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Abstract Background The early diagnosis and treatment of bacterial meningitis (BM) in young infants was very critical. But, it was difficult to make a definite diagnosis in the early stage due to nonspecific clinical symptoms. Our objectives were to find the risk factors associated with BM and develop a prediction model of BM especially for young infants. Methods We retrospectively reviewed the clinical data of young infants with meningitis between January 2011 and December 2020 in Children’s Hospital of Soochow University. The independent risk factors of young infants with BM were screened using univariate and multivariate logistic regression analyses. The independent risk factors were used to construct a new scoring model and compared with Bacterial Meningitis Score (BMS) and Meningitis Score for Emergencies (MSE) models. Results Among the 102 young infants included, there were 44 cases of BM and 58 of aseptic meningitis. Group B Streptococcus (22, 50.0%) and Escherichia coli (14, 31.8%) were the main pathogens of BM in the young infants. Multivariate logistic regression analysis identified procalcitonin (PCT), cerebrospinal fluid (CSF) glucose, CSF protein as independent risk factors for young infants with BM. We assigned one point for CSF glucose ≤ 1.86 mmol/L, two points were assigned for PCT ≥ 3.80 ng/ml and CSF protein ≥ 1269 mg/L. Using the not low risk criterion (score ≥ 1) with our new prediction model, we identified the young infantile BM with 100% (95% CI 91.9%-100%) sensitivity and 60.3% (95% CI 46.4%-72.9%) specificity. Compared with BMS and MSE model, our prediction model had larger area under receiver operating characteristic curve and higher specificity, the differences were statistically significant. Conclusion Our new scoring model for young infants can facilitate early identification of BM and has a better performance than BMS and MSE models.

IntroductionFever without a focus is a common reason for medical evaluations, hospitalizations, and the antimicrobial treatment of infants younger than 90 days. The presence of cerebrospinal fluid (CSF) pleocytosis could be challenge for clinicians who treat febrile young infants with urinary tract infection (UTI). We evaluated the factors associated with sterile CSF pleocytosis and the clinical outcomes of the patients.MethodsA retrospective review of patients aged 29–90 days with febrile UTIs who underwent a non-traumatic lumbar puncture (LP) at Pusan National University Hospital from January 2010 to December 2020 was conducted. CSF pleocytosis was defined as white blood cell (WBC) counts ≥9/mm3.ResultsA total of 156 patients with UTI were eligible for this study. Four (2.6%) had concomitant bacteremia. However, no patients had culture-proven bacterial meningitis. In correlation analysis, although weak strength, CSF WBC counts were positively correlated with C-reactive protein (CRP) level (Spearman r = 0.234; P = 0.003). Thirty-three patients had CSF pleocytosis [21.2%; 95% confidential interval (CI), 15.5–28.2]. The time from fever onset to the hospital visit, peripheral blood platelet counts, and CRP level at admission were statistically significant in patients with sterile CSF pleocytosis compared to those without CSF pleocytosis. In the multiple logistic regression, only CRP was independently associated with sterile CSF pleocytosis (cutoff, 3.425 mg/dl; adjusted odds ratio, 2.77; 95% CI, 1.19–6.88). The proportion of fever defervescence by hospital day 2 was 87.9% in patients with CSF pleocytosis and 89.4% in those without CSF pleocytosis (P = 0.759). There was no statistical difference in the fever defervescence curves between the two patient groups (P = 0.567). No patients had neurological manifestations or complications.ConclusionsCoexisting sterile CSF pleocytosis among febrile infants with UTIs suggest a systemic inflammatory response. However, the clinical outcomes between the two groups were similar. A selective LP should be considered in young infants with evidence of UTI, and inappropriate antibiotic therapy for sterile CSF pleocytosis should be avoided.

Background: The early diagnosis and treatment of bacterial meningitis (BM) in young infants was very critical. But, it was difficult to make a definite diagnosis in the early stage due to nonspecific clinical symptoms. Our objectives were to find the risk factors associated with BM and develop a prediction model of BM especially for young infants. Methods: We retrospectively reviewed the clinical data of young infants with meningitis between January 2011 and December 2020 in Children’s Hospital of Soochow University. The independent risk factors of young infants with BM were screened using univariate and multivariate logistic regression analyses. The independent risk factors were used to construct a new scoring model and compared with Bacterial Meningitis Score (BMS) and Meningitis Score for Emergencies (MSE) models. Results: Among the 102 young infants included, there were 44 cases of BM and 58 of aseptic meningitis. Group B Streptococcus (22, 50.0%) and Escherichia coli (14, 31.8%) were the main pathogens of BM in the young infants. Multivariate logistic regression analysis identified procalcitonin (PCT), cerebrospinal fluid (CSF) glucose, CSF protein as independent risk factors for young infants with BM. We assigned one point for CSF glucose ≤ 1.86 mmol/L, two points were assigned for PCT ≥ 3.80 ng/ml and CSF protein ≥ 1269 mg/L. Using the not low risk criterion (score ≥ 1) with our new prediction model, we identified the young infantile BM with 100% (95% CI 91.9%-100%) sensitivity and 60.3% (95% CI 46.4%-72.9%) specificity. Compared with BMS and MSE model, our prediction model had larger area under receiver operating characteristic curve and higher specificity, the differences were statistically significant. Conclusion: Our new scoring model for young infants can facilitate early identification of BM and has a better performance than BMS and MSE models. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of fever and cerebrospinal fluid pleocytosis in acute encephalitis in children. Study Design: Cross-sectional study. Place and Duration of Study: This study was conducted on admitted patients from Outpatient Department and Emergency in Children’s Hospital PIMS, Islamabad, from May 2009 to Mar 2010. Methodology: Fifty six patients with acute encephalitis were included in the study, meeting the criteria as per International classification of diseases 9 and 10. All children (both genders) between the ages of 4 months to 12 years with acute encephalitis were included. Cerebrospinal fluid routine examination was done in all patients and the findings of pleocytosis (WBC count >5u/l), protein and sugar were noted in proforma. Results: Out of 56 patients 38 (68%) were males and 18 (32%) were females. The ages ranged from 4 months to 12 years, with the mean age of 4.6 ± 3.2 years. Amongst the 56 enrolled patients all presented with fever. Cerebrospinal fluid examination showed Pleocytosis in 30 (54%) and normal cell count in 26 (46%). Cerebrospinal fluid protein content was normal in 45 (80%) and increased in 11 (20%). Conclusion: Fever was present in all cases of acute encephalitis in children admitted to Children’s Hospital PIMS, Islamabad with high frequency of cerebrospinal fluid pleocytosis.

Abstract Background Definitive diagnosis of meningitis is made by analysis of cerebrospinal fluid (CSF) culture or polymerase chain reaction (PCR) obtained from a lumbar puncture (LP), which may take days. A timelier diagnostic clue of meningitis is pleocytosis on CSF analysis. However, meningitis may occur in the absence of pleocytosis on CSF. Areas of Uncertainty: A diagnosis of meningitis seems less likely without pleocytosis on CSF, leading clinicians to prematurely exclude this. Further, there is little available literature on the subject. Methods Ovid/Medline and Google Scholar search was conducted for cases of CSF culture-confirmed meningitis with lack of pleocytosis. Inclusion criterion was reported cases of CSF culture-positive or PCR positive meningitis in the absence of pleocytosis on LP. Exclusion criteria were pleocytosis on CSF, cases in which CSF cultures/PCR were not performed, and articles that did not include CSF laboratory values. Results A total of 124 cases from 51 articles were included. Causative organisms were primarily bacterial (99 cases). Outcome was reported in 86 cases, 27 of which died and 59 survived. Mortality in viral, fungal and bacterial organisms was 0, 56 and 31%, respectively. The overall percentage of positive initial CSF PCR/culture for viral, fungal and bacterial organisms was 100, 89 and 82%, respectively. Blood cultures were performed in 79 of the 124 cases, 56 (71%) of which ultimately cultured the causative organism. In addition to bacteremia, concomitant sources of infection occurred in 17 cases. Conclusions Meningitis in the absence of pleocytosis on CSF is rare. If this occurs, causative organism is likely bacterial. We recommend ordering blood cultures as an adjunct, and, if clinically relevant, concomitant sources of infection should be sought. If meningitis is suspected, empiric antibiotics/antifungals should be administered regardless of initial WBC count on lumbar puncture.

A 6‐year‐old female‐neutered Cocker Spaniel was presented for investigation of a 3‐week history of persistent pyrexia, lethargy, thoracic spinal pain and anorexia. Bloodwork documented marked elevation in C‐reactive protein (CRP) 103.5 mg/L (0‐8.2 mg/L) and haematological changes consistent with marked systemic inflammation. Investigations confirmed non‐erosive immune‐mediated polyarthritis, sterile neutrophilic pericarditis, non‐degenerate neutrophilic inflammation within the cerebrospinal fluid (CSF) consistent with neutrophilic pleocytosis, a small volume pleural effusion, elevated cardiac troponin and proteinuria. Systemic lupus erythematous (SLE) was considered despite a borderline anti‐nuclear antibody titre (1:40). Following initiation of immunosuppressive therapy (2 mg/kg prednisolone q 24 hrs), the patient had rapid resolution of clinical signs with normalisation of proteinuria, CRP and pericardial effusion after 1 month of treatment. This case represents an interesting presentation of polysystemic autoimmune disease in the dog. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of fever and cerebrospinal fluid pleocytosis in acute encephalitis in children. Study Design: Cross-sectional study. Place and Duration of Study: This study was conducted on admitted patients from Outpatient Department and Emergency in Children's Hospital PIMS, Islamabad, from May 2009 to Mar 2010. Methodology: Fifty six patients with acute encephalitis were included in the study, meeting the criteria as per International classification of diseases 9 and 10. All children (both genders) between the ages of 4 months to 12 years with acute encephalitis were included. Cerebrospinal fluid routine examination was done in all patients and the findings of pleocytosis (WBC count >5u/l), protein and sugar were noted in proforma. Results: Out of 56 patients 38 (68%) were males and 18 (32%) were females. The ages ranged from 4 months to 12 years, with the mean age of 4.6 ± 3.2 years. Amongst the 56 enrolled patients all presented with fever. Cerebrospinal fluid examination showed Pleocytosis in 30 (54%) and normal cell count in 26 (46%). Cerebrospinal fluid protein content was normal in 45 (80%) and increased in 11 (20%). Conclusion: Fever was present in all cases of acute encephalitis in children admitted to Children's Hospital PIMS, Islamabad with high frequency of cerebrospinal fluid pleocytosis. [ABSTRACT FROM AUTHOR]

We identified 620 children with peripheral facial palsy of which 211 (34%) had Lyme disease. The 140 children who had a lumbar puncture performed were more likely to be hospitalized (73% LP performed vs 2% no LP) and to receive parenteral antibiotics (62% LP performed vs 6% no LP). [ABSTRACT FROM AUTHOR]

Purpose: This study aimed at reporting lymphocytic meningitis in patients diagnosed with sympathetic ophthalmia (SO).Methods: In this single-center retrospective observational case series, we reviewed cases diagnosed with SO. We analyzed the patients' inciting injuries, the characteristics of uveitis and the cerebrospinal fluid (CSF) analyses.Results: Nine patients were diagnosed with SO and CSF analyses were available in all cases. Four cases had lymphocytic pleocytosis, 3 of which showed marked CSF inflammation with more than 300 lymphocytes/mm3. The inciting event in these 3 patients was a globe perforation injury, whereas 4 patients without meningitis had SO following a surgical intervention.Conclusions: In this case series of patients with SO, lymphocytic meningitis was a common finding. The prevalence of meningitis in patients with SO and its value for the diagnosis of the disease needs to be further studied. [ABSTRACT FROM AUTHOR]

Abstract: Ictal events include those of the autonomic nervous system. This sympathetic stimulation may persist into the postictal period, affecting cardiopulmonary function. Such postictal effects include potentially fatal alterations in cardiac rhythm and ventilatory function, management challenges such as pulmonary edema, and diagnostically confusing laboratory abnormalities such as fever and cerebrospinal fluid pleocytosis. These and other effects on the heart and lung in the postictal period are accordingly reviewed. [ABSTRACT FROM AUTHOR]

Neurotuberculosis usually responds well to standard antitubercular therapy. Some; patients have prolonged course A 11 year old boy diagnosed TBM, an immunocompetent patient, had an unusual course of illness in the form of prolonged fever, persistent hyponatremia and CSF; pleocytosis despite adequate treatment. Clinical course in the management of TBM can be; protracted with complications despite adequate therapy., (Copyright © 2019 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.)

Background: Definitive diagnosis of meningitis is made by analysis of cerebrospinal fluid (CSF) culture or polymerase chain reaction (PCR) obtained from a lumbar puncture (LP), which may take days. A timelier diagnostic clue of meningitis is pleocytosis on CSF analysis. However, meningitis may occur in the absence of pleocytosis on CSF. Areas of Uncertainty: A diagnosis of meningitis seems less likely without pleocytosis on CSF, leading clinicians to prematurely exclude this. Further, there is little available literature on the subject.Methods: Ovid/Medline and Google Scholar search was conducted for cases of CSF culture-confirmed meningitis with lack of pleocytosis. Inclusion criterion was reported cases of CSF culture-positive or PCR positive meningitis in the absence of pleocytosis on LP. Exclusion criteria were pleocytosis on CSF, cases in which CSF cultures/PCR were not performed, and articles that did not include CSF laboratory values.Results: A total of 124 cases from 51 articles were included. Causative organisms were primarily bacterial (99 cases). Outcome was reported in 86 cases, 27 of which died and 59 survived. Mortality in viral, fungal and bacterial organisms was 0, 56 and 31%, respectively. The overall percentage of positive initial CSF PCR/culture for viral, fungal and bacterial organisms was 100, 89 and 82%, respectively. Blood cultures were performed in 79 of the 124 cases, 56 (71%) of which ultimately cultured the causative organism. In addition to bacteremia, concomitant sources of infection occurred in 17 cases.Conclusions: Meningitis in the absence of pleocytosis on CSF is rare. If this occurs, causative organism is likely bacterial. We recommend ordering blood cultures as an adjunct, and, if clinically relevant, concomitant sources of infection should be sought. If meningitis is suspected, empiric antibiotics/antifungals should be administered regardless of initial WBC count on lumbar puncture. [ABSTRACT FROM AUTHOR]

Objectives: To assess the etiology of cerebrospinal fluid (CSF) pleocytosis in critical care patients with seizure(s) or status epilepticus (SE). Many previous studies, some performed decades ago, concluded that CSF pleocytosis may be entirely attributable to seizure activity., Methods: We undertook a retrospective chart review of adult patients with an admitting or acquired diagnosis of seizure(s) or SE in critical care units at the Winnipeg Health Sciences Centre between 2009 and 2012. Patients were identified through a critical care information database at a tertiary care center. We limited our study to patients who had lumbar punctures at our center within 5 days of seizure(s) or SE., Results: Of 426 patients with seizures in critical care units, 51 met the inclusion criteria. Seizure subtypes included focal seizures (5 or 10%), generalized seizures (14 or 27%), and SE (32 or 63%). Twelve (seven with SE) of the 51 (24%) were found to have CSF pleocytosis. A probable etiological cause for the CSF pleocytosis was identified in all 12 cases., Conclusions: We conclude that seizures do not directly induce a CSF pleocytosis. Instead, the CSF pleocytosis more likely reflects the underlying acute or chronic brain process responsible for the seizure(s). This was not readily apparent in early studies without magnetic resonance imaging (MRI) of the brain and currently available laboratory investigations. An etiological cause of CSF pleocytosis must always be sought when patients present with seizures and it should never be assumed that seizures are the cause.