Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0085437 (bacterial meningitis)
 4,038 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Between November, 1991, and March, 1993, in Accra, Ghana, physicians admitted 103 children, 2 months to 12 years old, to the Korle Bu Teaching Hospital with suspected bacterial meningitis. They constituted 1.04% of all children presenting at the emergency rooms. Late referral to the hospital was likely responsible for the high case fatality rate within the 1st 24 hours of admission (59.1% of all deaths). 42.7% of all cases presented more than 96 hours after the onset of symptoms. 7 children died immediately after admission, allowing physicians no time to begin antibiotic treatment. The overall case fatality rate was 21.4%. Streptococcus pneumonia was isolated from the cerebrospinal fluid (CSF) in 53.8% of the early deaths and 55% of all 73 mortality cases from which bacteria were isolated. Leading causative organisms were $. pneumoniae (47.9%), Neisseria meningitides (38.4%), and Hemophilus influenza (9.6%). All bacterial isolates were sensitive to ceftriaxone. 5-17% of all isolates were resistant to penicillin and chloramphenicol. No bacteria were isolated in the CSF of any children within 48 hours of antibiotic treatment. The leading complications and sequelae of the 81 survivors were mild diarrhea (33%), neurological complications (22%), and secondary fever (14.8%). Even though the chloramphenicol/penicillin treatment regimen had the highest survivor outcome results (43%), its results were not significantly different than those of ceftriaxone alone for 48 hours followed by chloramphenicol/penicillin and ceftriaxone alone (24% and 20%, respectively; p =.6). These results suggest that health workers at less than optimum health facilities should administer the 1st dose of ceftriaxone to children suspected of having meningitis before transferring them to a tertiary facility for further management. This should greatly reduce case fatalities and sequelae. Health workers worldwide, even those in malaria endemic areas, should consider meningitis as a significant cause of fever.
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PMID:Bacterial meningitis in children in southern Ghana. 792 39

The patient was a 75-year-old male, who simultaneously showed symptoms of bacterial meningitis during steroid treatment for erythroderma and symptoms of respiratory failure. Based on ground-glass shadows in both lungs on chest X ray, bronchoalveolar lavage (BAL) was carried out and strongyloides was detected. In addition to strongyloidiasis, the patient was shown to have the complication of pneumocystis carinii (PC) pneumonia after PC DNA was detected in BAL fluid using a PCR assay. When other causes for immunodeficiency affecting the incidence of opportunistic infection were investigated, the ATL virus was detected in peripheral blood cells and monoclonal amplification was indicated, though the presence of anti-ATL antibody was negative. According to the results, this patient was found to have early stage adult T cell leukemia. In conclusion, we treated this adult T cell leukemia patient who had strongyloidiasis and amplification of PC DNA in BAL and for which the PCR assay, a new technology used for diagnosing PC pneumonia, was considered to be effective.
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PMID:[A case of adult T cell leukemia complicated with strongyloidiasis and amplification of pneumocystis carinii DNA in bronchoalveolar lavage fluid]. 804 Oct 45

During a 36-month period 83 cases of bacterial meningitis were seen, giving an overall annual incidence rate of 134 per 10(5) population. The highest incidence was seen in infants (930 per 10(5) infants) and 59% of the patients were 0-5 years of age (incidence rate 207 per 10(5) children). Pathogens were successfully identified in 80% of the cases, by employing a combination of microscopy and antigen detection using a commercially available latex agglutination kit. Neisseria meningitidis was identified in 58%, Streptococcus pneumoniae in 29%, Haemophilus influenzae type b in 11% and dual infection with H. influenzae type b and S. pneumoniae in 3% of the cases. Serogrouping was successfully performed on cerebrospinal fluid (CSF) deposits from 8 cases of meningococcal meningitis; 7 belonged to serogroup C and 1 to serogroup Y. There was a significant difference in the geometric mean age of meningitis caused by the three organisms. There was no seasonal or geographical clustering of cases caused by N. meningitidis. Although admissions for severe pneumonia in children less than 5 years of age peaked during the cold dry season (July-October), this was not associated with a similar peak in meningitis admissions caused by H. influenzae or S. pneumoniae. The overall case fatality rate was 15.7%, and the highest case fatality rate was found in infants (28%). Meningitis caused by H. influenzae was associated with the highest case fatality rate (29%) and N. meningitidis with the lowest (8%), but the difference was not statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The epidemiology of bacterial meningitis occurring in a Pacific Island population. 805 50

There is scant information about the etiology and epidemiology of bacterial diseases of infants and children in China because of very little success with bacterial culture. This study describes the severity of abuse of antibiotics among Chinese pediatricians and this abuse's potential interference in determining the etiology of bacterial diseases. According to a survey in Beijing Children's Hospital more than 98% of the patients in the Outpatient Department who were diagnosed with common cold were given antibiotics by physicians. More than one-third of the patients had been taking antibiotics before coming to the hospital. Using a sensitive Staphylococcus aureus assay we found that 70% of blood samples and 43% of cerebrospinal fluid samples from the patients with bacterial meningitis and pneumonia contained antibacterial activity. Bacteria were recovered significantly less often from the samples with antibacterial activity than from those who did not from which antibiotic was not recovered, both in blood (5.3% vs. 12.5%) and in cerebrospinal fluid (2.5% vs. 14.8%). This study indicates that antibiotic abuse is a severe problem in China and that judicious use of antibiotics is urgently needed.
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PMID:Abuse of antibiotics in China and its potential interference in determining the etiology of pediatric bacterial diseases. 810 25

In a prospective study over 7 years, 105 consecutive pediatric patients with hyperpyrexia (temperature > or = 41.1 degrees C [106 degrees F]) were evaluated to determine the incidence, sensitive indicators, and types of illnesses encountered. The incidence of hyperpyrexia in a large urban pediatric emergency department was 0.36 per 1,000 visits or approximately one in 2,759 visits. In patients with temperature > or = 41.1 degrees C, 65 (61.9%) had a serious illness. Pneumonia (33 lobar, three interstitial, two clinical) was the most common diagnosis (36.2%), followed by probable viral illness in 20 (19.0%) of the patients. Bacteremia (6.7%) and bacterial meningitis (5.7%) were less commonly found. Four (3.8%) patients died. The admission rate was 62.9%. Eighteen patients (17.1%) also had seizures. Sensitive indicators to help distinguish those with serious illness, with the exception of clinical appearance, were not found. Pneumonia is commonly found in children with hyperpyrexia. Temperature > or = 41.1 degrees C was associated with a high rate of serious disease.
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PMID:Association of hyperpyrexia with serious disease in children. 815 22

Hemophilus influenzae type b (Hib) is the most common cause of bacterial meningitis among children under 5 years old. Hib is also responsible for other invasive diseases including epiglottitis, cellulitis, sepsis, pneumonia, and osteomyelitis. A child's cumulative risk of systemic Hib disease during the first 5 years of life is approximately 1 in 200. A polysaccharide Hib vaccine was first marketed in 1985, and newer, more effective conjugated vaccines have been licensed since 1987. Immunization schedules have included increasingly younger children. No studies have been published that analyze the effects of a vigorous immunization program on a sample population representative of the United States at large. Records of pediatric patients ages 5 years and younger who were treated for Hib meningitis or epiglottitis (N = 373) at all U.S. Army medical facilities between 1986 and 1991 were reviewed. The combined incidence of these diseases declined by more than 86% in the study group during this period. The largest decrease occurred in infants less than 1 year old, before vaccines were licensed for use in this group. Meanwhile, the number of cases of bacterial meningitis due to other organisms in this cohort remained unchanged. Economic modeling validates the cost-effectiveness of vaccination. The impact of these preliminary trends on health care systems and otolaryngology-head and neck surgery will be significant. Almost two thirds of Hib disease has involved infants under 15 months old, for whom a conjugated vaccine has been available only since October 1990. The change in disease frequency will have substantial bearing on training programs, because management of neurologic sequelae and the emergent airway require the expertise of otolaryngologists. In the face of medical onslaught, Hib invasive disease is in retreat.
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PMID:The retreat of Hemophilus influenzae type B invasive disease: analysis of an immunization program and implications for OTO-HNS. 823 9

Hemophilus influenza type b (Hib), Neisseria meningitides (Mnc), and Streptococcus pneumonia (Pnc) cause more than three-quarters of all cases of acute bacterial meningitis in developing countries. A controlled clinical trial was carried out to compare the efficacy at day 4 of a double intramuscular injection of long-acting chloramphenicol 100 mg/kg with that of ampicillin administered intravenously for 8 days at 200 mg/kg (4 times a day). The study was conducted from May 1989 to May 1990 in the pediatric ward of Hopital Gabriel Toure in Bamako, Mali, and from March 1989 to May 1990 in the infectious diseases ward of the Hopital National in Niamey, Niger. Patients assigned to the ampicillin group received a solution of isotonic sodium chloride intravenously for 8 days. The final series consisted of 528 cases (274 in the ampicillin group and 254 in the chloramphenicol group). In 44.9% (123) of those who received ampicillin, the drug was injected intramuscularly. Among children aged 3 years, 48.5% (128) of the cases were caused by Hib, 27.3% (72) by Pnc, 10.6% (28) by Mnc, and 4.5% (12) by other agents. Among patients aged or = 3 years, 50.4% (133) of the cases were caused by Mnc, 1.9% (5) by Hib; 16.3% (43) by Pnc, and 1.9% (5) by other agents. The cumulative case fatality rate (CFR) at day 4 was 28% for the chloramphenicol group vs. 24.5% for the ampicillin group. The germ- specific hospital CFR and rate of major neurological sequelae, respectively were as follows: 13% (21/161) and 4.9% (7/140) for N. meningitides; 36.1% (48/133) and 28.2% (24/85) for H. influenza; 67% (77/115) and 21% (8/38) for S. pneumonia; and 64.7% (11/17) and 0% (0/6) for the other agents (8 deaths out of 10 cases of salmonella). The very high hospital CFR, (42%), irrespective of the treatment given, was noteworthy. These results are indicative of an endemic, since no outbreak of meningococcal meningitis occurred in either place during the study.
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PMID:Long-acting chloramphenicol for bacterial meningitis. 844 31

Previous studies of the value of the complete blood count (CBC) in distinguishing viral from bacterial infection in young febrile children have failed to exclude children with clinically evident bacterial infection and thus have inflated the positive predictive value of the test for occult focal infection. We prospectively studied 2492 children 3-24 months of age who presented to a children's hospital emergency department between March 1989 and August 1990 with fever (> or = 38.0 degrees C) of acute (< or = 4 days) onset but no evident bacterial focus of infection, 433 (17.4%) of whom received a CBC. We also carried out an 8-year retrospective analysis to estimate prior, or pre-test, probabilities (prevalences) and examine CBC results for rare occult bacterial infections (meningitis, osteomyelitis, and septic arthritis). Estimated prior probabilities for the four most common categories of infection that can be diagnosed at the initial visit were: non-pneumonitic viral infection, 88.6% in boys and 86.0% in girls; pneumonia, 8.5% in both sexes; urinary tract infection (UTI), 3.0% in boys and 5.5% in girls; and bacterial meningitis, 0.0066% in both sexes. The likelihood (sensitivity) of a total white blood cell (WBC) count > or = 15,000/mm3 was 25.5, 64.5, 62.5, and 50.0% for viral infection, pneumonia, UTI, and meningitis, respectively. Among children with a high total white blood cell count, neither a total polymorphonuclear count > or = 10,000/mm3 nor a band count > or = 500/mm3 was associated with significantly elevated likelihoods for occult pneumonia or UTI, a finding confirmed by multiple logistic regression analysis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Role of the complete blood count in detecting occult focal bacterial infection in the young febrile child. 848 99

Insulin-like growth factors (IGFs) have 6 types of binding proteins (IGFBPs), and IGFBP-3 is the major IGFBP in human sera. A proteolytic enzyme for IGFBP-3 has recently been reported to be present in human and animal pregnant sera. Although the physiological significance of a pregnancy-associated IGFBP-3 protease remains to be established, the proteolysis could result in lowering the affinity for IGFs, thereby enhancing their delivery to target tissues by increasing free IGFs in the circulation. The methods for detection of IGFBP-3 protease which have been widely used so far are a method reported by Lamson et al. which used affinity crosslinking or western ligand blotting. These methods need radioactive materials (iodinated IGFs and IGFBP-3) and it takes at least a few days to get the results. We have now developed a simple assay for the proteolysis of IGFBP-3. The method is western immunoblotting without radioactive materials. The results can be obtained in a day. With this method, we proved the absence of significant proteolytic activity in sera from rapidly growing children (early stage of puberty or precocious puberty), and sera from a severe type of growth hormone deficiency. Significant proteolytic activity, as in pregnant women, was detected in 6 out of 11 patients with acute disorders such as measles, Kawasaki disease, bacterial meningitis and mycoplasma pneumonia, some of whom were probably in a catabolic condition. These data suggests that the proteolysis of IGFBP-3 might also be important in modulating IGF action in some acute diseases during childhood. The increased bioavailability of IGFs by IGFBP-3 proteolysis may play a role in overcoming catabolic conditions.
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PMID:Proteolytic activity of IGFBP-3 in various clinical conditions during childhood studied by means of western immunoblotting. 855 66

Recently the incidence of infectious diseases caused by penicillin-resistant Streptococcus pneumoniae (PRSP) is increasing. Patients with meningitis caused by PRSP have been reported with high mortality especially in the field of pediatrics, and it is crucial to treat with accurate and precise choice of antibiotics. We report the first adult case of bacterial meningitis caused by PRSP in Japan. A 32-year-old male without immunological abnormalities developed acute pneumococcal meningitis. Empiric therapy with ampicillin and cefotaxime was not effective and the S. pneumonia from CSF showed resistance to multiple antibiotics such as penicillin and cefotaxime. He was treated successfully with the combination of panipenem/betamipron, vancomycin, and chloramphenicol. We assume that panipenem/betamipron is recommended to be added to empiric therapy of bacterial meningitis, considering an increasing incidence of PRSP infection.
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PMID:[An adult case of bacterial meningitis caused by penicillin-resistant Streptococcus pneumoniae]. 856 45


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