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PubMed1991

Detection of granulocyte-macrophage colony-stimulating factor in cerebrospinal fluid of patients with aseptic meningitis.

The level of granulocyte-macrophage colony-stimulating factor (GM-CSF) in the cerebrospinal fluid from 14 infants and children with meningitis and 6 patients who suffered other diseases besides meningitis was measured by our sensitive enzyme linked immunosorbent assay for GM-CSF. The minimal detection level of GM-CSF was 40 pg/ml. Six of 9 patients (67%) with aseptic meningitis had detectable GM-CSF in cerebrospinal fluid and the concentrations of GM-CSF ranged from 49 to 114 pg/ml (mean 72 pg/ml), whereas none of 5 patients with bacterial meningitis or 6 patients with other diseases besides meningitis had detectable GM-CSF levels. There was no clear correlation between the GM-CSF levels in cerebrospinal fluid and the leukocyte count in either peripheral blood or cerebrospinal fluid, or the concentration of protein or glucose in cerebrospinal fluid.

Child↗

PubMedDate not supplied

Hearing loss after Hemophilus influenzae meningitis. Follow-up study with auditory brainstem potentials.

Hearing loss was studied prospectively using auditory brainstem potentials in 34 children with Hemophilus influenzae meningitis treated with chloramphenicol and in 36 children with purulent meningitis caused by microorganisms other than H influenzae treated with ampicillin. Our results indicate that high doses of ampicillin are not associated with permanent hearing loss. Moreover, no statistically significant difference was found in the incidence of hearing loss following H influenzae meningitis and that following meningitis caused by other microorganisms, either during the acute phase or in the convalescent period. Neurological damage, when present, was probably located in the inner ear or in the auditory nerve. Finally, early hearing loss in purulent meningitis does not always constitute an irreversible lesion.

Ampicillin↗

PubMed2000

Oxidative stress in childhood meningitis: measurement of 8-hydroxy-2'-deoxyguanosine concentration in cerebrospinal fluid.

To examine the involvement of reactive oxygen species, we measured the concentration of 8-hydroxy-2'-deoxyguanosine (8-OHdG), a biomarker of oxidative stress, in cerebrospinal fluid samples from 63 children with and without meningitis. We observed that the mean concentration of 8-OHdG in samples obtained during the early phase of bacterial meningitis, but not aseptic meningitis, was significantly higher than that in control samples. Clinical and laboratory improvement was associated with a fall in the 8-OHdG concentration in the patients with bacterial meningitis. Our findings suggest the presence of enhanced oxidative stress in the central nervous system of children with bacterial meningitis.

8-Hydroxy-2'-Deoxyguanosine↗

PubMed2004

Severe symptomatic aseptic chemical meningitis following myelography: the role of procalcitonin.

Symptomatic aseptic, chemical meningitis is a rare complication of myelography. Its acute clinical course and standard laboratory findings are indistinguishable from those of bacterial meningitis. The authors present a case of severe postmyelographic chemical meningitis and compare CSF and serum inflammatory markers to a group of seven patients with proven bacterial meningitis. As in viral meningitis, procalcitonin might be able to discriminate between bacterial and chemical causes of CNS inflammation.

Adult↗

PubMed1976

Glioblastoma multiforme and the meningeal syndrome.

Brain tumors rarely may produce acute steile meningitis (the meningeal syndrome) resulting from the spillage of blood, lipid products of tumor necrosis, or malignant cells into the cerebrospinal fluid (CSF). The frequency of the associated meningeal syndrome is a function of tumor type and of the tproximity of tumor necrosis to the ventricles. The meningeal syndromes of lipid-induced chemical inflammation are seen most commonly with epidermoids, craniopharyngiomas, and infarcted pituitary adenomas. I report a patient with the rare association of the meningeal syndrome with glioblastoma multiforme. The lipid irritants of glioblastomas and craniopharyngiomas are similar chemically and can be detected in the CSF. The anti-inflammatory and immunosuppressant properties of steroids provide a rational basis for their efficacy in treatment of the syndrome.

Brain Neoplasms↗

PubMed1996

Cerebrospinal fluid concentrations of soluble tumor necrosis factor receptor in bacterial and aseptic meningitis.

Soluble tumor necrosis factor receptor (sTNF-R) is the natural homeostatic regulator of the action of TNF-alpha. The level of sTNF-R reflects the true biologic activity of TNF-alpha. We investigated whether sTNF-R increases in CSF during patients' acute stage of bacterial and aseptic meningitis by measuring p60 sTNF-R in CSF by a sandwich enzyme immunoassay. The concentrations of sTNF-R were significantly higher in the CSF of children with bacterial meningitis than in the CSF of those with aseptic meningitis or of control subjects. The patients with bacterial meningitis who died or had severe neurologic sequelae had higher sTNF-R levels than those who survived. Our findings suggest that the sTNF-R level in CSF during acute bacterial meningitis is important for predicting neurologic sequelae.

Child↗

PubMed1995

Middle meningeal artery aneurysm associated with meningioma: case report.

Middle meningeal artery aneurysms are rare. Fewer than 10 true aneurysms and 30 posttraumatic aneurysms on meningeal vessels have been reported. True meningeal aneurysms are associated with tumors, Paget's disease, arteriovenous malformations, and trauma. Potential morbidity is demonstrated with hemorrhage from true aneurysms as well as from pseudoaneurysms of the meningeal vessels. We have described a meningeal artery aneurysm of the vascular pedicle of a convexity meningioma and reviewed the literature.

Aged↗

PubMed1987

Clinical significance and source of raised catalytic activities of phosphohexose isomerase in the CSF in meningitis.

The value of phosphohexose isomerase (EC 5.3.1.9) determination in the CSF in the diagnosis of meningitis was tested under routine conditions. In 48 patients with untreated bacterial meningitis, enzyme activity concentrations between 40 and 2335 U/l were measured, whereas the highest phosphohexose isomerase activity concentration in 92 patients with viral meningitis was 34 U/l. Lysis of the CSF leukocytes with Triton X-100 resulted in a substantial increase of phosphohexose isomerase activity. In bacterial meningitis these values increased to 200 to 7000 U/l, but remained under 150 U/l in viral meningitis. The raised enzyme activities are derived from the leukocytes and appear to reflect their functional and metabolic state. The information provided by the leukocyte morphology can thus be appreciably extended by phosphohexose isomerase determination.

Adolescent↗

PubMed1997

[Laboratory and clinical variables in the differential diagnosis of aseptic and pyogenic meningitis in children].

We reviewed the charts of 573 children with a final diagnosis of pyogenic or aseptic meningitis, who were hospitalized in a large reference hospital for the treatment of infectious disease, from January 1990 to December 1992. Seizures, decreased consciousness, nuchal rigidity were more frequent in bacterial than in aseptic meningitis. A cerebrospinal fluid (CSF) glucose level lower than 45 mg/dL, a protein level equal or greater than 140 mg/dL and cell count greater than 600/mm3 were predictors of pyogenic meningitis. Receiver operating characteristic curve analysis was used to assess the best point in CSF measures of leukocytes, glucose and protein that could predict bacterial meningitis. These results suggest that clinicians should differentiate bacterial from aseptic meningitis in children with greater accuracy utilizing only clinical and simple CSF data.

Acute Disease↗

PubMed2001

Suspected allopurinol-induced aseptic meningitis.

Drug-induced aseptic meningitis is a syndrome with symptoms similar to those of infectious meningitis. A 60-year-old man with a history of recurrent renal stones was admitted to the hospital with fever, chills, and mental status changes after taking levofloxacin, allopurinol, and acetazolamide. No infectious source was identified. Once home, he resumed allopurinol, and within 2 hours, he experienced the same symptoms, requiring rehospitalization. He was diagnosed with suspected meningitis from an adverse drug reaction that we believe was due to allopurinol. It is important to remember, when all other causes are ruled out, that a patient's symptoms may be a drug-induced adverse effect. Drug-induced aseptic meningitis should be considered when patients with symptoms similar to those of infectious meningitis appear without infectious etiologies or cerebrospinal fluid pleocytosis, a suspected agent was recently started, and resolution of adverse effects occurs when the agent is withdrawn.

Allopurinol↗

PubMed2001

FLAIR MR imaging for diagnosing intracranial meningeal carcinomatosis.

OBJECTIVE: The purpose of this study was to compare unenhanced and contrast-enhanced fluid-attenuated inversion recovery (FLAIR) imaging with other sequences to visualize meningeal carcinomatosis. MATERIALS AND METHODS: Unenhanced FLAIR images were compared with spin echo T2-weighted and contrast-enhanced FLAIR images in five patients with documented meningeal carcinomatosis and four patients with suspected meningeal carcinomatosis. Comparisons were also made between contrast-enhanced T1-weighted and FLAIR images. RESULTS: In six patients, the unenhanced FLAIR images showed areas of abnormal hyperintensity within the sulci that were not noted on the spin-echo T2-weighted images. In all patients, the contrast-enhanced FLAIR images also showed meningeal enhancement, periventricular enhancement, or both. The contrast-enhanced T1-weighted and FLAIR images were equivalent in their depiction of abnormal enhancement in five of the nine patients; contrast-enhanced FLAIR images were superior in three patients. CONCLUSION: Unenhanced FLAIR images are of more value than spin-echo T2-weighted images for the diagnosis of intracranial meningeal carcinomatosis. Contrast-enhanced FLAIR images can sometimes surpass contrast-enhanced T1-weighted images in their quality.

Female↗

PubMedDate not supplied

Intrathecal synthesis of complement components C3c and C4 in the central nervous system infections with signs of the acute serous meningitis syndrome.

Two hundred and ten patients with meningismus and the infections of the central nervous system (CNS) with the clinical symptoms and signs of the acute serous meningitis syndrome, were divided in to groups according to etiology (enterovirus meningitis-ENTERO, serous meningitis various etiology-SM and tuberculous meningitis-TBC). Intrathecal synthesis (ITS) of C3c and C4 complement components and IgG were determined by the method of cerebrospinal indexes (I), to examine their role in differential diagnosis of this syndrome. Correlative study between the CSF/serum ratio (Q) for albumin (Alb) and QC3c and QC4 in patients with no proven ITS of this two complement proteins, and the comparative study of the increased value of C3cI and C4I (and IgGI) between the examined groups of the patients was done. Highly significant correlations were found between QAlb and QC3c (r = 0.89, p < 0.001) and QC4 (r = 0.85, p < 0.001). In 22.4% of the examined patients ITS of C3c and C4 were found. There was no difference in frequency of ITS of the two complement proteins between the examined groups, nor inside any particular group. TBC group had significantly lower (p < 0.05) intensity of ITS of C3c and C4 than MNG and ENTERO, and significantly higher intensity of ITS of IgG (p < 0.05) than the other tested groups. CSF index was confirmed as a valid method to detect intrathecal C3c and C4 production. Determination of ITS C3c and C4 could not be of great help in differential diagnosis in the acute serous meningitis syndrome. The intensity of ITS of C3c and C4, related to the intensity of ITS of IgG, could be of help in the determination of the duration of the disease.

Acute Disease↗

PubMed1987

Changing pattern of neonatal meningitis in Sweden. A comparative study 1976 vs. 1983.

A nationwide retrospective epidemiological survey of neonatal meningitis in Sweden was performed in order to estimate possible changes in incidence, etiology and mortality. The total number of newborns with meningitis was 137 and 40 (29%) were preterm (less than 37 gestational weeks) infants and 27 of these preterm boys (20%). Meningitis from group B streptococci and Escherichia coli, the two major causative organisms in 1976, had decreased markedly in 1983. The identification rate of viral origin was more frequent during 1983 compared to 1976. The total incidence of meningitis was 8.9/10,000 livebirths in 1983 vs. 5.6/10,000 in 1976 but the rate of verified bacterial meningitis had decreased from 3.6/10,000 (1976) to 1.9/10,000 (1983). The total outcome was improved significantly since the combined mortality and handicap rates decreased from 34% in 1976 to 15% in 1983.

Escherichia coli Infections↗

PubMed1999

[Community-acquired bacterial meningitis in the Loire-Atlantic region: evolution of pneumococcal and meningococcal sensitivity to penicillin].

OBJECTIVES: An epidemiological study of community-acquired bacterial meningitis was conducted in Loire-Atlantique in subjects aged over 1 month. Risk factors and changes in pneumococcal and meningococcal susceptibility to betalactams were analyzed. PATIENTS AND METHODS: All cases of proven or presumed bacterial meningitis registered by Loire-Atlantic bacteriology laboratories between May 1995 and April 1998 were analyzed. RESULTS: One hundred two cases were registered (annual incidence: 3.12 cases per 100,000 inhabitants). In children (33 cases) the main germs were meningococci (51%), pneumococci (24%) and Haemophilus influenzae (6%). In adults (69 cases), pneumococci (49%), meningococci (14%) and Listeria (4%) predominated. An underlying disease was noted 44% of the cases. Mortality was 17.6%. Sequellae were observed in 9.5%. Some degree of penicillin resistance was observed in 45% of the pneumococcal strains and in 50% of the meningococcal strains. Half of the pneumococcal strains were also resistant to third generation cephalosporins (C3G). No risk factor was significantly related to resistant strains. Susceptibility to antibiotics was not correlated with mortality for either pneumococcal or meningococcal strains, but sequellae were more frequent after meningitis caused by resistant pneumococci. CONCLUSION: For cases of community-acquired meningococcal meningitis diagnosed in 1999, it would be advisable to prescribe a combination C3G-vancomycin regimen as the first line empirical treatment while waiting for results of susceptibility tests. Certain guidelines proposed by the February 1996 consensus conference on community-acquired purulent meningitis would thus need to be amended.

Adult↗

PubMed1999

[Distribution of transplantation HLA antigens in children and adolescents with meningitis of various etiology].

An interaction between HLA antigens and predisposition to meningitis of specific and nonspecific etiology was studied in children and adolescents from an Azerbaijan population. The distribution of HLA antigens was found to be heterogeneous in the patients with meningitis of various etiology. Tuberculous meningitis was characterized by a significant rise in the detection rate of HLA-DR3 antigen, by a considerable frequency of B14 and DR2 antigens; patients with purulent meningitis much more significantly showed HLA-B12 antigen; in terms of locus A, there was an increase in the detection rates of HLA-A19 antigen in serous meningitis.

Adolescent↗

PubMed2000

Impact of Haemophilus influenzae type b (Hib) conjugate vaccines on Haemophilus influenzae meningitis in Wisconsin.

The first effective Haemophilus influenzae type b (Hib) conjugate vaccines were approved for use in children and infants between 1987 and 1990. In 1993, the federal government began the Childhood Immunization Initiative (CII), a program to improve the rate of vaccination of children nationwide. Subsequently, the proportion of 19 to 35-month-old children who received three or more doses of Hib vaccine rapidly increased from 28% in 1992 to 90% by 1995, with a concurrent dramatic decline in the incidence of H. influenzae meningitis. We reviewed cases of H. influenzae meningitis reported to the Wisconsin Division of Public Health from 1981 to 1997. The mean annual incidence of H. influenzae meningitis declined 96% from 2.4 cases per 100,000 persons in the pre-vaccination period (1981-1986) to less than 0.1 case per 100,000 persons after Wisconsin had achieved 90% Hib vaccination coverage (1994-1997). H. influenzae meningitis occurrence declined dramatically among all age groups, including 96% among children aged less than 1 year old, 99% among 1-4 and 5-9 year olds, and 46% among persons 10 or more years old. Consistent with national trends, the majority of H. influenzae meningitis cases reported in 1997 was caused by non-type b strains of H. influenzae.

Age Factors↗

PubMed2001

Epidemiology and diagnosis of meningitis: results of a five-year prospective, population-based study.

Implementation of the advice to give penicillin prior to admission, a fall in the lumbar puncture rate and the introduction into routine use of the meningococcal polymerase chain reaction (PCR) test are factors that have led us to reassess the way meningitis is diagnosed. We examined data for the period 1994-98 from a health district of 800,000 population. Of the 355 cases of meningitis reported, 258 (73%) had either confirmed, probable or possible meningococcal disease. Only 28% of meningococcal cases had received pre-admission benzylpenicillin. The proportion of suspected meningitis cases undergoing lumbar puncture fell over the period. It was 79% in 1994 and 61% in 1998 (p < 0.001). After meningococcal PCR was introduced in 1996, 73 (68%) meningococcal cases were microbiologically confirmed, compared to 72 (48%) before 1996 (p = 0.001). In all cases, age was an independent predictor of meningitis mortality, and for meningococcal cases, age and serogroup were independent predictors. Advice to general practitioners (GPs) to give preadmission benzylpenicillin to any suspected case of meningitis or meningococcal septicaemia should be reinforced regardless of age or whether a rash is present.

Adolescent↗

PubMed2005

[Serotype distribution of enteroviruses isolated from paediatric cases prediagnosed as aseptic meningitis between 2001-2004 period].

Enteroviruses have major clinical and public health importance and are one of the leading causes of aseptic meningitis. There are many diseases with similar clinical symptoms and cerebrospinal fluid (CSF) findings of aseptic meningitis, thus virus isolation and identification is crucial for definitive diagnosis. Virological diagnosis is nonetheless important to distinguish between induced meningitis and other treatable causes of disease with a similar clinical picture. A total of 249 samples obtained from 246 cases (age range: 0-15 years), prediagnosed as aseptic meningitis, were sent to Virology Laboratory of Refik Saydam Hygiene Center. The patients were followed at Department of Pediatric Infectious Diseases in the Social Security Hospital, Ankara, Turkey, between 2001 and 2004. Stool (n: 180), CSF (n: 54) and throat swab (n: 15) samples have been inoculated to RD (rhabdomyosarcoma), Hep-2 (human epithelioma) and L20B (transgenic mice) cell lines, and followed up for the presence of cytopathic effects. A total of 95 enterovirus strains were isolated from 85 (34.6%) cases, and serotyped by using RIVM (National Institute of Public and the Environment, Nederlands) antisera with microneutralization method. As a result, the most frequently isolated types were found as echovirus type 30 (n: 24) and coxsackievirus type B (n: 19), which were most frequently isolated between July to October. This is the first report from Turkey for aseptic meningitis cases due to echovirus type 25 (n:3), 18 (n:2), 14 (n:1), 13 (n:4), 11 (n:6), 9 (n:1), 6 (n:9), 5 (n:1), 4 (n:1) and coxsackievirus type A9 (n:1).

Adolescent↗