RESUMO
The optimal duration of antibiotic treatment for the most common bacterial meningitis etiologies in the pediatric population, namely Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis, is not well-established in the literature. Therefore, we aimed to perform an updated meta-analysis comparing shorter versus longer antibiotic treatment in children with meningitis. PubMed, EMBASE, and Cochrane databases were searched for randomized controlled trials (RCTs) that compared shorter (up to 7 days) versus longer (10 days or double the days of the equivalent short course) duration of antibiotic treatment in children with meningitis and reported the outcomes of treatment failure, death, neurologic sequelae, non-neurologic complications, hearing impairment, nosocomial infection, and relapse. Heterogeneity was examined with I2 statistics. RevMan 5.4.1 was used for statistical analysis and RoB-2 (Cochrane) for risk of bias assessment. Of 684 search results, 6 RCTs were included, with a cohort of 1333 children ages 3 weeks to 15.5 years, of whom 49.51% underwent a short antibiotic course. All RCTs included monotherapy with ceftriaxone, except one, which added vancomycin as well. No differences were found comparing the short and long duration of therapy concerning treatment failure, relapse, mortality, and neurologic complications at discharge and at follow-up. Conclusion: Because no statistically significant differences were found between groups for the analyzed outcomes, the results of this meta-analysis support shorter therapy. However, generalizing these results to complicated meningitis and infections caused by other pathogens should be made with caution. (PROSPERO identifier: CRD42022369843). What is Known: ⢠Current recommendations on the duration of antibiotic therapy for bacterial meningitis are mostly based on clinical practice. ⢠Defining an optimal duration of antibiotic therapy is essential for antimicrobial stewardship achievement, improving patient outcomes, and minimizing adverse effects. What is New: ⢠There are no differences between shorter versus longer antibiotic treatment duration in regard to treatment failure, relapse, mortality, neurologic complications, and hearing impairment at discharge and at follow-up.
Assuntos
Perda Auditiva , Meningites Bacterianas , Criança , Humanos , Antibacterianos/efeitos adversos , Meningites Bacterianas/tratamento farmacológico , Meningites Bacterianas/complicações , Ceftriaxona/uso terapêutico , Perda Auditiva/etiologia , Perda Auditiva/induzido quimicamente , RecidivaRESUMO
OBJECTIVE: To determine the prevalence of bacteremia and meningitis (invasive bacterial infection [IBI]) in hypothermic young infants, and also to determine the prevalence of serious bacterial infections (SBI) and neonatal herpes simplex virus and to identify characteristics associated with IBI. STUDY DESIGN: We conducted a retrospective cohort study of infants ≤90 days of age who presented to 1 of 9 hospitals with historical or documented hypothermia (temperature ≤36.0°C) from September 1, 2017, to May 5, 2021. Infants were identified by billing codes or electronic medical record search of hypothermic temperatures. All charts were manually reviewed. Infants with hypothermia during birth hospitalization, and febrile infants were excluded. IBI was defined as positive blood culture and/or cerebrospinal fluid culture treated as a pathogenic organism, whereas SBI also included urinary tract infection. We used multivariable mixed-effects logistic regression to identify associations between exposure variables and IBI. RESULTS: Overall, 1098 young infants met the inclusion criteria. IBI prevalence was 2.1% (95% CI, 1.3-2.9) (bacteremia 1.8%; bacterial meningitis 0.5%). SBI prevalence was 4.4% (95% CI, 3.2-5.6), and neonatal herpes simplex virus prevalence was 1.3% (95% CI, 0.6-1.9). Significant associations were found between IBI and repeated temperature instability (OR, 4.9; 95% CI, 1.3-18.1), white blood cell count abnormalities (OR, 4.8; 95% CI, 1.8-13.1), and thrombocytopenia (OR, 5.0; 95% CI, 1.4-17.0). CONCLUSIONS: IBI prevalence in hypothermic young infants is 2.1%. Further understanding of characteristics associated with IBI can guide the development decision tools for management of hypothermic young infants.
Assuntos
Bacteriemia , Infecções Bacterianas , Hipotermia , Meningites Bacterianas , Infecções Urinárias , Humanos , Lactente , Recém-Nascido , Bacteriemia/complicações , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/complicações , Hipotermia/epidemiologia , Meningites Bacterianas/epidemiologia , Meningites Bacterianas/complicações , Prevalência , Estudos Retrospectivos , Infecções Urinárias/epidemiologiaRESUMO
INTRODUCTION: Acute bacterial meningitis (ABM) continues to be a challenge from a diagnostic and therapeutic point of view. Identifying severity risk factors and predictive scores may guide interventions to reduce poor outcome. METHODS: Data from a retrospective study for ABM in children admitted to the Institute of Tropical Medicine in Paraguay was analyzed. ABM was defined as positive cerebrospinal fluid culture, positive latex agglutination, or identification of microorganism by real time-polymerase chain reaction. Univariate and multivariate analyses of risk factors at hospital admission that predicted major morbidity or death during hospitalization were performed. A point-based scoring system that included variables, which were clearly different among those who passed away, was constructed. RESULTS: One hundred fourteen children hospitalized with ABM were eligible for the study. The mean age was 46 ± 57 months (range, 1-192 months). The observed mortality was 33% (38/114 patients). When a point-based scoring system was used, for score of 0 (n = 29) and 1 (n = 12), no death was observed. Among patients with a score of 2 (n = 14), 3 (n = 10 patients), 4 (n = 12 patients), and 5 (n = 13 patients), the mortality rate was 14.3%, 40%, 50%, and 53.8%, respectively. When the score was 6 or higher, the mortality rate was at least 63.6%. CONCLUSIONS: The present score accurately discriminated the probability of death in children hospitalized with ABM, and it could be a useful tool to select candidates for admission to the intensive care unit and for adjunctive therapy in clinical trials.
Assuntos
Meningites Bacterianas , Criança , Humanos , Pré-Escolar , Estudos Retrospectivos , Meningites Bacterianas/complicações , Meningites Bacterianas/diagnóstico , Fatores de Risco , Hospitalização , Progressão da DoençaRESUMO
Our objective was to explore the importance of underweight on the course of childhood bacterial meningitis (BM) at different study sites, because prior studies showed discrepant results. Using directly comparable, prospective data from three continents, weight-for-age z-scores (WAZ) were determined by WHO Anthro programs in children with BM in Finland (N = 318), LatAm (N = 580), and Angola (N = 780) and compared with data describing the admission, course, and outcome of BM. WAZ < -1 indicates underweight; either mild (< -1 to -2), moderate (< -2 to -3), or severe (< -3). The mean WAZ (SD) was 0.17 (1.17), -0.42 (1.53), and -1.36 (1.44), and the prevalence of moderate-severe underweight 2.8%, 12.6%, and 31.3%, in Finland, LatAm, and Angola, respectively. In univariate analysis, LatAm and Angola showed an association between lower WAZ and poorer condition on admission, slower recovery, and more deaths. In Finland, infrequent underweight limited meaningful analysis. In multivariate analysis of different variables for increasing the odds of death, severe underweight had lower odds compared to disease severity in Angola, but highest in LatAm. Thus, the apparent discrepancy in underweights´ importance for increasing deaths varied from primary to more secondary according to locally more prominent risks.
Assuntos
Meningites Bacterianas , Magreza , Angola/epidemiologia , Criança , Finlândia/epidemiologia , Humanos , Lactente , América Latina , Meningites Bacterianas/complicações , Meningites Bacterianas/epidemiologia , Estudos Prospectivos , Magreza/complicações , Magreza/epidemiologiaRESUMO
Pituitary apoplexy (PA) is a clinical diagnosis comprising a sudden onset of headache, neurological deficits, endocrine disturbances, altered consciousness, visual loss, or ophthalmoplegia. However, clinically, the presentation of PA is extremely variable and occasionally fatal. While meningitis and cerebral infarcts are themselves serious diseases, they are rarely seen as manifestations of PA and are exceedingly rare when present together. We present the case of a 20-year-old male with a rapid progression of symptoms of meningitis, PA and stroke. The present article seeks to emphasize a rare manifestation of PA with an attempt to understand the intricacies of its evaluation and management.
Assuntos
Humanos , Masculino , Adulto , Apoplexia Hipofisária/cirurgia , Apoplexia Hipofisária/etiologia , Meningites Bacterianas/complicações , Acidente Vascular Cerebral/complicações , Punção Espinal/métodos , Apoplexia Hipofisária/diagnóstico por imagem , Infarto Cerebral/complicações , Endoscopia/métodosRESUMO
Abstract Introduction The cochlea and the vestibular receptors are closely related in terms of anatomy and phylogeny. Patients with moderate to profound sensorineural hearing loss (MPSHL) should have their vestibular organ functions tested. Objective To evaluate the incidence of vestibular abnormalities in patients with MPSHL and to study the correlation between the etiology of hearing loss (HL) and a possible damage to the labyrinth. Methods A case-control retrospective study was performed. In the case group, 20 adults with MPSHL of known etiology were included. The control group was composed of 15 adults with normal hearing. The case group was divided into 4 subgroups based on the etiology (bacterial meningitis, virus, vascular disease, congenital). Cervical vestibular-evoked myogenic potentials (cVEMPs) were used to rate the saccular function and lower vestibular nerve. Results The study was performed in 70 ears, and it highlighted the presence of early biphasic P1-N1 complex in 29 (71.5%) out of 40 ears in the study group, and in all of the 30 ears in the control group (p = 0.001). Regarding the presence or absence of cVEMPs among the four subgroups of patients with MPSHL, the data were statistically significant (p < 0.001). The comparison between the latencies and amplitude of P1-N1 in case and control groups from other studies and in the four subgroups of cases in the present study did not detect statistically significant differences. Conclusion The present study demonstrates that patients with MPSHL have a high incidence of damage to the labyrinthine organs, and it increases the current knowledge about the etiopathogenesis of sensorineural HL, which is often of unknown nature.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Potenciais Evocados Miogênicos Vestibulares , Perda Auditiva Neurossensorial/diagnóstico , Perda Auditiva Neurossensorial/etiologia , Perda Auditiva Neurossensorial/fisiopatologia , Audiometria de Tons Puros , Doenças Vasculares/complicações , Viroses/complicações , Estudos de Casos e Controles , Doenças Vestibulares/diagnóstico , Doenças Vestibulares/epidemiologia , Incidência , Estudos Retrospectivos , Meningites Bacterianas/complicações , Perda Auditiva Neurossensorial/congênito , Doenças do Labirinto/diagnóstico , Doenças do Labirinto/fisiopatologia , Doenças do Labirinto/epidemiologiaRESUMO
The relationship between parasites and glomerulonephritis (GN) is well documented in certain parasitoses, but not in cases of Strongyloides stercolaris (S. stercolaris) where there are few cases described being the majority GN of minimal changes. We report a case of hyperinfestation by S. stercolaris in a patient affected by a membranous GN treated with oral corticosteroids with fatal outcome for the patient. This case provides a double teaching: first about a rare association of strongyloid and membranous GN and second about the importance of establishing a diagnosis of suspected and appropriate treatment for certain infections or diseases with little clinical expression before starting any immunosuppressive treatment.
Assuntos
Glomerulonefrite Membranosa/complicações , Imunossupressores/efeitos adversos , Prednisona/efeitos adversos , Strongyloides stercoralis , Estrongiloidíase/complicações , Síndrome de Resposta Inflamatória Sistêmica/etiologia , Animais , Criptococose/complicações , Diagnóstico Tardio , Quimioterapia Combinada , Equador/etnologia , Enterococcus faecium , Infecções por Escherichia coli/complicações , Evolução Fatal , Glomerulonefrite Membranosa/tratamento farmacológico , Glomerulonefrite Membranosa/urina , Infecções por Bactérias Gram-Positivas/complicações , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/uso terapêutico , Pneumopatias Fúngicas/complicações , Masculino , Meningites Bacterianas/complicações , Pessoa de Meia-Idade , Pneumonia Bacteriana/complicações , Prednisona/uso terapêutico , Choque Séptico/etiologia , Espanha , Stenotrophomonas maltophilia , Estrongiloidíase/diagnósticoRESUMO
The most commonly identified pathogens related to bacterial meningitis are group B streptococcus and gram-negative enteric flora; anaerobic sepsis and meningitis are very rare. We report a case on a preterm and extremely low-birth weight infant who developed meningitis caused by Bacteroides fragilis and his mother who had postpartum sepsis also caused by the same agent.
Assuntos
Bactérias Anaeróbias , Bacteroides fragilis , Meningites Bacterianas/diagnóstico , Meningites Bacterianas/microbiologia , Adulto , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Bacteroides fragilis/efeitos dos fármacos , Biomarcadores , Feminino , Humanos , Recém-Nascido , Meningites Bacterianas/complicações , Meningites Bacterianas/tratamento farmacológico , Testes de Sensibilidade Microbiana , Avaliação de Sintomas , Resultado do TratamentoRESUMO
An 86-year-old man was found with altered mental status, fever and aphasia. His physical exam revealed nuchal rigidity but no other meningeal signs. Because the patient's mental status was declining, he was intubated and placed in mechanical ventilation. His head CT scan was unremarkable, without evidence of mass effect. A lumbar puncture yielded cerebrospinal fluid that was remarkable for the presence of gram-positive cocci in pairs. His blood cultures showed gram-negative bacilli. Given the presence of these organisms, a polymicrobial infection was suspected. An abdomino pelvic CT scan showed a multi-septated abscess within the right hepatic lobe. CT-guided percutaneous drainage was performed and a specimen for culture obtained, which grew Klebsiella pneumoniae. After receiving intravenous antibiotics and supportive care, the patient showed clinical improvement. In this patient, there was a central nervous system infection secondary to bacteremia in the setting of an intrabdominal infection. The inquiring clinician should take note that whenever a polymicrobial infection is evidenced, more than one site of infection should be considered in the differential diagnosis.