bacterial meningitis

 Elizabethkingia meningoseptica (EM) is a gram-negative aerobic organism that can cause severe infections. Although the incidence is higher in developing countries, human infections associated with this organism are seldom described in Serbia. This bacterium is usually resistant to most antibiotics, making the treatment challenging.We present a single twin born as a late-preterm newborn who developed sepsis and meningitis caused by EM.

 This case report aims to show that this rare bacterium is present in our country and the clinical presentation of the resulting disease and bacterial resistance to antibiotics. In addition, we assessed if a more thorough diagnosis, including the immunological status of the newborn, is needed.

 Considering the high mortality and morbidity rates of EM and its multiresistance, early identification of the infection cause and determining the patient’s immunological status are vital for treatment and improved patient outcomes.

This study aimed to compare the diagnostic efficacy of standard culture method with multiplex quantitative real-time polymerase chain reaction (qPCR) in examining cerebrospinal fluid (CSF) samples collected from patients with suspected meningitis.

A retrospective evaluation was conducted on 166 patients with suspected meningitis, who were treated in Vali-Asr hospital in Birjand, Iran between 2011 and 2020. Diagnosis of bacterial meningitis was based on CSF culture and multiplex qPCR results.

Among 166 patients, conventional methods identified causative pathogens in only 10.3% of cases, while multiplex qPCR detected pathogens in eight out of 25 culture-negative cases as well. The most common pathogens identified were enterovirus, Epstein-Barr virus, herpes simplex, Haemophilus influenzae, and Streptococcus pneumoniae.

Multiplex qPCR appears to be a more effective method than conventional culture in identifying bacterial and viral pathogens that most commonly cause meningitis. The incorporation of qPCR as a routine diagnostic method for meningitis in clinical practice could significantly enhance clinical decision-making and patient care.

Cerebrospinal fluid (CSF) and blood biomarkers are widely evaluated as diagnostic tools to distinguish between bacterial meningitis and viral meningitis in emergency laboratory tests. So, this aimed to examine the levels of diagnostic parameters in blood and CSF to discriminate between bacterial and viral meningitis in young children referred to Khoy Hospital.

A total of 101 young children with meningitis were enrolled in this prospective study. The diagnosis of bacterial and viral meningitis was based on clinical features and laboratory findings.

Of the 101 patients with meningitis, 18 (17.82%) were bacterial, and 83 (82.17%) were viral meningitis. The levels of CSF glucose and CSF/blood glucose ratio were significantly lower in the bacterial meningitis group than in the viral meningitis group (p < 0.01). In contrast, white blood cells count, CSF protein, interleukin-6, C-reactive protein, and ferritin levels were significantly higher in patients with bacterial meningitis compared to viral meningitis (p < 0.01). However, there was no difference between viral and bacterial meningitis groups concerning mean serum glucose.

This study suggests that decreased CSF glucose and CSF/blood glucose ratio and increased white blood cells count, CSF protein, ferritin, interleukin-6, and C-reactive protein combined with clinical symptoms can help better diagnosis of bacterial meningitis, especially in comparison with viral meningitis.

Meningitis is a clinical syndrome that occurs for a variety of reasons such as bacterial infections. Acute bacterial meningitis can occur at any age, and is a leading cause of mortality worldwide. Streptococcus pneumonia is a bacterial meningitis that can lead to pneumococcal meningitis, especially in children. In recent decades, the percentage of pneumococcal strains resistant to penicillin and cephalosporins isolated from children has increased. This has made vancomycin the first empirical antibiotic therapy for children with suspected bacterial meningitis.In this report, we introduce a 13-month-old child who was brought to the emergency department of Akbar Children’s Hospital, Mashhad (a city in northeastern Iran) with complaints of high-grade fever and drowsiness. Meningitis was diagnosed via sampling of cerebrospinal fluid, and the culture indicated S. pneumonia that was non-sensitive to vancomycin. The e-test and microdilution have been approved to determine the minimum inhibitory concentration (MIC) of vancomycin; however, the e-test is a more straightforward method and the error probability is less while providing similar results to microdilution. Also, both methods can predict vancomycin tolerance or reduce sensitivity to vancomycin. Results of the e-test indicate MIC=2.

Childhood bacterial meningitis (BM) requires prompt and precise diagnosis to provide proper treatment and decline mortality and morbidity.

We aimed to evaluate the World Health Organization (WHO) criteria and polymerase chain reaction (PCR) for diagnosing BM in children admitted to a tertiary referral hospital in Shiraz, southern Iran. Materials: We included all 492 children aged one month to 17 years suspected of meningitis who had cerebrospinal fluid (CSF) leukocytosis admitted to Nemazi Hospital from August 2016 to September 2017. The CSF specimens were examined for routine analysis, Gram staining, and culture. A multiplex real-time PCR was used to identify Streptococcus pneumoniae, Haemophilus influenzae type b (Hib), and Neisseria meningitidis in the CSF samples. Seven viruses were also investigated using real-time PCR. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated using the WHO criteria and the multiplex real-time PCR results.

Seventy-four CSF samples had leukocytosis. Nineteen (22.9%) patients had BM caused by S. pneumoniae (n = 14), Hib (n = 2), Salmonella enterica (n = 2), and N. meningitidis (n = 1). The PCR test detected all cases, except for two with Salmonella meningitis (sensitivity 89.4%, specificity 100%, PPV 100%, and NPV 96%). The WHO criteria detected all cases, except three who received antibiotics at least four days before performing lumbar puncture (sensitivity 84.2%, specificity 98.2%, PPV 94.1%, and NPV 94.7%). Enterovirus was the most common viral etiology (6.75%).

The WHO criteria and the multiplex real-time PCR had high accuracy in our setting, and their use could decrease the antibiotic over-prescription in febrile children suspected of meningitis.

This study aimed to define risk factors associated with suppurative complications, short-term sequelae, and death in pediatric patients with bacterial meningitis.

A retrospective cohort study was conducted on children with bacterial meningitis, aged 0 months to 18 years, who were admitted to the Hospital Infantil João Paulo II, reference in infectious diseases, from 2005 to 2018.

In 178 cases, meningococcal meningitis was the most prevalent disease form (51%), followed by pneumococcal meningitis (31%) andHaemophilus influenzae type Bmeningitis (10%). Themain clinical findings at admission were fever (93.1%), vomiting (67.9%), drowsiness (47.8%), headache (36.5%), irritability (28.3%), and seizures (26.4%). Suppurative complications were recorded in 19% of the patients. The prevalence of neurological sequelae during hospital discharge was 12.4%. Hearing (41%; n = 9) and cognitive (9%) impairments were prominent among the diagnosed sequelae. Incidences of epileptic crises, vestibular disorders, or hydrocephalus were noted in one case each (4.5%), and 12.4% of the patients died.

Streptococcus pneumoniae and H. influenzae type B were associated with the diagnosis of sequelae during hospital discharge, seizures were considered a risk factor for suppurative complications, and gastrointestinal symptoms or signs of clinical severity were associated with death.

Whether early lumbar puncture (LP) and blood indicators are suitable as diagnostic criteria and helpful to treatment strategies for newborns remains to be solved. The study was to evaluate the value of cerebrospinal fluid (CSF) at the first LP and blood indicators at the similar time in the early diagnosis and the drug therapy of neonatal bacterial meningitis.

We conducted a retrospective observational study of 997 infants with suspected bacterial meningitis between June 2012 and June 2018. CSF and blood parameters were evaluated by three stepwise logistic models to assess their ability: to distinguish bacterial meningitis from nonbacterial meningitis, to distinguish positive CSF culture from negative, and to distinguish Gram‑positive bacteria from negative.

Of the 997 neonates, 236 (23.67%) were later diagnosed as bacterial meningitis. Of the neonates with meningitis, 54 (22.88%) had positive CSF culture results. And of neonates with positive CSF culture, 27 (50%) had Gram‑positive results. One or more CSF indicators were added to the three models. Only blood hypersensitive C‑reactive protein and blood lactate dehydrogenase were added to the first model, while no blood parameters was added to the other two models. The areas under the effect‑time curves of the three models were 0.91 (95% confidence interval [CI]: 0.89–0.92, P < 0.001), 0.69 (95% CI: 0.63–0.75, P < 0.001), and 0.86 (95% CI: 0.74–0.94, P < 0.001), respectively.

LP was irreplaceable predictor of bacterial meningitis, and comprehensive analysis of CSF indicators can predict the offending organism, which enables refinement of therapy.

Bacterial meningitis is the 10th most common cause of death worldwide. Early detection and treatment can decrease the mortality and morbidity rates. In this review, the treatment regimen of bacterial meningitis will be discussed in adult patients based on the microorganism. The benefits of the usage of corticosteroid (Dexamethasone in particular) will be elaborated in lowering the rates of death and neurological complications. The results of different studies on patients in developed and developing countries will the presented. Also, meta- analysis studies will review the patients with different ages and those affected with different microorganism to emphasize the benefit of the corticosteroid regimen as a part of the bacterial meningitis treatment.

A correct diagnosis of a disease among several diseases with the same clinical symptoms is very important and is a difficult task in medical science. Misdiagnosis of these diseases in the short term causes very high and serious damage to the health of patients and usually results in loss of golden time. In this paper, our purpose is to achieve the best conclusion, which contributes to the diagnosis of the critical illness without losing the golden opportunity based on clinical data and using mathematical models, especially fuzzy mathematics. The data regarding patient’s signs and symptoms were collected in the hospitals. We attained the best choice of diseases among the considered options of diseases by using basic fuzzy rules, fuzzy control techniques, fuzzy mathematics and fuzzy systems. To write the basic fuzzy rules, the information that we used was adopted by experts in infectious diseases or data records of patients who reached a definite diagnosis of disease by various tests. Then, by using these rules, the system of mathematical equations was formed. By solving this system, coefficients of a linear equation were estimated witch its values according to the clinical signs of a patient indicates the probability that the patient will be infected with that disease. In this process, the number of patients studied is n not effective. But the more patients are studied, the more accurately the coefficients of the diagnosis equation are obtained. The symptoms of some patients whose disease have been definitely diagnosed were used as inputs of the system of our equations and it was observed that the system’s outputs approximately coincide the exact diagnosis of the disease, which indicates that the equations obtained for the diagnosis of diseases are acceptable. The findings of this study can help to correctly diagnose the disease without losing golden opportunities. We hope that using the results of this research, the error in the initial diagnosis of diseases is significantly reduced.

Military personnel and recruits are generally a high-risk group for meningococcal disease, with a reported incidence of four to ten times greater than that of the general population. Unlike progresses in medicine, bacterial meningitis is still recognized as a medical emergency, which necessitates immediate actions for the definitive diagnosis and subsequently proper antimicrobial regimen. The mortality and morbidity rate are still high even with proper therapeutics and diagnosed cases, if left unattended, can reach 100% mortality. Epidemics with certain pathogens, especially N. meningitidis, might result in grave situations in public health levels in crowded places, namely military bases and camps, and this necessitates proper precautionary actions. Various vaccines have been introduced to control outbreaks in the public health context. In this review article, 45 related literatures regarding the “acute bacterial meningitis” were studied searching the Internet using Medical data bases such as PubMed and Google Scholar, using the keyword of acute bacterial meningitis. Due to high morbidity and mortality rate, providing accurate, detailed, and citable information is vital, especially, concerning the etiology and persons at highest risk to guarantee and ensure public health and appropriate management. Despite a decrease in morbidity and mortality in the recent years, it is still one of the fatal diseases of the world. However, a definitive diagnosis, prompt therapeutic strategy, decent adjunctive treatment, and vaccinations can all have positive influences in the context of the best patient care.

Streptococcus pneumoniae (S. pneumoniae) is a gram-positive pathogen bacteria which causes a variety of diseases, including otitis media, bacteremia, and meningitis.
Cases Report: A 19-year-old man with paroxysm was admitted to emergency department of hospital. He was diagnosed with S. pneumoniae meningitis on the basis of an analysis of the cerebrospinal fluid and blood culture.
We present a rare case of meningitis. The treatment was successful by just relying on the antibiogram test results. Vancomycin treatment was discontinued, and the patient fully recovered with Ceftriaxone

Meningitis is an acute inflammation of the protective membranes covering the brain and spinal cord, which are known as the meninges. This infection may be caused by Streptococcus pneumonia bacteria. In this study, we presented the case of a female newborn with meningitis secondary to Streptococcus pneumonia. Her birth weight and height were normal. After 24 hours of birth, the neonate was diagnosed with tachypnea, without presenting any signs of fever or respiratory distress. The newborn was referred to Sheikh Children's Hospital, where chest X-ray showed clear lungs with no evidence of abnormality. Furthermore, the cardiothoracic ratio was normal. A complete blood count demonstrated white blood cell (WBC) count of 5400/uL. In Blood/Culcture ratio (B/C) test, Streptococcus pneumonia was reported, and the results of the cerebrospinal fluid (CSF) analysis confirmed this result. Following 14 days of receiving antibiotic therapy, the results of CSF analysis were within the normal range. Her visual and hearing examinations were normal, and demonstrated improved situation. The infant was discharged with exclusive breastfeeding.

Meningitis is a serious inflammation of the meninges, mainly caused by bacteria. Treatment of this life threatening disease should not be delayed; therefore, rapid empirical antibiotic therapy should be immediately started. Antimicrobial therapy based on early Cerebrospinal Fluid (CSF) examination has an important role in limitation of bacterial meningitis.. The current study aimed to identify the prevalence of etiological agents of bacterial meningitis and their susceptibility patterns against commonly used antibiotics..Patients and This cross-sectional study was performed within a two-year period 2011-2013 on all patients with suspected meningitis referring to Nemazee Hospital, Shiraz, Iran. Cerebrospinal fluid specimens were collected aseptically, and conventional methods were employed to isolate and identify the bacteria. Antimicrobial susceptibility tests were performed using disk diffusion method according clinical and laboratory standards institute (CLSI) recommendation.. Out of 2229 suspected meningitis cases, 255 (11.4%) were detected as positive culture. Most of the isolates were Gram-positive cocci, which 116 (45.5%) were Staphylococcus epidermidis, and 20 (7.8%) identified as Streptococcus spp. Among Gram-negative isolates, Escherichia coli and Acinetobacter spp., each with 19 isolates (5.9%), were predominant. Overall, the most effective antibiotics against Gram-positive cocci were vancomycin (91.5%), chloramphenicol (75.2%), and gentamicin (59.3%), respectively. Gram-negative isolates were mostly susceptible to gentamicin (65.1%), chloramphenicol (42.9%), and ciprofloxacin (39.7%), respectively.. Gram-positive cocci, such as (Coagulase-Negative Staphylococci) CoNS and aerobic Gram-negative bacilli, were identified as the common etiologic agents of bacterial meningitis. Since the majority of these isolates was part of the normal flora and considered as opportunistic nosocomial infections, it is required to consider the importance of infection control programs in the healthcare centers..