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

We analyzed data from the records of 422 patients with acute bacterial or viral meningitis. A cerebrospinal fluid (CSF) glucose level less than 1.9 mmol/L, a CSF-blood glucose ratio less than 0.23, a CSF protein level greater than 2.2 g/L, more than 2000 x 10(6)/L CSF leukocytes, or more than 1180 x 10(6)/L CSF polymorphonuclear leukocytes were individual predictors of bacterial infection with 99% certainty or better. Although any one of these tests could rule in bacterial meningitis with high probability, none could rule it out. To better predict whether a patient has bacterial vs viral infection, we developed a logistic multiple regression model using CSF-blood glucose ratio, total polymorphonuclear leukocyte count in CSF, age, and month of onset. This proved highly reliable when validated in an independent test sample, with an area under receiver operating characteristic curve of 0.97. The model should allow physicians to differentiate between acute viral and acute bacterial meningitis with greater accuracy.
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PMID:Differential diagnosis of acute meningitis. An analysis of the predictive value of initial observations. 281 Jun 3

Mixed bacterial infection in meningitis is well-documented, but there have been few previous reports of mixed viral-bacterial meningitis. A retrospective analysis of the bacterial and viral cerebrospinal fluid (CSF) cultures from a 1-year period in a 315-bed children's hospital revealed 5 patients with mixed viral-bacterial meningitis among 276 patients with viral and/or bacterial culture-positive meningitis. These 5 accounted for 2.8% of the patients with positive CSF viral cultures and 4.8% of those with positive CSF bacterial cultures. All of the viruses were identified as enteroviruses, and the bacteria were Group B Streptococcus, Group D Salmonella, Streptococcus pneumoniae, Haemophilus influenzae type b and Staphylococcus aureus. The ages of the patients ranged from 10 days to 22 years. The clinical course of each of the illnesses was typical of bacterial meningitis. This relatively high frequency of mixed viral-bacterial meningitis could affect the utility of rapid viral diagnostic tests for CSF viruses.
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PMID:Simultaneous recovery of bacterial and viral pathogens from cerebrospinal fluid. 284 46

In 26 infants and children with septicemia or bacterial meningitis, significantly elevated plasma levels of elastase-alpha 1-proteinase inhibitor (E-alpha 1-PI) were present at time of recognition of infection, even in those patients with neutropenia (range of reference values: 25 to 190 micrograms/L, n = 142; patients: 444 to 2049 micrograms/L, n = 26). After initiation of therapy, normalization of E-alpha 1-PI levels was observed in all patients who recovered from infection. In addition, 18 of 19 children with bacterial meningitis had increased cerebrospinal fluid concentrations of E-alpha 1-PI above the range of normal (range of reference values: 0 to 39 micrograms/L, n = 62; patients: 30 to 3490 micrograms/L, n = 19); concentrations of E-alpha 1-PI in bacterial meningitis were significantly increased when compared with those in aseptic meningitis (range 25 to 194 micrograms/L; n = 15). In 30 patients with local bacterial infections (pneumonia, urinary tract infections, etc.), E-alpha 1-PI was also elevated. These data suggest that E-alpha 1-PI is a sensitive indicator of systemic and local bacterial infection in childhood.
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PMID:Elastase-alpha 1-proteinase inhibitor: an early indicator of septicemia and bacterial meningitis in children. 349

All types of central nervous system (CNS) infections were investigated in a 1966 birth cohort of 12,000 children from Northern Finland followed up from birth to the age of 14. 174 CNS infections occurred in 167 children, 110 boys and 64 girls. The annual incidence of bacterial CNS infections was 36.3/100,000 and that of viral infections 688.0/100 000. It is concluded that bacterial CNS infections were recorded very fully but only 2/3 of the viral infections could be traced, even though the more severe cases were quite well documented. 8/55 children (14.5%) with bacterial meningitis died; the corresponding figure for viral encephalitis and meningitis (excluding mumps) was 3/67 (4.5%). 17/55 (30.9%) developed mental retardation, epilepsy, cerebral palsy or hearing defect or some combination of these after bacterial CNS infection, and 9 (8.1%) after viral infection. The difference with respect to the children who had not experienced CNS infection was statistically significant only for the bacterial infection cases. CNS infections explained 7.6% of all deaths from 28 days to 14 years, 3% of the handicapping cases of cerebral palsy, mental retardation and epilepsy or some combination of these, and 6.6% of the hearing defects.
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PMID:Incidence and prognosis of central nervous system infections in a birth cohort of 12,000 children. 376 48

Four hundred thirty-four febrile infants two months of age or younger were evaluated in the emergency departments of five major teaching hospitals over a one-year period. A culture-proven bacterial infection was present in 3.5% of the infants; bacteremia was detected in 3.3%. Bacterial meningitis was present in 2.4%, and aseptic meningitis was noted in 13.4%. Twenty-one percent had clinically apparent serious disease including pneumonia, otitis media, and gastroenteritis with dehydration. Six variables (age less than 1 month, lethargy, no contact with an ill individual, breast-feeding, total polymorphonuclear greater than or equal to 10,000/mm3 and band count greater than or equal to 500/mm3) were correlated with bacterial infection by step-wise discriminant analysis. However, these findings were neither sensitive nor specific enough to be clinically useful. Management varied, and 62% of the infants were hospitalized. Fifty-four percent, some of whom were managed as outpatients, received antibiotics. Febrile infants two months of age or younger require a comprehensive emergency department assessment, including appropriate laboratory studies (CBC, differential, urinalysis and culture, lumbar puncture, and blood culture), since 3.5% have bacterial infection that may be life-threatening. Hospitalization is warranted if the infant appears ill, laboratory studies indicate serious infection, or follow-up care is uncertain.
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PMID:Fever in infants less than two months of age: spectrum of disease and predictors of outcome. 384 82

C-Reactive protein (CRP) has been measured in 90 consecutive CSF specimens using both latex agglutination and an immunoradiometric assay (IRMA). In the 60 CSF specimens otherwise normal by standard biochemical and microbiological criteria, the median CRP level was 32 micrograms/l (95% confidence limits, 0-108 micrograms/l) and in the remaining abnormal specimens the median level was 176 micrograms/l (95% confidence limits, 110-325 micrograms/l, p = 0.001). C-Reactive protein was detected by a commercial latex agglutination kit at a level of approximately 120 micrograms/l and all significant CNS bacterial infections were positive (7 bacterial meningitis, 2 infected shunts). In addition, viral encephalitis, extensive intracranial malignancy and subarachnoid haemorrhage gave positive agglutinations, but not in every case. A further nine specimens with a minor elevation of CRP level were detected by IRMA (median 76 micrograms/l), but this was of little practical significance. We have shown that normal CSF C-reactive protein levels are very low and we conclude that latex agglutination set at a sensitivity of 120 micrograms/l, although only semi-quantitative, is a rapid and useful method to assess CSF C-reactive protein in routine clinical practice and, when positive, is strong supporting evidence for bacterial infection.
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PMID:The clinical value of rapid C-reactive protein measurement in cerebro-spinal fluid. 399 76

The presence of C-reactive protein in the cerebrospinal fluid (CSF) has been proposed as an early indicator of bacterial meningitis in children. A commercial latex agglutination test (CR-test, Hyland) was performed in CSF obtained at first lumbar puncture in 114 children (26 neonates and 88 children aged from 1 month to 15 years) presenting with meningitis-like episodes. The CSF was regarded as normal in 41 cases; 50 had non-bacterial meningitis, and bacterial infection was diagnosed in 14 and suspected in 9. The latex agglutination test was positive in the first CSF sample from 2 neonates with bacterial meningitis, but its specificity was low (= 0.58). In older infants and children the test was positive in 18/21 cases of bacterial meningitis (sensitivity = 0.86) and negative in the 18 cases with normal CSF, as well as in 47/49 cases of non-bacterial meningitis (specificity = 0.97). The presence of C-reactive protein in CSF obtained at first lumbar puncture therefore is unreliable to distinguish between bacterial and aseptic meningitis.
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PMID:[C-reactive protein of the cerebrospinal fluid in children. A new evaluation of its diagnostic value]. 623 60

Bacterial infections are frequent events in premature and newborn infants. The reason is a defective specific and nonspecific defence of bacterial organisms. Some immunoglobulins like IgM and IgA including secretory IgA are absent. Premature infants also show a decreased level of IgG. Cellular immunity is anatomically intact but functionally defective. A number of complement factors are lacking, the activation of the alternative pathway is impaired. Newborn infants with perinatal problems like asphyxia or difficult delivery, show defects of leucocyte function like decreased deformability, defective chemotaxis and defective killing of ingested bacteria. Certain diseases, like hypoxia and malformations of immature organ functions in this age group (decreased acid production in the stomach), facilitate bacterial colonization of surface epithelia and the invasion of tissues. Consequences of these pathogenetic mechanisms are an unimpaired propagation of bacterial organisms into the blood and meninges without localization of the infecting organisms at the entry site. Bacterial meningitis is not considered a separate disease entity but a complication of bacteremia and sepsis. Clinical symptoms are nonspecific at the onset of the infection. Fever is frequently absent; decreased appetite, vomiting, a bloated abdomen, diarrhea, tachycardia, tachypnea are early signs of a bacterial infection, a grey mottled appearance, cyanosis, jaundice, petechiae, apneic spells, seizure activity and a metabolic acidosis are symptoms of advanced infection. Successful treatment at this stage is often not possible. Every sign of a decreased well being of a newborn of premature infant warrants laboratory and bacteriologic work up for septicemia.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Chemotherapy of severe bacterial infections in pediatrics]. 631 69

The current incidence of neonatal sepsis in the United States varies from less than 1 to 8.1 per 1000 live births. The incidence of bacterial meningitis is about one-third of the number of infants with sepsis. The mortality is 20 to 30% and many survivors are severely impaired. Group B streptococcus and Escherichia coli are the most frequent causes of meningitis. Because of the difficulty of clinical diagnosis, many infants receive presumptive therapy for suspected sepsis or meningitis although few have documented infection. Between 5 and 10% of newborn infants born in the United States receive antimicrobial agents in the nursery, usually a penicillin and an aminoglycoside. To lower the continued high mortality and morbidity of meningitis due to gram-negative enteric bacilli, collaborative randomized trials evaluated the efficacy of gentamicin administered via the intrathecal route, gentamicin administered into the ventricle and most recently, the efficacy of moxalactam. Neither intrathecal or intraventricular drug, both in combination with parenteral drug, was advantageous when compared with parenterally administered drug alone. The mortality rate and number of days of culture positive cerebrospinal fluid were similar in infants who received moxalactam and ampicillin and infants who received amikacin and ampicillin. Adjunctive therapies including granulocyte transfusion, administration of hyperimmune gamma globulin and exchange transfusion are now under investigation. Initial studies of prevention of systemic bacterial infection by prophylactic ampicillin administered to the mother at delivery and use of group B streptococcal vaccine administered to susceptible women in the child bearing age show promise.
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PMID:Recent advances in management of bacterial meningitis in neonates. 639 49

The results of cerebrospinal fluid (CSF) examination and other initial laboratory investigations have been analysed in one hundred and forty-nine patients with meningitis. The CSF differential leucocyte count clearly distinguished between bacterial and viral meningitis in 92 per cent of patients evaluated: CSF glucose and protein concentrations were less predictive by comparison. CSF glucose values were particularly unreliable because of hyperglycaemia in patients with bacterial meningitis and predictive accuracy increased when CSF levels were expressed as a percentage of blood glucose concentration. Results were not influenced by the age of the patients, and laboratory evidence of bacterial infection did not appear to be masked by prior antimicrobial therapy. A management algorithm based on the results of initial tests was applied retrospectively to the patients in whom Gram-stained CSF did not reveal bacteria. The algorithm indicated immediate antimicrobial therapy for all thirty patients with pyogenic infections, and for only one of sixty-three patients with a final diagnosis of viral meningitis.
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PMID:The value of initial laboratory investigations in the management of meningitis. 663 Oct 27


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