The aim of this study is to use a defined population of patients with meningococcal septicaemia to calculate the incidence of orthopaedic complications. Medical records and radiographs were analyzed retrospectively for all patients admitted to the Paediatric Intensive Care Unit (PICU) of the Bristol Royal Hospital for Children from 01/01/2001 to 31/12/2012 with meningococcal septicaemia. Of the 130 patients with meningococcal septicaemia alive at discharge, 10 developed orthopaedic sequelae, representing an overall incidence in this patient population of 7.7%. 9 patients required an amputation, mostly in the lower limb, 16/22 (72.7%). 48 growth plate abnormalities were identified in 8 patients. 39 (81.3%) The most commonly affected was the distal tibia (38.5%). 10 ankles were identified as having a varus malalignment. 6 patients had documented leg length discrepancy Using a clearly defined denominator this study has identified an incidence of orthopaedic sequelae following meningococcal septicaemia of 7.7%. The National Institute for Clinical Excellence (NICE) suggested that the incidence of growth disturbance is approximately 3%. This study highlights the underestimation of orthopaedic complications following meningococcal septicaemia. Close follow up of at risk patients should be considered to reduce the potential impact of these debilitating injuries.
The data related to the distribution of other focal infections in central nervous system (CNS) infection patients is inconsistent in medical literature. Infectious Diseases International Research Initiative (ID-IRI) has been carrying on multicenter and multinational studies since 2008 and provided bulk of information on pneumococcal meningitis, brucellar meningitis, tuberculous meningitis, and herpetic meningoencephalitis as the largest case series in the literature. In this study, the databases of ID-IRI studies were reanalyzed and one fourth of pneumococcal and brucellar meningitis patients, and slightly less than half of tuberculous meningitis patients had another focal involvement out of CNS. Herpetic meningoencephalitis had only 7% coexistent other focal involvement. Consequently, the treating clinician should not undervalue the presence of another site of involvement in a CNS infection patient. Hence, diagnostic and therapeutic interventions for other site of involvement in due course of CNS infectious diseases should seriously be taken into consideration.
Antibiotic resistance has led to the search for more effective antimicrobial agents among plant materials that can serve as source and template for the synthesis of new antimicrobial drugs. The current study aims to analyses the oil, extracted from the leaves of Crotalaria pallida for its physicochemical and antimicrobial properties. Leaf oil was extracted by petroleum ether (40–60 °C) and its fatty acid constituents were isolated as a mixture after saponification. Mixture of fatty acid was purified by TLC and characterized by IR, GC and GC–MS analysis by converting them into their FAME. MIC of the oil against the Gram positive and Gram negative bacteria was determined by agar diffusion method. Nineteen fatty acids were identified by gas-liquid chromatography followed by GC–MS. It was found that unsaturated fatty acids were present in greater amounts than saturated fatty acids. Most predominating unsaturated and saturated fatty acids were linolenic acid (34.06 ± 0.23%) and palmitic acid (24.47 ± 0.22%) respectively. The acid value (19.63 ± 0.22) and saponification value (109.08 ± 2.87) were also estimated to evaluate the quality of the oil. The oil showed good antimicrobial activities against Gram-positive bacteria, Bacillus subtilis as well as Gram-negative bacteria, Escherichia coli and Acinetobacter junii.
Community-acquired meningitis is a serious disease that is associated with high morbidity and mortality. The purpose of this study was to investigate the gender differences involved with the clinical presentations of and prognostic factors for this disease. We conducted a retrospective study of 619 adults diagnosed with community-acquired meningitis in Houston, Texas, who were hospitalized between 2005 and 2010. Patients were categorized as male or female. Those who were evaluated to have a Glasgow Outcome Scale score of four or less were classified to have an adverse clinical outcome. Males consisted of 47.2% (292/619) of the total cohort, and more often presented with coexisting medical conditions, fever, abnormal microbiology results, and abnormalities on head computed tomography. Females more often presented with nuchal rigidity. On logistic regression, fever, CSF glucose <45 mg/dL, and an abnormal neurological examination were predictors of an adverse outcome in male patients, while age greater than 60 years and an abnormal neurological examination were associated with a poor prognosis in female patients. Thus, community-acquired meningitis in males differs significantly from females in regards to comorbidities, presenting symptoms and signs, abnormal laboratory and imaging analysis, and predictors of adverse clinical outcomes.
Objective: Visual impairment is a common problem in tuberculous meningitis (TBM). Present study has been conducted to evaluate the prevalence of visual impairment at presentation and at 3 months. Methods: Twenty seven consecutive HIV negative patients with TBM were included. Visual acuity, colour vision, field of vision, and visual evoked potentials (VEP) were recorded at baseline and at 3 months. The criteria for visual impairment were: visual acuity <6/12 and
Most affected humans with west-nile virus (WNV), a mosquito-borne virus of the flaviviridae family, remain asymptomatic, while a minority may develop neurological manifestation such as meningitis, encephalitis or a flaccid paralysis. Gastrointestinal symptoms such as anorexia and abdominal pain are less common, whereas full blown symptomatic acute pancreatitis has only been described twice in the literature. These cases occurred in the Netherlands and in Israel where WNV is fairly endemic. We report the first clinical case in North America of a previously healthy 52 year old man who developed full blown WNV meningo-encephalitis with concurrent acute pancreatitis. Acute WN viral meningo-encephalitis was confirmed by a lumbar puncture, while other causes of meningitis/encephalitis were excluded. Acute WNV pancreatitis was diagnosed clinically as well as by abnormal serological markers including elevated amylase and lipase levels. The patient was treated conservatively, and his symptoms gradually improved until full recovery, requiring a total of three weeks from onset. WNV and its complications are reviewed, in addition to a description of prior cases of pancreatitis associated with WNV infection.
Meningitis is a contagious infectious disease with high rates of mortality. Most pathogenic microbes in humans have the ability to cause bacterial meningitis. However, the most common pathogens are Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae type b (Hib). It was found that the susceptibility to this infectious disease may be related to genetic characteristics of the host, such as the occurrence of single nucleotide polymorphisms (SNPs). In our previous work, association of SNPs in DNA repair genes with bacterial meningitis (BM) was demonstrated. In this study we evaluated two non-synonymous SNPs of the repair gene XRCC1 Arg194Trp (rs 1799782) and Arg399Gln (rs 25487) in patients with BM and health volunteers. The patient genotypes were investigated by PCR-RFLP. DNA damages were quantified using the genomic DNA with formamidopyrimidine DNA-glycosylase (FPG). Cytokines and chemokines were quantified from cerebrospinal fluid samples from BM patients. Concerning the SNP XRCC1 Arg194Trp, none association was found relation to BM. However, a higher frequency of heterozygous genotype for XRCC1 Arg399Gln was observed in the control group compared to the BM group (P=0.043; OR=0.426). DNA damage and cytokine/chemokines levels were not positively correlated with polymorphic genotypes. In conclusion, there is an indication that the SNP XRCC1 Arg399Gln could have a possible protective effect against BM.
Objective: The initial clinical appearances of aseptic and bacterial meningitis in children are similar, but the treatment and outcome are quite different. To clarify the clinical presentation and laboratory results, we retrospectively reviewed our patients. Methods: The charts of hospitalized children under age 18 with discharge diagnosis of aseptic meningitis and bacterial meningitis during 2007~2014 were reviewed. Patients with aseptic meningitis were recruited as pleocytosis and negative bacterial growth in cerebrospinal fluid (CSF), while those with bacterial meningitis were recruited only who had positive CSF bacterial culture results. Traumatic tapping, contaminated cultures, or having received previous intravenous antibiotic therapy were excluded. Viral pathogens in CSF of aseptic meningitis were identified by CSF culture or polymerase chain reaction. Results: A total of 141 patients were enrolled as aseptic meningitis and 56 patients as bacterial meningitis. Aseptic meningitis occurred more in older than one-month-old children. Fever, headache, vomiting, and neck stiffness were significantly more in aseptic meningitis children, while convulsion, consciousness change, fontanelle bulging, and desaturation were significantly more in bacterial group. Significant laboratory differences were lymphocyte dominant in CSF, lower CSF protein level, higher CSF glucose level, and lower blood CRP level in aseptic meningitis group. Aseptic patients had shorter hospital duration (5.0 ± 2.0 days vs. 20.0 ± 8.0 days, p<0.001). All aseptic meningitis patients survived and were discharged without significant neurologic sequel. Among bacterial meningitis patients, 54.5% recovered completely, 10.9% died, and 34.5% had sequel. The outcome of aseptic meningitis group was significantly better than bacterial group. Conclusion: Aseptic meningitis occurred more in toddLers and older children, and had more meningeal symptoms/signs. More than half bacterial meningitis occurred in neonates and revealed more dreadful systemic presentations. Laboratory results can be helpful for differentiation of aseptic meningitis from bacterial meningitis. Careful monitoring clinical conditions and laboratory results are mandatory.
Recombinant proteins (M1K2–N963-LEH6, MA28–N963-LEH6 and ME135–H328-LEH6) have been created on the basis of the genome sequence of IgA1 protease of N. meningitidis serogroup B strain H44/76. It is revealed that, similarly to the native enzyme isolated earlier from N. meningitidis serogroup A strain A208, these proteins induce formation of animal protection against the infection with the virulent strain of meningococcus serogroup B. It is shown that these compounds are promising as a basis for a polyvalent anti-meningococcal vaccine.
Objective: Evaluation of the in vitro susceptibility to Resveratrol of a bacterial collection representing the S. pneumoniae and N. meningitidis strains prevalent in the Brazilian state of Minas Gerais from 2007 to 2013. Methods: One reference strain of S. pneumoniae (ATCC 49619), and sixty-three strains (31 S. pneumoniae, and 32 N. meningitidis) isolated from patients with meningitis and available at the certified strains collection of Ezequiel Dias Foundation were tested. The susceptibility to Resveratrol was tested on blood agar containing this drug at eight concentrations ranging from 25 mg/L to 200 mg/L diluted in 0.5% ethanol, and control plates with blood agar with 0.5% ethanol. Pneumococci were also tested for susceptibility to currently available antimicrobials used to treat meningitis using E-test and disc diffusion methods. The association between pneumococcal susceptibility to Resveratrol and to any other antibiotic tested was assessed with chi-square test, and the toxic doses of Resveratrol were determined upon L929 mammalian cells. Results: The MIC100 for Resveratrol was 75 mg/L for meningococci (range: 50-75 mg/L), and 200 mg/L for pneumococci (range: 125-200 mg/L). There was no association between pneumococcal susceptibility to Resveratrol and to any currently available antimicrobials tested suggesting different modes of action. However, low selectivity indices (SI) calculated as the ratio between the IC100 in L929 cells and the MIC values were found for meningococci (0.332) and pneumococci (0.125). Conclusion: Resveratrol inhibited the growth of all N. meningitidis and S. pneumoniae strains causing meningitis in the state of Minas Gerais, Brazil, from 2007 to 2013. Our results, despite the low selectivity indices observed, may warrant further studies to assess the potential of Resveratrol derivates as antimicrobial alternatives to treat meningococcal and pneumococcal infections.
