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

Detection of cytomegalovirus (CMV) DNA by the polymerase chain reaction (PCR) in samples of cerebrospinal fluid (CSF) has been shown to be a sensitive method of diagnosing CMV disease in the central nervous system. Since CMV causes latent infection in white blood cells, an unanswered question is whether detection of latent CMV DNA in the cell fraction of CSF samples by PCR is possible in seropositive patients. In a prospective study, the finding of CMV DNA in CSF of CMV seropositive patients with suspected viral infection of the central nervous system (CNS) was evaluated clinically. Fractionation of 64 CSF samples from seropositive patients was carried out before analysing the samples for CMV DNA by PCR. In four of the five patients who had CMV DNA in the cell pellet and/or supernatant, the clinical data suggested CMV-associated neurological disease. The remaining 59 samples were negative in both pellet and supernatant. In addition, 11 CSF samples with high cell counts from patients with bacterial meningitis were examined for CMV DNA and found to be negative in 10 patients and positive in 1. One hundred thirty two uncentrifuged CSF samples were used as negative controls. The results of the study indicate that detection of CMV DNA in CSF samples by PCR correlated well with disease and was not due to latent CMV infection.
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PMID:Detection of cytomegalovirus DNA in cerebrospinal fluid in immunocompetent patients as a sign of active infection. 756 3

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

The value of DNA single-cell cytometry for the detection of neoplasia in Feulgen-stained cerebrospinal fluid cytological specimens was tested on 34 cases of Non-Hodgkin's lymphoma or leukemia and on 66 cases of viral or bacterial meningitis as a disease control group. The DNA content of 200 randomly chosen nuclei was measured on one pre-existing, cytologically representative slide per case, using a TV-image analysis system TAS-plus (Leitz, Germany). Neoplasia was diagnosed, if at least three nuclei with a DNA content above 5c (5cEE > or = 3) were found. The sensitivity investigating only one slide per case was 79.4% (27/34), the specificity 78.8% (52/66). Three lymphomas and 7 inflammatory cases were classified as suspicious (0 < 5cEE < 3). In 4 lymphoma cases (11.8%) a false-negative diagnosis and in 7 cases (10.6%) of viral meningitis a false-positive diagnosis were made. No false-positive diagnosis occurred in bacterial meningitis. While the false-negative diagnoses may be due to the only slightly increased number of cells in cerebrospinal fluid, no final explanation for increased DNA values after viral infection can be given. Therefore, before using DNA single-cell cytometry to prove the malignant character of lymphocytic pleocytosis in cerebrospinal fluid, viral meningitis has to be clinically excluded.
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PMID:DNA single cell cytometry in lymphocytic pleocytosis of the cerebrospinal fluid. 831 Jul 92

To be effective, treatment of meningitis should be based on the history and physical examination, careful examination of the cerebrospinal fluid, and good clinical judgment regarding the most likely pathogen. Meningitis in adults is usually caused by certain common viruses and bacteria, although atypical pathogens should be considered in immunocompromised patients. Supportive therapy measures are appropriate for viral disease, and intravenous acyclovir (Zovirax) may be given if infection with herpes simplex virus is suspected. In cases of presumed bacterial meningitis, antimicrobial agents should be selected that penetrate the blood-brain barrier and maintain activity against the most likely pathogens; antibiotic therapy should be instituted right away, along with supportive measures. Although corticosteroids have proven benefits in the treatment of pediatric populations with Haemophilus influenzae meningitis, their effectiveness in adults has not yet been established. Prophylaxis with vaccines or rifampin is sometimes useful.
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PMID:Adult meningitis. Rapid identification for prompt treatment. 841 63

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

Acute encephalitis is mainly of viral origin. Two groups of are considered: i) primary encephalitis, such as Herpes simplex encephalitis with intra-thecal synthesis of antibodies, and ii) post-viral infection encephalitis or acute disseminated encephalitis with immune dysregulation. The most common clinical presentation (fever, consciousness disturbance and seizures) is not specific and may reveal bacterial meningitis or cerebral abscess which require a specific treatment. Acyclovir has allowed consistant advances in the treatment of herpes encephalitis. Vaccination against selected viral infection, such as measle vaccine, is the only way to prevent acute disseminated encephalitis.
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PMID:[Acute encephalitis in children]. 878 67

An open circuit indirect calorimeter was used to measure resting energy expenditure in febrile infants. Twelve infants admitted to hospital with fever (axillary temperature 37.5 degrees C) were studied on admission and then again at the same time of day and in similar environmental conditions after the fever had resolved. Mean age of the infants was 0.31 years (range 0.12-0.54) and the mean body weight 6.59 kg (range 4.50-8.88 kg). On average the infants' axillary temperatures were +2.1 degrees C higher when they were febrile. Overall the mean difference in oxygen consumption (VO2), carbon dioxide production (VCO2), and resting energy expenditure (REE) between the febrile and afebrile measurements was not statistically significant. Of eight infants with a greater REE when febrile, five were diagnosed as having viral illness and three had bacterial meningitis. Of the four with a lower REE when febrile, two had viral illness and two had bacterial infection (one chest infection and one meningitis). In conclusion, there was no consistent alteration of REE during a fever in infants 1 to 6 months of age. In particular, age and type of infection were not predictors of whether REE would increase or decrease during the illness.
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PMID:Metabolic rate in febrile infants. 878 23

La Crosse encephalitis, a mosquito-borne viral disease that can be mistaken for herpes simplex encephalitis, is under-recognized in the United States, despite case reports from 28 states and an incidence in endemic areas (20-30/100,000) exceeding that of bacterial meningitis. The disease recurs every summer in endemic foci in the midwestern and mid-Atlantic United States in areas forested with hardwood trees, which provide breeding sites for the treehole-dwelling mosquito vector, Aedes triseriatus. La Crosse encephalitis should be considered in the child presenting with meningoencephalitis in summer and early fall, particularly for children living in (or recent travel to) endemic areas in mid-Atlantic and midwestern states.
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PMID:California-La Crosse encephalitis. 949 31

The progressive sensorineural hearing loss due to infectious causes can involve different etiological agents like bacteria, viruses, protozoons or mycetes. These infectious agents can act in various ways: directly through a labyrinthitis that may destroy the neuroepithelium; through an ischaemic process secondary to a septic embolus; or through a thrombus. In some cases the damage can occur in a meningitis context, because of the passage of the germ in the inner through the nerves, the vases or the labyrinthine liquids. Bacterial meningitis is one of the causes of progressive sensorinueral hearing loss. Among bacteria, the Mycobacterium Tuberculosis has nowadays acquired a remarkable importance which is also due to its considerable diffusion, despite modern therapy, and to its association with HIV infection. Bacteria can also cause a labyrinthitis acting directly on the inner ear: among these, Treponemas Pallidum, a spirochaete which causes syphilis and Borrelia Burgdorferi, a spirochaete that causes Lyme Disease, must be mentioned. The viruses that are certainly involved in the etiology of progressive sensorineural hearing loss are Cytomegalovirus and Rubella virus. The virus usually causes a labyrinthitis after the viraemia, wich may be due to the passage of the virus from the blood to the endolymph, through the stria vascularis with the consequent infection of the sensorial cells of the organ of Corti. Less frequently the viral damage to the inner ear can occur after a vasculitis, a meningitis or an alteration of the cell-mediated immunity. Progressive sensorineural hearing loss can also occur because of some congenital viral infections such as those caused by Cytomegalovirus and Rubella virus. More recently even the Human Parvovirus B19 seems to have been involved. This virus seems to act through autoimmune and/or immunologic processes, like that causing sudden hearing loss in Lassa fever. Another viral infection which can nowadays more frequently be considered among the cause of progressive hearing loss is HIV. In the HIV infection the neurological toxic lesions due to the administered ototoxic drugs are added up to the damages caused by the opportunistic infectious agents (virus, bacterium, protozoon mycete). However, in these patients HIV itself could be the cause of the auditory and vestibular lesions. More rarely, a progressive hearing loss may be due to the action of a protozoon or mycete only.
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PMID:[Progressive sensorineural hearing loss from infectious agents]. 1020 33

When a toxic newborn or young infant presents with fever and lethargy or irritability, it is important to consider the diagnosis of meningitis even if the classic localizing signs and symptoms are absent. Cerebrospinal fluid should be obtained (unless lumbar puncture is clinically contraindicated) to enable initial therapy to be planned. Initial results of cerebrospinal fluid testing may not conclusively differentiate between aseptic and bacterial meningitis, and antimicrobial therapy for all likely organisms should be instituted until definitive culture results are available. Comprehensive therapy, including antibacterial and antiviral agents, should continue until a cause is identified and more specific therapy is initiated, an etiology is excluded or the patient improves considerably and the course of antimicrobial therapy is completed. Group B streptococcus is the most common bacterial etiologic agent in cases of meningitis that occur during the first month after birth. Etiologies of aseptic meningitis include viral infection, partially treated bacterial meningitis, congenital infections, drug reactions, postvaccination complications, systemic diseases and malignancy. Long-term sequelae of meningitis include neuromuscular impairments, learning disabilities and hearing loss. Prompt diagnosis and treatment are essential to improved outcome.
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PMID:Aseptic meningitis in the newborn and young infant. 1034 69


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