MENINGITIS

January 2007

Diagnosis, Diagnostics, Immunodiagnosis & Immunodiagnostics:

15901. Al-Tawfiq JA. Haemophilus influenzae type e meningitis and bacteremia in a healthy adult. Intern Med. 2007;46(4):195-8.

15902. Avery RA, Frank G, Eppes SC. Predictive model for Lyme meningitis: a reply. Pediatrics. 2007 Jan;119(1):219-20.

15903. Caws M, Thwaites GE, Duy PM, Tho DQ, Lan NT, Hoa DV, Chau TT, Huyen MN, Anh PT, Chau NV, Chinh TN, Stepniewska K, Farrar J. Molecular analysis of Mycobacterium tuberculosis causing multidrug-resistant tuberculosis meningitis. Int J Tuberc Lung Dis. 2007 Feb;11(2):202-8.

15904. Dinnes J, Deeks J, Kunst H, Gibson A, Cummins E, Waugh N, Drobniewski F, Lalvani A. A systematic review of rapid diagnostic tests for the detection of tuberculosis infection. Health Technol Assess. 2007 Jan;11(3):1-196. Review.

15905. Ebell MH. Predicting the likelihood of bacterial meningitis in children. Am Fam Physician. 2007 Feb 15;75(4):533-5.

15906. Fitch MT, van de Beek D. Emergency diagnosis and treatment of adult meningitis. Lancet Infect Dis. 2007 Mar;7(3):191-200. Review.

15907. Kalita J, Misra UK, Ranjan P. Predictors of long-term neurological sequelae of tuberculous meningitis: a multivariate analysis. Eur J Neurol. 2007 Jan;14(1):33-7.

15908. Maree F, Hesseling AC, Schaaf HS, Marais BJ, Beyers N, van Helden P, Warren RM, Schoeman JF. Absence of an association between Mycobacterium tuberculosis genotype and clinical features in children with tuberculous meningitis. Pediatr Infect Dis J. 2007 Jan;26(1):13-8.

15909. Marom R, Sakran W, Antonelli J, Horovitz Y, Zarfin Y, Koren A, Miron D. Quick identification of febrile neonates with low risk for serious bacterial infection: an observational study. Arch Dis Child Fetal Neonatal Ed. 2007 Jan;92(1):F15-8.

15910. Pedro LG, Boente RF, Madureira DJ, Matos JA, Rebelo CM, Igreja RP, Barroso DE. Diagnosis of meningococcal meningitis in Brazil by use of PCR. Scand J Infect Dis. 2007;39(1):28-32.

15911. Rafi W, Venkataswamy MM, Nagarathna S, Satishchandra P, Chandramuki A. Role of IS6110 uniplex PCR in the diagnosis of tuberculous meningitis: experience at a tertiary neurocentre. Int J Tuberc Lung Dis. 2007 Feb;11(2):209-14.

15912. Rafi W, Venkataswamy MM, Ravi V, Chandramuki A. Rapid diagnosis of tuberculous meningitis: a comparative evaluation of in-house PCR assays involving three mycobacterial DNA sequences, IS6110, MPB-64 and 65 kDa antigen. J Neurol Sci. 2007 Jan 31;252(2):163-8.

Vaccines:

15913. Backhouse JL, Gidding HF, MacIntyre CR, McIntyre PB, Gilbert GL. Population-based seroprevalence of Neisseria meningitidis serogroup C capsular antibody before the introduction of conjugate vaccine, in Australia. Vaccine. 2007 Jan 26;25(7):1310-5.

15914. Miller E, Andrews N, Stowe J, Grant A, Waight P, Taylor B. Risks of convulsion and aseptic meningitis following measles-mumps-rubella vaccination in the United Kingdom. Am J Epidemiol. 2007 Mar 15;165(6):704-9.

15915. Nigrovic LE, Kuppermann N, Macias CG, Cannavino CR, Moro-Sutherland DM, Schremmer RD, Schwab SH, Agrawal D, Mansour KM, Bennett JE, Katsogridakis YL, Mohseni MM, Bulloch B, Steele DW, Kaplan RL, Herman MI, Bandyopadhyay S, Dayan P, Truong UT, Wang VJ, Bonsu BK, Chapman JL, Kanegaye JT, Malley R; Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics. Clinical prediction rule for identifying children with cerebrospinal fluid pleocytosis at very low risk of bacterial meningitis. JAMA. 2007 Jan 3;297(1):52-60.

Chemotherapy, Immunotherapy, Management & Drugs:

15916. Klein M, Koedel U, Pfister HW. Oxidative stress in pneumococcal meningitis: a future target for adjunctive therapy? Prog Neurobiol. 2006 Dec;80(6):269-80.

15917. Nadel S, Kroll JS. Diagnosis and management of meningococcal disease: the need for centralized care. FEMS Microbiol Rev. 2007 Jan;31(1):71-83. Review.

15918. Thwaites GE, Macmullen-Price J, Tran TH, Pham PM, Nguyen TD, Simmons CP, White NJ, Tran TH, Summers D, Farrar JJ. Serial MRI to determine the effect of dexamethasone on the cerebral pathology of tuberculous meningitis: an observational study. Lancet Neurol. 2007 Mar;6(3):230-6.

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April 2007

Selected abstracts:

1. Auburtin M, Wolff M, Charpentier J, Varon E, Le Tulzo Y, Girault C, Mohammedi I, Renard B, Mourvillier B, Bruneel F, Ricard JD, Timsit JF. Detrimental role of delayed antibiotic administration and penicillin-nonsusceptible strains in adult intensive care unit patients with pneumococcal meningitis: the PNEUMOREA prospective multicenter study. Crit Care Med. 2006 Nov;34(11):2758-65.

From the Service de Reanimation Medicale et des Maladies Infectieuses, Hopital Bichat-Claude-Bernard, AP-HP, Paris, France.

OBJECTIVE: To identify factors associated with mortality and morbidity among adults admitted to intensive care units (ICUs) for pneumococcal meningitis, particularly the impact of delayed antibiotic administration. DESIGN: We conducted a prospective, multicenter, observational study of 156 consecutive adults hospitalized for pneumococcal meningitis. We analyzed parameters associated with 3-month survival. SETTING: Fifty-six medical and medical-surgical ICUs in France. INTERVENTION: None. RESULTS: Of the 148 strains isolated, 56 (38%) were nonsusceptible to penicillin G. At 3 months after ICU admission, the mortality rate was 33% (51/156), and 34% of survivors (36/105) had neurologic sequelae. Multivariate analysis identified three variables as independently associated with 3-month mortality: Simplified Acute Physiology Score II (odds ration [OR], 1.12; 95% confidence interval [CI], 1.072-1.153; p = .002); isolation of a nonsusceptible strain (OR, 6.83; 95% CI, 2.94-20.8; p < 10(-4)), and an interval of >3 hrs between hospital admission and administration of antibiotics (OR, 14.12; 95% CI, 3.93-50.9; p < 10(-4)). In contrast, a cerebrospinal fluid leukocyte count >10(3) cells/microL had a protective effect (OR, 0.30; 95% CI, 0.10-0.944; p = 0.04). CONCLUSIONS: Independent of severity at the time of ICU admission, isolation of penicillin-nonsusceptible strains and a delay in antibiotic treatment following admission were predictors of mortality among patients with pneumococcal meningitis.

2. Shalabi M, Whitley RJ. Recurrent benign lymphocytic meningitis. Clin Infect Dis. 2006 Nov 1;43(9):1194-7.

Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL 35294, USA.

Recurrent benign lymphocytic meningitis is a recurring, typically innocuous, painful form of aseptic meningitis. This syndrome is associated with transient neurological symptoms in one-half of afflicted patients. The causative agent is usually herpes simplex virus type 2, which can be confirmed by detection of viral DNA in the cerebrospinal fluid using polymerase chain reaction. Clinical disease resolves spontaneously; however, acyclovir, valacyclovir, and famciclovir have been administered to some patients for both episodic therapy and suppression of recurrences. This therapy is thought to be beneficial, although there is no controlled trial data to support efficacy and safety.

Diagnosis, Diagnostics, Immunodiagnosis & Immunodiagnostics:

15459. Belorgey L, Lalani I, Zakaria A. Ischemic stroke in the setting of tuberculous meningitis. J Neuroimaging. 2006 Oct;16(4):364-6.

15460. Nagafuchi M, Nagafuchi Y, Sato R, Imaizumi T, Ayabe M, Shoji H, Ichiyama T. Adult meningism and viral meningitis, 1997-2004: clinical data and cerebrospinal fluid cytokines. Intern Med. 2006;45(21):1209-12.

15461. Nolte FS. Case studies in cost effectiveness of molecular diagnostics for infectious diseases: pulmonary tuberculosis, enteroviral meningitis, and BK virus nephropathy. Clin Infect Dis. 2006 Dec 1;43(11):1463-7.

15462. Rayamajhi A, Singh R, Prasad R, Khanal B, Singhi S. Clinico-laboratory profile and outcome of Japanese encephalitis in Nepali children. Ann Trop Paediatr. 2006 Dec;26(4):293-301.

15463. Saha SK, Baqui AH, El Areefin S, Qazi S, Billal DS, Islam M, Roy E, Ruhulamin M, Black RE, Santosham M. Detection of antigenuria for diagnosis of invasive Haemophilus influenzae type b disease. Ann Trop Paediatr. 2006 Dec;26(4):329-36.

15464. Zerr DM, Frenkel LM, Huang ML, Rhoads M, Nguy L, Del Beccaro MA, Corey L. Polymerase chain reaction diagnosis of primary human herpesvirus-6 infection in the acute care setting. J Pediatr. 2006 Oct;149(4):480-5.

Pathogenesis:

15465. Mogensen TH, Paludan SR, Kilian M, Ostergaard L. Two neisseria meningitidis strains with different ability to stimulate toll-like receptor 4 through the MyD88-independent pathway. Scand J Immunol. 2006 Dec;64(6):646-54.

Vaccines:

15466. Bonnet MC, Dutta A, Weinberger C, Plotkin SA. Mumps vaccine virus strains and aseptic meningitis. Vaccine. 2006 Nov 30;24(49-50):7037-45.

15467. Brenneman G, Rhoades E, Chilton L. Forty years in partnership: the American Academy of Pediatrics and the Indian Health Service. Pediatrics. 2006 Oct;118(4):e1257-63.

15468. Granerod J, Davison KL, Ramsay ME, Crowcroft NS. Investigating the aetiology of and evaluating the impact of the Men C vaccination programme on probable meningococcal disease in England and Wales. Epidemiol Infect. 2006 Oct;134(5):1037-46.

15469. Kelly DF, Snape MD, Cutterbuck EA, Green S, Snowden C, Diggle L, Yu LM, Borkowski A, Moxon ER, Pollard AJ. CRM197-conjugated serogroup C meningococcal capsular polysaccharide, but not the native polysaccharide, induces persistent antigen-specific memory B cells. Blood. 2006 Oct 15;108(8):2642-7.

15470. Moore HC, Lehmann D. Decline in meningitis admissions in young children: vaccines make a difference. Med J Aust. 2006 Oct 2;185(7):404.

15471. Saha SK, Baqui AH, El Areefin S, Qazi S, Billal DS, Islam M, Roy E, Ruhulamin M, Black RE, Santosham M. Detection of antigenuria for diagnosis of invasive Haemophilus influenzae type b disease.Ann Trop Paediatr. 2006 Dec;26(4):329-36.

15472. Savory EC, Cuevas LE, Yassin MA, Hart CA, Molesworth AM, Thomson MC. Evaluation of the meningitis epidemics risk model in Africa. Epidemiol Infect. 2006 Oct;134(5):1047-51.

Therapy:

15473. Al Khorasani A, Banajeh S. Bacterial profile and clinical outcome of childhood meningitis in rural Yemen: a 2-year hospital-based study. J Infect. 2006 Oct;53(4):228-34.

15474. Caws M, Thwaites G, Stepniewska K, Nguyen TN, Nguyen TH, Nguyen TP, Mai NT, Phan MD, Tran HL, Tran TH, van Soolingen D, Kremer K, Nguyen VV, Nguyen TC, Farrar J. Beijing genotype of Mycobacterium tuberculosis is significantly associated with human immunodeficiency virus infection and multidrug resistance in cases of tuberculous meningitis. J Clin Microbiol. 2006 Nov;44(11):3934-9.

15475. Fisk BA, Jackson WL Jr. Outcomes following pneumococcal meningitis: room for improvement remains expansive. Crit Care Med. 2006 Nov;34(11):2853-5.

15476. Jubelt B. Dexamethasone for the treatment of tuberculous meningitis in adolescents and adults. Curr Neurol Neurosci Rep. 2006 Nov;6(6):451-2.

15477. Ricard JD, Wolff M, Lacherade JC, Mourvillier B, Hidri N, Barnaud G, Chevrel G, Bouadma L, Dreyfuss D. Levels of vancomycin in cerebrospinal fluid of adult patients receiving adjunctive corticosteroids to treat pneumococcal meningitis: a prospective multicenter observational study. Clin Infect Dis. 2007 Jan 15;44(2):250-5.

15478. Weisfelt M, van de Beek D, Spanjaard L, Reitsma JB, de Gans J. Community-acquired bacterial meningitis in older people. J Am Geriatr Soc. 2006 Oct;54(10):1500-7.

15479. Weisfelt M, Hoogman M, van de Beek D, de Gans J, Dreschler WA, Schmand BA. Dexamethasone and long-term outcome in adults with bacterial meningitis. Ann Neurol. 2006 Oct;60(4):456-68.

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July 2007

Diagnosis, Diagnostics, Immunodiagnosis & Immunodiagnostics:

15901. Al-Tawfiq JA. Haemophilus influenzae type e meningitis and bacteremia in a healthy adult. Intern Med. 2007;46(4):195-8.

15902. Avery RA, Frank G, Eppes SC. Predictive model for Lyme meningitis: a reply. Pediatrics. 2007 Jan;119(1):219-20.

15905. Ebell MH. Predicting the likelihood of bacterial meningitis in children. Am Fam Physician. 2007 Feb 15;75(4):533-5.

15906. Fitch MT, van de Beek D. Emergency diagnosis and treatment of adult meningitis. Lancet Infect Dis. 2007 Mar;7(3):191-200. Review.

15907. Kalita J, Misra UK, Ranjan P. Predictors of long-term neurological sequelae of tuberculous meningitis: a multivariate analysis. Eur J Neurol. 2007 Jan;14(1):33-7.

15910. Pedro LG, Boente RF, Madureira DJ, Matos JA, Rebelo CM, Igreja RP, Barroso DE. Diagnosis of meningococcal meningitis in Brazil by use of PCR. Scand J Infect Dis. 2007;39(1):28-32.

Vaccines:

Chemotherapy, Immunotherapy, Management & Drugs:

15916. Klein M, Koedel U, Pfister HW. Oxidative stress in pneumococcal meningitis: a future target for adjunctive therapy? Prog Neurobiol. 2006 Dec;80(6):269-80.

15917. Nadel S, Kroll JS. Diagnosis and management of meningococcal disease: the need for centralized care. FEMS Microbiol Rev. 2007 Jan;31(1):71-83. Review.

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October 2007

Selected abstracts:

1. Chavanet P, Schaller C, Levy C, Flores-Cordero J, Arens M, Piroth L, Bingen E, Portier H. Performance of a predictive rule to distinguish bacterial and viral meningitis. J Infect. 2007 Apr;54(4):328-36.

Service des Maladies Infectieuses, EA 652, University Hospital, Hopital du Bocage, 21000 Dijon, France. pascal.chavanet@chu-dijon.fr <pascal.chavanet@chu-dijon.fr>

OBJECTIVE: Although diagnostic performance has recently improved by using new diagnostic methodologies, acute patient management is usually initiated after considering only fairly elementary findings of CSF examination. Using these early findings it is often difficult to distinguish between bacterial and aseptic (viral) meningitis. In order to help distinguish these two categories, scoring tools have been proposed that are more or less complex and validated. METHODS: The aim of this study was to establish a simple scoring tool and compare it to other available decision making systems. We retrospectively analysed all the meningitis cases from our patients at our institution and established a scoring tool for pediatric meningitis and for meningitis in adults by using categorized analysis tree methodology. RESULTS: Main categories for bacterial etiology were, leucocytosis >15 giga, CSF leucocytes count >1700 per ml, CSF neutrophil percentage >80, CSF protein >2.3g/l and glucose CSF/blood ratio <0.33 for adults and CSF leucocytes count >1800, CSF neutrophil percentage >80, CSF protein >1.2g/l and glucose CSF/blood ratio <0.3 for children. Additionally, our new scoring tool and five published ones were compared using our data and two external data sets; from these scores, three, including ours, exhibited good sensitivity and specificity. We then performed several thousand Monte Carlo simulations of both bacterial and viral meningitis for children and adults. We found that our scoring tool (Meningitest) had very high performances with positive and negative predictive values of 97% and 94%, respectively. CONCLUSION: Thus, from this analysis of five meningitis scoring systems, we believe that our new tool is simple, does not need any complex calculation and is effective in identifying bacterial vs viral meningitis in fully immunocompetent children and adults.

2. Ghani NA, Jaafar R, Ishak S, Zainuddin AA, Mukari SA, Mahdy ZA. Mother with post-partum group B Streptococcus meningitis and cerebellar abscess. J Obstet Gynaecol Res. 2007 Apr;33(2):195-8. Review.

Department of Obstetrics and Gynaecology, Hospital Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia. azurah@mail.hukm.ukm.my

We report the case of a 25-year-old Malay woman, admitted for preterm delivery at 35 weeks' gestation. Vaginal swab did not isolate any organism. She delivered a baby girl who developed respiratory distress syndrome, requiring ventilation. Although chest radiograph showed hyaline membrane disease with pneumonia, septic workout was negative. The mother was discharged on the next day. Seven days postpartum, the mother presented with fever and fits and was diagnosed to have meningo-encephalitis. Lumbar puncture isolated group B Streptococcus (GBS) and MRI revealed a superior cerebellar abscess. She was treated and survived the episode. This case illustrates the uncommon situation where GBS infection was confirmed via maternal septic workout rather than neonatal, although both presented with severe disease.

3. Lichtenstein DA. Point-of-care ultrasound: Infection control in the intensive care unit. Crit Care Med. 2007 May;35(5 Suppl):S262-7. Review.

Service de R�animation M�dicale, H�pital Ambroise-Par�, Facult� Paris-Ouest, Boulogne, France. dlicht@free.fr

Ultrasound provides a diagnostic modality that allows a whole-body approach at the bedside of a critically ill patient in the search for infectious foci. Both common sites of infection, such as the lung and pleura, central veins, and maxillary sinuses, and also less common sites, such as gastrointestinal perforation, sepsis due to mesenteric ischemia, or even meningitis, provide characteristic ultrasound patterns. Optimal use of ultrasound also combines bedside diagnosis with subsequent interventional procedures that can decrease the need for transfer to other imaging and interventional suites. Experience has shown that fevers of unknown origin in the critical care unit often have ultrasound equivalents. Thus, if a comprehensive ultrasound examination is negative, it is now appropriate to speak of fever of unknown sonographic origin.

Diagnosis, Diagnostics, Immunodiagnosis & Immunodiagnostics:

16443. Chanet V, Brazille P, Honore S, Michel M, Schaeffer A, Zarrouk V. Lactobacillus septic arthritis. South Med J. 2007 May;100(5):531-2.

16444. Fix A, Lang VJ. A complication of forceful nose-blowing. Am J Med. 2007 Apr;120(4):328-9.

16445. Gao B, Yang J, Zhuang S, Deng Y, Yang W, Yu Y, Wang Y, Luo L, Dai K. Mollaret meningitis associated with an intraspinal epidermoid cyst. Pediatrics. 2007 Jul;120(1):e220-4.

16446. Hirotani M, Yabe I, Hamada S, Tsuji S, Kikuchi S, Sasaki H. Abnormal brain MRI signals in the splenium of the corpus callosum, basal ganglia and internal capsule in a suspected case with tuberculous meningitis. Intern Med. 2007;46(8):505-9.

16447. Jolobe OM. Community-acquired bacterial meningitis in older people. J Am Geriatr Soc. 2007 Apr;55(4):628-9; author reply 629-30.

16448. Kuan CC, Kaga K, Tsuzuku T. Tuberculous meningitis-induced unilateral sensorineural hearing loss: a temporal bone study. Acta Otolaryngol. 2007 May;127(5):553-7.

16449. Kutlu T, Tugrul S, Aydin A, Oral O. Tuberculous meningitis in pregnancy presenting as hyperemesis gravidarum. J Matern Fetal Neonatal Med. 2007 Apr;20(4):357-9.

16450. Leaman J. Meningitis in an infant: all that's aseptic is not viral. JAAPA. 2007 Jun;20(6):26, 29-31.

16451. Lee BE, Davies HD. Aseptic meningitis. Curr Opin Infect Dis. 2007 Jun;20(3):272-7. Review.

16452. Mittal MK, Shah SS, Friedlaender EY. Group B streptococcal cellulitis in infancy. Pediatr Emerg Care. 2007 May;23(5):324-5. Review.

16453. Obaro S. Prediction rule for bacterial meningitis in children. JAMA. 2007 Apr 18;297(15):1653-4; author reply 1654-5.

16454. Okuma H, Kobori S, Shinohara Y, Takagi S. A case of hypertrophic pachymeningitis with prolonged headache, attributable to Epstein-Barr virus. Headache. 2007 Apr;47(4):620-2.

16455. Sparks JR, Recchia FM, Weitkamp JH. Endogenous group B streptococcal endophthalmitis in a preterm infant. J Perinatol. 2007 Jun;27(6):392-4.

16456. Srikanth SG, Taly AB, Nagarajan K, Jayakumar PN, Patil S. Clinicoradiological features of tuberculous meningitis in patients over 50 years of age. J Neurol Neurosurg Psychiatry. 2007 May;78(5):536-8.

16457. Wolff AE, Hansen KE, Zakowski L. Acute Kawasaki disease: not just for kids. J Gen Intern Med. 2007 May;22(5):681-4. Review.

Vaccines:

16458. Riddell A, Buttery JP, McVernon J, Chantler T, Lane L, Bowen-Morris J, Diggle L, Morris R, Lockhart S, Pollard AJ, Cartwright K, Moxon ER. A randomized study comparing the safety and immunogenicity of a conjugate vaccine combination containing meningococcal group C and pneumococcal capsular polysaccharide--CRM197 with a meningococcal group C conjugate vaccine in healthy infants: challenge phase. Vaccine. 2007 May 10;25(19):3906-12.

16459. Stephens DS, Greenwood B, Brandtzaeg P. Epidemic meningitis, meningococcaemia, and Neisseria meningitidis. Lancet. 2007 Jun 30;369(9580):2196-210. Review.

16460. Swingler G, Fransman D, Hussey G. Conjugate vaccines for preventing Haemophilus influenzae type B infections. Cochrane Database Syst Rev. 2007 Apr 18;(2):CD001729. Review.

Chemotherapy, Immunotherapy, Management & Drugs:

16461. Bhat V, Manjunath D. Cerebrospinal fluid otorrhea presenting in complicated chronic suppurative otitis media. Ear Nose Throat J. 2007 Apr;86(4):223-5.

16462. Kannoth S, Iyer R, Thomas SV, Furtado SV, Rajesh BJ, Kesavadas C, Radhakrishnan VV, Sarma PS. Intracranial infectious aneurysm: presentation, management and outcome. J Neurol Sci. 2007 May 15;256(1-2):3-9.

16463. Spremo S, Udovcic B. Acute mastoiditis in children: susceptibility factors and management. Bosn J Basic Med Sci. 2007 May;7(2):127-31.

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