Role of lumbar puncture in clinical outcome of suspected acute bacterial meningitis

BACKGROUND Meningitis remains a significant source of mortality and morbidity,with an incidence of 1 per 100000 persons in the United States.Guidelines recommend obtaining blood cultures and cerebrospinal fluid(CSF)studies in patients presenting with acute meningitis syndrome,and beginning treatment with broad spectrum antibiotics based on the age and certain predisposing conditions.In some patients however,the diagnostic lumbar puncture(LP)is not performed due to a multitude of reasons,ranging from increased intracranial pressure to failed attempt.In such situations,appropriate therapy is initiated empirically and often continued without establishment of a definitive diagnosis.AIM To determine whether a diagnostic LP in acute meningitis syndrome was associated with a better outcome and less duration of antibiotic therapy,along with potential causes for deferral of procedure.METHODS A retrospective study was conducted amongst the patients presenting to a 360 bedded community hospital in central Massachusetts with a diagnosis of acute meningitis syndrome between January 2010-September 2022.The electronic health records were accessed to collect necessary demographic and clinical data,including etiology of meningitis,lumbar puncture results,reason for procedure deferral,duration of antibiotic therapy and clinical outcome.The patients were subsequently divided into two groups based on whether they received a LP or not,and data was analyzed.RESULTS A total of 169 patients admitted with acute meningitis syndrome between September 2010-2022 were included in the study.The mean age of the participants was 54.3 years(SD+/-19.2 years).LP was performed for 130(76.9%)participants,out of which,28(21.5%)showed some growth in CSF culture.The most commonly identified organism was streptococcus pneumoniae.Amongst the 39 patients in whom LP was deferred,the major reasons recorded were:Body habitus(n=6,15.4%),and unsuccessful attempt(n=4,10.3%).While 93(71.5%)patients with LP received antibiotic therapy,only 19(48.7%)patients without LP received the antibiotics,with the principal reason being spontaneous improvement in sensorium without any diagnosed source of infection.The mean duration of antibiotic use was 12.3 days(SD+/-5.6)in the LP group and 11.5 days(SD+/-7.0)in the non-LP group(P=0.56;statistically not significant).We observed higher long term sequalae in the non-LP group(n=6,15.4%)compared to the LP group(n=9,6.9%).Similarly,the death rate was higher in the non-LP group(n=7,18.0%)compared to the LP group(n=9,6.9%).CONCLUSION LP remains the cornerstone for diagnosing meningitis,but often CSF results are unavailable,leading to empiric treatment.Our study identified that body habitus and unsuccessful attempts were the most common reasons for LP not being performed,leading to empiric antibiotic coverage.There was no difference between the duration of antibiotics received by the two groups,but a lower proportion of patients without LP received antibiotics,attributed to a spontaneous improvement in sensorium.However,the residual neurological sequelae and death rates were higher in patients without LP,signifying a potential under-treatment.A LP remains crucial to diagnose meningitis,and a lack of CSF analysis predisposes to under-treatment,leading to higher neurological sequelae and increased chances of death.

Numerical Analysis of Bacterial Meningitis Stochastic Delayed Epidemic Model through Computational Methods

Based on theWorld Health Organization(WHO),Meningitis is a severe infection of the meninges,the membranes covering the brain and spinal cord.It is a devastating disease and remains a significant public health challenge.This study investigates a bacterial meningitis model through deterministic and stochastic versions.Four-compartment population dynamics explain the concept,particularly the susceptible population,carrier,infected,and recovered.The model predicts the nonnegative equilibrium points and reproduction number,i.e.,the Meningitis-Free Equilibrium(MFE),and Meningitis-Existing Equilibrium(MEE).For the stochastic version of the existing deterministicmodel,the twomethodologies studied are transition probabilities and non-parametric perturbations.Also,positivity,boundedness,extinction,and disease persistence are studiedrigorouslywiththe helpofwell-known theorems.Standard and nonstandard techniques such as EulerMaruyama,stochastic Euler,stochastic Runge Kutta,and stochastic nonstandard finite difference in the sense of delay have been presented for computational analysis of the stochastic model.Unfortunately,standard methods fail to restore the biological properties of the model,so the stochastic nonstandard finite difference approximation is offered as an efficient,low-cost,and independent of time step size.In addition,the convergence,local,and global stability around the equilibria of the nonstandard computational method is studied by assuming the perturbation effect is zero.The simulations and comparison of the methods are presented to support the theoretical results and for the best visualization of results.

Infantile bacterial meningitis combined with sepsis caused by Streptococcus gallolyticus subspecies pasteurianus:A case report

BACKGROUND Streptococcus gallolyticus subspecies pasteurianus(SGSP)is a rare pathogen responsible for infant sepsis and meningitis and is potentially overlooked because it is not included in routine group B streptococcal screenings.Hence,we present a case of SGSP-induced infant meningitis and sepsis,accompanied by bronchopneumonia induced by multidrug-resistant Staphylococcus aureus(MRSA),providing insights into the identification,management,and prognosis of this bacterial infection.CASE SUMMARY A 45-day-old female infant presented with two episodes of high fever(maximum temperature:39.5°C)and two generalized grand mal seizure episodes that lasted over ten seconds and self-resolved without concomitant symptoms.Postadmission,the patient’s C-reactive protein level was 40.73 mg/L,white blood cell count was 13.42×10^(9)/L,neutrophil ratio was 78.4%,procalcitonin level was 7.89μg/L,cerebrospinal fluid(CSF)white cell count was 36×10^(6)/L,multinucleated cell ratio was 95.2%,and protein concentration was 0.41 g/L.Blood and CSF culture revealed that the pathogen was SGSP.The bacterium was sensitive to ampicillin,furazolidone,penicillin,lincomycin,moxifloxacin,rifampicin,vancomycin,and levofloxacin but resistant to clindamycin and tetracycline.Sputum culture revealed the presence of MRSA,which was sensitive to vancomycin.The patient was diagnosed with meningitis and sepsis caused by SGSP,accompanied by bronchopneumonia induced by MRSA.Ceftriaxone(100 mg/kg/d)combined with vancomycin(10 mg/kg/dose,q6h)was given as an anti-infective treatment postadmission.After 12 days of treatment,the infant was discharged from the hospital with normal CSF,blood culture,and routine blood test results,and no complications,such as subdural effusion,were observed on cranial computed tomography.No growth retardation or neurological sequelae occurred during follow-up.CONCLUSION SGPSP-induced infant bacterial meningitis and sepsis should be treated with prompt blood and CSF cultures,and a sensitive antibiotic therapy to ensure a favorable prognosis.

Endogenous Endophthalmitis as a Triggering Factor for Fatal Bacterial Meningitis Caused by Streptococcus pneumoniae: A Case Report

Endogenous endophthalmitis is a rare condition with a poor long-term visual prognosis and significant mortality, often associated with the hematogenous spread of intravitreal infections and subsequent disruption of the blood-ocular barrier. Its anatomical proximity to the central nervous system (CNS) poses a high risk of infection dissemination, although cases documented in the literature are rare, and endogenous endophthalmitis is typically described as secondary to neuroinfections. We report the case of an 82-year-old female patient with a history of hypertension who presented with fever, decreased visual acuity, severe headache, chemosis, and conjunctival injection. Endogenous endophthalmitis was diagnosed, and antimicrobial treatment was initiated alongside surgical intervention by the ophthalmology service. However, the patient’s condition worsened neurologically, and Streptococcus pneumoniae was identified in cerebrospinal fluid cultures. Despite intensive medical treatment, the patient’s clinical course was poor, leading to death.

Epidemiological, Clinical, Bacteriological and Evolutionary Profiles of Bacterial Meningitis in Children in Bangui (CAR)

Background: Bacterial meningitis is a major public health problem worldwide due to its severity. It is a vaccine-preventable disease. Methodology: It was a retrospective descriptive study conducted at the Pediatric Teaching Hospital of Bangui from June 2019 to May 2021. Children aged 1 month to 15 years hospitalized for bacterial meningitis were included in the study. Data were entered and analyzed using Stata/IC version 16.1. Results: Of 2490 patients hospitalized during the study period, 122 (4.9%) had bacterial meningitis. The patients were male in 54.92% of cases with a sex ratio of 1.21. The mean age was 35.95 months ± 49.16. Most of the patients (84.42%) came directly from home. The average consultation delay was 3.4 days ± 2.6. The vaccination coverage was 56.55%. The CSF study isolated germs from 24 patients (19.67%), the main ones being S. pneumoniae (75%) and H. influenzae (16.67%). Ceftriaxone was prescribed alone or in combination in all cases as first-line treatment. The average duration of antibiotic therapy was 8.95 days. The mortality rate was 27.87% and 12.30 % of patients had sequelae. Conclusion: Bacterial meningitis is common in Bangui and still poses a public health problem despite the introduction of new vaccines in the EPI. Improving vaccination coverage and raising awareness for early consultation could improve the situation.

Pituitary Adenoma Complicated by Acute Bacterial Meningitis in a Patient in Kara (Togo)

Introduction: In the context of pituitary adenoma, bacterial meningitis is a possible complication of surgical or medical treatment. The occurrence of meningitis before any treatment is exceptional, explained by the existence of an osteomeningeal breach caused by the adenoma whose main symptom is rhinorrhea. Case Report: We report a case of bacterial meningitis complicating a prolactin pituitary macroadenoma. The patient had been referred for jet vomiting in a febrile context preceded by headaches and visual blurring. There was no rhinorrhea. The examination revealed a meningeal syndrome and the diagnosis of acute bacterial meningitis was made. The isolated germ was the pneumococcus. Faced with headaches and visual blurring, a cerebral scan revealed a pituitary macroadenoma and pituitary hormone dosage had shown hyperprolactinemia. The meningitis was sterilized and the prolactinoma was treated with dopaminergic agonists. This allowed the normalization of prolactinemia and the disappearance of symptoms. Conclusion: The pituitary adenoma was complicated by bacterial meningitis without treatment and the presence of a meningeal breach. Hormonal and bacterial treatments have been successful.

Comparative study between bacterial meningitis vs.viral meningitis and COVID-19

Meningitis is the inflammation of brain and spinal cord protective membrane. It is a deadly and enfeebling disease that affects people of all ages and most often caused by a bacterial or viral infection. Bacterial meningitis is a more serious and life-threatening condition, while viral meningitis the most frequent kind is often less severe and self-limiting. Therefore, successful treatment of meningitis depends on identifying the suspected or known causative organism. In this article, we aim to review the latest information about the etiology of meningitis and explore its possible occurrence and complication followed COVID-19 infection.

Epidemiology and antibiotic resistance of bacterial meningitis in Dapaong,northern Togo

Objective:To assess the seasonality of the bacterial meningitis and the antibiotic resistance of incriminated bacteria over the last three years in the northern Togo.Methods:From January 2007 to January 2010,533 cerebrospinal fluids(CSF) samples were collected from patients suspected of meningitis in the Regional Hospital of Dapaong(northern Togo).After microscopic examination,samples were cultured for bacterial identification and antibiotic susceptibility. Results:The study included 533 patients(306 male and 227 female) aged from 1 day to 55 years [average age(13.00±2.07) years].Bacterial isolation and identification were attempted for 254/533 (47.65%) samples.The bacteria]species identified were:Neisseria meningitidis A(N.meningitidis A)(58.27%),Neisseria meningitidis W135(N,meningitidis W135)(7.09%),Streptococcus pneumoniae(S.pneumoniae)(26.77%),Haemophilus influenza B(H.influenza B)(6.30%) and Enterobacteriaceae(1.57%).The results indicated that bacterial meningitis occur from November to May with a peak in February for H.influenzae and S.pneumoniae and March for Neisseriaceae. The distribution of positive CSF with regards to the age showed that subjects between 6 and 12 years followed by subjects of 0 to 5 years were most affected with respective frequencies of 67.82%and 56.52%(P【0.001).Susceptibility tests revealed that bacteria have developed resistance to several antibiotics including aminosides(resistance rate】20%for both bacterial strains),macrolides(resistance rate】30%for H.influenzae) quinolones(resistance rate】15% for H.influenzae and N.meningitidis W135).Over three years,the prevalence of S.pneumoniae significantly increased from 8.48%to 73.33%(P【0.001),while the changes in the prevalence of H.influenzae B were not statistically significant:4.24%,vs.8.89%,(P= 0.233).Conclusions: Our results indicate that data in African countries differ depending on geographical location in relation to the African meningitis belt.This underlines the importance of epidemiological surveillance of bacterial meningitis.

Laboratory Diagnosis of Bacterial Meningitis in a Patient with COVID-19

Against the background of a COVID-19 infection, the overlap of bacterial coinfection is associated with an increased risk of poor treatment outcomes. A 76-year-old man was treated for ischemic stroke in the period of one week. During his hospital stay, he showed symptoms of a viral infection, due to which a PCR sample was taken for SARS-CoV-2. The test result was positive. Meningoencephalitis is suspected on the basis of the clinical symptoms shown and the initial blood test. K. pneumonia was detected by a cerebrospinal fluid (CSF) microbiological examination. The risk of bacterial coinfection with COVID-19 remains unclear. Timely and rapid diagnosis and treatment of bacterial meningitis, in the context of a proven COVID-19 infection, require a variety of biological tests and a multidisciplinary approach. In the early stages of acute bacterial and viral meningitis, the signs and symptoms are often nonspecific and it is not always possible to make a differential diagnosis. Laboratory tests, characterizing COVID-19, should determine the type, prognosis, and outcome of a bacterial coinfection. Refining the laboratory diagnosis of a bacterial infection with COVID-19 is a new challenge for doctors.

Hepatitis B virus in cerebrospinal fluid of a patient with purulent bacterial meningitis detected by multiplex-PCR:A case report

BACKGROUND Bacterial meningitis(BM)is a common central nervous system inflammatory disease.BM may cause serious complications,and early diagnosis is essential to improve the prognosis of affected patients.CASE SUMMARY A 37-year-old man was hospitalized with purulent meningitis because of worsening headache for 12 h,accompanied by vomiting,fever,and rhinorrhea.Head computed tomography showed a lesion in the left frontal lobe.Infectious disease screening showed positivity for hepatitis B surface antigen,hepatitis B e antigen,and hepatitis B core antigen.Cerebrospinal fluid(CSF)leak was suspected based on clinical history.Streptococcus pneumoniae(S.pneumoniae)was detected in CSF by metagenomic next-generation sequencing(mNGS)technology,confirming the diagnosis of purulent BM.After treatment,multiplex PCR indicated the presence of hepatitis B virus(HBV)DNA and absence of S.pneumoniae DNA in CSF samples.CONCLUSION We report a rare case of HBV in the CSF of a patient with purulent BM.Multiplex PCR is more sensitive than mNGS for detecting HBV DNA.

Clinical Presentation and Outcome of Bacterial Meningitis in University Hospital

Purpose: To determine the clinical characteristics and outcome of bacterial meningitis in adult patients using CT, MRI and CSF culture. Methods: Patients admitted to the university hospital with clinical diagnosis of meningitis were included in the present study. All patients were subjected to clinical examination as well as CT, MRI scanning and CSF-bacteriological culture. Results: The age distribution of the patients shows that there is high frequency of symptoms found in the age group between ages 40 - 45. CSF in the present study included WBS, RBC, glucose and protein, which is associated with the adverse outcome. Meningitis can be confirmed by many methods, in the present study three different methods were used, which included CT scan, MRI and CSF analysis and bacterial culture. In CT scan, among the predictors of meningitis, persons with TB (P = 0.037), patients with HIV (P = 0.036) and stroke (P = 0.036) showed significant association. Whereas MRI findings were significantly associated with TB meningitis (P = 0.015). Meningitis was prevalent in the age group of <45. Conclusion: This study highlights the importance of several modalities for diagnosing and predicting the outcome of meningitis in adults.

Predictors of Bacterial Meningitis among Paediatric Patients Aged 0 - 5 Years at Kenyatta Hospital, Kenya

Introduction: Meningitis remains a common and serious problem in children worldwide. One million instances of meningitis are assessed to happen in children worldwide each year. In Africa, where outbreaks are common 70% of meningitis cases are diagnosed in children under the age of five (5) years. Though in most cases, doctors diagnose early and adequate treatment started, 5% to 10% of patients still succumb during the 24 - 48 hours after onset of clinical features. In 2009, the mortality rate in Africa was four thousand deaths. Study Objective: This study describes the predictors of bacterial meningitis among children aged 0 - 5 years admitted at Kenyatta National Hospital (K.N.H.) paediatric wards. Methodology: The study adopted a descriptive cross-sectional design. It was carried out in K.N.H. paediatric wards. Data were obtained from consenting parent or guardian and healthcare workers (nurses and registrars). Study participants were selected by convenient sam-pling method. A total of 104 study participants were included in the study sample. In-depth interviews of key informants were conducted on 7 health workers;5 nurses from the paediatric wards and paediatric emergency unit and 2 paediatric registrars. Ethical consideration included full disclosure to participants, confidentiality, security of health records and informed consent. Data were collected by use of researcher administered semi-structured ques-tionnaire and desk reviews of patients’ files were also used. Qualitative data from the interviews were audio-taped. Logistic regression analysis was used for data analysis. Quantitative data were cleaned, entered and analysed using Statistical Package for Social Sciences (SPSS) version 23. Results were displayed by utilization of tables, pie charts. Qualitative data were transcribed, grouped in themes and analysed manually. Study Results: The majority of the children (55.8%) were female. The highest percentage of the children (53.8%) was aged less than one year. The highest proportion of the parents (39.4%) was within the age group of 26 - 30 years. Neonatal sepsis (37.5%), neonatal jaundice (25.0%) and for observation (25.0%) were the common reasons for admission to NBU. Children admitted and managed in the nursery unit were significantly 2.7 times more likely to have bacterial meningitis compared to those children never admitted to the nursery [OR = 2.75;95% CI = 1.08 - 7.00;P = 0.031]. Streptococcus pneumonia was the main (51.2%) causative agent of bacterial meningitis among the children. Children who were taken to hospital in delay after illness were 1.740 times more likely to exhibit meningitis than those taken to hospital immediately. Children whose parents had higher levels of income were two times less likely to exhibit meningitis than those with lower. Majority (62.5%) resided in mid urban and slum areas. Most lived in a one (1) bed-roomed house and most houses (60.6%) had more than five people living in it. The main co-existing illnesses among the children were pneumonia (53.8%) and heart disease (22.9%). Conclusions: Streptococcus pneumoniae was the common causative agent of meningitis among the study population. The enviromnetal factors such as living in overcrowded areas, inadequate exposure to health education contributed to contracting and developing meningitis. Financial contraints among caregivers posed a hindrance to the participants in seeking medical attention early. A previous upper respiratory tract infection more often led to contracting meningitis.

Cerebrospinal fluid analysis,predictors of bacterial meningitis:a study in 312 patients with suspected meningial infection

Objective:Patients with cerebrospinal fluid(CSF)pleocytosis are routinely admitted to the hospital and treated with parenteral antibiotics,although few have bacterial meningitis(BM).The aim of this study was to evaluate predictors to differentiate BM from aseptic meningitis(ASM).Methods:The study was conducted in Razi hospital,a training center affiliated to Ahvaz Joundishapoor University of Medical Sciences in Iran.and all patients were 18 years old or above and were treated in the hospital between 2003 and 2007.Data of those who had meningitis,tested as CSF pleocytosis but had not received antibiotic treatment before lumbar puncture were retrospectively analyzed.Results:Among 312 patients with CSF pleocytosis,two hundred fifteen(68.9%)had BM and ninety seven(31.1%)had ASM.The mean age for patients with BM was(34.7±17.7)years(P=0.22,NS).Sixty percent of the BM cases and 61.2% of the ASM cases occurred in men(P=0.70,NS).We identified the following predictors of BM:CSF-WBC count>100 per micro liter,CSF-glucose level<40 mg/dL,CSF-protein level>80 mg/dL.Sensitivity,specificity,PPV,NPV of these predictors,and LR for BM are 86.5%,52.6%,80.2%,63.7% and 104.1 for CSF-WBC count and 72.1%,83.5%,90.6%,57.4% and 164.2% for CSF glucose,and 49.7%,91.8%,93.4%,45.2% and 104.5% for CSF protein.Conclusion:The CSF WBC count should not be used alone to rule out bacterial meningitis.When it is combined with other factors such as CSF glucose and protein improved decision making in patients with suspected BM may occur.

Case-by-Case Surveillance for Bacterial Meningitis in Benin: Data Analysis, 2016 to 2018

Background: Bacterial meningitis is an inflammation of the meninges caused mainly by three bacterial species Neisseria meningitidis, Streptococcus pneumoniae and Haemophilus influenzae that are transmitted by nasopharyngeal secretions emitted by carriers. Meningitis is a public health problem in Benin, like all countries in the African meningitis belt. This study aims to analyze the epidemiological surveillance data of meningitis in Benin from 2016 to 2018. Methods: Each suspect case of meningitis was recorded and Cerebrospinal Fluid (CSF) samples were collected. CSF collection was accompanied by the Integrated Disease Surveillance and Response form. This sheet provides information on the patient’s social-demographic and epidemiological data. CSF specimens were sent to the laboratory for analysis and identification (Gram stain, biochemical parameters, and latex agglutination test) of pathogens according to the WHO standards. Results: Of the 2992 patients with suspected meningitis, 2893 were hospitalized with a death rate of 9.4% (281/2992). The sex ratio of registered patients was 1.29 in favor of men. The median age was 4 years (min: 0;max: 90). Patients younger than five years were the most represented (44.8%). During the study period, there was a decrease in the incidence of meningitis per 100,000 inhabitants (6.3 to 3.2 from 2016 to 2018). Of 2928 CSF samples collected we were able to identify 899 pathogenic bacterial species. The most represented species are S. pneumoniae (63.4%), N. meningitidis (24.4%) and H. influenzae (12.2%). Conclusion: The burden of disease is disproportionate in the northern departments as in others. The frequency of bacterial meningitis in the northern region increased during the study period. However, deaths have been recorded in the departments of the South (“Atlantic”, “Plateau”). This suggests an improvement in epidemiological surveillance and case management throughout the national territory.

Case Report: Bilateral Intra-Parenchymal Hematomas Caused by Ventricular Flood Complicating Neonatal Salmonella typhi Meningitis

Salmonella meningitis is an uncommon condition in neonates, and when it does occur, it is often linked to serious complications, such as subdural collections and abscesses. We present a case involving a 23-day-old neonate diagnosed with Salmonella meningitis, who developed complications including bilateral intra-parenchymal hematomas with ventricular involvement. The infant showed significant improvement following an extended course of systemic antibiotics and supportive care.

Early Nursing Intervention in Children with Viral Meningitis

Aim: To explore the effect of a WeChat peer education program in children with severe viral meningitis combined with respiratory failure. Design: Retrospective cohort study. Methods: Patients who had severe viral meningitis combined with respiratory failure, were admitted to the hospital from March 2017 to June 2018, and who received the WeChat-based nursing intervention were included. Patients who received routine nursing were used as controls. The family’s emotional state, self-care ability, and rehabilitation were analyzed. Results: There were 37 patients in the WeChat group (19 boys (51.3%) and 18 girls (48.7%);mean of 5.1 ± 2.4 years of age) and 37 controls (20 boys (54.1%) and 17 girls (45.9%);mean of 5.9 ± 2.4 years of age) (all P > 0.05). After nursing, improvements in the self-assessed anxiety score and self-assessed depression score were better in the WeChat group (anxiety: -29.2% vs. -20.3%, P = 0.015;depression: -25.2% vs. -15.4%, P = 0.009). After nursing, the improvements in the condition management ability scale and condition management difficulty scale scores were better in the WeChat group (ability: +80.5% vs. +44.4%. P = 0.001;difficulty: +58.4% vs. +37.8%, P = 0.003). After nursing, the improvement in the Fugl-Meyer score was better in the WeChat group (+138.0% vs. +53.0%, P Conclusion: Early nursing intervention combined with WeChat peer education can improve the emotional state of children with severe viral meningitis combined with respiratory failure and their caregivers. Impact: Viral meningitis is associated with a good prognosis, but central nervous system complications can be observed. Early intervention is the key to a good prognosis. Internet-based nursing and coaching can improve self-efficacy and care ability in patients with various conditions, as well as improve the emotional state of the children and their caregivers. The research might have an impact on any children’s hospital that deals with viral meningitis.

Predictors of cerebrospinal fluid GeneXpert MTB/RIF positivity in patients with tuberculous meningitis:A prospective cohort study

Objective:To identify the clinical,laboratory,and radiological markers that could predict a positive GeneXpert result in patients suspected of tuberculous meningitis.Methods:In this prospective,observational study,patients with tuberculous meningitis were systematically evaluated.Various clinical,laboratory[including cerebrospinal fluid(CSF)microscopy,culture,and GeneXpert],and neuroimaging factors were examined.All participants were administered anti-tuberculous treatment and corticosteroids.A six-month follow-up was done to evaluate the outcome.Results:Of the 116 patients studied,54(46.6%)tested positive for GeneXpert,while 62(53.4%)were negative.Third cranial nerve involvement(OR 3.71,95%CI 1.052-13.09,P=0.04)and the presence of basal exudates on neuroimaging(OR 5.22,95%CI 2.03-13.42,P=0.001)emerged as independent predictive factors for a positive GeneXpert result.A positive CSF GeneXpert result(P=0.002)and drug resistance(P=0.004)were significantly linked to adverse outcomes.Additionally,a high score on the Medical Research Council stageⅢ(OR 5.64,95%CI 1.18-26.87,P=0.03)and elevated CSF cell counts(OR 1.002,95%CI 1.00-1.001,P=0.03)were identified as independent predictors of poor prognosis.Conclusions:Third cranial nerve involvement and the presence of basal exudates were significant indicators of a positive GeneXpert result.MRC stageⅢdisability and elevated CSF cell counts predicted poor outcomes.

Sensitivity of diagnosis of spontaneous bacterial peritonitis is higher with the automated cell count method

BACKGROUND Spontaneous bacterial peritonitis(SBP)is one of the most important complications of patients with liver cirrhosis entailing high morbidity and mortality.Making an accurate early diagnosis of this infection is key in the outcome of these patients.The current definition of SBP is based on studies performed more than 40 years ago using a manual technique to count the number of polymorphs in ascitic fluid(AF).There is a lack of data comparing the traditional cell count method with a current automated cell counter.Moreover,current international guidelines do not mention the type of cell count method to be employed and around half of the centers still rely on the traditional manual method.AIM To compare the accuracy of polymorph count on AF to diagnose SBP between the traditional manual cell count method and a modern automated cell counter against SBP cases fulfilling gold standard criteria:Positive AF culture and signs/symptoms of peritonitis.METHODS Retrospective analysis including two cohorts:Cross-sectional(cohort 1)and case-control(cohort 2),of patients with decompensated cirrhosis and ascites.Both cell count methods were conducted simultaneously.Positive SBP cases had a pathogenic bacteria isolated on AF and signs/symptoms of peritonitis.RESULTS A total of 137 cases with 5 positive-SBP,and 85 cases with 33 positive-SBP were included in cohort 1 and 2,respectively.Positive-SBP cases had worse liver function in both cohorts.The automated method showed higher sensitivity than the manual cell count:80%vs 52%,P=0.02,in cohort 2.Both methods showed very good specificity(>95%).The best cutoff using the automated cell counter was polymorph≥0.2 cells×10^(9)/L(equivalent to 200 cells/mm^(3))in AF as it has the higher sensitivity keeping a good specificity.CONCLUSION The automated cell count method should be preferred over the manual method to diagnose SBP because of its higher sensitivity.SBP definition,using the automated method,as polymorph cell count≥0.2 cells×10^(9)/L in AF would need to be considered in patients admitted with decompensated cirrhosis.

A Rare Case of Aortic Valve Endocarditis and Acute Meningitis Due to Haemophilus influenzae

HACEK organisms represent a rare but important group of causative pathogens in endocarditis. These bacteria have historically been associated with culture-negative endocarditis;however, modern laboratory techniques have made this less common. In this case, we present a 74-year-old man who presented with acute onset altered mentation, fever, and sepsis. He was ultimately found to have Haemophilus influenzae meningitis, cerebral empyema, aortic valve endocarditis, psoas myositis, and L2 - L3 diskitis with osteomyelitis. Although HACEK organisms are commonly found in the oropharynx and upper respiratory tract in humans, our patient did not report recent preceding dental or ENT procedures. H. influenzae is responsible for approximately 0.16% of all cases of bacterial endocarditis, representing a very limited subset. Although generally considered low virulent pathogens, this case demonstrates the unusual extent of infection from a HACEK organism, H. influenzae, causing aortic valve endocarditis as well as atypical non-cardiac sequelae, including acute meningitis.

Improving treatment plan and mental health in children with abdominal infection for broad-spectrum bacterial infections

BACKGROUND Pediatric abdominal infection is a common but serious disease that requires timely and effective treatment.In surgical treatment,accurate diagnosis and rational application of antibiotics are the keys to improving treatment effects.AIM To investigate the effect of broad-spectrum bacterial detection on postoperative antibiotic therapy.METHODS A total of 100 children with abdominal infection who received surgical treatment in our hospital from September 2020 to July 2021 were grouped.The observation group collected blood samples upon admission and sent them for broad-spectrum bacterial infection nucleic acid testing,and collected pus or exudate during the operation for bacterial culture and drug sensitivity testing;the control group only sent bacterial culture and drug sensitivity testing during the operation.RESULTS White blood cell count,C-reactive protein,procalcitonin,3 days after surgery,showed better postoperative index than the control group(P<0.05).The hospital stay in the observation group was significantly shorter than that in the control group.The hospitalization cost in the observation group was significantly lower than that in the control group,and the difference between the two groups was statistically significant(P<0.05).CONCLUSION Early detection of broad-spectrum bacterial infection nucleic acids in pediatric abdominal infections can help identify pathogens sooner and guide the appropriate use of antibiotics,improving treatment outcomes and reducing medical costs to some extent.