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

With the use of gas-liquid chromatographic techniques, the chemical characteristics of Streptococcus pneumoniae type 3, Escherichia coli, group B Neisseria meningitidis, Haemophilus influenzae type b, and Staphylococcus aureus, organisms that commonly cause bacterial meningitis, were identified. The combination of lipid, carbohydrate, and lipopolysaccharide components provided discriminating markers for chemotyping these bacteria. E. coli had a high content of 17- and 19-carbon cyclopropane fatty acids, whereas none of the other organisms tested revealed any cyclic acids, apart from a possible trace amount in S. pneumoniae. The content of isomethyl branching fatty acids clearly distinguished S. pneumoniae and S. aureus. N. meningitidis and H. influenzae were somewhat similar in their overall fatty acid compositions, but the presence of galactose without rhamnose in extracts of N. meningitidis readily distinguished N. meningitidis from H. influenzae. Only extracts from E. coli contained mannose; erythrose was an exclusive marker in extracts of S. pneumoniae. These data suggest that these differences in chemotype might be useful in developing a gas-liquid chromatographic assay of spinal fluid for the rapid laboratory diagnosis of bacterial meningitis.
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PMID:Diagnosis of bacterial meningitis by gas-liquid chromatography. I. Chemotyping studies of Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, Staphylococcus aureus, and Escherichia coli. 39 61

We report the development and testing of an enzyme-linked immunosorbent assay with excellent sensitivity for the detection of Haemophilus influenzae type b (HI(b)) antigen in clinical specimens from patients with HI(b) meningitis. The assay, an indirect sandwich technique, uses polystyrene balls as a solid phase and an alkaline phosphatase-labeled goat anti-rabbit globulin conjugate. Specimens are incubated with polystyrene balls armed with burro anti-HI(b) antiserum, and recognition antibody is visualized by addition of alkaline phosphatase-labeled anti-globulin, together with the enzyme substrate p-nitrophenyl phosphate. Concentrations of antigen are determined from standard curves prepared by using purified HI(b) capsular antigen polyribophosphate. The assay reproducibly detects polyribophosphate at concentrations between 1 and 5 ng/ml. Cross-reactions have not as yet been encountered in simulated and authentic clinical specimens containing other species including Escherichia coli, Klebsiella pneumoniae, group B Streptococcus, Pseudomonas aeruginosa, Streptococcus pneumoniae, Staphylococcus aureus, Neisseria meningitidis, and Listeria monocytogenes. In preliminary tests with 11 spinal fluid specimens, 2 serum specimens, and 5 urine specimens from patients with culture-proved HI(b) meningitis, antigen was detected in all specimens in concentrations ranging from 1 to 7,000 ng/ml. Antigen was not detected in any of 62 clinical specimens which were culture negative for HI(b), including 11 spinal fluid specimens from patients with bacterial meningitis caused by microorganisms other than HI(b). The enzyme-linked immunosorbent assay technique described here is considerably simpler than radioimmunoassay and, based on concurrent tests with 14 positive clinical specimens, may be more sensitive than counterimmunoelectrophoresis. It seems, therefore, to hold considerable promise for clinical use in rapid detection of systemic HI(b) infections.
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PMID:Indirect sandwich enzyme-linked immunosorbent assay for rapid detection of Haemophilus influenzae type b infection. 39 14

The usefulness of CRP in early detection of neonatal septicemia/meningitis and urinary tract infection was studied in a neonatal unit using a semiquantitative latex-agglutination as a rapid screening method, and electroimmuno assay as reference method for CRP determination. In 94% of non-infected infants CRP was less than or equal to 15 mg/l and 82% had CRP less than 10 mg/l up to 3 days of age. After 3 days of age 96% had CRP less than 10 mg/l. The initial CRP level was increased in 16 out of 18 patients (89%) with bacterial septicemia. Low CRP was seen in one patient with total agranulocytosis and septicemia from Streptococcus type B and in one patient with Staphylococcus albus sepsis. A rise in CRP was also seen in very pre-term infants with septicemia. Increased initial CRP was uncommon in neonatal urinary tract infection (2 of 9), but a rise was seen in 3 additional patients. A comparison between CRP, total neutrophil blood cell count and band neutrophil count as diagnostic parameters was in favour of CRP at this early stage of infection. CRP is of definite value as an aid in early diagnosis of neonatal septicemia and bacterial meningitis.
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PMID:C-reactive protein (CRP) in early diagnosis of neonatal septicemia. 39 15

Four patients with bacterial meningitis are reported. On initial examination 1 patient had a slightly abnormal cerebrospinal fluid (CSF), and in the other 3 patients the CSF was completely normal. An obviously purulent CSF was obtained when lumbar puncture was repeated 14-48 hours later. All 4 patients presented initially with pyrexia, and either neck stiffness or convulsions. In 3 of the 4 patients a cause for pyrexia was found on initial examination but lumbar punctures were done for neck stiffness or convulsions to exclude meningitis. The problems and the need to repeat a lumbar puncture, as well as the importance of blood cultures in a patient with suspected meningitis, are discussed. The fact that a normal specimen of CSF does not exclude meningitis is stressed.
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PMID:The need to repeat lumbar puncture. 40 17

A randomized therapeutic trial of carbenicillin (CB) or ampicillin (AMP) in purulent meningitis was performed in 86 pediatric and adult patients (41 Haemophilus influenzae, 22 Streptococcus pneumoniae, 13 Neisseria meningitidis, and 10 of unknown etiology). All isolates, incuding H. influenzae, were susceptible to CB and AMP. Median cerebrospinal fluid (CSF) antibiotic concentrations were 0.85 and 1.60 mug/ml for CB and AMP, respectively, during administration of daily doses of 400 mg/kg and 0.65 and 0.45 mug/ml, respectively, on daily doses of 200 mg/kg. Higher CSF concentrations, up to a median concentration of 4.5 mug/ml, were observed in patients with CSF protein concentrations >/=75 mg/100 ml. Clinical responses were equivalent on either antibiotic regimen. Among AMP patients (45), 8 had significant residua and 3 died; among CB patients (41), 5 had residua and none died. However, 38% of H. influenzae patients treated with CB had positive CSF cultures on day 1 follow-up lumbar punctures, compared with only 5.8% of AMP patients with H. influenzae. The significance of a delay of CSF sterilization among CB-treated patients is unknown, since there was no correlation between persistence of hemophilus organisms and the frequency of adverse outcome. AMP and CB are equivalent for the treatment of bacterial meningitis due to susceptible organisms.
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PMID:Comparative trial of carbenicillin and ampicillin therapy for purulent meningitis. 40 62

Amoxycillin a new broad spectrum antibiotic has been found to be effective against common gram positive and negative bacteria diagnosed in clinical practice. Moreover, it achieves higher blood levels as compared to Ampicillin. Since it was available only for oral use it had not been tried in the treatment of bacterial meningitis. Recently Amoxycillin Trihydrate became available for parenteral administration. Here we report its use as a single drug in 11 cases of Pyogenic meningitis. The dose administered by intravenous route was 200-400 mg/kg/day. All the cases recovered. Only three had minor neurological sequelae. Amoxycillin Trihydrate appears to be a safe and effective drug as there were no side effects or toxic manifestation even with the high dosage schedule.
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PMID:Amoxycillin trihydrate (Ibeamox) in the treatment of pyogenic meningitis-a preliminary report. 41 54

Penetration of the aminoglycoside, amikacin, into the cerebrospinal fluid (CSF) of twenty children with acute bacterial meningitis was studied at various times after intramuscular administration and at various stages of therapy. Six of the patients were evaluated during therapy with amikacin at 7.5 mg/kg (intramuscularly) every 12 hours plus ampicillin every 6 hours at 300 mg/kg/day (intravenously); thirteen of the remaining fourteen patients were treated with ampicillin alone, but were given a single intramuscular dose of 7.5 mg/kg of amikacin for evaluation of CSF concentration. Amikacin concentration in CSF with respect to time after administration followed essentially the same pattern as in serum. A minimum concentration of 2 microgram/ml was found in 76% of the CSF samples obtained between 0.5 and 7 hours after administration. A mean amikacin serum/CSF ratio of 3:1 was demonstrated up to 7 hours after dose in all patients who underwent clinical improvement. Patient response was predictable by a correlation of in vitro MIC values with in vivo CSF concentration in three of the six patients who received amikacin therapy.
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PMID:Amikacin concentration in the cerebrospinal fluid of children with acute bacterial meningitis. 42 64

It was originally our intention to study the suitability of the nitroblue-tetrazolium (NBT) test for differentiating the causes of granulocytic pleocytosis of the cerebrospinal fluid (CSF). However, several methodological problems were encountered and required extensive preliminary studies. The test was initially performed on 51 CSF samples from 37 patients using the method described by Park et al. in 1968. Although bacterial meningitis was demonstrated in 19 patients, the NBT test resulted in more than 11% NBT positive granulocytes in only four cases. No NBT positive cells were found in 24 of the samples tested. These rather poor results are not surprising if one considers that NBT is only taken up by granulocytes as macrocomplex containing heparin or fibrinogen. CSF does not contain measurable quantities of fibrinogen--either under normal conditions or in cases of viral or bacterial meningitis. A comparative study of the NBT test with and without the addition of heparin was performed using CSF samples from six patients with proven bacterial meningitis. Without heparin there were less than 11% NBT positive granulocytes in five cases, while all samples demonstrated more than 11% positive cells after addition of heparin. Best results were achieved with 70 IU of heparin in each sample. Preparation and evaluation were facilitated by use of 0.1% NBT solution and concentration of the CSF cells in a sedimentation chamber.
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PMID:The nitroblue-tetrazolium test in granulocytes of the cerebrospinal fluid--methodological problems. 42 51

Cefuroxime (25 mg/kg) given intravenously every four hours to 7 children with bacterial meningitis resulted in satisfactory therapeutic blood and CSF levels. All children made a full recovery and side effects were absent.
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PMID:Cefuroxime plasma and CSF levels in children with meningitis. 43 12

White-cell count and differential blood count, total protein, lactate dehydrogenase activity (E.C. 1.1.1.27) and lactate concentration were determined in 496 CSF samples, obtained by lumbar puncture. Lactate was measured with a new enzymatic test. Reference values were determined for lactate and lactate dehydrogenase (90% limits: 1.2-2.1 mmol/l and 6-26 U/l, respectively). Lactate content proved to be best in the differential diagnosis between acute bacterial and abacterial meningitis: concentrations of 3.5 mmol/ml and above were found exclusively in bacterial meningitis. As for other diseases, markedly increased lactate concentrations were measured only in patients with brain tumour or cerebrovascular disease (up to 9.3 mmol/l). Determination of lactate concentration alone would have led to a misdiagnosis of acute bacterial meningitis in 3% of cases. If the CSF contains 3.5 mmol/l lactate or more and the leucocyte cell count is above 800/microliter, brain tumour or cerebrovascular disease can be practically excluded and the diagnosis of bacterial meningitis made with a high degree of reliability.
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PMID:[Diagnostic significance of lactate concentration in CSF in patients with meningitis (author's transl)]. 43 27


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