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Query: UMLS:C0085437 (bacterial meningitis)
 4,038 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Escherichia coli K1 is the most common cause of gram-negative neonatal bacterial meningitis and septicemia. In an attempt to identify genetic markers in E. coli K1 that are associated with the capacity of the organism to cause neonatal meningitis, we used rRNA gene restriction patterns. E. coli strains isolated from the CSF of neonates with meningitis (n = 43) on two continents were compared to strains isolated from the blood of neonates with bacteremia who did not have meningitis (n = 29) and to isolates from the vaginas of asymptomatic pregnant women whose neonates remained without infection (n = 39). E. coli strains from CSF are genetically less heterogeneous than isolates from blood and the vagina: 44.2% of the CSF isolates belonged to only two types, whereas no more than two blood vaginal strains were of the same type. After HindIII digestion, a 14.9-kb rDNA-containing fragment was found in 81.3% of the strains from CSF vs. 28.0% of the isolates from blood and only 12.8% of the vaginal isolates (P = .001). Thus, genotyping might provide markers to identify organisms in the maternal vaginal flora that are highly likely to cause neonatal meningitis. This observation may have very practical implications for the early identification of these organisms in pregnant women and thus for the selective establishment of preventive measures per partum or for the early treatment of colonized neonates.
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PMID:Genotyping may provide rapid identification of Escherichia coli K1 organisms that cause neonatal meningitis. 882 85

Before effective vaccines were available, Haemophilus influenzae type b (Hib) was the most common cause of bacterial meningitis among children in the United States, and an estimated one of 200 children aged < 5 years developed invasive Hib disease. From December 1987--when Hib conjugate vaccines were introduced--through 1994, the incidence of invasive Hib disease declined 95% among children aged < 5 years. Eliminating invasive Hib disease among children aged < 5 years by 1996 is a goal of the Childhood Immunization Initiative (CII). This report summarizes data about trends in invasive H. influenzae (Hi) disease during 1987-1995 from three separate surveillance systems (CDC's National Notifiable Diseases Surveillance System [NNDSS]; the National Bacterial Meningitis and Bacteremia Reporting System [NBMBRS]; and an active, multistate, laboratory-based surveillance system). The findings underscore the need for age-appropriate vaccination of infants and for complete investigation and reporting of cases of invasive Hi disease.
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PMID:Progress toward elimination of Haemophilus influenzae type b disease among infants and children--United States, 1987-1995. 892 12

Increasing resistance to antimicrobial agents has occurred among many pathogens, but the emergence of resistant Streptococcus pneumoniae will have the greatest impact on the practice of outpatient medicine. Consequences of resistance include complicated management of acute otitis media and meningitis treatment failures. Pneumococci have acquired resistance to penicillin, third-generation cephalosporins and other antibiotics at an alarming rate; in some areas, 25 percent of isolates are nonsusceptible to penicillin. In areas with high resistance rates, the addition of vancomycin to cefotaxime or ceftriaxone is warranted for empiric treatment of bacterial meningitis. Changes in empiric therapy for pneumonia, bacteremia and otitis media may eventually be necessary. Previous antibiotic use is a risk factor for invasive disease with resistant pneumococci. Patients may be best protected by avoiding unnecessary use of antibiotics. Patient education materials as well as recommendations for avoiding the use of antibiotics for some upper respiratory tract infections are currently being developed to help physicians achieve this goal.
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PMID:Resistant pneumococci: protecting patients through judicious use of antibiotics. 937 Oct 6

Klebsiella infection has been considered to be an uncommon cause of meningitis. To determine its incidence and clinical features, we reviewed the microbiologic records of cerebrospinal fluid (CSF) and blood cultures and the medical records of patients with bacterial meningitis admitted between 1981 and 1995. Klebsiella meningitis was diagnosed in 79 patients with 83 episodes. All patients had klebsiella isolated from CSF and/or blood and typical symptoms and signs of acute bacterial meningitis. Of these, 74 were over 16 years of age and 2 of the 5 children were infants. There was an increased prevalence rate of klebsiella meningitis after 1986. Of the 83 episodes, only 9 occurred between 1981 and 1986, accounting for 7.8% of 115 cases with CSF and/or blood culture-proven acute bacterial meningitis, whereas in 1987-95, there were 74 episodes accounting for 17.7% of 419 bacteriologically proven cases. K. pneumoniae accounted for 69 episodes, K. oxytoca, 11 episodes and K. ozaenae, 3 episodes. Male gender, diabetes mellitus and liver cirrhosis were commonly associated with K. pneumoniae meningitis. Neurosurgical procedures were frequently associated with K. oxytoca meningitis. All three patients with K. ozaenae meningitis had a primary disease of the nasopharyngeal pathway. The mortality rate due to K. pneumoniae was 48.5%, K. oxytoca, 10% and K. ozaenae, 0%. In patients with K. pneumoniae meningitis, poor prognostic factors included age over 60 years, diabetes mellitus, bacteremia and severe neurological deficits on the first day of treatment.
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PMID:Klebsiella meningitis in Taiwan: an overview. 936 11

Meningococcal disease is an infection caused by Neisseria meningitidis, a gram-negative diplococcus that is the leading cause of bacterial meningitis in children and young adults in the United States, with an estimated 2,600 cases reported each year. N. meningitidis infection rates are highest in children 3 to 12 months of age. Four distinct clinical situations are associated with meningococcal infection. The most common is asymptomatic nasopharyngeal colonization. Benign bacteremia is discovered in the absence of classical clinical findings of meningococcemia, but blood cultures are positive for N. meningitidis. Meningitis, the most common pathologic presentation, is associated with fever, headache, and nuchal rigidity. The mortality rate is about 5% in children and 10% to 15% in adults. Meningococcemia, the most severe form of infection, may involve petechial rash, hypotension, and disseminated intravascular coagulation. It is a fulminant condition that can, if untreated, progress from initial symptoms to coma and death in 12 to 48 hours. Spread of these endemic cases can be controlled by administering prophylactic antibiotics to close contacts of patients.
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PMID:Meningococcal disease: recognition, treatment, and prevention. 971

Antibiotic-resistant strains of Streptococcus pneumoniae are becoming more prevalent throughout the world; this has resulted in modifications of treatment approaches. Management of bacterial meningitis has the greatest consensus. Strategies for treating other systemic infections such as pneumonia, bacteremia, and musculoskeletal infections are evolving, in part related to the availability of new antibiotics which are active in vitro against isolates resistant to penicillin and the extended-spectrum cephalosporins. However, there are currently very limited data related to the clinical efficacy of these new agents. The studies upon which current recommendations are based are reviewed. Otitis media represents the single most common infection due to S. pneumoniae. Recommendations for treatment of acute otitis media due to drug-resistant strains and the rationale for these recommendations are discussed.
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PMID:Management of infections due to antibiotic-resistant Streptococcus pneumoniae. 976 60

Pneumococcal diseases, caused by the bacterium Streptococcus pneumoniae, include pneumonia and otitis media, which accounts for some 12 million doctor visits per year in the United States alone. Each year around the world, pneumococcus causes 1.2 million deaths due to pneumonia, 39% of which are in children under the age of five. In a three-year Phase III clinical trial involving 38,000 children, in which half of the infants received a new pneumococcal vaccine and half received a placebo vaccine, the new vaccine demonstrated an efficacy rate of 100% against bacterial meningitis and bacteremia, the two most deadly pneumococcal afflictions.
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PMID:Look, Ma! No pneumococcus! 1033 59

The seriousness of bacterial meningitis has encouraged the development of animal models that characterize complex pathogenetic and pathophysiologic mechanisms, provide evaluation of pharmacokinetic and antimicrobial effects of antibiotics (especially since the worldwide emergence of multiresistant bacteria), and establish new adjuvant treatment strategies (e.g., use of anti-inflammatory agents). The information obtained from an animal model depends on the site of inoculation. For example, using intranasal, intravenous, subcutaneous, or intraperitoneal inoculation, it is the bacterial and host factors that determine the development of bacteremia and the potential for a pathogen to invade the central nervous system that primarily are studied. In contrast, experimental models using direct inoculation into the cerebrospinal fluid can reliably produce lethal infections over a predictable time course. Furthermore, because adult animals will not reliably develop meningitis after intranasal or intraperitoneal challenge, infant animals are used. Because these models bypass the natural dissemination of bacteria from the intravascular compartment to the central nervous system, the pathogenesis is artificial. These models, however, are extremely useful for the study of pathogen and host factors leading to meningeal inflammation and resulting complications, and for evaluating potentially useful agents for treatment therapy. During the past decade, the design of clinical studies has been stimulated by findings obtained from these animal models.
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PMID:Models of experimental bacterial meningitis. Role and limitations. 1047 May 55

The purpose of this study was to determine the applicability of two accepted outpatient management protocols for the febrile infant 1-2 months of age (Boston and Philadelphia protocols) in febrile infants 1-28 days of age. We retrospectively reviewed charts of patients 1-28 days of age with a temperature greater than or equal to 38.0 degrees C. Criteria from each of the above-cited management protocols were applied to the patients to determine their applicability in screening for serious bacterial infection (SBI). An SBI was defined as bacterial growth in cultures from blood, urine, cerebrospinal fluid (CSF), stool, or any aspirated fluid. Overall, 372 febrile infants were included in the study. Ages ranged from 1 to 28 days of age. The mean age was 15 days. SBI occurred in 45 patients (12%). The mean age of the patients with an SBI was 13 days. Thirty-two infants (8.6%) had a urinary tract infection; 12 (3.2%), bacteremia; five (1.3%), bacterial meningitis; three (0.8%), cellulitis; one (0.3%), septic arthritis; one (0.3%), bacterial gastroenteritis; and one (0.3%), pneumonia. Ten infants had more than one SBI. Of 372 patients, 231 (62%) met the Boston's laboratory low-risk criteria; eight (3.5%) would have been sent home with an SBI with these criteria. Philadelphia's laboratory low-risk criteria would have been met by 186 patients (50%); six (3.2%) would have been sent home with an SBI with these criteria. The negative predictive value of both the Boston and Philadelphia protocols for excluding an SBI was 97%. We conclude that current management protocols for febrile infants 1-2 months of age when applied to febrile infants 1 to 28 days of age would allow 3% of febrile infants less than 28 days of age to be sent home with an SBI. Current guidelines recommending admitting all febrile infants less than 28 days of age should be followed until the outcome of those 3% of febrile infants with an SBI treated as outpatients can be determined.
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PMID:Applying outpatient protocols in febrile infants 1-28 days of age: can the threshold be lowered? 1069 44

Twenty percent of febrile children have fever without an apparent source of infection after history and physical examination. Of these, a small proportion may have an occult bacterial infection, including bacteremia, urinary tract infection (UTI), occult pneumonia, or, rarely, early bacterial meningitis. Febrile infants and young children have, by tradition, been arbitrarily assigned to different management strategies by age group: neonates (birth to 28 days), young infants (29 to 90 days), and older infants and young children (3 to 36 months). Infants younger than 3 months are often managed by using low-risk criteria, such as the Rochester Criteria or Philadelphia Criteria. The purpose of these criteria is to reduce the number of infants hospitalized unnecessarily and to identify infants who may be managed as outpatients by using clinical and laboratory criteria. In children with fever without source (FWS), occult UTIs occur in 3% to 4% of boys younger than 1 year and 8% to 9% of girls younger than 2 years of age. Most UTIs in boys occur in those who are uncircumcised. Occult pneumococcal bacteremia occurs in approximately 3% of children younger than 3 years with FWS with a temperature of 39.0 degrees C (102.2 degrees F) or greater and in approximately 10% of children with FWS with a temperature of 39.5 degrees C (103.1 degrees F) or greater and a WBC count of 15, 000/mm(3) or greater. The risk of a child with occult pneumococcal bacteremia later having meningitis is approximately 3%. The new conjugate pneumococcal vaccine (7 serogroups) has an efficacy of 90% for reducing invasive infections of Streptococcus pneumoniae. The widespread use of this vaccine will make the use of WBC counts and blood cultures and empiric antibiotic treatment of children with FWS who have received this vaccine obsolete.
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PMID:Management of fever without source in infants and children. 1109 1


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