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Был проведен ретроспективный анализ 290 историй болезни детей, госпитализированных в Киевскую городскую детскую клиническую инфекционную больницу в течение 2010–2015 годов с диагнозом «менингит». Среди них 73 истории болезни детей первых трех лет жизни. Установлено, что особенностью течения менингита у детей первых 3 лет жизни было преобладание гнойного менингита менингококковой (33 %) и неустановленной (55 %) этиологии и преобладание в клинической симптоматике общеинфекционного и менингеального синдромов при гнойном менингите и общемозгового синдрома при серозном менингите. Отмечено, что у 85 % детей менингит тяжелой степени тяжести, у 75 % — осложненного течения, в структуре осложнений менингита у детей первых 3 лет жизни превалирует отек головного мозга.

Background. The importance of timely leptospirosis diagnosis and treatment has increased due to sporadic children morbidity. It is crucial in order to prevent the complications and adverse outcomes development.Clinical Case Description. The data from literature and our own clinical observation of leptospirosis with benign outcome in infant (with kidney damage, purulent meningitis, hemorrhagic syndrome and congenital heart disorder) is presented.Conclusion. The description of leptospirosis symptoms and course in the child is presented in the form of analysis of the clinical setting for further medical education, including differential diagnostics with viral hepatitis.

To date, only a few cases of intracranial infection related to severe acute respiratory syndrome‐coronavirus‐2 (SARS‐CoV‐2) were reported. Here we describe a case of coronavirus disease 2019 (COVID‐19) that was comorbid with purulent meningitis. A 62‐year‐old male patient was diagnosed with moderate COVID‐19 and had no fever or cough after treatment. However, he suffered from a head injury and experienced headache and fever immediately after the accident. Computed tomography (CT) of the brain showed bilateral frontal lobe contusion, subdural hematoma, and subarachnoid hemorrhage. In the following days, the patient suffered from recurrent fever, although chest CT did not show evidence of worsening of infection. Several lumbar punctures were made, confirming increased cerebrospinal fluid (CSF) pressure and karyocyte count. SARS‐CoV‐2 nucleic acid was not detected in CSF but revealed the presence of Escherichia coli. Thus, the patient was diagnosed with purulent meningitis, presumably caused by brain trauma or the immunologic dysfunction caused by COVID‐19, which was supported by the significant reduction of all kinds of immune cells. Since immunologic dysfunction is commonly presented in COVID‐19 patients, comorbidity with meningitis should be considered when a COVID‐19 patient presents with headache and fever. Lumbar punctures and CSF cultures may help in the diagnosis.

Pediatric bacterial purulent meningitis (BPM) and viral encephalitis (VE) are significant medical and social problems due to their course severity, high frequency of death cases, and formation of neurologic deficiency at the disease outcome. Activation of hormonal regulation and severity syndrome of systemic inflammatory response are important factors to evaluate the character of BPM and VE course. Objective. To study the level of cortisol and laboratory indicators of systemic inflammation in children with various variants of BPM and VE course depending on the period of the disease (acute period, reconvalescence) to specify their role in the pathogenesis of acute neuroinfections. Object and methods. There were investigated hematological indicators, the level of cortisol, C-reactive protein in blood serum of 60 children, 39 of them had BPM and 21 ones – VE. The comparison group included 14 children aged from 1 to 14 years old who were undergoing rehabilitation care due to neurologic problems at the Federal State-Financed Institution Pediatric Research and Clinical Center for Infectious Diseases under the Federal Medical Biological Agency. Results. The patients were divided into some subgroups according to the severity of their condition at the moment of hospitalization, i.e. urgent condition or critical condition requiring organ replacement therapy. The maximum increase of cortisol level and laboratory markers of systemic inflammation during the acute period was revealed in case of BPM in comparison with VE with a subsequent normalization to the stage of reconvalescence. The level of cortisol during the acute period of BPM was reliably higher in the subgroup with urgent conditions, whereas in case of VE – in the subgroup with critical conditions. There were no significant differences in the laboratory indicators of systemic inflammation response among the subgroups. There was established a correlation interrelation of cortisol level and the content of granulocytes and blood lymphocytes. Conclusion. There were identified characteristic features of cortisol content in children with bacterial and viral neuroinfections depending on the course of the disease.

Purulent meningitis in children can be both primary and secondary. The latter are the result of various surgical interventions, ENT pathology, immunosuppressive therapy, as well as craniocerebral and spinal trauma, which justifies the need for an integrated approach to differential diagnosis to select the appropriate therapy tactics. The article presents a clinical observation of a child in whom purulent meningitis developed on the background of epiduritis, which was the result of a spinal injury. The diagnostic search algorithm is described. The authors concluded that if the patient has laboratory confirmed purulent meningitis and adequate therapy with clinical improvement in the patient’s condition, but persistent febrile fever, an increase in inflammatory changes in the blood amid a decrease in the level of acute phase inflammation proteins (C-reactive protein) and negative procalcitonin the test requires a search for a local inflammatory focus using additional examination methods, such as MRI or CT, as well as consultations with a neurosurgeon That allows you to specify the diagnosis and to determine the conduct of tactics, thus providing a favorable outcome.

Purulent meningitis and viral encephalitis are the most common neuroinfections in children. The severity of the lesion, the frequency of disabling manifestations, as well as high mortality, determine the relevance of their study. Violations of hemostasis both in purulent meningitis and in viral encephalitis are some of the important pathogenetic mechanisms that determine the nature of the course and the similarity of the disease. The material for clinical, laboratory, and radiation studies was 100 children with purulent meningitis of various etiologies and viral encephalitis from the age of 1 month to 17 years 11 months. In addition to clinical monitoring, all patients underwent D-dimer and circulating endotheliocytes in the acute period and disease dynamics. The different nature of vascular damage has been proved: with the prevalence of endothelial damage in purulent meningitis, and a violation of its functional activity with vascular tone dysfunction — in case of viral encephalitis. Radiation markers of cerebral vascular damage in the acute period of neuroinfections are described. The pathogenetic significance of structural and functional disorders of the vascular wall and hemostasis in the genesis of purulent meningitis and viral encephalitis in children has been established.

The aim of the present study was to evaluate the role of ceftriaxone sodium combined with dexamethasone on the treatment of infant purulent meningitis (PM) and to measure brain-derived neurotrophic factor (BDNF) levels in children with PM. Of the 177 patients enrolled into the present study, 92 patients received ceftriaxone sodium+dexamethasone (combination group) and 85 patients received ceftriaxone sodium alone (monotherapy group). The time taken for the body temperature, peripheral blood (PB) and cerebrospinal fluid (CSF) white blood cell (WBC) counts to recover back to normal levels were compared between the two groups. In addition, changes in the CSF WBC counts, CSF protein and sugar concentrations, BDNF levels, effective treatment rates and incidence of adverse reactions three days before treatment (T1), after one week of treatment (T2) and after two weeks of treatment (T3) were compared between the two groups. In the combination group, the recovery time of body temperature, WBC counts in both PB and CSF were significantly lower compared with those in the monotherapy group. The combination group also exhibited lower CSF protein concentrations and higher CSF sugar concentrations at T2 and T3 compared with those in the monotherapy group (P

Neonatal purulent meningitis (NPM) leads to higher mortality and neurological sequelae rates. miR184 involves in inflammation and tumor, but the role of miR-184 in NPM remains unclear. NPM patients and non-intracranial infected neonates were collected and miR-184 expression in cerebrospinal fluid was assessed by real-time PCR. The Neuro-2a cell line was cultured and divided into control group, inflammation group (treated with LPS), and miR-184 inhibitor group, which was transfected with miR-184 inhibitor on the basis of inflammation followed by analysis of miR-184 and TLR4 expression by Real time PCR, Caspase 3 activity, cell proliferation by MTT assay, secretion of IL-1β and IL-6 by ELISA, NLRP3 expression by real time PCR and western blot, and Caspase-1 p20 and NF- B level by western blot. miR-184 expression level was significantly increased in cerebrospinal fluid of NPM group (P < 0 05) and also elevated in inflammation group along with significantly inhibited cell proliferation was inhibited, increased Caspase 3 activity, IL-1β and IL-6 secretion, and decreased TLR4, NLRP3, Caspase-1 p20 and NFκ- B expression (P < 0 05). miR-184 inhibitor significantly down-regulated miR-184 expression in the inflammation group, promoted cell proliferation, decreased Caspase 3 activity, IL-1β and IL-6 secretion, and increased TLR4, NLRP3, Caspase1 p20 and NF- κB expression (P < 0 05). miR-184 expression is increased in neonatal purulent meningitis and it can inhibit inflammation by targeting TLR4/NLRP3 signaling pathway, leading to amelioration of the progression of neonatal purulent meningitis.

Objective To determine the diagnostic accuracy of pneumococcal antigen detection in diagnosis of pneumococcal meningitis in children. Methods Purulent meningitis was diagnosed according to European Society for Clinical Microbiology and Infectious Diseases (ESCMID) guideline between July 2014 and June 2016. Along with a cerebrospinal fluid (CSF) culture, pneumococcal antigen detection in cerebrospinal fluid (CSF) was performed, and further identification of pathogens was done with 16S rDNA-PCR and high-throughput sequencing. Results CSF samples collected from 184 children (median age of 1.92 mo). CSF culture was used as the gold standard. 46 (25%) had positive results for culture and 10 (5.4%) were pneumococci; 34 (18.5%) were pneumococcal antigen positive. The sensitivity and specificity of pneumococcal antigen detection were 100% (95% CI: 89.4%-100%) and 86.2% (95% CI: 96.4%-99.9%), respectively. 92.3% (12/13) were confirmed by nucleic acid detection to be pneumococci. Conclusions Pneumococcal antigen detection in CSF has adequate sensitivity and specificity in diagnosing pneumococcal meningitis.

Background The 13-valent pneumococcal conjugate vaccine (PCV13) entered Cameroon’s childhood national immunization programme (NIP) in July 2011 under a 3-dose schedule (6, 10, 14 weeks of age) without any catch-up. We described the impact of PCV13 onserotype distribution among pneumococcal meningitis cases over time. Methods We used laboratory-based sentinel surveillance data to identify meningitis cases among 2- to 59-month-old children with clinically-suspected bacterial meningitis (CSBM) admitted to hospitals in Yaoundé (August 2011-December 2018). Purulent meningitis cases had a cerebrospinal fluid (CSF) white blood cell (WBC) count ≥20 per mm3. Pneumococcal meningitis cases had S. pneumoniae identified from CSF, with serotyping by polymerase chain reaction. Years 2011-2014 were described as early PCV13 era (EPE) and years 2015-2018 as late PCV13 era (LPE) impact periods. Results Among children hospitalized with CSBM who had a lumbar puncture obtained, there was no significant change from the EPE versus the LPE in the percentage identified with purulent meningitis: 7.5% (112/1486) versus 9.4% (154/1645), p = 0.0846. The percentage of pneumococcal meningitis cases due to PCV13 vaccine-serotype (VST) decreased from 62.0% (31/50) during the EPE to 35.8% (19/53) in the LPE, p = 0.0081. The most frequent pneumococcal meningitis VSTs during the EPE were 6A/6B (30%) and 5 (6%), and during the LPE were 14 (13.2%), 3 (7.6%), 4 (5.6%) and 18C (5.6%). Conclusion Four to seven years after PCV13 introduction, the proportion of pneumococcal meningitis due to vaccine serotypes has declined, mainly due to reductions of serotypes 6A/6B, 1, 19A, and 23F; nevertheless, PCV13 VSTs remain common. Because the analyzed surveillance system was not consistent or population based, we could not estimate incidence or overall impact; this emphasizes the need for improved surveillance to document further the utility of PCV13 immunization in Cameroon.

Streptococcus suis, a prevalent porcine pathogen, may sporadically cause infections in humans, and has recently emerged as a cause of zoonoses in some professionals. The aim of this article was to review available data on epidemiology, etiopathogenesis, diagnostics, and management of the most common form of S. suis infection, purulent meningitis. Literature data show that S. suis is an important etiological factor of purulent meningitis, especially in subjects being occupationally exposed to contact with pigs and/or pork meat. Owing to growing incidence of S. suis meningitis, a history of such exposure should be verified in each patient presenting with typical meningeal symptoms. Whenever S. suis was confirmed as the etiological factor of purulent meningitis, therapeutic protocol should be adjusted appropriately, to avoid patient's exposure to potentially ototoxic antimicrobial agents and corticosteroids. Considering the biphasic character of S. suis meningitis and its frequently atypical outcome, all individuals with this condition should be optimally supervised by a multidisciplinary team, including an ENT specialist.

Purulent meningitis (PM) is a severe disease, characterized by high mortality and a formation of a residual neurological deficit. Loss of treatment of PM leads to the lethal outcome in 100% of cases. In addition, death and the development of residual neurological complications are possible despite adequate therapy. The aim of the study was to evaluate the cerebroprotective effects of a new pharmacological compound 2-ethyl-6-methyl-3-hydroxypyridine-2,6-dichlorophenyl(amino)phenylethanoic acid (EMHDPA) on the bacterial purulent meningitis in a model of experimental pneumococcal meningitis. Meningitis was simulated by intrathecal injection of the suspension containing Streptococcus pneumoniae at the concentration of 5 × 109 CFU/mL. The cerebroprotective effect was evaluated by survival rates, the severity of neurological deficit, investigatory behaviors, and results of short-term and long-term memory tests. The group administered with EMHDPA showed high survival rates, 80%. Animals treated with the studied compound showed a higher clinical assessment of the rat health status and specific force, and a lesser intensity of neurological deficit compared to the control group (p &lt, 0.05). Locomotor activity of the animals treated with EMHDPA was significantly higher compared to the control group (p &lt, 0.05). There is a decrease in the activity of all estimated indicators of oxidative stress in the group administered with 2-ethyl-6-methyl-3-hydroxypyridine-2,6-dichlorophenyl(amino)phenylethanoic acid relative to the control group: a decrease in the activity of catalase—17%, superoxide dismutase—34%, malondialdehyde and acetylhydroperoxides—50%, and nitric oxide—85% (p &lt, 0.05). Analysis of the data obtained during the experiment leads to the conclusion about the effectiveness of 2-ethyl-6-methyl-3-hydroxypyridine-2,6-dichlorophenyl(amino)phenylethanoic acid in the treatment of the experimental PM.

Objective: Hydrocephalus is a potentially lethal complication of neonatal purulent meningitis. Early detection of hydrocephalus helps to determine optimal treatment, improve prognosis, and reduce financial burden. We aimed to analyze the risk factors for hydrocephalus in neonates with purulent meningitis and discuss the characteristics of the disease. Methods: The records of neonatal purulent meningitis admitted to the Children Hospital of Fudan University from January 2013 to September 2019 were retrospectively included in the study cohort. The data of clinical, laboratory, and cranial magnetic resonance images (MRIs) were collected and analyzed (except discharge data) by univariate analysis, and P values Results: A total of 197 children who met the inclusion criteria were enrolled in the study cohort. Overall, 39.6% (78/197) of the patients had positive pathogen cultures, and 60.4% (119/197) of patients had clinical diagnosis of meningitis with negative pathogen cultures. Among 197 children, 67 of them experienced hydrocephalus, and the factors that were significantly associated with hydrocephalus in multivariate analysis were female sex, cerebrospinal fluid glucose Conclusions: Female sex, cerebrospinal fluid glucose

This study aimed to investigate the diagnostic value of heparin-binding protein (HBP) in the cerebrospinal fluid of children with purulent meningitis (PM). This study included 118 children with PM diagnosed at our hospital from January 2018 to January 2020, 110 children with viral meningitis (VM) and 80 children with suspected meningitis who were ruled out by cerebrospinal fluid (CSF) analysis during the same period. HBP and white blood cell (WBC) count in the CSF, and inflammatory factors, including C-reactive protein (CRP), tumor necrosis factor (TNF)-α, and procalcitonin (PCT), were measured. Receiver-operator characteristic curves were used to analyze the predictive value of HBP, CRP, PCT, and TNF-α levels in the diagnosis of PM by CSF analysis. HBP levels in the CSF of children with PM were higher, while the CRP and serum PCT and TNF-α levels were elevated in all groups (P

Herein we report a case of a 67-year-old man with chronic lymphocytic leukaemia who developed acute onset of fever and altered mental status while receiving ibrutinib therapy. He was eventually found to have Capnocytophaga canimorsus meningitis. Timely diagnosis and appropriate antimicrobial therapy was associated with a favourable outcome. We describe challenges associated with appropriate identification of, and briefly review infections caused by Capnocytophaga sp. To our knowledge, this is the first case of invasive C. canimorsus infection in the setting of ibrutinib therapy, and adds to the growing list of serious infections that have been associated with this agent.

ObjectiveTo evaluate the use of cerebrospinal fluid (CSF) ferritin levels in the diagnosis of purulent meningitis (PM).MethodWe studied 81 children between 28 days and 12 years of age who presented with clinical suspicion of meningitis to the emergency department. CSF ferritin levels were measured and compared between diagnostic groups (PM, aseptic meningitis (AM) and no meningitis).ResultsThe median age was 24 (IQR 8–69) months. There were 32 patients with AM (39%), 23 with PM (28%) and 26 with no meningitis (32%). Median CSF ferritin was 4.2 ng/mL (IQR 3.0–6.5), 52.9 ng/mL (IQR 30.7–103 ng/mL) and 2.4 ng/mL (IQR 2–4), respectively. CSF ferritin was higher in children with PM compared with AM (pConclusionCSF ferritin may be a useful biomarker to discriminate PM in children with clinical symptoms of this disease.

Aim. To study the clinical peculiar features of type b Haemophilus influenza-caused purulent meningites among children in Perm. Materials and methods. Twenty children with purulent meningitis were examined. Clinical and bacteriological studies, latex-agglutination reaction, polymerase chain reaction (PCR) were used. Results. Most patients with Hib-meningitis (70 %) were hospitalized in grave condition during the first three days of disease with fever, meningeal symptoms. Spastic syndrome was diagnosed in 5 patients, disseminated intravascular clotting syndrome – in 6 patients. Conclusions. Hib-meningitis in 80 % of cases is developing in children aged under two, has an acute onset and severe course with general cerebral and meningeal symptoms, changes in blood and liquor, typical for bacterial infection, high neutrophilic pleocytosis and hyperproteinorrhea; it is frequently accompanied by complications. In etiological diagnosis of Hib-meningitis PCR is the most informative method.

Data on etiology, epidemiology, clinical course and consequences of bacterial purulent meningitis in children of the city of Moscow are presented. The analysis of the dynamics of morbidity for the last 5 years is presented depending on etiology. In Moscow in recent years, there has been a change in serovars of meningococcus with an increase in W135, an increase in the proportion of pneumococcus and a decrease in the proportion of haemophilic type b. The modern aspects of the clinic, diagnosis, therapy and prevention of meningitis in children are considered.

There is a need for easy-to-use molecular assays for diagnosis of invasive meningococcal disease. Here, we report the rapid identification of Neisseria meningitidis in a cerebrospinal fluid sample from a patient with purulent meningitis using a commercially available loop-mediated isothermal amplification assay, resulting in a prompt de-escalation of the initial empiric antibiotic therapy.

Matrix metalloproteinase 2 (MMP-2) and tissue inhibitor of metalloproteinase-1 (TIMP-1) levels in cerebrospinal fluid of pediatric patients with neonatal purulent meningitis were observed to analyze changes in serum procalcitonin (PCT) and the correlation among the three factors (MMP-2, TIMP-1 and PCT). Sixty pediatric patients with neonatal purulent meningitis from April 2015 to December 2016 were enrolled as the purulent meningitis group and 60 pediatric patients with viral encephalitis treated during the same period were enrolled as the viral encephalitis group. Additionally, 60 healthy newborns who underwent physical examinations in our hospital during the same period were enrolled as the control group. The levels of MMP-2 were 136.73±25.42 ng/ml in the purulent meningitis group, 45.32±6.57 ng/ml in the viral encephalitis group and 1.32±0.51 ng/ml in the control group and the differences between the three groups were statistically significant (F=15.052, p

Relevance. Treatment of patients with severe thermal injury includes therapy comorbidities and complications, among which the special role played by the central nervous system. Their development is largely determines the weighting of the condition worsens the prognosis, as well as leading the timing of recovery. For burn disease may be accompanied by the development of the cerebral neurological complications, such as burn encephalopathy, acute violation of cerebral circulation, secondary purulent meningitis. Intention – identify the main pathogenetic mechanisms of neurologic complications and their correction have burned. Methods Review and analysis of literature data on neurological complications from burned and their treatment options. Results and Discussion. In the genesis of neurological disorders in the burned main role constitute the hemodynamic, electrolyte disorders, violations, breach the blood-brain barrier in the face of intoxication. Develops complex disorders, which can result in secondary purulent meningitis and meningoencephalitis. A comprehensive treatment, including surgical restoration of the skin integument, infusion therapy, antibiotics, drugs neuroprotektors stimulants avoids a number of severe complications. Conclusion. Timely pathogenetically justified treatment of neurological complications in burned, carried out within the framework of the integrated therapy of burn disease is essential, because such an approach contributes to the best possible outcomes.

The article tells about the most common bacterial infection in the world - pneumococcal disease, in particular, pneumococcal meningitis, which is the second most common purulent meningitis and the most common cause of mortality and severe neurological deficits in recovered patients. A clinical case of severe pneumococcal meningitis in infant is described in detail.

Background Invasive infections caused by Capnocytophaga canimorsus are rare. Immunocompromised patients, who report being bitten by or having a close contact with an animal, represent a high-risk group for this infection. There are only few dozens of infections by this bacteria manifesting as purulent meningitis reported worldwide. The reported case is a first reported case of purulent meningitis caused by by Capnocytophaga canimorsus in Czech Republic with only a limited risk factor history. Case presentation The patient, a 74 years old man, was referred to the infectious diseases department of a teaching hospital with clear signs of developing purulent meningitis. His anamnestic data did not show any unusual findings. He was treated for compensated diabetes mellitus type II. The blood cultures were negative and the etiological agent did not grow from the cerebrospinal fluid (CSF) on common media. Eventually, it was identified by detecting pan-bacterial DNA and DNA sequencing. Subsequently, the pathogen was confirmed by anaerobic cultivation from CSF. Only after then the patient recalled being bitten by his German shepherd puppy during play. The patient was successfully treated intravenously by ceftriaxone. Conclusions Purulent meningitis caused by Capnocytophaga spp. is a rare disease, but it needs to be considered in patients at risk with pre-existing conditions, who report close contact with or being bitten by an animal. It is important to test for this microbe in cases with negative microbiological results for the more common agents.

Background: High production of pro-inflammatory cytokines associated with procalcitonin synthesis and its increased blood levels play an important role in the pathophysiology of systemic inflammation in generalized bacterial infections. Aim: To assess diagnostic value of procalcitonin measurement as a marker of bacterial inflammation in cerebrospinal fluid for differential diagnostics of bacterial and viral meningitis. Materials and methods: Procalcitonin levels in blood and cerebrospinal fluid were measured by immunoenzyme analysis in 88 children aged from 3 months to 14 years who had been admitted to the hospital. Forty five percent (45.4%) of them had acute bacterial meningitis, 27.3%, viral meningitis and 27.3% had the meningitis-like syndrome (control group). Results: There was a high procalcitonin level in cerebrospinal fluid in patients with bacterial purulent meningitis (0,14 [0.0; 0.34] ng/mL (р < 0.006), with the normal range in the control group of 0.07 [0.0; 0.07] ng/mL. This parameter correlated with blood procalcitonin level (9.8 [2.05; 13.19] ng/mL) and severity of meningitis. In patients with viral meningitis, the procalcitonin levels were below the normal range (0.02 [0.01; 0.07] ng/mL). Conclusion: Measurement of procalcitonin levels in cerebrospinal fluid could be recommended for inclusion into the differential diagnostic algorithm of meningitis of various etiologies in children.

The data presented in the article deal with research of hormone changes in hypophysial-paranephric system in the course of neuroinfections. The given work was carried out with the purpose of detection of dependence of the cortisol and adrenocorticotropin hormone level on aetiology, gender, severity and period (cycle) of the disease.A comprehensive clinical and laboratorial checkup of 109 children with different nosological forms of neuroinfections was carried out: meningitis: viral, enteroviral, purulent and cerebromeningitis. Control board group was composed of 10 healthy children of the identical age. All the patients underwent the Adrenocorticotropin Hormone and Cortisol blood serum level, IFA technique being used, during acuity and reconvalesence. It has been determined that in case of neuroinfections irrrespective of the ethiology, hypophysis trophic funtction undergoes arrest during the whole disease period. While studying adrenal gland functioning during the acuity the increased cortisol secretion is observed, the degree of which is authentically higher in case of purulent meningitis and meningoencephalitis compared to hydromeningitis. On recovery the cortisol values decrease to healthy children’s level. A reliable dependence of the ACTH and cortisol level on the severity degree in case of purulent meningitis and meningoencephalitis was discovered ( brought to light). It is also satisfactorily brought to light that ACTH and cortisol levels depend on the severity degree in case of purulent meningitis and meningoencephalitis. It is proved that adrenal gland system function does not depend on the patients’ gender and age in case of neuroinfections.

Zusammenfassung. Wir berichten über einen 80-jährigen Patienten, der einen oberen Molar wegen Gesichtsscherzen entfernt hatte und im Verlauf eine Sinusitis maxillaris bei einem ektopischen Zahn entwickelte. Als Fieber und Nackenschmerzen auftraten, wurde eine eitrige Meningitis vermutet. Der unauffällige Liquor und der Nachweis im CT von typischen Verkalkungen um den Dens axis führten endlich zur korrekten Diagnose eines «Crowned Dens»-Syndroms.

Background Purulent meningitis (PM) is a serious life-threatening infection of the central nervous system (CNS) by bacteria or fungi and associated with high mortality and high incidence of CNS sequelae in children. However, the conventional cerebrospinal fluid (CSF) culture method is time-consuming and has a low sensitivity. Methods Our study developed a real-time PCR-based purulent meningitis-TaqMan array card (PM-TAC) that targeted 21 PM-related pathogens and could produce results within 3 h. Primers and probes were adapted from published sources possibly. The performance of them were evaluated and optimized and then they were spotted on TAC. Results The PM-TAC showed a sensitivity and specificity of 95 and 96%, respectively. For all of the 21 targeted pathogens, the PM-TAC assay had a LOD ranging from 5 copies/reaction to 100 copies/reaction, an intra-assay variation of 0.07–4.45%, and an inter-assay variation of 0.11–6.81%. Of the 15 CSF samples collected from patients with PM after empiric antibiotic therapies, the positive rate was 53.3% (8/15) for our PM-TAC assay but was only 13.3% (2/15) for the CSF culture method. Of the 17 CSF samples showing negative CSF culture, the PM-TAC assay identified a case of Neisseria meningitidis infection. Furthermore, all of the 10 CSF samples from patients without CNS infection showed negative for the PM-TAC assay. Conclusions Our PM-TAC assay also demonstrated that the pathogen loads in the CSF samples correlated with the severity of PM. Thus, the PM-TAC may be helpful to improve the prognosis of PM and clinical outcomes from antibiotic therapies. Electronic supplementary material The online version of this article (10.1186/s12879-019-3856-z) contains supplementary material, which is available to authorized users.

This study aimed to investigate the value of MRI enhanced fluid-attenuated inversion recovery (FLAIR) combined with TNF-α in cerebrospinal fluid in the diagnosis of neonatal purulent meningitis. Fifty neonates with purulent meningitis were randomly selected in the purulency group, 50 patients with viral meningitis (VM) in the virus group and 50 neonates without purulent meningitis in the no meningitis group. All neonates were selected from April 2015 to May 2018 in Women and Children's Hospital (Linyi, China). Clinical baseline data of the three groups were compared, and logistic regression analysis was conducted to analyze the risk factors of the disease. The risk factors of neonatal purulent meningitis include white bold cell count, TNF-α, encephaledema, encephaledema combined with abnormal EEG, erythrocyte sedimentation rate and FLAIR sequential apparent diffusion coefficient (ADC). TNF-α in cerebrospinal fluid combined with FLAIR sequential ADC obtained higher sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy and AUC than single TNF-α in cerebrospinal fluid examination or single FLAIR sequence. MRI enhanced FLAIR sequence scan combined with TNF-α in cerebrospinal fluid has the highest rate in early diagnosis of neonatal purulent meningitis, and it is worthy of clinical promotion.

Rationale: Klebsiella pneumonia (K. pneumonia), primarily a hospital-acquired pathogen, can cause a variety of deep-seated infections with significant morbidities. However, in the current scenario of global rise in antibiotic abuse, unexpected infection could be caused by K. pneumoniae. Patient concerns: A 56-year-old male who presented with intermittent headache and low fever was admitted, he had transsphenoidal surgery for pituitary adenoma 3 years ago. Routine laboratory tests revealed an elevated WBC count of 10.12 × 109/L and C-reactive protein (CRP) 12.9 mg/L. computed tomography (CT) revealed the sellar region with suspicious hemorrhage. Diagnoses: The patient was initially diagnosed with acute residual tumor hemorrhage. But the consequent diagnose of Klebsiella pneumoniae purulent meningitis was made based on the cerebrospinal fluid lab test and cerebrospinal fluid (CSF) and blood culture, and CT scan. Interventions: Lumbar puncture examination was made and the antibiotics were adjusted to meropenem and vancomycin according to the antibiotic sensitivity test. But because of the patient's unstable vital signs, his family refuse further lateral ventricular drainage. Outcomes: The infection was out of control and the patient died of spontaneous breath and heartbeat arrest. Lessons: Through this case, we could learn that any clue of suspicious intracranial infection should be carefully considered in the current scenario of global rise in antibiotic abuse. The manifestation of intermittent headache and mild fever could be potential signs of fatal infection, and prompt appropriate measures should be taken timely.

Rationale: Purulent meningitis refers infection of the subarachnoid space by various purulent bacteria and the corresponding inflammation of the leptomeninges. However, purulent meningitis due to Rhodococcus equi is extremely rare. Patient concerns: A 40-year-old man presented with fever and intermittent headache for 6 days. Two hours prior to admission, he developed epileptic seizures. Diagnoses: Brain computed tomography and magnetic resonance imaging showed intracerebral malacic lesions. Bacterial culture of cerebrospinal fluid revealed the presence of R. equi. A diagnosis of purulent meningitis caused by R. equi was made. Interventions: The patient was treated with intravenous meropenem (1000 mg every 8 hours) for 19 days; then he was discharged and instructed to continue the intravenous meropenem for two weeks. After a follow-up period of 2 months, the patient had recovered completely. Outcomes: After a follow-up period of 2 months, the patient had recovered completely. Lessons: Central nervous system infection caused by R. equi is rare. Early bacterial culture of CSF is important for timely diagnosis. With sufficient antibiotic therapy, the prognosis can be favorable.

Background Infantile purulent meningitis (PM) is a commonly severe intracranial infectious disease in infants under age 1 year. In recent years, several diagnostic and treatment methods were reported, but in these cases the neurological complications and sequel were often observed, among which subdural effusion (SE) is the most common complication in PM. Timely diagnosis and early intervention are vital for better outcomes. In this study, the surgical treatments for infantile PM complicated by SE were investigated. Material/Methods Patients who had PM complicated by SE in the Children’s Hospital of Hebei Province from June 2000 to June 2012 were retrospectively analyzed and 170 patients were enrolled in the study. Surgical treatment for each patient was adopted according to producing effusion time, leucocyte count, protein content, intracranial pressure, and bacteria culture, coupled with cranial ultrasound examination, CT, and MRI scans. Results Nearly, 15 patients were cured using serial taps, with a 50% cure rate. Seventeen out of 30 (56.6%) patients receiving subcutaneous reservoir drainage had better outcome. Nearly 80% of patients (55/69) who underwent minimally invasive trepanation and drainage were positive. Surgical procedure of minimally invasive trepanation and drainage combined with drug douche was effective in 63% of patients (19/30). In addition, 6 patients were cured with subdural-peritoneal shunt. Only 1 patient died, after the recurrence of meningitis, and the remaining 4 patients were cured by craniotomy. Conclusions For infantile PM complicated with SE, treatment needs be chosen according to the specific situation. Surgical procedure of minimally invasive trepanation and drainage is a very effective treatment in curing PM complicated by SE. The treatment was highly effective with the use of drug douche. Subdural-peritoneal shunt and craniotomy were as effective as in refractory cases.

The study of cerebrospinal fluid is essential for effective treatment. The aim of this study was to examine the basic principles of the treatment of bacterial meningitis. IP!adherence included patients received in-patient treatment with the diagnosis of meningitis. Research conducted in the department neuro-communicable diseases №1 Clinical Children's Hospital №2 named A.F.Garaeva, follow Isa-CSF in 25 patients (aged 1 to 10 years) BGM!time personal cause. According to the authors to clarify the etiological factors in BGF is expedient to appoint panampitsillina (polusinte-matic drug penicillin) in high doses. Summarizing the above outlined can come to the conclusion that the effectiveness of those causal therapy, when given their pectoralis complications and course of the disease may be assessed only on the basis of liquorologic research.

In the review modern data on taxonomy, biological features and clinical significance of agent of meningococcal infection and bacterial purulent meningitis are presented. Methods of laboratory diagnostics as well as recommendations about use of high-quality culture media and diagnostic kits for isolation and identification of microorganisms are described. Modern techniques to detect sensitivity of bacteria to antibiotics are proposed.

To assess an effect of the combined use of Cytoflavin and Sulodexide on the course and outcomes of purulent meningitis in children.Fifty children with purulent meningitis, aged from 5 to 17 years 11 month, were studied. Thirty patients of the treatment group (n=30; mean age 6,8 ± 2,2 years) received Cytoflavin (0,6 mcg/kg once a day) during 5 days with the following treatment with Sulodexide (250 LSU/day in children 5-12 years, 500 LSU/day in children above 12 years). Patients of the comparison group (n=20), aged 5,9±1,8 years, received standard antibacterial treatment. Duration and persistent of fever, cerebral, meningeal symptoms, the recovery period of CSF, the normalization of the number of desquamated epithelial cells (DEC), D-dimer were estimated. Outcomes of purulent meningitis were assessed using a working scale representing a modification of Rankin's, Fisher's, and Glasgow scales.The combination of drugs reduces the duration of cerebral and meningeal symptoms, leads to the normalization of hematological parameters (the level of leukocytes, desquamous epithelial cells, D-dimer) and improves outcomes.Цель исследования. Оценка влияния комбинированного назначения лекарственных препаратов Цитофлавин и Сулодексид на течение и исходы гнойного менингита у детей. Материал и методы. Проведено обследование 50 детей в возрасте от 5 лет до 17 лет 11 мес с гнойным менингитом. В основную группу вошли 30 пациентов с гнойным менингитом, получавшие в составе патогенетической терапии Цитофлавин в течение 5 дней (0,6 мл/кг 1 раз в сутки), а после курса Цитофлавина принимавшие Сулодексид в течение 14 дней (5-12 лет - 250 ЛЕ/сут, старше 12 лет - 500 ЛЕ/сут). Средний возраст пациентов составил 6,8±2,2 года. В группу сравнения вошли 20 детей, сопоставимых по возрасту (5,9±1,8 года), получавших базовую антибактериальную терапию без ЛП Цитофлавин и Сулодексид. В ходе исследования оценивали длительность сохранения лихорадки, общемозговых, менингеальных симптомов, сроки санации цереброспинальной жидкости, нормализации количества десквамированных эндотелиоцитов, D-димера. Исходы гнойных менингитов оценивали с помощью педиатрической шкалы исходов гнойных менингитов. Заключение. Выявлено, что сочетанное применение препаратов способствует сокращению продолжительности общемозговых и менингеальных симптомов, сроков нормализации гематологических показателей (уровни лейкоцитов, десквамированнных эндотелиоцитов, D-димера), улучшению исходов.

One of the most important areas in the structure of infectious diseases is occupied by infections of the central nervous system (CNS), which are characterized by severe courses, high mortality (8‐36%), and frequent residual sequelae affecting the nervous system (26‐75%). Despite significant advances in the study of pediatric infections, mortality from neuroinfections remains high and organic CNS disorders during the residual period are seen in almost half of the children falling ill. Thus, increases in the efficacy of the treatment of bacterial purulent meningitis (BPM) and viral encephalitis (VE) in children constitute a relevant

Objectifs de l’etude. L’objet de cette etude pilote est l’evaluation de la technique de PCR en temps reel dans le diagnostic des agents bacteriens responsables de meningites purulentes au Burkina Faso. Methodologie. Il s’agit d’une etude retrospective sur des specimens collectes d’avril 2009 a fevrier 2010. Les analyses moleculaires ont ete faites sur les liquides cephalo-rachidiens (LCR) de patients suspectes de meningite, provenant de differents districts sanitaires du Burkina Faso, chez qui les diagnostics traditionnels – culture et agglutination aux particules de latex sensibilise – avaient ete pour la plupart d’entre eux realises. Resultats. Cent soixante et onze patients (171) hospitalises dans huit districts sanitaires du Burkina ont participe a cette etude. Les germes responsables de la meningite ont ete detectes chez 108/171 (63,2%) patients par PCR en temps reel contre 56/93 (60 %) par culture et 66/86 (76,74 %) par le latex. Neisseria meningitidis (NmA) du serogroupe A et Streptococcus pneumoniae etaient les deux principales bacteries responsables de meningites purulentes dans notre cohorte, quelle que soit la technique de diagnostic utilisee : PCR en temps reel (NmA = 59,3% et Spn = 34,3%), culture (NmA = 78,6% et Spn = 17,8%) et le latex (NmA = 77,3% et Spn = 21,2%). La PCR en temps reel a ameliore non seulement la sensibilite et la specificite du diagnostic des germes impliques dans les cas de meningites purulentes, mais aussi sa rapidite. Elle a aussi permis de mettre en evidence NmW135 et NmY, qui n’ont pu etre detectes ni par la culture ni par le latex, ainsi que de determiner les bacteries responsables de meningites a partir de cultures contaminees.