positive culture of CSF were studied. Results: Among 468 newborn suspected to infection, lumbar Puncture (LP) was performed for 233 cases (50%). Of 233 neonates, 148 neonates (63.5%) had negative results for CSF culture and 85 cases (36.5%) had positive CSF culture. 94% of cases with meningitis were born premature. Blood culture had positive results in 80% of infants with late-onset meningitis and negative in 20%. The most common clinical findings were respiratory symptoms (94%). Klebsiella pneumoniae and Entrobacter aerugenes were the most common microorganisms of meningitis. Gestational disorders were observed in 55.3% of newborns with meningitis. C-Reactive Protein (CRP) of neonates with meningitis was twice higher than normal cases, and leukocytes and proteins in the CSF in neonates with meningitis were higher than healthy ones. Finally, 36% of neonates with meningitis died in our study. For analyzing the relationships between variables, independent t-test was used after controlling the normality, and Chi-square was used for analyzing the relationship of variables with nominal scale. Conclusion: The most common pathogens of meningitis were Klebsiella pneumoniae and Enterobacter aerogenes. Respi- ratory symptoms were the most common clinical signs, and laboratory symptoms included increased CRP, increased leuko- cytes and proteins in CSF

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Global Case Fatality of Bacterial Meningitis During an 80-Year Period

van Ettekoven,

Liechti,

Brouwer

et al. 2024

JAMA Netw Open

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ImportanceThe impact of vaccination, antibiotics, and anti-inflammatory treatment on pathogen distribution and outcome of bacterial meningitis over the past century is uncertain.ObjectiveTo describe worldwide pathogen distribution and case fatality ratios of community-acquired bacterial meningitis.Data SourcesGoogle Scholar and MEDLINE were searched in January 2022 using the search terms bacterial meningitis and mortality.Study SelectionIncluded studies reported at least 10 patients with bacterial meningitis and survival status. Studies that selected participants by a specific risk factor, had a mean observation period before 1940, or had more than 10% of patients with health care–associated meningitis, tuberculous meningitis, or missing outcome were excluded.Data Extraction and SynthesisData were extracted by 1 author and verified by a second author. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Random-effects models stratified by age (ie, neonates, children, adults), Human Development Index (ie, low-income or high-income countries), and decade and meta-regression using the study period’s year as an estimator variable were used.Main Outcome and MeasureCase fatality ratios of bacterial meningitis.ResultsThis review included 371 studies performed in 108 countries from January 1, 1935, to December 31, 2019, describing 157 656 episodes. Of the 33 295 episodes for which the patients’ sex was reported, 13 452 (40%) occurred in females. Causative pathogens were reported in 104 598 episodes with Neisseria meningitidis in 26 344 (25%) episodes, Streptococcus pneumoniae in 26 035 (25%) episodes, Haemophilus influenzae in 22 722 (22%), other bacteria in 19 161 (18%) episodes, and unidentified pathogen in 10 336 (10%) episodes. The overall case fatality ratio was 18% (95% CI, 16%-19%), decreasing from 32% (95% CI, 24%-40%) before 1961 to 15% (95% CI, 12%-19%) after 2010. It was highest in meningitis caused by Listeria monocytogenes at 27% (95% CI, 24%-31%) and pneumococci at 24% (95% CI, 22%-26%), compared with meningitis caused by meningococci at 9% (95% CI, 8%-10%) or H influenzae at 11% (95% CI, 10%-13%). Meta-regression showed decreasing case fatality ratios overall and stratified by S pneumoniae, Escherichia coli, or Streptococcus agalactiae (P &lt; .001).Conclusions and RelevanceIn this meta-analysis with meta-regression, declining case fatality ratios of community-acquired bacterial meningitis throughout the last century were observed, but a high burden of disease remained.

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Clinical Prognosis in Neonatal Bacterial Meningitis: The Role of Cerebrospinal Fluid Protein

Cited by 39 publications

References 31 publications

Blood-brain barrier damage as a predictor of outcome in patients with purulent meningitis

Blood-brain barrier damage as a predictor of outcome in patients with purulent meningitis

Etiology, clinical findings and laboratory parameters in neonates with acute bacterial meningitis

Global Case Fatality of Bacterial Meningitis During an 80-Year Period

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