Epidemiological, Diagnostic, Therapeutic, and Prognostic Profile of Non-Tuberculous Community-Acquired Purulent Pleurisy in Children at the Bouaké University Hospital Center, 2017-2021

Introduction: In Côte d’Ivoire, there is a scarcity of data on children’s purulent pleurisies. Objective: This study aims to elucidate the epidemiological, diagnostic, therapeutic, and evolutionary facets of non-tuberculous purulent pleurisies in pediatric patients. Methods: A retrospective analysis was conducted using the medical records of children aged one month to fifteen years with purulent pleurisies at Bouaké University Hospital Center from January 2017 to December 2021. Results: The study identified 124 cases of purulent pleurisies, constituting 18% of lower respiratory tract infections and 0.8% of all hospitalizations. The majority of these cases (69%) were in children between 1 and 24 months of age. Prominent symptoms included dyspnea (85.5%), O2 saturation below 95% in room air (76.6%), respiratory distress (68.5%), cutaneous-mucosal pallor (63.7%), and fever (43.5%). Radiological findings predominantly showed right-sided pleurisy (62.1%). The pleurisy was often extensive (78.2%), accompanied by pneumothorax (37.1%), alveolo-interstitial opacities (8.1% of cases), and abscess formations (1.6%). Pleural fluid cultures were positive in 46.9% of cases, with Staphylococcus aureus (75%, methi-S) identified among 32 bacteria. Initial antibiotic treatment was empirical, favoring oxacillin (53.2%) or amoxicillin-clavulanic acid (53.2%) in dual (42%) or triple therapy (33%) with gentamicin (64.1%) and/or metronidazole (21.8%). Treatments also included pleural drainage (68.5%) or repeated evacuation punctures (33.1%), and blood transfusion (39%). The mortality rate was 18.8%. Conclusion: Non-tuberculous purulent pleurisy remains a significant concern in pediatric hospitalizations at the CHU of Bouaké, marked by high mortality rates.

Evolution of the Etiologies of Purulent Meningitis in Children over a Period of 24 Months in Conflict-Affected Rural Areas of the Central African Republic after the Introduction of 2 New Vaccines in the Expanded Vaccination Program

Background and Objective: Purulent meningitis is a therapeutic emergency and remains a real public health problem in the world, particularly in limited resources countries. The study aimed to describe the epidemiological clinical, etiological and scalable features of purulent meningitis in children in Bria. Methods: A cross-sectional descriptive study was conducted from January 1, 2018 to December 31, 2019 (24 months). It included all suspected cases of purulent meningitis in children aged 0 to 15 years, confirmed by agglutination with Pastorex meningitis. A standard sheet was used to collect the data which was entered and analyzed on Epi Info 7 software. Results: A total of 37 cases of purulent meningitis were confirmed among 90 suspected cases. The female gender predominated (59.5%), with a sex ratio of 0.7. The age group from 0 to 11 months was majority (48.6%). Nearly 2 thirds of children were not vaccinated (64.8%). The most frequent functional signs were fever (83.8%), and convulsion (51.4%). The etiologies were Streptococcus (51.4%), Neisseria meningitidis (35.1%) and Haemophilus influenzae (13.5%). Therapeutic success under 3rd generation cephalosporin treatment was obtained in 86.5% including 8.1% with sequelae;13.5% of death was observed. Streptococcus was the most lethal bacterium at 21.1%. Conclusion: The results of these studies show that pediatric purulent meningitis is still common despite the availability of free vaccination. They require early therapeutic management to limit the occurrence of sequelae and death. Hence, it is important to strengthen prevention strategies.

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.

Physicochemical Properties of Musk Deer Pneumonia and Purulent Disease Viruses

[ Objective] To understand the physicochemical properties of musk deer pneumonia and purulent disease viruses. [ Method] The pneu- monia and purulent disease viruses were isolated from the abnormal and purulent lung tissues of musk deer. Then the isolated viruses were inocula- ted into the Vero cells. After culturing, the virus solution was collected and used to determine TCID50 and genoma types. The sensitivity to fat sol- vent, resistance to hydrochloric acid and trypsin as well as tolerance to heat of the musk deer pneumonia and purulent disease viruses were detec- ted, respectively. [ Result] The obvious cytopathic effects （CPE） were found in Veto cells infected by the isolated viruses. The virus was 2-1.43 TCID50/ml and its genome was RNA. The virus was not sensitive to chloroform, 1% trypsin and heats, and it had a certain tolerance to 0.1 mol/L hy- drochloric acid. [ Conclusion] The study on the physicochemical properties of musk deer pneumonia and purulent disease viruses lays a foundation for prevention and control of the musk deer pneumonia and purulent diseases.

Serotypes of Bacteria Encountered in Childhood Purulent Meningitis in Children in Parakou (Benin) in 2011

Introduction: In the North-Benin, there are three agents causing pediatric purulent meningitis outside the neonatal period. These are: Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae type b. The aim of this research work was to investigate bacteria serotypes that caused childhood purulent meningitis in the pediatric unit of the Borgou à Regional University Teaching Hospital (CHUD-Borgou) located in Parakou (North-Benin). Patients and Methods: Through a prospective and descriptive study centered on children aged 0 to 5 years old suspected of meningitis and hospitalized, the cerebrospinal fluid (CSF) samples of those children were analyzed at the WHO reference laboratory in Banjul for serotyping by real time polymerase chain reaction (RT/PCR). Results: Among the 1396 children hospitalized during that period, 366 were suspected of meningitis and had benefitted from lumbar puncture. Among those 366 suspected cases, 51 cases of purulent meningitis were confirmed after CSF cytobacteriological and biochemical test at the CHUD-Borgou laboratory. Among 51 CSF samples in which purulent meningitis was confirmed, 44 were sent to Banjul. In addition, 310 CSF samples from non-confirmed cases of meningitis were also sent to Banjul. In the whole set of samples sent for real time PCR, 151 cases of Streptococcus pneumoniae (42.7%) were found, 5 cases of Neisseria meningitidis (1.4%) and 1 case of Haemophilus influenzae (0.3%) were also encountered. As regards Streptococcus pneumonia, the serotypes encountered were: 1, 3, 4, 5, 7F, 8, 9V, 9V/9A, 9N/9L, 14, 18C, 19A, 23F, 33F as well as non typed and non typable serotypes. As for Neisseria meningitidis, only serogroup A was found in it. For Haemophilus influenzae, only serotype b was identified. Conclusion: Four non vaccine serotypes (8, 9V/9A, 9N/9L and 33F), non typed and non typable serotypes which are not covered by 13-valent pneumococcal conjugate vaccine (PCV 13) were identified. This highlights the need to enhance surveillance of pediatric purulent meningitis and serotyping by RT/PCR of all CSF samples in order to adapt if necessary future new pneumococcal vaccines to circulating non vaccine serotypes.

Significance of cerebrospinal fluid and plasma biochemical indicator ratio in identifying the tuberculous meningitis and purulent meningitis

Objective:To explore the significance of cerebrospinal fluid and plasma biochemical indicator ratio in identifying the tuberculous meningitis and purulent meningitis.Methods: A total of 43 patients with tuberculous meningitis who were admitted in our hospital from August 2015 to July 2017 were included in the study and served as the tuberculous meningitis group. Moreover, 40 cases with purulent meningitis were served as the purulent meningitis group. The morning fasting peripheral venous blood was collected and centrifuged for the plasma. Lumbar puncture was used to collect cerebrospinal fluid. The fully automatic biochemical analyzer was used to detect GSH, the plasma protein, chloride, glucose, lactic acid, and ADA. GSF/plasma ratio was calculated. The immunity transmission turbidity was used to detect GSH and Cys-C. FCM was used to detect CD64. ELISA was used to detect MMP-9.Results:GSF chloride and lactic acid in the tuberculous meningitis group were significantly lower than those in the purulent meningitis group, while ADA was significantly higher than that in the purulent meningitis group. The plasma protein, chloride, and lactic acid in the tuberculous meningitis group were significantly lower than those in the purulent meningitis group, while ADA was significantly higher than that in the purulent meningitis group. ADA ratio in GSF in the tuberculous meningitis group was significantly higher than that in the purulent meningitis group, while chloride and lactic acid ratio was significantly lower than that in the purulent meningitis group. CD64 in GSF in the tuberculous meningitis group was significantly lower than that in the purulent meningitis group, and MMP-9 was significantly higher than that in the purulent meningitis group, while the comparison of Cys-C between the two groups was not statistically significant.Conclusions: GSF, plasma protein, chloride, lactic acid, and ADA concentration ratio in the tuberculous meningitis group and purulent meningitis group have a certain difference. Combined detection of CD64 and MMP-9 contribute to identifying the two meningitis.

Comparative Evaluation of Different Treatment for Purulent Wounds in Dogs

To compare the healing of purulent wounds with Shilajit dressing vs. Vishnevsky dressing in dogs with purulent wounds of >2 weeks of duration, eight dogs were chosen from same ages in two groups i.e., Shilajit and Vishnevsky dressing group. Dressing was done on every day basis for more than two weeks of follow up period. Main outcome of healing measure was completed at three weeks. Wound healing status was assessed at three days intervals till end of three weeks. Shilajit treated achieved complete decrease in the wound surface area, effect of healing score in Shilajit dressing group in comparison to the Vishnevsky dressing group at p > 0.05 level of significance. Shilajit is highly effective in achieving a characteristic feature of regenerative and granulation healing of purulent wounds as compared to Vishnevsky dressing group in dogs.

Twenty cases of HIV infectors without symptoms at early stage treated by purulent moxibustion

Objective To observe the clinical effect of purulent moxibustion on HIV infectors without symptoms at early stage. Methods Purulent moxibustion on Zusanli （足三里 ST 364 Xuanzhong （悬钟 GB 39） and Guanyuan （关元 CV 4） was used in these twenty cases of HIV infectors, and the course of treatment was haJf a year. Score of clinical symptoms and signs, Karnovsky score, CD4＋ cell count and QOL score were observed before and after treatment. Results The score of clinical symptoms and signs, Karnovsky score, CD4＋ cell count and QOL score of these patients were all improved obviously after moxibustion （P〈0.05, P〈0.01）. Conclusion Purulent moxibustion can relieve the clinical symtoms, improve or stabilize the level of CD4＋ cell, and improve the QOL of patients with HIV.

Effect of purulent moxibustion on Zúsānlǐ(足三里ST 36) point on the clinical symptoms of patients with malignant tumor

Objective To discuss the effect of purulent moxibustion on Zusanli （足三里 ST 36） point on the clinical symptoms and life quality of patients with malignant tumor. Methods Sixty patients with malignant tumor were divided into an observation group and a control group with 30 cases in each group. The observation group was treated with purulent moxibustion on Zusanli （足三里 ST 36） in combination with herbal medicine; the control group was only treated with herbal medicine. After 80 days, the changes of the clinical symptoms and KPS of the two groups before and after the treatment were observed. Results The effective rates for the improvement of lassitude, poor appetite and insomnia in the observation group were 72.4% （21/29） ,25.0% （15/20） ,71.4% （15/21）, and those in the control group were 42.9%（12/28） ,55.6% （10/18） ,42.9% （6/14）, and there was no statistical significance of difference between the two groups（P〉0.05）. KPS has statistical significance in the two groups after the treatment （P〈0.01）,and the observation group was higher than the control group. Conclusion Purulent moxibustion on the point of Zusanli （足三里 ST 36） has certain effect to improve the clinical symptoms of patients with malignant tumor, and raise KPS and upgrade the life quality of patients.

化脓性脑膜炎的治疗

本文综述化脓性脑膜炎(PM)的病原学及其耐药性变迁;探讨了抗菌治疗的药理基础;对PM 治疗现状及发展进行了评述并提出治疗不同类型 PM 的合理用药方案。

Laparoscopic treatment of complicated colonic diverticular disease:A review

Up to 10% of acute colonic diverticulitis may necessitate a surgical intervention. Although associated with high morbidity and mortality rates,Hartmann's procedure(HP) has been considered for many years to be the gold standard for the treatment of generalized peritonitis. To reduce the burden of surgery in these situations and as driven by the accumulated experience in colorectal and minimally-invasive surgery,laparoscopy has been increasingly adopted in the management of abdominal emergencies. Multiple case series and retrospective comparative studies confirmed that with experienced hands,the laparoscopic approach provided better outcomes than the open surgery. This technique applies to all interventions related to complicated diverticular disease,such as HP,sigmoid resection with primary anastomosis(RPA) and reversal of HP. The laparoscopic approach also provided new therapeutic possibilities with the emergence of the laparoscopic lavage drainage(LLD),particularly interesting in the context of purulent peritonitis of diverticular origin. At this stage,however,most of our knowledge in these fields relies on studies of low-level evidence. More than ever,well-built large randomized controlled trials are necessary to answer present interrogations such as the exact place of LLD or the most appropriate sigmoid resection procedure(laparoscopic HP or RPA),as well as to confirm the advantages of laparoscopy in chronic complications of diverticulitis or HP reversal.

莫西沙星治疗病原菌不明的成人化脓性脑膜炎1例

本文主要针对莫西沙星治疗成人化脓性脑膜炎进行分析,以我院1例病原菌不明的成人化脓性脑膜患者为例,总结其治疗效果,并分析莫西沙星的应用价值。

Yersinia enterocolitica Infection of a Prosthetic Knee Joint.Case Report and Review of the Literature on Deep Sited Infections Caused by Y.enterocolitica

Prosthetic joint infection is a rare manifestation of Yersinia enterocolitica. We report a case of a patient presenting with fever and a purulent infection in his prosthetic knee joint caused by Y. enterocolitica. He had been operated in 1990 for arthrosis of the right knee. Re-operation was performed in 2007 for loosening of the prosthesis. Seven months later, following progressively increasing knee pain, he became acutely febrile and a purulent knee joint infection was diagnosed. Y. enterocolitica was isolated from the joint fluid. Serum antibodies against Y. enterocolitica were also positive. He was treated with debridement, replacement of the liner component of the prosthesis and a long course of intravenous antimicrobial therapy. The infection was thought to be in a chronic suppressive state. The final outcome after all therapy was good.