MENINGITIS

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 Réanimation Médicale, Hôpital Ambroise-Paré, Faculté 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.