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

Six children aged 13 days to nine years with herpes simplex encephalitis (HSE) are presented. Institution of appropriate antiviral treatment was later than six days in three cases; original diagnosis in these cases were post-traumatic epilepsy, bacterial meningitis and febrile convulsion. Initially pyrexia was absent in two cases and cranial CT was normal in two cases. Encephalitic changes were observed on the EEGs of five children. Diagnosis was confirmed by paired serological titres, brain biopsy, vesicle culture and CSF titres. The outcome for all six children was poor. HSE should always be considered in children presenting with focal seizures, even when apyrexial and with normal CT findings. In such situations, saving CSF for antibody titres or antigen identification should be routine practice. Treatment with acyclovir is justified before precise virological diagnosis has been established.
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PMID:Herpes simplex virus encephalitis: problems in diagnosis. 152 55

Beta-2-microglobulin was determined in 147 patients admitted to hospital because of suspicion of CNS disease. Patients with meningism were chosen as control group. The concentration of beta-2-microglobulin in the spinal fluid of control patients was correlated with age. Reference values for 0-40 years were 0.34-1.58 mg/l. Above 40 years of age the values were 0.46-3.14 mg/l. CSF beta-2-microglobulin levels of patients with meningism, aseptic and bacterial meningitis overlap too much to be relevant in distinguishing between these entities. Five patients with herpes simplex encephalitis had markedly elevated levels ranging from 4.4 to 9.0 mg/l. Ten patients with herpes zoster-associated encephalitis had values from 1.1 to 6.1 mg/l. In the patient groups with CNS infections, the ratio of serum to spinal fluid beta-2-microglobulin was significantly more frequently less than 1 as compared with the meningism group, indicating intrathecal production of the protein. Further studies on the clinical relevance of CSF beta-2-microglobulin in the diagnosis of encephalitis seem warranted.
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PMID:Beta-2-microglobulin in the cerebrospinal fluid of patients with infections of the central nervous system. 269 28

Leukocyte subsets in CSF and peripheral blood (PB) were determined in 21 patients with acute inflammation of the CNS using the monoclonal antibodies OKT3, OKT4, OKT8, Leu12, and OKM1 in an immunoperoxidase slide assay. There was a predominance of OKT3-positive cells in nearly all samples. Significant differences between acute aseptic and bacterial meningitis only were found in CSF and represented by a higher Leu12 and a lower OKT3 percentage in aseptic inflammation and a higher absolute amount of OKT4-, OKM1- and Leu12-positive cells in bacterial meningitis. Comparison between CSF and PB showed significant differences only in aseptic meningitis with a higher percentage of Leu12-positive cells and a lower percentage of OKT8-positive cells in CSF. The OKT4/OKT8 ratio seems to be generally lower in aseptic meningitis but significant differences only were found in comparison with healthy blood donors. In a case of herpes simplex encephalitis the ratio was strongly increased in CSF during the early phase of specific antibody production because of an absolute rise of OKT4-positive cells.
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PMID:Cerebrospinal fluid and peripheral blood leukocyte subsets in acute inflammation of the CNS. 330 13

The presence of viral infection was evaluated in 160 children older than three months with bacterial meningitis who were admitted to Children's Medical Center or Parkland Memorial Hospital, Dallas, TX, between October 1979 and March 1982. Results were compared with a single serologic specimen in 138 children without meningitis. A recent history of upper respiratory infection was obtained from 60% of patients, including 10/13 with pneumococcal, 9/16 with meningococcal, and 77/131 with Haemophilus influenzae meningitis. Viral infection was documented by serologic response (23.8%) or viral isolation (13.2%) in 63/160 (40%) of patients with meningitis. There were 23 positive cultures (one patient with both adenovirus and respiratory syncytial virus). Picornaviruses, including two rhinoviruses, were isolated from six of the 24 subjects without meningitis who had viral cultures. There were 69 serologic conversions in meningitis patients, with 12 patients converting to two organisms and four patients converting to three organisms. Viral diagnoses included: adenovirus, 32 children; respiratory syncytial virus, 14; influenza A, 8; influenza B, 4; parainfluenza (1, 2, and 3), 12; picornaviruses, 9; herpes simplex virus, 1; and cytomegalovirus, 1. Additionally, 6/15 seroconverted to Mycoplasma pneumoniae. The acute geometric mean serum antibody titers of meningitis patients were lower than those of the comparison group for adenovirus (3.5 vs. 6.6, p less than or equal to 0.001) and influenza B (1.2 vs. 1.6, p less than or equal to 0.05). Twenty nine of 131 patients with H. influenzae had evidence of recent adenovirus infection. Primary infection with adenoviruses and possibly influenza B or mycoplasma precedes development of bacterial meningitis in some patients and may be a predisposing factor.
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PMID:Possible association of mycoplasma and viral respiratory infections with bacterial meningitis. 381 56

Viral meningitis is part of the aseptic meningitis syndrome but must be distinguished from bacterial meningitis on the basis of a careful examination of the CSF and sound clinical judgment. Enteroviruses probably account for the bulk of cases of aseptic meningitis that occur in the United States and which are reported to the Centers for Disease Control each year. The seasonal pattern in the incidence of aseptic meningitis is largely due to the seasonal variation of enteroviral infections. Early on, the CSF in patients with viral meningitis frequently contains a predominance of polymorphonuclear leukocytes and may even have a low glucose level. The presence of neutrophils in the initial CSF sample is especially common in patients with enteroviral infections. A CSF glucose level lower than 50 per cent of a simultaneously drawn blood glucose determination is not uncommon in patients with viral meningitis due to mumps, LCM, and herpes simplex. In a patient with a predominance of polymorphonuclear leukocytes in the initial CSF specimen and in whom a viral infection is suspected, antibiotics may be withheld if a spinal tap is repeated within 12 hours. A shift from polymorphonuclear leukocytes to mononuclear cells makes viral meningitis the likely diagnosis. Both herpes simplex and varicella-zoster may infect the meninges by means of spread from cervical and dorsal root ganglia in a retrograde fashion much the way they spread in an antegrade fashion to the skin. HSV-2 is more likely to cause the clinical syndrome of viral meningitis, while HSV-1 is more likely to cause a meningoencephalitis with serious brain dysfunction. The identification of a specific viral agent in body fluids, especially the CSF, in a patient with aseptic meningitis is of more than academic interest, since it can shorten duration of hospital stay and eliminate unnecessary antimicrobial therapy. The diagnosis of enteroviral infections depends upon the isolation of a virus from CSF, stool, or throat plus a fourfold antibody response in the serum to the viral isolate. The 60-odd serotypes of enterovirus, each with different antigenic determinants, preclude serologic testing alone as a useful diagnostic test to identify the patient infected with coxsackievirus or echovirus. For infections, due to herpes simplex, varicella-zoster, LCM, and arboviruses, a serologic test alone can be useful.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Viral meningitis. 399 Apr 41

An inhibition enzyme-linked immunosorbent assay (ELISA) for the detection of herpes simplex virus antigens in cerebrospinal fluid (CSF) has been developed. A Triton X-100 extract of herpes simplex virus type 1 (HSV-1) infected HEp-2 cells was used to coat wells of polyvinyl chloride plates. Rabbit anti-HSV-1 globulin served as the reference antibody and the CSF specimens were tested at a final dilution of 1:4. Positive results were obtained in CSF specimens from 11/18 (61%) neonates with HSV infection, 15/23 (65%) older individuals with HSV culture positive brain biopsies, and in 4/29 (14%) patients with culture negative brain biopsies. The assay was negative with CSF from 14 infants without HSV infections, from 30 patients with bacterial meningitis and 10 with cryptococcal meningitis. The test was positive in 10/21 patients within 10 days of onset, 11/14 within 11-20 days, and in 5/6 more than 20 days after onset of the herpetic infection. The overall sensitivity of the assay was 63% and the specificity was 95%.
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PMID:ELISA for the detection of herpes simplex virus antigens in the cerebrospinal fluid of patients with encephalitis. 631 49

Several patients with herpes simplex encephalitis developed a prolonged humoral immune reaction within the central nervous system, which was evaluated by the measurement of locally synthesized immunoglobulin fractions in cerebrospinal fluid. Such phasic immune responses seem to occur predominantly in CNS infections with herpes and myxo/paramyxo viruses. In many cases the B-cell response follows a primary neutrophilic and a secondary mononuclear phase. Most benign viral encephalomeningitis cases lack this type of strong local B-cell activity. This is also true in most cases of bacterial meningitis, that recover after a strong neutrophilic attack and a minor mononuclear reaction. The initial phase of a purulent meningitis is characterized by a complete breakdown of the blood-CSF barrier. This occurs also in some cases of "apurulent bacterial meningitis", that are characterized by very low CSF-cell counts in spite of a totally broken barrier. The "compartmental leucopenia" is interpreted as an imbalance between the supply from the blood and an intense phagocytic consumption within the CSF space. The influence of the hydrodynamic size of viruses on the mode of entry into the central nervous system and on the dynamics of the inflammatory reactions is discussed.
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PMID:The process dynamics of viral and bacterial diseases of the central nervous system. 696 52

Beta 2-microglobulin (beta 2m) determination in CSF of 72 neonates who underwent a spinal tap as part of a sepsis or meningo-encephalitis workup was performed to evaluate the usefulness of this test in the diagnosis of CNS infections. Beta 2m was measured by enzyme immunoassay. Sixty neonates had sterile culture and normal neurological status at discharge. Twelve infants had CNS infections: 8 bacterial meningitis, 3 TORCH infections (T = toxoplasmosis, O = others, R = rubella, C = cytomegalovirus and H = herpes simplex) and 1 viral meningitis. Neonates with CNS infection exhibited significantly higher CSF beta 2m levels compared to neonates with sterile culture (6.24 +/- 2.66 vs 1.74 +/- 0.5 mg/l; P < 0.0001). CSF beta 2m levels did not correlate with the white cell count, total protein concentration or glucose level in CSF. When serum and CSF levels were measured simultaneously, the CSF beta 2m level was significantly higher than the corresponding serum level in patients with CNS infection (6.98 +/- 2.5 vs 3.2 +/- 0.25 mg/l; P < 0.01). Sensitivity, specificity, and predictive values were estimated for different cut-off points. The best operational diagnostic cut-off value was 2.25 mg/l. Receiver operating characteristic curve analysis showed an appropriate trade-off between specificity and sensitivity and indicated that CSF beta 2m was accurate in distinguishing between neonates with and without CNS infection. Conclusion. CSF beta 2m may be a useful ancillary tool in neonates when CNS infection is suspected.
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PMID:Cerebrospinal fluid beta 2-microglobulin in neonates with central nervous system infections. 760 83

A survey was performed of acute encephalitis and bacterial meningitis in infancy and childhood from 1984 to 1993 using a questionnaire directed to departments of pediatrics in large hospitals in Aichi prefecture. The case records for 391 patients with acute encephalitis including related diseases and 328 patients with bacterial meningitis were obtained from 63 hospitals. Of 391 patients with acute encephalitis, 224 were male and 167 were female. Of 328 patients with bacterial meningitis, 200 were male and 128 were female. Sex ratio were 1.3, 1.6 respectively. Of the patients, 52.4% of encephalitis and 84.8% of meningitis were under 4 years of age and 0 year olds made up 53.7% of the latter. The causes of these diseases were confirmed in 38.7% and 82.9% of the encephalitis and meningitis patients, respectively, etiologically. In encephalitis, rubella virus was the most frequent with 29 cases, followed by measles virus (27 cases), herpes simplex virus (24) and varicella-zostervirus (19). In meningitis H. influenzae (95 cases), S. pneumoniae (56), Group B streptococcus (41) and E. coli (27) were frequently diagnosed. These diseases showed respective patterns of age distribution and clinical course, and moreover, the increases in their onset were clearly related to the prevalence of causal infections. Therefore, the results of this study should be utilized in the development of administrative measures for prevention of these diseases.
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PMID:[Acute encephalitis and bacterial meningitis in children in Aichi Prefecture (1984-1993)]. 764 51

Interferon (IFN)-gamma was analysed immunologically in cerebrospinal fluid (CSF) sampled in the acute phase from 27 patients (15-66 years) with viral meningitis and from 18 patients (0.5-90 years) with bacterial meningitis. Increased CSF concentrations were observed in 19/27 viral and in 13/18 bacterial cases. CSF-IFN-gamma did not distinguish between viral and bacterial meningitis. Five of 8 patients with meningitis due to herpes simplex virus type 2 (HSV-2) had CSF-IFN-gamma levels above the highest found in enteroviral meningitis. Thus, a markedly increased CSF-IFN-gamma value in patients with suspected viral meningitis ought to indicate HSV-2 etiology. The patients with Streptococcus pneumoniae meningitis (6 adults and 1 child) had significantly higher levels than the 7 children with Haemophilus influenzae meningitis. This may indicate that S. pneumoniae induces more IFN-gamma secretion than H. influenzae, and/or that during meningitis, adults are more apt to react with IFN-gamma production, than are children.
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PMID:Interferon-gamma in cerebrospinal fluid from patients with viral and bacterial meningitis. 803 69


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