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)st...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.展开更多
Objectives: The main aim of the current study is to examine the influence of socio-economic status and environmental factors on serologically diagnosed Japanese encephalitis cases in the state of West Bengal, India du...Objectives: The main aim of the current study is to examine the influence of socio-economic status and environmental factors on serologically diagnosed Japanese encephalitis cases in the state of West Bengal, India during 2005-2010. Materials and methods: A total of 648 blood/CSF specimens were collected and/or referred from the suspected AES cases, admitted in the different medical colleges and hospitals of the state during the year of 2005-2010. These specimens were subjected to JE Mac ELISA to determine the actual JE case amongst these AES. The association of the socio-economic status and environmental factors with the serologically diagnosed JE positive cases was studied by a statistical analysis through Normal Deviate test or Z test. Result: Out of 648 specimens, only 175 (27.0%) specimens were reactive to JE IgM antibody, of which 60.0% were from the male individuals and 40.0% from the female population. Major cases were observed in the age group of 0 - 10 years;followed by 11 - 20 years. Regarding literacy, only 58.3% cases had no education and 41.7% were from the literate with varying level of education, i.e., from primary level to post gra- duate level. A total of 65.7% cases were from low income group where as only 34.3% cases were from high income group. Regarding house type, 62.3% cases lived in mud house and 37.7% cases lived in the brick house. In most of the cases (74.3%), persons were living in close proximity to rice fields/lakes/ponds. 69.7% cases were found to occur in the monsoon and post-monsoon period whereas 30.3% cases were reported in the pre-monsoon period. Conclusion: Our study concludes that socio-economic status and environmental conditions were statistically significant contextual risk factors for serologically diagnosed JE incidences in West Bengal where JE is proved to be endemic in nature and such study constitutes a new report of this kind in the region.展开更多
目的分析2013-2021年宝鸡市急性脑炎脑膜炎症候群(Acute Meningeal and Encephalitis Syndrome,AMES)监测病例中乙型脑炎(乙脑)病例的构成和临床特征,为指导乙脑病例的诊断提供依据。方法按照宝鸡市AMES病例定义开展监测,所有病例进行...目的分析2013-2021年宝鸡市急性脑炎脑膜炎症候群(Acute Meningeal and Encephalitis Syndrome,AMES)监测病例中乙型脑炎(乙脑)病例的构成和临床特征,为指导乙脑病例的诊断提供依据。方法按照宝鸡市AMES病例定义开展监测,所有病例进行乙型脑炎病毒IgM抗体检测,对阳性病例按照入院诊断分为乙脑疑似病例组和非乙脑疑似病例组,比较两组病例临床表现与脑脊液生化特征的差异,比较监测实施前后宝鸡地区乙脑病例在陕西省的占比。结果2013-2021年共报告AMES病例2636例,乙脑IgM阳性158例,阳性率为5.99%,其中72例(45.57%)从入院诊断为疑似乙脑病例中检出,86例(54.43%)从AMES其它诊断中检出。临床表现为头痛、恶心、呕吐、抽搐比例在疑似和非疑似乙脑病例中无统计学意义(P>0.05)。发热、意识障碍、颈项强直、脑膜刺激征在疑似乙脑病例组高于非疑似乙脑病例组(P<0.05)。入院诊断为乙脑疑似病例和非乙脑疑似病例的脑脊液外观、蛋白含量、白细胞计数、葡萄糖和氯化物含量无统计学差异(P>0.05)。2005-2012年宝鸡市乙脑病例数占全省的10.65%(134/1258),2013-2021年占16.58%(161/971)。结论急性脑炎脑膜炎症候群监测可提高乙脑检出率,指导临床对乙型脑炎病例的诊断,应继续加强监测。展开更多
Hematopoietic cell transplantation（HCT） is widely performed for neoplastic and non-neoplastic diseases. HCT involves intravenous infusion of hematopoietic progenitor cells from human leukocyte antigen（HLA）-matched...Hematopoietic cell transplantation（HCT） is widely performed for neoplastic and non-neoplastic diseases. HCT involves intravenous infusion of hematopoietic progenitor cells from human leukocyte antigen（HLA）-matched donor（allogeneic） or from the patient（autologous）. Before HCT, the patient is prepared with high dose chemotherapy and/or radiotherapy to destroy residual malignant cells and to reduce immunologic resistance. After HCT, chemotherapy is used to prevent graft rejection and graft versus host disease（Gv HD）. Neurological complications are related to the type of HCT, underlying disease, toxicity of the conditioning regimens, immunosuppression caused by conditioning regimens, vascular complications generated by thrombocytopenia and/or coagulopathy, Gv HD and inappropriate immune response. In this review, neurological complications are presented according to time of onset after HCT：（1） early complications（in the first month）-related to harvesting of stem cells, during conditioning（drug toxicity, posterior reversible encephalopathy syndrome）, related to pancytopenia,（2） intermediate phase complications（second to sixth month）-central nervous system infections caused by prolonged neutropenia and progressive multifocal leukoencephalopathy due to JC virus,（3） late phase complications（after sixth month）-neurological complications of Gv HD, second neoplasms and relapses of the original disease.展开更多
文摘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.
文摘Objectives: The main aim of the current study is to examine the influence of socio-economic status and environmental factors on serologically diagnosed Japanese encephalitis cases in the state of West Bengal, India during 2005-2010. Materials and methods: A total of 648 blood/CSF specimens were collected and/or referred from the suspected AES cases, admitted in the different medical colleges and hospitals of the state during the year of 2005-2010. These specimens were subjected to JE Mac ELISA to determine the actual JE case amongst these AES. The association of the socio-economic status and environmental factors with the serologically diagnosed JE positive cases was studied by a statistical analysis through Normal Deviate test or Z test. Result: Out of 648 specimens, only 175 (27.0%) specimens were reactive to JE IgM antibody, of which 60.0% were from the male individuals and 40.0% from the female population. Major cases were observed in the age group of 0 - 10 years;followed by 11 - 20 years. Regarding literacy, only 58.3% cases had no education and 41.7% were from the literate with varying level of education, i.e., from primary level to post gra- duate level. A total of 65.7% cases were from low income group where as only 34.3% cases were from high income group. Regarding house type, 62.3% cases lived in mud house and 37.7% cases lived in the brick house. In most of the cases (74.3%), persons were living in close proximity to rice fields/lakes/ponds. 69.7% cases were found to occur in the monsoon and post-monsoon period whereas 30.3% cases were reported in the pre-monsoon period. Conclusion: Our study concludes that socio-economic status and environmental conditions were statistically significant contextual risk factors for serologically diagnosed JE incidences in West Bengal where JE is proved to be endemic in nature and such study constitutes a new report of this kind in the region.
文摘目的分析2013-2021年宝鸡市急性脑炎脑膜炎症候群(Acute Meningeal and Encephalitis Syndrome,AMES)监测病例中乙型脑炎(乙脑)病例的构成和临床特征,为指导乙脑病例的诊断提供依据。方法按照宝鸡市AMES病例定义开展监测,所有病例进行乙型脑炎病毒IgM抗体检测,对阳性病例按照入院诊断分为乙脑疑似病例组和非乙脑疑似病例组,比较两组病例临床表现与脑脊液生化特征的差异,比较监测实施前后宝鸡地区乙脑病例在陕西省的占比。结果2013-2021年共报告AMES病例2636例,乙脑IgM阳性158例,阳性率为5.99%,其中72例(45.57%)从入院诊断为疑似乙脑病例中检出,86例(54.43%)从AMES其它诊断中检出。临床表现为头痛、恶心、呕吐、抽搐比例在疑似和非疑似乙脑病例中无统计学意义(P>0.05)。发热、意识障碍、颈项强直、脑膜刺激征在疑似乙脑病例组高于非疑似乙脑病例组(P<0.05)。入院诊断为乙脑疑似病例和非乙脑疑似病例的脑脊液外观、蛋白含量、白细胞计数、葡萄糖和氯化物含量无统计学差异(P>0.05)。2005-2012年宝鸡市乙脑病例数占全省的10.65%(134/1258),2013-2021年占16.58%(161/971)。结论急性脑炎脑膜炎症候群监测可提高乙脑检出率,指导临床对乙型脑炎病例的诊断,应继续加强监测。
文摘Hematopoietic cell transplantation（HCT） is widely performed for neoplastic and non-neoplastic diseases. HCT involves intravenous infusion of hematopoietic progenitor cells from human leukocyte antigen（HLA）-matched donor（allogeneic） or from the patient（autologous）. Before HCT, the patient is prepared with high dose chemotherapy and/or radiotherapy to destroy residual malignant cells and to reduce immunologic resistance. After HCT, chemotherapy is used to prevent graft rejection and graft versus host disease（Gv HD）. Neurological complications are related to the type of HCT, underlying disease, toxicity of the conditioning regimens, immunosuppression caused by conditioning regimens, vascular complications generated by thrombocytopenia and/or coagulopathy, Gv HD and inappropriate immune response. In this review, neurological complications are presented according to time of onset after HCT：（1） early complications（in the first month）-related to harvesting of stem cells, during conditioning（drug toxicity, posterior reversible encephalopathy syndrome）, related to pancytopenia,（2） intermediate phase complications（second to sixth month）-central nervous system infections caused by prolonged neutropenia and progressive multifocal leukoencephalopathy due to JC virus,（3） late phase complications（after sixth month）-neurological complications of Gv HD, second neoplasms and relapses of the original disease.
