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Neuromeningeal infections caused by carbapenemase-secreting Enterobacteriaceae are a serious complication with a high mortality rate. The management of carbapenemase encephalitis/meningitis is complicated by the limited therapeutic options available, due to pan-resistance to antibiotics and their poor distribution in cerebrospinal fluid. Carbapenemase- secreting Klebsiella pneumoniae has recently become endemic, posing a global public health problem, and several - still rare - cases of meningitis caused by this germ have been reported. We describe a case of post-craniectomy nosocomial meningitis caused by K. pneumoniae carbapenemase-secreting New Delhi metallo-betalactamase (NDM), described for the first time in the literature. treated effectively with intrathecal polymyxin E. [ABSTRACT FROM AUTHOR]

Central pontine myelinolysis is a demyelinating disorder mainly affecting the central pons. In some cases, it is associated with extrapontine myelinolysis. It is usually caused by rapid correction of hyponatremia and osmotic shock. We here report the case of a 3.5-year-old girl diagnosed with acute lymphoblastic leukemia admitted to our Oncology Unit with neutropenic fever and diarrhea. Laboratory tests showed mild neutropenia, normochromic normocytic anemia. Electrolyte tests were normal without hyponatremia. She received antibiotic therapy with Metronidazole. Five days later, she developed flaccid quadriparesis with mutism. Computerized tomography (CT) scan was normal, cerebrospinal fluid (CSF) examination was normal (there was no evidence of leukemic cells) and ophthalmological examination did not show any abnormalities. Brain MRI found hyperintense signal in the pons. The child improved without specific treatment, and clinical and complete neurological recovery was noted. This case highlights that myelinolysis can occur under some circumstances not related with hyponatremia such as malignancy, chemotherapy. [ABSTRACT FROM AUTHOR]

Copyright of Nouveau Praticien Vétérinaire Canine & Féline is the property of EDP Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: hydrocephalus is a progressive distension of the anatomical spaces (ventricles and subarachnoid space) containing the cerebrospinal fluid. It most commonly affects children. In developed countries, its prevalence and incidence are estimated between 0.9 to 1.2 per 1000 and 0.2 to 0.6 per 1000 live births respectively and between 50 000 and 100 000 new cases develop each year in the world. The purpose of this study was to describe the clinical, paraclinical and therapeutic features of hydrocephalus in 4 medical facilities in Lubumbashi. Method: we conducted a descriptive cross-sectional study at the University Clinics of Lubumbashi, Cinquantenaire Hospital, Sendwe General Reference Hospital and ARS Clinic from April 1st, 2015 to September 30th, 2019. Data were collected on the basis of a data collection sheet containing several study parameters including age, sex, clinical signs, birth weight, patient's history, head circumference, CT scan assessment and disease progression. Our sample consisted of 91 subjects with hydrocephalus Result: the age group 29 days to 24 months (infant) was most commonly affected, i.e. 57.14%, with a sex ratio of 1.67 and a male predominance. The main detecting sign was macrocrania in all patients, followed by setting-sun sign in 53.85% of patients. Brain CT scan was performed in all patients and 65.92% of them had tetraventricular hydrocephalus. Ventriculoperitoneal shunt was performed in all patients. There were no deaths in the postoperative period; postoperative infectious and mechanical complications accounted for 8.79% and 4.40% respectively. The average length of stay in the hospital was 5.65 days. Conclusion: hydrocephalus is the most common reason for pediatric neurosurgery. Clinicians should focus on these results which highlight the importance of early diagnosis and proper management. [ABSTRACT FROM AUTHOR]

The aim of this paper is to present an extensive overview of numerical simulations aimed at confirming and completing the theoretical results obtained in the analysis of some cerebrospinal fluid dynamics models which are treated from a purely mathematical view point. The present study is designed to support the first attempts in the approach to these physiological models from a more theoretical standpoint since their investigation in literature only concerns the modelization and the clinical feedback.

We here report the case of a 12-month old infant with congenital polymalformation including right temporal meningocele and homolateral eyeball aplasia. Brain CT scan confirmed this malformation with bone defect in the right temporal lobe, meningeal hernia containing cerebrospinal fluid and absence of the right eyeball. Surgery was performed to treat meningocele. Patient's outcome was favorable. The purpose of this study was to highlight the rarity of this disease on the basis of a literature review. [ABSTRACT FROM AUTHOR]

Résumé: Les méningites à Neisseria meningitidis sont exceptionnelles en période néonatale. Leur gravité est liée à l'immaturité du système immunitaire des nouveau-nés. Elles diffèrent des méningites de l'enfant plus âgé et de l'adulte par de nombreux points qui rendent leur diagnostic difficile. Nous rapportons le premier cas de méningite néonatale à méningocoque isolé au service de microbiologie au CHU Hassan II de Fès. Il s'agit d'un nouveau-né de 10 jours, admis pour hypotonie avec fièvre. L'examen direct du liquide céphalo-rachidien et les antigènes solubles ont permis d'identifier le germe. Les céphalosporines de troisième génération étaient le traitement de choix. L'évolution était favorable. [ABSTRACT FROM AUTHOR]

Empty sella syndrome is a condition in which the sella turcica is partially or totally filled with cerebrospinal fluid causing a displacement of the pituitary gland. We here report the case of a 49-year old obese patient with progressive headaches, physical asthenia and hypothyroidism. Brain scanner showed empty sella syndrome. [ABSTRACT FROM AUTHOR]

Tarlov cyst or perineural cyst is a local dilation of the subarachnoid space formed within the nerve root and filled with cerebrospinal fluid. There is no consensus on the best treatment of syntomatic sacral perinervous cysts. Many methods have been used to treat these symptomatic lesions, with variable results. We report a case series including 20 patients undergoing surgery for sacral Tarlov cyst. Our results were satisfactory; 80% of patients improved without neurological worsening in the post-operative period. Our surgical technique (sacral laminectomy+cyst puncture+establishment of dural sheat) described for the first time in this study seems to have been effective in the 20 cases reported in our study. [ABSTRACT FROM AUTHOR]

This case study presents an unusual pathogenic association among several cranioencephalic lesions characterized by the association of osteitis of the cranial vault, due to Aspergillus fumigatus, with underlying thrombophlebitis complicated by intracranial hypertension resulting from hydrocephalus. The study involved a 43-year old HIV (human immunodeficiency virus) negative man with multi-recurrent infection of the frontal scalp. The patient was successfully treated with cerebrospinal fluid diversion (CFD), Ketoconazole and low molecular weight heparin. This study describes the different pathophysiological and therapeutic features of this exceptional pathogenic association. [ABSTRACT FROM AUTHOR]

Copyright of Gériatrie et Psychologie Neuropsychiatrie du Vieillissement is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Gériatrie et Psychologie Neuropsychiatrie du Vieillissement is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Résumé La mesure de la charge virale est un progrès important pour la compréhension physiopathologique, le diagnostic et le suivi thérapeutique des infections par le cytomégalovirus, le virus d’Epstein-Barr, les herpèsvirus humains 6 et 8. Les méthodes de PCR quantitative, en particulier la PCR en temps réel, ont rendu la mesure de l’ADN génomique sensible, reproductible, accessible et applicable à un grand nombre de matrices biologiques, au premier rang desquelles le sang total, le plasma et le liquide cérébrospinal. Des améliorations sont cependant encore nécessaires en termes de standardisation des techniques et mise à disposition d’étalons de quantification internationalement reconnus. Il faut également préciser et homogénéiser les critères d’interprétation de la charge virale en ce qui concerne le diagnostic des infections actives, la prédiction de survenue des maladies associées, les indications des traitements antiviraux et le suivi de leur efficacité. La mesure de la charge virale à cytomégalovirus est actuellement devenue un élément essentiel de la surveillance des sujets immunodéprimés. En ce qui concerne le virus d’Epstein-Barr, la charge virale est utilisée pour anticiper la survenue des lymphoproliférations associées alors que la charge virale à HHV-8 n’a pas encore d’indications parfaitement précisées dans le diagnostic des maladies tumorales associées, au premier rang desquelles la maladie de Kaposi. Des valeurs très élevées de la charge virale à herpèsvirus humain 6 doivent faire évoquer, outre une réactivation virale intense, une intégration chromosomique de l’ADN viral, évènement propre à ce virus et observé chez environ 1% de la population générale. Summary Measuring the viral load has provided a significant advance in the pathophysiological understanding, diagnosis and therapeutic monitoring of cytomegalovirus, Epstein-Barr virus, human herpesvirus 6, and human herpesvirus 8 infections. The methods of quantitative PCR, especially real-time PCR, have made the quantification of DNA genome sensitive, reproducible, accessible and applicable to numerous biological matrices, among which whole blood, plasma and cerebrospinal fluid. However improvements are still required, in terms of standardization of techniques and disposal of internationally recognized quantification standards. It is also needed to clarify and homogenize the criteria for interpreting viral load values regarding the diagnosis of active infections, prediction of occurrence of associated diseases, indications of antiviral treatments and monitoring of their effectiveness. The measurement of viral load cytomegalovirus has now become an essential element in the monitoring of immunocompromised patients. Regarding Epstein-Barr virus, the viral load is used to anticipate the occurrence of associated lymphoproliferations while the viral load HHV-8 has still not perfectly specified indications in the diagnosis of associated malignancies, the first of which being Kaposi's sarcoma. Besides the possibility of an intense viral reactivation, very high values of viral load in the case of human herpesvirus 6 should evoke a chromosomal integration of viral DNA, specific to this virus and observed in about 1% of the general population. [ABSTRACT FROM AUTHOR]

Résumé Introduction Les méningites du nourrisson et de l’enfant demeurent une affection préoccupante en pédiatrie tant par sa fréquence que par sa gravité. Objectif Rapporter notre expérience dans les méningites du nourrisson et de l’enfant. Matériels et méthodes Il s’agissait d’une étude rétrospective portant sur 150 patients atteints de méningite colligés dans le service de pédiatrie A du CHU Mohamed VI de Marrakech du 1 er janvier 2009 au 31 décembre 2012. Résultats L’âge moyen a été de 60 mois et la prédominance a été masculine avec un sex-ratio de 2/2. Une otite a été la principale porte d’entrée dans 10 % et une antibiothérapie préalable a été administrée dans 26 % des cas. Les principaux signes cliniques ont été dominés par une fièvre (95 %), des vomissements (82 %) et des céphalées (68 %). Une ponction lombaire a été effectuée chez tous nos patients. Elle a montré une méningite virale (52 %), une méningite purulente (47 %) et une méningite tuberculeuse dans 2 cas. Les germes isolés ont été le pneumocoque (51 %) puis le méningocoque (40 %) et l’Haemophilus dans un cas. Le traitement instauré a été la céftriaxone (70 %) et l’association ceftriaxone et vancomycine dans 6 cas. L’évolution a été marquée par la survenue de séquelles dans 13 % et une létalité dans 1 % des cas. Conclusion Les méningites du nourrisson et de l’enfant posent encore un problème dans notre contexte car les méningites purulentes à pneumocoque les plus redoutables ont été retrouvées dans presque la moitié des cas dans notre étude. Summary Introduction Meningitis in infants and children remains a worrying condition in pediatrics as its frequency by severity. Objective To report our experience in meningitis in infants and children. Materials and methods This was a retrospective study of 150 patients with meningitis collected in the pediatric ward A CHU Mohamed VI of Marrakech from 1 January 2009 to 31 December 2012. Results The average age was 60 months and the dominance was male with a sex ratio of 2/2. Otitis was the main gateway to 10% and prior antibiotic therapy was administered in 26% of cases. The main clinical signs were dominated by fever (95%), vomiting (82%) and headache (68%). A lumbar puncture was performed in all patients. It showed viral meningitis (52%), purulent meningitis (47%) and tuberculous meningitis in 2 cases. The bacteria isolated were pneumococcus (51%) and meningococcal (40%) and Haemophilus in one case. The established treatment was ceftriaxone (70%) and ceftriaxone and vancomycin combination in 6 cases. The evolution was marked by the occurrence of sequelae in 13% and lethality in 1% of cases. Conclusion Meningitis in infants and children still pose a problem in our context as purulent meningitis in most formidable pneumococcus were found in almost half of cases in our study. [ABSTRACT FROM AUTHOR]

Résumé Les méningites néonatales sont particulièrement redoutables car elles surviennent sur un terrain à l’immunité immature et un cerveau en développement. Elles se distinguent des méningites de l’enfant plus âgé et de l’adulte par de nombreux points qui rendent leur diagnostic difficile. L’absence de signes cliniques spécifiques conduit à une fréquence accrue des ponctions lombaires. Dans ce contexte le prélèvement peut être traumatique, rendant l’analyse difficile, ou contre-indiqué du fait de l’instabilité du nouveau-né, d’où une réalisation différée, sous antibiotiques. Le streptocoque du groupe B ( Streptococcus agalactiae ) et Escherichia coli sont les deux principales étiologies bactériennes, responsables respectivement d’environ 60 % et 30 % des cas. Listeria monocytogenes a vu son incidence chuter à moins de 5 %. Mais d’autres bactéries peuvent être en cause comme les bactéries à tropisme méningée classiques (méningocoque, pneumocoque) ou bien des germes atypiques, tel le genre Ureaplasma . Les méningites virales sont aussi fréquentes et méconnues, liées principalement aux entérovirus et parechovirus qui, bien que souvent bénignes, peuvent parfois s’avérer mortelles, notamment chez les nouveau-nés de moins de 6 jours de vie. Les virus herpès sont responsables de méningoencéphalites beaucoup plus rares mais dont le pronostic est gravissime en l’absence de traitement. La faible quantité de prélèvement disponible, combinée aux difficultés du diagnostic et à la gravité du pronostic en cas de traitement inadapté, fait du diagnostic des méningites néonatales un défique seule une parfaite collaboration entre le pédiatre et le biologiste est à même de relever. Summary Neonatal meningitis is particularly dreadful as it occurs on a developing brain with immature immunity. It differs from meningitis in older children and adults by many points that make it difficult to diagnose. The lack of specific clinical signs leads to an increased frequency of lumbar punctures. In this context the sample can be traumatic, making it difficult to analyze, or the sampling can be contra-indicated due to the instability of the newborn, resulting in delayed realization under antibiotic treatment. Group B streptococcus ( Streptococcus agalactiae ) and Escherichia coli are the two major pathogens responsible of approximately 60 % and 30 % of cases, respectively. The incidence of Listeria monocytogenes has declined to less than 5 %. Other bacteria may be involved such as bacteria with classic meningeal tropism (meningococcus, pneumococcus) or atypical organisms, such as Ureaplasma genus. Viral meningitis is also frequent and unrecognized primarily caused by enteroviruses and parechoviruses which, though often benign, can sometimes be fatal, especially in infants less than 6 days of life. Herpes viruses are responsible for the much rarer meningoencephalitis whose prognosis is extremely serious in the absence of treatment. The small amount of sample available, combined with the difficulties of diagnosis and severity of the prognosis in case of inadequate treatment, makes the diagnosis of neonatal meningitis a challenge that only a perfect collaboration between the pediatrician and the biologist is able to meet. [ABSTRACT FROM AUTHOR]

Quantification is a major task in proteomics. Among the different analytical strategies to enable peptide and protein quantification, tagging with isotopic labels has emerged as a practical, versatile, and efficient alternative. In particular, isobaric labels, such as TMT or iTRAQ, are now widely employed to make relative comparison of the protein amounts in separate biological samples with tandem mass spectrometry (MS/MS). We used herein a shotgun proteomic approach based on labelling with tandem mass tags (TMTs) for the relative quantification of proteins, and the absolute quantification of their tryptic peptides in human cerebrospinal fluid (CSF). First, the comparison of ante- and post-mortem CSF samples was carried out for the discovery of protein marker candidates of brain-damage disorders. Second, tryptic peptides representative of these candidates were measured in CSF using reporter-ion calibration curves. These works highlighted the advantages and limitations of such strategies for quantification purposes in proteomics.

Summary: Streptococcus intermedius is a member of the Streptococcus anginosus group, also known as the Streptococcus milleri group. Although this is a commensal agent of the mouth and upper airways, it has been recognized as an important pathogen in the formation of abscesses. However, it has rarely been involved in the formation of brain abscess in children. We report 4 pediatric cases of brain abscess caused by S. intermedius. Three boys and 1 girl, all aged over 2years, were admitted for a febrile meningeal syndrome and seizures, caused by a S. intermedius brain abscess. Diagnosis was obtained by brain imaging combined with culture of cerebrospinal fluid. The outcome was favorable after antibiotic therapy and abscess puncture. S. intermedius should be considered a potential pathogen involved in the development of brain abscess in children. [Copyright &y& Elsevier]

Summary: Lyme borreliosis should be considered in any child affected with acute peripheral facial palsy without obvious cause in endemic areas, especially if it happens from May to November, with a history of erythema migrans, tick bite, or possible exposure during the previous weeks. The clinical appearance of Lyme borreliosis differs between adults and children and according to the geographical origin of the infection: therefore it is difficult to interpret and follow the recommendations for the management and treatment of this disease. Neuroborreliosis is more frequent in Europe than in the United States, and meningitis associated to facial palsy occurs earlier and is more frequent among the European pediatric population, too. When peripheral facial palsy occurs and there is suspicion of Lyme borreliosis, it seems necessary to perform a lumbar puncture in order to support the diagnosis with detection of intrathecal synthesis of specific antibodies, sometimes more abundant than in the serum, and thus to adapt the antibiotic therapy modalities. Parenteral antibiotherapy is recommended if any involvement is detected in the cerebrospinal fluid, while oral antibiotherapy should be prescribed for isolated facial palsies. Follow-up should be made according to clinical symptoms with a close collaboration between pediatricians, infection disease specialists, and ENT specialists. [ABSTRACT FROM AUTHOR]

Summary: We describe a case of accidental cannabis poisoning in a 10-month-old girl, who presented with impaired consciousness, with drowsiness and restlessness, generalized hypotonia, and inadequate smiles. No circulatory or respiratory problems were observed. Initial investigations were not informative (blood biology, CT scan, and cerebrospinal fluid examination), while the main causes of coma (meningoencephalitis, head trauma, metabolic disorders) were excluded. Questioning the parents led to suspecting accidental ingestion of a piece of cannabis, which was confirmed by the detection of high blood and urine levels of cannabinoid derivatives. Management was symptomatic and the clinical course, marked by the occurrence of agitation and irritability episodes lasting up to H18, led to complete regression of symptoms. Because of the high consumption in France, pediatric poisoning by cannabis seems increasingly common. The toxic levels in children are unknown however. Diagnosis is based on questioning and the search for cannabinoid derivatives in urine. In children, clinical symptoms are more expressive compared to adults, with neurological (drowsiness, agitation, abnormal behavior, ataxia, hypotonia, coma, and convulsions) or cardiopulmonary (tachycardia, bradypnea, apnea) or homeostatic presentations (hypothermia). Treatment in children is essentially symptomatic but sometimes requires active resuscitation. Recommendations are based on clinical monitoring the first 24h after intoxication and on medicosocial support. [ABSTRACT FROM AUTHOR]

Summary: Introduction: Human parvovirus B19 (PVB19) causes erythema infectiosum or 5th disease in childhood, which mainly affects children between 3 and 15 years of age. PVB19 infections have also been described in association with a variety of neurologic manifestations including encephalitis. Case report: This 3-year 8-month-old boy developed febrile encephalitis (mental status change with seizures and left limb hypertonia) associated with a rash. The electroencephalographs revealed focal slowing with some spikes in front of the left centro-temporo-occipital areas ; bacteriological and biochemical cerebrospinal fluid (CSF) analysis were normal, brain radiologic studies (tomography and magnetic resonance imaging) were normal. The diagnosis of encephalitis associated with PVB19 primo infection was based on viral DNA detection in the serum and CSF using PCR and on the specific immunoglobulin M (without immunoglobulin G) detection in the serum. Discussion: In France, encephalitis etiology is unknown in 48% of the cases. PVB19 accounts for 4.3% of undiagnosed meningoencephalitis in children. Although there is no specific sign, seizures and rash are reported in about one-half and one-quarter of cases, respectively. Conclusion: Even if PVB19 research is not cited in the French or American infectious disease society recommendations on the diagnosis and management of infectious encephalitis, this virus may be responsible, especially in cases of child febrile rash. Therefore, PVB19 research seems reasonable if the clinical presentation is concordant in children due to its diagnostic simplicity and efficacy. [ABSTRACT FROM AUTHOR]

Copyright of IBS, Immuno-analyse & Biologie Specialisee is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Reanimation is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: The pathogenicity of human herpesvirus 6 (HHV-6) still raises numerous questions. Acute HHV-6 infections correspond to primary infections, reactivations or exogenous reinfections. The expression of related clinical symptoms is highly variable but may be extremely severe, particularly among immunocompromised patients. The prototypic severe disease associated with these infections is limbic encephalitis occurring in stem cell transplant recipients. The diagnosis of acute HHV-6 infections relies on the quantitation of viral load in whole blood by means of quantitative PCR. The demonstration of HHV-6 causative role in the genesis of clinical symptoms requires additional investigations such as the search for HHV-6 DNA in cerebrospinal fluid in case of encephalitis. The chromosomal integration of HHV-6 DNA is a rare event among HHV-6-infected subjects but may alter the interpretation of virological results. Therapy with ganciclovir, foscarnet or cidofovir has not yet clear indications but, at the current stage of knowledge, only concerns the treatment of highly symptomatic infections. The usefulness of prophylactic or pre-emptive antiviral chemotherapy has not yet been convincingly demonstrated. Treatment efficacy must be checked through a clinical and virological follow up, based in part on quantitative PCR approaches. Controlled studies are urgently needed with the goal of evaluating the cost-effectiveness of HHV-6 follow up and therapy in different clinical situations. [Copyright &y& Elsevier]

Abstract: The PCR assays are currently used in diagnosis of enterovirus (EV) meningitis. Nevertheless, the use of molecular diagnosis of EV should be investigated in respiratory tract infections (RTI). Objectives: To perform enterovirus molecular diagnostic tools, PCR and genotyping, in nasal samples for diagnostic and epidemiologic purposes. Methods: During 2008, 3612 nasal specimen (NS) were studied by IFD and MRC5 culture. Next, we realised successively viral isolation on HuH7 culture (for NS negative by IFD assay) and a duplex PCR enterovirus-rhinovirus for the 816 HuH7 positive supernatants. Furthermore, 327 NS collected from neonates were systematically tested by a real-time RT-PCR. This assay was used in routine for EV diagnosis setting in cerebrospinal fluid. Enterovirus genotyping was then performed for the 68 positive supernatants. Results: Thirty-five NS (0.97%) were positive for EV by culture (MRC5). A combination of both PCR assays, PEVRV and PEV, allowed an additional identification of 41 EV, eight EV-RV and 12 RV, increasing the number of positive to 96 NS (2.6%). Among the neonates, 32 NS (11.3%) were positive for EV by PEV. Of the 98 NS tested by the two PCR assays (PEV and PEVRV), 27 were positive and we detected 10 EV, five EV-RV and 12 RV. From January to December 2008, the circulation of EV showed the usual peak in June–July when a small outbreak of aseptic meningitis occurred and an additional autumnal peak corresponding to respiratory tract infections. Five main serotypes were isolated: 19 EV68 (29.7%), 12 CB3 (18.7%), nine E3 (14,1%), six CA9 (9.4%) and six CB1 (9.4%); the 19 EV68 were isolated in October–November and 17/19 (89.5%) of positive patients were hospitalised for severe respiratory diseases. Conclusion: The use of molecular screening techniques (PCR assays and genotyping) on nasal samples collected from patients with respiratory infections allowed a prospective, effective and precise identification of circulating strains. [Copyright &y& Elsevier]

Abstract: Chronic meningitis is defined by the association of symptoms of more than 1 month duration and an abnormal cellularity of the cerebrospinal fluid. About 10% of all meningitis are chronic meningitis. The differential diagnosis is wide and relies on anamnestic data, daily life characteristics and activities, immune status, clinical presentation and signs, and systematic search of most frequent causes. The main causes of chronic meningitis are tuberculous, cryptococcal, mainly in immunosuppressed patients, carcinomatous and systemic diseases associated meningitis. The first part of the paper details the overall etiological strategy to be used in the diagnosis of chronic meningitis. The second part is a literature-based review of the common and rare causes of chronic meningitis. [Copyright &y& Elsevier]

Abstract: Objective: The purpose of our study was to identify strains of Neisseria meningitidis isolated from 2005 to 2007 in Mali. Patients and method: We carried out a cross-sectional and descriptive study of 1573 meningitidis suspected case cerebrospinal fluid (CSF) samples before antibiotherapy. The identification of isolated germs was serogroup, serotype, subtype, sequence type, and clonal complexes. Results: CSF samples were taken from children under 1 (30.1%), children between 1 and 4 (26.3%), and children between 5 and 14 years of age (25.7%). Neisseria meningitidis was identified in 144 out of 244 CSF positive samples. Streptococcus pneumoniae (73/244), and Haemophilus influenzae b (44/244) were also present. The most frequent Neisseria meningitidis serogroups were A, W135, and Y. Genotyping of the 33 live Neisseria meningitidis strains showed that three clonal complexes were present, especially serogroup A complex ST-5 with sequence type ST-7 and ST-2859, serogroup W135 complex ST-11 with sequence type ST-11, and serogroup Y complex ST-167 with sequence type ST-167 and ST-192. Discussion: The introduction of tetravalent vaccine ACYW135 should be considered in Mali and West Africa. [ABSTRACT FROM AUTHOR]

Abstract: Because of population ageing, the prevalence of Alzheimer''s disease (AD), the most common cause of dementia, increases progressively. This condition is now considered as a public health priority. New disease modifying therapeutic strategies could be available in the next few years that would necessitate an accurate and early diagnosis of the disease. Recently developed diagnostic tools are being assessed. Development of structural brain imaging allows to measure the hippocampus volume. Metabolic imaging can assess a broad range of functional parameters such as cerebral blood flow and dopaminergic activity with single photon emission computed tomography, cerebral glucose metabolism and cerebral amyloid burden with positron emission tomography. Those imaging methods are under evaluation to appreciate cerebral abnormalities that may occur earlier than structural ones. Cerebrospinal fluid biomarkers, in particular amyloid and tau peptides, allow us to look at in vivo biochemical cerebral changes related to AD, before possible serum biomarkers. Studies are under way to confirm the relevance of these new diagnostic tools. It will help us to improve evaluation of patients with AD or related diseases. [Copyright &y& Elsevier]

Summary: Benign afebrile seizures associated with mild gastroenteritis and normal serum electrolytes are often described in Asian infants under the name of convulsions with mild gastroenteritis (CwG). Herein, we report 3 cases of CwG that occurred in Caucasian children. Clinical features and outcomes are described and the cases reported in the literature are reviewed. The CwG syndrome is now recognized as a distinct entity characterized by the following criteria: (1) it occurs in previously healthy 6-month to 3-year-old children who present with afebrile convulsions, (2) it is associated with mild gastroenteritis, (3) seizures tend to occur in a clustered manner, (4) interictal EEG shows no paroxysmal discharge, and (5) laboratory examinations are normal, including normal cerebrospinal fluid, serum electrolytes and glycemia. The CwG syndrome is a self-limited disease with a short course and a good prognosis. Investigations must be targeted and anticonvulsivant therapy is not required. As rotavirus is the most common agent among the diarrheal viruses detected to be the cause of CwG, one could hypothesize that this virus may play a role in the CwG pathogenesis. [ABSTRACT FROM AUTHOR]

Abstract: We report the case of a patient in whom three blood patches had to be performed to treat a post-dural puncture headache following the insertion of an epidural catheter for labour analgesia. There are few data about repeated blood patches used to treat recurring symptoms after failure of a previous blood patch. The technical guidelines used to perform a first blood patch should be followed for the next procedure as well. The role of the cerebrospinal fluid leaking in the symptoms has to be verified, to avoid performing a useless blood patch and to miss another cause, which needs an urgent treatment. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To describe the epidemiological and clinical features of enteroviral meningitis as well as the biological profile of the cerebrospinal fluid (CSF). Methods: A retrospective study conducted in a single centre between 2004 and 2008. All aseptic meningitis due to Enterovirus were included. Results: Fifty-nine patients were included. The triad including fever, headache and neck stiffness was reported in 62% of patients. Twelve patients (20%) had a neutrophilic leukocytosis and 23 (39%) an elevated CRP level. Twenty-eight patients (47%) had a prominent neutrophilic reaction in the CSF and nine (15.2%) had a low glucose concentration. A presumptive anti-bacterial treatment was initiated in 47 patients (80%) for an average of 3.2 days. Conclusion: Due to the lack of specificity of clinical features and biological manifestations of Enterovirus meningitis, the widespread use of real-time Enterovirus PCR is a priority for reducing the number of unnecessary anti-bacterial treatment. Guidelines based on clinical and biological features may be associated to help physicians in the differential diagnosis between bacterial and viral meningitides. [Copyright &y& Elsevier]

Abstract: Objectives: Between 1st January and 31st December 2007, 331 Streptococcus pneumoniae strains were collected from 20 participating laboratories in the Pneumococcus Network Pays de la Loire county to assess their susceptibility to antibiotics and to evaluate serogroups of strains. Method: The coordinating centre performed MICs of penicillin G, amoxicillin and cefotaxime by the reference agar dilution method. Results were interpreted according to CA-SFM breakpoints. Sensitivity to other antibiotics were studied and serotyping of each strain performed. Results: Three hundred and thirty one strains were isolated in 2007. They were collected from 30 cerebrospinal fluids, 239 blood samples, 53 middle ear fluids and nine pleural fluids. The percentage of pneumococci with decreased susceptibility to penicillin G (PDSP) was 39% and was higher in children (51%) than in adults (35%). The PDSP were often multidrug resistants especially with a high percentage of resistance to erythromycin (87.6% versus 8.4% for pneumococci sensitive to penicillin G). Finally, the most prevalent serogroup was the serogroup 19 (29.6% of isolates). Conclusion: A decrease of PDSP was observed since 2001 and high-level resistant strains to β-lactams remain low. The rate of PDSP in Pays de la Loire is in the national average. [Copyright &y& Elsevier]

Abstract: Regional pneumococcal observatories in region Centre, created in 1997, participate with the others pneumococcal observatories alongside the National Reference Center for Pneumococci and the Institut de Veille Sanitaire at the monitoring of the evolution of resistance of pneumococci to antibiotics in France. Between 1997 and 2007, 2427 strains of Streptococcus pneumoniae were isolated in part from cerebrospinal fluids, blood and middle ear fluid, from children and adults. The prevalence of pneumococci with a decreased susceptibility to penicillin (PDSP) decreased strongly in region Centre: 56.8 % in 2001, 39.6 % en 2007. These data are similar to the French national data over the same period. [Copyright &y& Elsevier]

Abstract: The use of ultrasonographic guidance for regional anaesthesia has known recently a big interest in children in recent years. The linear ultrasound probes with a 25mm active surface area (or probes with 38mm active surface area in older children), with high sound frequencies in the range 8–14MHz, allow a good compromise between excellent resolution for superficial structure and good penetration depths. In children, the easiest ultrasound guided blocks are axillar blocks, femoral blocks, fascia iliaca compartment blocks, ilio-inguinal blocks and para-umbilical blocks, caudal blocks. They permit a safe and easy learning curve of these techniques. The main advantage of ultrasound guided regional anaesthesia is the visualization of different anatomical structures and the approximate localization of the tip of needle. The other advantages for ultrasound guided peripheral nerve blocks in children are: faster onset time of sensory and motor block, longer duration of sensory blockade, increase of blockade quality and reduction of local anesthetic injection. The use of ultrasonographic guidance for central block allows to visualize different structures as well as spine and his content. Spinous process, ligament flavum, dura mater, conus medullaris and cerebrospinal fluid are identifiable, and give some information on spine, epidural space and the depth between epidural space and skin. At last, in caudal block, ultrasounds permit to evaluate the anatomy of caudal epidural space, especially the relation of the sacral hiatus to the dural sac and the search of occult spinal dysraphism. Benefit of this technique is the visualization of targeted nerves or spaces and the spread of injected local anaesthetic. [Copyright &y& Elsevier]

Abstract: CSF sterilization should be obtained very rapidly to reduce both mortality and morbidity due to bacterial meningitis. Thus, antibiotic treatment should be adapted to the suspected bacterium and administered as early as possible at high dosage with – if necessary – a loading dose and continuous perfusion. The rates of abnormal susceptibility to penicillin of Streptococcus pneumoniae, Neisseria meningitis and Haemophilus influenzae are 37%, 30% and 12% respectively. Thus, ceftriaxone or cefotaxim must be used as empirical treatment. Listeria monocytogenes remains fully susceptible to aminopenicillin, so, the combination aminopenicillin and aminoglycoside is the first-line treatment. Antibiotic resistance, allergy or contra-indications, are in fact rare but in these cases, antibiotic combinations are often needed. The latter are more or less complex and clinically validated; they include molecules such as vancomycine, fosfomycin, fluoroquinolone or linezolid. [Copyright &y& Elsevier]

Abstract: The rational selection of antibiotics for the treatment of meningitis must take into account several criteria, among which their intrinsic activity against the causative bacteria, and their pharmacokinetic and pharmacodynamic properties. The intrinsic activity is evaluated by the Minimal Inhibitory Concentration (MIC), which, however, does not give any information on the bactericidal potency of the drug (important property for infections localized in compartments with low immune defense such as the CSF). The capacity of the antibiotic to reach the infected compartment depends on its physicochemical properties (molecular weight, lipophilicity) and its protein binding capacity, but also on the properties of the blood-CSF barrier (permeability modulated by inflammation and activity of active transporters). Pharmacodynamics correlate intrinsic activity to pharmacokinetics by determining the optimal value of the ratio between MIC and time of exposure, area under the curve, or peak concentration. On these bases, β-lactams appear as first-line antibiotics, if used with large and repeated doses (or even as a continuous infusion), because of their time-dependent activity. The choice of the molecule is based on the susceptibility of the bacterium. Potential alternatives include chloramphenicol (limited however by its toxicity), moxifloxacin (showing high bactericidal effect, a low MIC, and appropriate penetration) but little clinically documented, linezolid and vancomycin for Methicillin-Resistant Staphylococcus aureus (MRSA), and vancomycin for penicillin non-susceptible pneumococci. Other molecules in clinical development are being evaluated for this indication. [Copyright &y& Elsevier]

Abstract: The most frequent bacteria responsible for acute bacterial meningitis, after the neonatal period, are meningoccoci and pneumococci, very rarely Haemophilus influenzae and Listeria monocytogenes. The microbiological diagnosis is based on cell count, Gram stain, and culture of cerebrospinal fluid. Antigen detection and DNA detection are useful to identify the bacteria in cases of negative cultures, because of the fragility of some bacterial species (meningococci), or a prior antibiotic administration, before a lumbar puncture. Some tests for screening antimicrobial resistances are needed, such as those for detection of resistance to ßlactam agents in pneumococcal isolates. Blood cultures, serum samples, skin rash biopsies also contribute to the diagnosis. [Copyright &y& Elsevier]

Abstract: Clinical diagnosis of acute bacterial meningitis may be delayed, either because off lack of sensitivity of clinical signs, or because of a poor vital prognosis; but over diagnosing is also frequent, leading to useless, expensive, and potentially dangerous hospitalizations. We conducted a comprehensive review of English and French literature from 1997 to 2007 by searching MEDLINE to review the accuracy of clinical examination for the diagnosis of meningitis. Additional references were identified by reviewing reference lists of articles back to 1993. We used the keywords “meningitis”, “meningitis and clinical features”, “cerebrospinal fluid (CSF) pleocytosis”, “headache and fever”, “Kernig sign”, “Brudzinski sign”, and “neck stiffness”. We excluded nosocomial meningitis. Sensitivity for clinical signs such as headache, vomiting, or fever was low, generally less than 30%, neck stiffness could reach 45%, but the absence of two signs among fever, headache, neck stiffness, and altered mental status eliminated meningitis with a negative predictive value of 95%. Given the seriousness of bacterial meningitis, clinicians perform lumbar puncture (or brain imaging) too often, especially in high-risk patients. Further prospective clinical research is needed to improve the accuracy of bacterial meningitis clinical diagnosis. [Copyright &y& Elsevier]

Abstract: Clinical and biological symptoms of neuroleptospirosis are misleading. We report a 62-year-old man, without any risk factor, suffering from febrile headache with a pseudotumoral cerebral spinal fluid due to neuroleptospirosis. Thereby, we present useful diagnostic assays and their practical interest. [Copyright &y& Elsevier]

Résumé: Le syndrome de Parsonage-Turner, ou névralgie amyotrophique de l’épaule, peut être secondaire à diverses infections. Nous rapportons quatre cas de syndrome de Parsonage-Turner révélateurs d’une borréliose de Lyme. Le syndrome de Parsonage-Turner est typique (douleur scapulaire aiguë, suivie de déficit et d’atrophie des muscles de la ceinture scapulaire), confirmé par des signes de dénervation à l’électromyographie (EMG) dans tous les cas. Un érythème chronique migrant après morsure de tique n’est signalé que dans un cas. Le liquide céphalorachidien (LCR) est pathologique (lymphocytose et hyperprotéinorachie) dans trois cas. La sérologie de maladie de Lyme est positive dans le sérum dans tous les cas et dans le LCR dans deux cas. L’évolution sous antibiotiques est toujours favorable, avec guérison dans deux cas à six mois. Le syndrome de Parsonage-Turner peut être considéré comme une manifestation des neuroborrélioses ; devant un tableau de syndrome de Parsonage-Turner, une sérologie de maladie de Lyme est indiquée. [Copyright &y& Elsevier]

Abstract: Enterovirus (EV – 68 serotypes) infections comprise a wide spectrum of clinical presentations including infections of the central nervous system. In severe clinical presentation or epidemics, the precise identification of the involved serotype is necessary. Objectives: To perform enterovirus genotyping directly in cerebrospinal fluid (CSF) samples, and to assess its feasibility in a laboratory setting. Methods: Enterovirus genotyping was carried out directly with CSF specimens tested for the diagnostic procedure by amplifying the complete 1D gene encoding the VP1 protein of the HEV-B serotypes (the most frequent) – providing results in two days. Secondly, sequences 1A/1B encoding the VP4/VP2 capsid proteins, respectively, were analysed (results in five days). Results: Direct enterovirus genotyping allowed the identification of enterovirus involved in 77 out of 81 (95%) meningitis cases between January 2006 and December 2007. In combination with the indirect genotyping of enterovirus isolates, identification of the type was achieved in 94 out of 97 (96.9%) patients included in the study. The most frequent serotypes were echovirus 6 (E6) and 13 in 2006, coxsackievirus B2 and E30 in 2007. Four children presented an EV71 associated meningitis. Conclusion: When prospectively applied in a laboratory setting, direct enterovirus genotyping in CSF samples allows the identification of the involved enterovirus in two to five days. This time frame is relevant for an optimal patient management, the rapid identification of a new enterovirus variant or in the context of an epidemic alert. [Copyright &y& Elsevier]

Abstract: Purpose: To review the current concepts in the biological diagnosis of Alzheimer''s disease (AD) and related disorders. Current knowledge and key points: As new therapeutics specific of AD may be available soon, early diagnosis of AD in the context of mild cognitive impairment (MCI) or dementia appears to be challenging. The high amount of atypical clinical forms of AD leads to develop new tools allowing in vivo diagnosis. New CerebroSpinal Fluid (CSF) biomarkers seem to reflect specific aspects of deep neuropathological changes observed in AD, i.e. amyloid deposits and neurofibrillary tangles. Amyloid β-peptide 1–42 (Aβ1–42) and hyperphosphorylated tubulin associated unit (tau) isoforms appear to be the most sensitive and specific CSF biomarkers, the combination of these biomarkers depicting the best diagnosis value for AD. These molecules are also efficient in the prediction of the conversion from the MCI state to the dementia state of AD. Combined to clinical and neuro-imaging information, CSF biomarkers appear thus to be highly relevant in improving the early etiological diagnosis of dementia. Future prospects and projects: The current research focalises on the development of new molecules coming from Aβ and tau protein families, in the CSF and in the serum, as well as molecules reflecting other pathological metabolism changes, as α-synuclein in Lewy Body Disease. The diagnosis value of CSF biological markers is so promising that they have been recently included in the research diagnosis criteria of AD. [Copyright &y& Elsevier]

Abstract: Introduction: Spontaneous low cerebrospinal fluid pressure syndrome is a spontaneous intracranial hypotension pressure due to a cerebrospinal fluid leak without any known dural effraction. It is clinically characterised by postural headaches relieved by supine position. We report a 38-year-old patient with this syndrome and review the literature. Exegesis: The diagnosis is sometimes difficult in atypical presentation of the syndrome and can lead to incapacitating chronic headache and rarely to complications. Cerebral magnetic resonance imaging has dramatically improved identification, diagnosis and management of this syndrome. Treatment is mainly based on blood patch realisation. Cerebrospinal fluid leak probably due to a spontaneous defect in the dural mater is suspected to be the main mechanism of this syndrome without any history of lumbar puncture or penetrating trauma. Conclusion: Early diagnosis, often easy on the basis of clinical characteristics of the headache may avoid complications. [Copyright &y& Elsevier]

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Copyright of Bio Tribune Magazine is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Introduction: A syndrome of headache with neurologic deficits and cerebrospinal fluid (CSF) lymphocytosis is uncommon and clinicians should be aware of this entity. Exegesis: We report a 28-year-old man without previous medical history of migraine, who presented with severe headache and temporary focal, neurological deficits. Lumbar puncture revealed aseptic lymphocytic pleiocytosis. The patient completely recovered within one month. This condition was suggestive of a transient syndrome of headache with neurologic deficits and lymphocytosis. The main characteristics and the pathophysiology of this uncommon disorder, generally with a benign course, are discussed. Conclusion: Such syndrome of headache, neurologic deficits and CSF lymphocytosis should be included in the differential diagnosis of meningo-encephalitis. The constant benign course of this affection should be emphasized. [Copyright &y& Elsevier]