Meningoencephalitis due to Listeria monocytogenes in a Young Immunocompetent Patient: Case Report with Literature Review

Meningoencephalitis secondary to Listeria monocytogenes (L. monocytogenes) mainly affects newborns, the elderly and immunocompromised people;there are extremely rare cases in which said infection occurs in immunocompetent individuals. We present the case of a young adult patient without immunocompromise, who developed meningoencephalitis due to L. monocytogenes;This case is exceptional, since it occurred in an individual outside the classic age group, in addition to not having risk factors, which is why it should be considered an atypical causal agent.

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.

The lymphatic system:a therapeutic target for central nervous system disorders

The lymphatic vasculature forms an organized network that covers the whole body and is involved in fluid homeostasis,metabolite clearance,and immune surveillance.The recent identification of functional lymphatic vessels in the meninges of the brain and the spinal cord has provided novel insights into neurophysiology.They emerge as major pathways for fluid exchange.The abundance of immune cells in lymphatic vessels and meninges also suggests that lymphatic vessels are actively involved in neuroimmunity.The lymphatic system,through its role in the clearance of neurotoxic proteins,autoimmune cell infiltration,and the transmission of pro-inflammatory signals,participates in the pathogenesis of a variety of neurological disorders,including neurodegenerative and neuroinflammatory diseases and traumatic injury.Vascular endothelial growth factor C is the master regulator of lymphangiogenesis,a process that is critical for the maintenance of central nervous system homeostasis.In this review,we summarize current knowledge and recent advances relating to the anatomical features and immunological functions of the lymphatic system of the central nervous system and highlight its potential as a therapeutic target for neurological disorders and central nervous system repair.

The lymphatic drainage systems in the brain:a novel target for ischemic stroke?

Recent studies have proposed three lymphatic drainage systems in the brain,that is,the glymphatic system,the intramural periarterial drainage pathway,and meningeal lymphatic vessels,whose roles in various neurological diseases have been widely explored.The glymphatic system is a fluid drainage and waste clearance pathway that utilizes perivascular space and aquaporin-4 protein located in the astrocyte endfeet to provide a space for exchange of cerebrospinal fluid and interstitial fluid.The intramural periarterial drainage pathway drives the flow of interstitial fluid through the capillary basement membrane and the arterial tunica media.Meningeal lymphatic vessels within the dura mater are involved in the removal of cerebral macromolecules and immune responses.After ischemic stroke,impairment of these systems could lead to cerebral edema,accumulation of toxic factors,and activation of neuroinflammation,while restoration of their normal functions can improve neurological outcomes.In this review,we summarize the basic concepts of these drainage systems,including drainage routes,physiological functions,regulatory mechanisms,and detection technologies.We also focus on the roles of lymphatic drainage systems in brain injury after ischemic stroke,as well as recent advances in therapeutic strategies targeting these drainage systems.These findings provide information for potential novel strategies for treatment of stroke.

Advances in viral encephalitis:Viral transmission,host immunity,and experimental animal models

Viral infections have led to many public health crises and pandemics in the last few centuries.Neurotropic virus infection-induced viral encephalitis(VE),especially the symptomatic inflammation of the meninges and brain parenchyma,has attracted growing attention due to its high mortality and disability rates.Understanding the infectious routes of neurotropic viruses and the mechanism underlying the host immune response is critical to reduce viral spread and improve antiviral therapy outcomes.In this review,we summarize the common categories of neurotropic viruses,viral transmission routes in the body,host immune responses,and experimental animal models used for VE study to gain a deeper understanding of recent progress in the pathogenic and immunological mechanisms under neurotropic viral infection.This review should provide valuable resources and perspectives on how to cope with pandemic infections.

Vimentin as a potential target for diverse nervous system diseases

Vimentin is a major type Ⅲ intermediate filament protein that plays important roles in several basic cellular functions including cell migration, proliferation, and division. Although vimentin is a cytoplasmic protein, it also exists in the extracellular matrix and at the cell surface. Previous studies have shown that vimentin may exert multiple physiological effects in different nervous system injuries and diseases. For example, the studies of vimentin in spinal cord injury and stroke mainly focus on the formation of reactive astrocytes. Reduced glial scar, increased axonal regeneration, and improved motor function have been noted after spinal cord injury in vimentin and glial fibrillary acidic protein knockout(GFAPVIM) mice. However, attenuated glial scar formation in post-stroke in GFAP–/– VIM–/– mice resulted in abnormal neuronal network restoration and worse neurological recovery. These opposite results have been attributed to the multiple roles of glial scar in different temporal and spatial conditions. In addition, extracellular vimentin may be a neurotrophic factor that promotes axonal extension by interaction with the insulin-like growth factor 1 receptor. In the pathogenesis of bacterial meningitis, cell surface vimentin is a meningitis facilitator, acting as a receptor of multiple pathogenic bacteria, including E. coli K1, Listeria monocytogenes, and group B streptococcus. Compared with wild type mice, VIMmice are less susceptible to bacterial infection and exhibit a reduced inflammatory response, suggesting that vimentin is necessary to induce the pathogenesis of meningitis. Recently published literature showed that vimentin serves as a double-edged sword in the nervous system, regulating axonal regrowth, myelination, apoptosis, and neuroinflammation. This review aims to provide an overview of vimentin in spinal cord injury, stroke, bacterial meningitis, gliomas, and peripheral nerve injury and to discuss the potential therapeutic methods involving vimentin manipulation in improving axonal regeneration, alleviating infection, inhibiting brain tumor progression, and enhancing nerve myelination.

Disseminated tuberculosis presenting as meningitis and spondylodiscitis in an immunocompetent adult

Rationale:Disseminated tuberculosis involves the central nervous system in up to a third of cases.However,meningitis and spondylodiscitis due to miliary tuberculosis rarely occur together,particularly in the immuno-competent population.Patient concerns:A 37-year-old immunocompetent male presented with altered level of consciousness for one week and lower back pain with evening pyrexia for one month.Examination revealed spastic paraplegia and left hemiparesis.Diagnosis:Disseminated tuberculosis presenting with meningitis and spondylodiscitis.Interventions:Category I anti-tuberculous therapy with a tapering regimen of intravenous dexamethasone was administered.Outcomes:There was clinical improvement after nine months of treatment.Lessons:Tuberculosis may present with atypical clinical manifestations.Contrast enhanced computed tomography scan or magnetic resonance imaging combined with histopathological features,a high index of suspicion and clinical improvement with anti-tuberculous treatment can confirm the diagnosis in the absence of microbiological evidence,especially in extrapulmonary tuberculosis.

Prevotella oris-caused meningitis and spinal canal infection:A case report

BACKGROUND Prevotella oris-induced meningitis and Prevotella oris-induced meningitis concomitant with spinal canal infection are extremely rare.To the best of our knowledge,only 1 case of Prevotella oris-induced central system infection has been reported.This is the second report on meningitis combined with spinal canal infection due to Prevotella oris.CASE SUMMARY We report a case of a 9-year-old boy suffering from meningitis and spinal canal infection.The patient presented to the neurosurgery department with lumbosacral pain for 1 mo and headache and vomiting for 1 d.He had been treated with cephalosporin and nonsteroidal anti-inflammatory drugs for fever,otalgia and pharyngalgia in a local hospital 2 mo prior to this admission.During hospitalization,magnetic resonance imaging suggested meningitis and L3-S1 lumbosacral dural sac infection.The cerebrospinal fluid and blood cultures were negative,but the cerebrospinal fluid specimen indicated the presence of Prevotella oris by metagenomic next-generation sequencing.Previous cases of Prevotella oris infection were retrieved from PubMed to characterize the clinicopathological features and identify the prognostic factors and related antimicrobial treatment of infection due to Prevotella oris.CONCLUSION This report shed light on the characteristics of Prevotella oris infection and highlighted the role of metagenomic next-generation sequencing in pathogen detection.

Varicella-zoster virus meningitis with hypoglycorrhachia: A case report

BACKGROUND Varicella-zoster virus(VZV)is a common viral infection,but meningitis is a rare complication of VZV infection.The cerebrospinal fluid glucose of viral meningitis is usually within the normal range,which is different from bacteria,fungi,and cancerous meningitis.This paper reports a case of VZV meningitis with hypoglycorrhachia and the relevant literature was reviewed.CASE SUMMARY We report a case of an immunocompetent 39-year-old male,presenting with severe headache and fevers,without meningeal signs or exanthem,found to have VZV meningitis by the metagenomic next-generation sequencing of cerebrospinal fluid.The cerebrospinal fluid analysis revealed hypoglycorrhachia(cerebrospinal fluid glucose of 2.16)and he was treated successfully with intravenous acyclovir.Our literature review identified only ten cases diagnosed with VZV meningitis with hypoglycorrhachia previously reported to date in the English literature whose cerebrospinal fluid glucose was from 1.6 to 2.7mmol/L,with a ratio of cerebrospinal fluid to serum glucose from 0.30 to 0.49.CONCLUSION Although rare,the cerebrospinal fluid of patients with VZV meningitis may have hypoglycorrhachia,which broadens the understanding of the disease.

Persistent dysexecutive syndrome after pneumococcal meningitis complicated by recurrent ischemic strokes:A case report

Meningitis is a possible complication of pneumococcal infection concerning acute otitis media and sinusitis.It might compromise cognitive function,both for the infection itself and the vascular events that sometimes follow the acute phase.CASE SUMMARY Here we describe the case of a 32-year-old female patient admitted to the emergency room due to extensive pneumococcal meningitis as a consequence of sinus outbreak.She presented with extensive laminar ischemic damage in the acute phase,resulting in severe cognitive and behavioural impairment.Four years of follow-up,through neuropsychological assessments and neuroradiological investigations,demonstrated the presence of subsequent vascular events,3 months and 2 years after onset.CONCLUSION The case is discussed in light of scientific knowledge of the long-term outcomes of this pathology in order to potentially improve diagnosis and promote better outcomes.

Ischemic Stroke Complicating Neuromeningeal and Pulmonary Tuberculosis in Children: About a Case in Senegal

Tuberculosis is a major public health problem, especially in developing countries. Neuro-meningeal involvement is rare but represents one of the most severe forms with high morbidity and mortality. We report the case of an ischemic stroke complicating neuromeningeal and pulmonary tuberculosis in a four-month-old infant at the National Hospital Center of children Albert Royer (Senegal). The case was a four-month-old, male infant with no history. His vaccination was up to date according to Senegal’s expanded vaccination program. There was no notion of tuberculosis contagion. He was seen for a prolonged fever for more than a month and chronic cough. He had moderate malnutrition. Neurological examination revealed coma, meningeal syndrome, generalized tonic convulsions and hypertonia. The pupils were in bilateral miosis. Osteotendinous reflexes were abolished with a bilateral Babinski sign. He also had severe respiratory distress, bilateral pulmonary condensation syndrome. Brain computed tomography was in favor of an ischemic stroke. The test GeneXpert MTB/RIF was positive on cerebrospinal fluid and gastric tubing fluid. The curative treatment was based on a quadruple therapy based on rifampicin, isoniazid, pirazinamide and ethambutol. The evolution was unfavorable with the death of the patient.

In Hospital Death among under Five Years Children Hospitalized with Meningitis in the Eastern of the Democratic Republic of Congo

Background: Meningitis is a major public health problem needing timely diagnosis, appropriate treatment, prevention and control. Despite the advances in diagnosis and treatment of infectious diseases, meningitis is still considered as an important cause of mortality and morbidity, especially in the paediatric population of lower income countries such as the Democratic Republic of the Congo (DR Congo). In this study, we aimed to analyse the fatality aspect of suspected meningitis among children under five years. Materials and Methods: A prospective, descriptive study was carried out in the Paediatrics departments of four hospitals in the South-Kivu province in the Eastern part of the DR Congo from April 2021 to March 2022. Of the 1386 children enrolled, 251 children were suspected of meningitis. This study captures data generated in the framework of routine medical practice, which includes medical history, clinical diagnosis and results of locally conducted laboratory tests. Results: Throughout the study period, a total of 251 patients (18.1%) aged 1 month to 59 months with suspected meningitis were recruited out of 1386 children hospitalized in the Paediatrics. The fatality among hospitalized children with suspected meningitis during the study period was 27.9%, however the mortality linked to meningitis decreases with age, ranging from 37.5% among children under 2 years to 19.4% among those over 2 years old. Children hospitalized for meningitis with malnutrition as an underlying conditions, had a 3.5 times greater risk of dying. The case fatality rate was higher in transferred and not vaccinated children respectively (2.3 and 2.5 times). We observe that the death occurs early within the first 3 days. Conclusion: Our study noted a higher fatality rate in children with suspected meningitis that could probably be linked to the gape in vaccination and malnutrition as underline condition.

Analytical Optimization of GeneXpert Ultra for Detection of Tuberculosis in CSF Samples

Detection of Mycobacterium tuberculosis complex (MTBC) in extrapulmonary specimens can be challenging due to their paucibacillary nature. This difficulty is especially true for cerebrospinal fluid (CSF), and the low sensitivity and specificity for diagnosis hampers rapid detection and treatment in vulnerable populations. GeneXpert MTB/RIF Ultra has been shown to provide rapid results for detection of MTBC and associated Rifampin resistance, but there is limited data regarding standardized methods for CSF processing on this assay. In this study, we sought to provide guidance regarding the best methods for CSF processing, including optimal volumes to test, length of incubation with sample reagent and finally effects of long-term freezing on detection.

Meningitis Outbreak Caused by Neisseria meningitidis Serogroup C ST 10217 in 2019 in Diapaga, Burkina Faso

Introduction: Meningitis caused by Neisseria meningitidis constitutes a burden for the countries in the meningitis belt of sub-Saharan in general and particularly for Burkina Faso. In 2019 the Diapaga health district experienced a meningitis epidemic due to N. meningitidis serogroup C. Methods: This is a cross-sectional study with a descriptive aim in the health district of Diapaga where all cases of meningitis were included in this work. Rapid diagnostic tests (RDTs), culture as well as real-time PCR were used for the biological analysis of cerebral spinal fluid (CSF) samples. Results: Of 155 CSF samples analysed, 42% (65/155) were tested positve. Of them, N. meningitidis C accounted for 83% of all positive cases. Likewise, all thirteen (13) NmC strains were susceptible to oxacillin, ceftriaxone, penicillin and chloramphenicol. All strains of NmC belonged to the sequence type (ST) 10 217 and to the clonal complex (CC) 10 217. These CCs belonged to the same variant PorA type: P1.21-15.16;FetA type: F1-7;PorB type: 3-463. Conclusion: Burkina Faso had known an epidemic of meningitis caused by NmC in 2019 in the health district of Diapaga. This outbreak was contained in time due to the performance of the epidemiological surveillance system which made it possible to investigate on time and introduce the vaccine against the pathogen NmC.

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.

Identified Bacteria and Virus in the Cerebrospinal Fluid of under Five Years Hospitalized Children for Clinical Meningitis at Panzi Hospital in the Eastern Part of DRC

Background: Meningitis remains a leading cause of death among children below 5 years of age in the Democratic Republic of the Congo (DR Congo). Distinguishing children with bacterial meningitis from those with viral meningitis in the emergency department is sometimes difficult. Here we identified bacteria and virus in the cerebral spinal fluid (CSF) of children with meningitis. Material and Methods: This is a prospective, analytical study carried out in the Pediatrics department of Panzi Hospital in the South-Kivu province of DR Congo. Between April 2021 and March 2022, 150 of 251 collected CSF from children aged from 1 to 59 months hospitalised due to clinical meningitis at Panzi referral university hospital, Bukavu, Eastern DR Congo were sent to the Lancet laboratory for bacteria identification by a multiplex real-time PCR assay for detection of the most different viruses and bacterial species causing meningitis. Result: The used multiplex real-time PCR assay allowed us to identify germs in 24.7% of cases (37/150). We isolated bacteria in 25/37 (67.5%) cases, and viruses in 9/37 (24.3%) while virus and bacteria co-infection was detected in 3/37 (8.1%). The most frequently identified bacteria were Streptococcus pneumoniae 14/37 (37.8%) followed by Haemophilus influenzae 6/37 (16.2%). The main virus was cytomegalovirus 5/37 (3.5%). Despite the age, the most found bacterial are common in children from rural areas and unvaccinated children. Bacterial and virus co-infection were identified in 66.7% of children aged between 25 - 60 months, mainly among male children, and in all children from rural areas (100%). The overall case fatality rate was 30% and was very high among cases with co-infection CMV-Pneumococcal (66.7%), followed by Streptococcus pneumoniae (50%). Conclusion: Meningitis remains frequent among children aged from one to 59 months among Bukavu Infants. We noticed that, Children with co-infection with bacteria and viruses might need higher attention when having meningitis symptoms, as this could lead to fatal outcomes. The introduction of molecular techniques, such as multiplex real-time PCR, has the potential to improve diagnosis and patient outcomes.

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.

An Assessment of the Relationship between Built Environment and Socioeconomic Factors with the Incidence of Meningococcal Meningitis in Kaduna Urban Area, Nigeria

Meningococcal meningitis is an airborne disease that has been a threat to human life in many regions of the world, especially in West Africa. The disease has caused permanent physical impairment to some of its victims and many lives have been lost due to the disease. Factors that are associated with the incidence of the disease which are geographically referenced include built environment, geographical location and climatic conditions. Others are socioeconomic and demographic factors. This study established the relationship between built environment and socioeconomic factors with the incidence of the disease. Data that were used include the incidences of the disease from 2007 to 2011, housing conditions, population density, number of house ownership, employment, income level, and the number of hospitals, schools and refuse dumps. Neighborhoods were used as the unit of analysis in the study. The method of analyzing the data includes factor analysis and some statistical techniques in Geographical Information System such as the Ordinary Least Square (OLS). The findings of the study reveal the spatial variations of the incidence of Meningococcal meningitis in Kaduna Urban Area (KUA). The study recommends that there should be strict observance of the development control regulations especially at the high density residential neighborhood. The model can also be used for other communicable disease to ensure the health of the public.

Role of cerebrospinal fluid lactate in diagnosing meningitis in critically ill patients

BACKGROUND Meningitis is a life-threatening clinical condition associated with high mortality and morbidity.Early diagnosis and specific treatment may improve outcomes.Lack of specific clinical signs or tests make the diagnosis challenging.AIM To assess the efficacy of cerebrospinal fluid(CSF)lactate in diagnosing meningitis in critically ill patients.METHODS A prospective,observational cohort study was carried out in a neuro-medical intensive care unit(ICU)over a 22 mo period.Adult patients,with suspected meningitis admitted in ICU,were serially recruited.Patients who refused consent,those with peripheral sensorineural deficit,or with any contraindication to lumber puncture were excluded.CSF cytology,bio-chemistry,lactates,culture and polymerase chain reaction based meningo-encephalitis panel were evaluated.Patients were divided in two groups based on clinical diagnosis of meningitis.The efficacy of CSF lactate in diagnosing meningitis was evaluated and compared with other tests.RESULTS Seventy-one patients were included and 23 were diagnosed with meningitis.The mean values of CSF total leucocyte count(TLC),proteins and lactates were significantly higher in meningitis group.There was a significant correlation of CSF lactate levels with CSF cultures and meningo-encephalitis panel.CSF lactate(>2.72 mmol/L)showed good accuracy in diagnosing meningitis with an area under the curve of 0.81(95% confidence interval:0.69-0.93),sensitivity of 82.6%,and specificity 72.9%.These values were comparable to those of CSF TLC and protein.Twelve patients with bacterial meningitis had significantly higher CSF lactate(8.9±4.7 mmol/L)than those with non-bacterial meningitis(4.2±3.8 mmol/L),P=0.006.CONCLUSION CSF lactate may be used to aid in our diagnosis of meningitis in ICU patients.CSF lactate(>2.72 mmol/L)showed good accuracy,sensitivity,and specificity in diagnosing meningitis and may also help to differentiate between bacterial and non-bacterial meningitis.

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.