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

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

The seriousness of bacterial meningitis in pediatrics mandates more rapid and accurate diagnostic tests. Of the available tests to detect bacterial antigens, latex particle agglutination appears to be the best because it is simple and highly sensitive. For differentiation between bacterial and aseptic meningitis, serum C-reactive protein levels in excess of 50 mg/liter and cerebrospinal fluid lactate levels higher than 2.2 mmol/ml indicate a bacterial etiology. Available data confirm that one of the newer "third generation" cephalosporins can be used effectively and safely as a single drug for therapy of meningitis caused by the usual spectrum of bacteria, if the achievable cerebrospinal fluid drug levels exceed the minimal inhibitory concentration of the infecting bacteria by at least 10-fold. Use of these agents will obviate the potential toxicity of current antibiotics and may result in considerable cost savings.
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PMID:Advances in diagnosis and treatment of childhood meningitis. 400 Oct 1

Serum creatine kinase was assessed in 94 consecutive patients without convulsions admitted to hospital due to suspicion of infection of the central nervous system. No reliable discrimination between patients with aseptic and those with bacterial meningitis was obtained. Patients with bacterial meningitis and brain oedema, as well as patients with encephalitis, had significantly higher values (P less than 0.01) than patients with meningism, aseptic meningitis and bacterial meningitis without cerebral oedema. Very high values, above 2500 U/1, were encountered in only the most severe cases of bacterial meningitis. The highest serum CK value found in patients with encephalitis was 725 U/l. Reference values for control patients with meningism were 16-269 U/1. In a subset of 9 patients creatine kinase isoenzyme analysis was performed. In all cases only muscle type (MM) isoenzyme was found.
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PMID:Creatine kinase in the serum of patients with acute infections of the central nervous system. 400 61

A retrospective case-control records review was conducted to determine the usefulness of the cerebrospinal fluid (CSF) cytocentrifuge in the diagnosis of meningitis. Over a two-year period, 7,114 records were reviewed, from which 53 cases of aseptic meningitis (AM) and 22 cases of bacterial meningitis (BM) were obtained. Twenty-four cases, judged to be free of meningeal disease, obtained during a three-week period in July 1982, were used as controls. The mean percent polymorphonuclear leukocytes by cytocentrifuge was 14.5% +/- 25.4% in controls, 34.2% +/- 29.6% in AM patients, and 86.4% +/- 13.3% in BM patients. Statistically significant differences existed between the means of each group when compared overall (P less than 0.001) and when each group's mean was compared pair-wise to the two other group means in the study (P less than 0.01 to P less than 0.001). Knowledge of the percent PMNs by cytocentrifuge may be useful in distinguishing patients with meningitis, particularly bacterial, from those free of meningeal disease.
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PMID:The use of the cytocentrifuge in the diagnosis of meningitis. 402 27

The pharmacokinetics of ceftriaxone was studied in the plasma, urine, and cerebrospinal fluid of seven neonates and seven infants with meningitis. In addition, plasma and urine data were obtained in five neonates and one infant receiving ceftriaxone for other serious infections. All neonates younger than 14 days received daily doses of 50 mg/kg ceftriaxone; all other patients but two received 100 mg/kg. The average weight-corrected values for total body clearance (ClT), volume of distribution (Vdss), and biologic half-life (t 1/2) were 0.37 ml/min/kg, 0.45 L/kg, and 16.2 hours in neonates younger than 1 week; 0.77 ml/min/kg, 0.48 L/kg, and 9.2 hours in neonates older than 1 week; and 1.03 ml/min/kg, 0.39 L/kg, and 7.1 hours in older infants, respectively. There was a significant difference in ClT and t 1/2 between the neonates younger and both neonates older than 1 week, and infants. The Vdss was not significantly different among the three age groups. The average renal clearance in neonates younger than 1 week (0.28 ml/min/kg was 70%, in neonates older than 1 week (0.54 ml/min/kg) was 77%, and in older infants (0.49 ml/min/kg) was 47% of ClT, indicating that nonrenal elimination was less developed in neonates. The quantitation of CSF diffusion of ceftriaxone was assessed by comparison of the areas under the CSF and plasma concentration-time curve. The mean ceftriaxone penetration into the CSF in neonates and infants with bacterial meningitis was 17%. On the other hand, penetration in patients with aseptic meningitis amounted to only 4%. Mean ceftriaxone concentrations in the CSF in patients with bacterial meningitis were 2.8 mg/L after 24 hours, exceeding by many times the minimum inhibitory concentration of the common meningitis pathogens at this time.
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PMID:Pharmacokinetics of ceftriaxone in neonates and infants with meningitis. 608 47

In 52 children with meningitis caused by Hemophilus influenzae, pneumococci, meningococci and group B streptococci the organism responsible could be identified in 41 cases (79%) within one hour with specific antisera by means of countercurrent immunoelectrophoresis (CIE). False positive results were not observed in meningitis caused by other organisms, aseptic meningitis, septicemia, etc. In 4 cases the organism could only be identified by CIE since the children had received antibiotics and the culture was negative. Group B meningococci are often missed in CIE. CIE proved to be a valuable tool in diagnostic procedures of bacterial meningitis.
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PMID:[The diagnostic significance of countercurrent immunoelectrophoresis (CIE) in bacterial meningitis in children (author's transl)]. 611 17

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

The cyclic 3',5'-adenosine monophosphate (cAMP) concentrations in the cerebrospinal fluid of 20 children with neonatal bacterial meningitis and aseptic meningitis were measured by radioimmunoassay method. The cAMP levels were found to be significantly elevated above control levels (P less than .01) during the acute phase in most of the patients. In the convalescent stage the cAMP concentration was decreased but levels remained significantly elevated (P less than .01) in patients with complications. During the acute phase, the cAMP levels were higher in neonatal bacterial meningitis than in aseptic meningitis (P less than .01). The results suggest that cAMP is a sensitive indicator of transient cellular metabolic disturbance in the brain and may be used to monitor the course of neonatal meningitis.
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PMID:Elevation of cAMP levels in cerebrospinal fluid of patients with neonatal meningitis. 630 12

We identified, by diagnostic categories, the iatrogenic and financial costs that arise from hospitalizing febrile infants 60 days of age or younger. Thirty-seven (19.5%) of all admissions resulted in 48 separate complications. Twenty-nine (60.4%) of these complications were preventable, and six complications (12.5%) occurred in infants who probably did not require hospitalization for therapy. Twenty-four (50%) of all complications resulted from intravenous therapy. In addition to the complications, 26 diagnostic misadventures were identified. The average length of hospitalization for all infants was 7.0 days, with a range of two to 28 days. The average cost of hospitalization in 1979-80 dollars was $2,130 per infant, with a range from $6,345 for those infants with bacterial meningitis to $1,480 for those infants with aseptic meningitis. On the average, 25.6% of the bill was for diagnostic studies and 8.3% for physician fees.
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PMID:Iatrogenic risks and financial costs of hospitalizing febrile infants. 641 58

To assess the implications of meningitis in a more mature population, we reviewed the records of patients with meningitis: 71 aged 50 years and older and 138 patients aged 15 to 49 years. Among the older population, 54 (76%) had bacterial, nine (13%) had granulomatous, and eight (11%) had aseptic meningitis. Among the cases of bacterial meningitis in the older age group, Streptococcus pneumoniae accounted for 24% (13/54) and enteric bacilli accounted for 17% (9/54). Serious complications occurred in 38 elderly patients (70%) with bacterial meningitis, and mortality occurred in 24 (44%). In the younger age group with bacterial meningitis, the complication rate and mortality were 41% (13/32) and 13% (4/32), respectively. Meningitis in the elderly is likely to be bacterial and to cause greater morbidity and mortality.
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PMID:Bacterial meningitis in the elderly. 646 18


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