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18 cases from 2021, 17 cases from 2022 and 15 cases from 2023 were analyzed, in total 50 children, boys and girls. The following were recorded: the child's age, sex, environment of origin, the main biochemical parameters (amount of glucose, proteins, chlorine, number of elements, cytobacteriological parameters (normal or pathological cytology, presence of pathogens-meningococcus, pneumococcus, diplococcus) such as and the macroscopic appearance of the cerebrospinal fluid (color, transparency, appearance). The working methods were the classic ones (macroscopic, microscopic examination, Pandy reaction, culture on agarose gel, smear). In Bacău County, the most frequent meningitis were the bacterial forms that predominated with a percentage of 72% in 2021, while the viral forms predominated in 2022 with a percentage of 65% and in the year 2023 with a percentage of 60%. Bacterial meningitis registered in the 3 years at the level of Bacău County have as pathogens: Koch's bacillus 43%, meningococcus 36%, streptococcus 14%, unspecified etiology 7%. In bacterial forms, regardless of etiology, changes in C.S.F. they are the same. C.S.F. is clear, opalescent or hemorrhagic. Cytology is dominated by polymorphonuclear leukocytesreaching 100%. The biochemical changes are: hyperproteinorachia, up to 0 and hypochloruria. In viral forms, although the etiology is viral, the C.S.F. changes, biochemistry and cytology are similar. Thus, C.S.F. is normal, clear, or slightly opalescent. Predominantly polymorphonuclear. [ABSTRACT FROM AUTHOR]

While enteroviruses (EV) are a well-recognized cause of aseptic meningitis in children, human parechoviruses (HPeV), especially genotype 3, have been increasingly reported as a frequent cause of sepsis-like illness and meningitis among young infants. The aim of this study was to describe the epidemiological, clinical, and laboratory characteristics of HPeV infections in infants and to compare them with those of well-known EV infections. This monocentric retrospective study was carried out at the pediatric unit of Nantes University Hospital from January 2015 to August 2018. All patients under 18 years of age with diagnosis codes referring to fever, for whom viral infection was suspected and cerebrospinal fluid (CSF) specimens were collected, were included. All CSF specimens were screened by duplex real-time polymerase chain reaction (PCR) assay that allows for the simultaneous detection of EV and HPeV in clinical samples. During the study period, 1373 CSF specimens from patients under 18 were included. A total of 312 CSF samples were positive for HPeV (n = 34) or EV (n = 278). Among the 34 HPeV-positive patients, 97% (33/34) were under 3 months of age, whereas the rate was 54% (149/278) for EV-positive patients (P < 0.001); thus, patients under 3 months of age were defined as the study population for the rest of this work. A review of the medical records was carried out for the positive cases. In this population, the HPeV detection rate was 5.6% versus 25.3% (P < 0.001) for EV. All but one of the HPeV samples available for genotyping were HPeV-3. No seasonality was observed for HPeV infections. Length of hospital stay tended to be longer for children infected with HPeV compared with those infected by EV (3 days vs. 2 days, P = 0.05). Clinicians reported more severe illness presentations among HPeV-infected infants, with more frequent administration of fluid bolus (P < 0.02). Regarding laboratory characteristics, a significant lack of cellular reaction in the CSF (P = 0.004) as well as lower C-reactive protein (CRP) levels (P = 0.006) and neutrophil counts (P < 0.001) were noted for HPeV infections compared with EV infections. Our results confirm the early onset of HPeV infections (more than 95% of patients aged under 3 months). The clinical presentation and laboratory characteristics of the two infections was similar. However, some higher clinical severity criteria and a lack of CSF pleocytosis were regularly observed in patients with HPeV infections. Considering the significant proportion (5.6%; 95% CI, 3.7–7.5) of all CSF samples in our series, HPeV detection should be systematically included in the microbiological diagnosis of febrile children under 3 months of age. [ABSTRACT FROM AUTHOR]

Purpose: Previous estimates of the cause- and age-specific frequency of pediatric meningitis in Korea were mainly derived from single- and multi-center studies. Herein, we used data on the number of cases of bacterial and viral meningitis from the Health Insurance Review and Assessment Service database to examine time- and sex-related trends. Methods: We extracted data on meningitis diagnoses registered in the Health Insurance Review and Assessment Service from 2009 to 2017, using Korean Standard Classification of Disease and Cause of Death codes. Information on 202,254 children aged 0 to 18 years was extracted. Detailed demographic and disease information was available for 84,543 children who underwent hospitalization. Results: Among all hospitalized patients, 2166, 36,155, and 46,192 children were diagnosed with bacterial, viral, or other types of meningitis, respectively. There were 30 cases of fungal meningitis and another 30 cases of meningitis attributable to other pathogens. The number of cases of bacterial and viral meningitis was highest among infants (1,087 [50.2%]) and patients in their early childhood (12,949 [35.9%]), respectively. Meningitis outbreaks were most likely to occur during the summer, and boys were more susceptible to meningitis than girls. The following pathogens most commonly caused infant meningitis: group B Streptococcus, Escherichia coli, and type B Haemophilus influenzae. Conclusion: This study reports the number of pediatric meningitis cases, stratified by age, disease type, and month/year. The present findings contribute to a better understanding of pediatric meningitis in Korea and provide a foundation for future research to identify the risk factors for this disease. [ABSTRACT FROM AUTHOR]

To study the clinical diagnosis of suppurative infantile meningitis by ultramicroscope. The subjects of this study were 72 cases of clinically suspected intracranial infection admitted in hospital from February 2018 to February 2020. The cerebrospinal fluid of children was obtained by lumbar puncture and detected without staining using ultramicroscope to determine its clinical diagnosis value. Of the 72 suspected cases of intracranial infection, 26 were diagnosed with suppurative meningitis, 36 with aseptic meningitis (3 with a history of mumps within two weeks before onset), 4 with acute disseminated encephalomyelitis, 4 with acute cerebellar ataxia and 2 with severe pneumonia with toxic encephalopathy. Among the 26 children with suppurative meningitis, the detection rate of ultramicroscope test method was 96.15%, while that of smear test method by common low power microscope was 38.46%. The difference between the two groups was statistically significant P<0.05. Observed under ultramicroscope, the bacteria were parasitic in the cytoplasm of neutrophils or monocytes, in pairs and scattered round luminescent particles, with strong activity. In addition, cerebrospinal fluid cell classification differences were also very significant in different clinical stages. Ultramicroscope has high clinical value in the clinical diagnosis of suppurative infantile meningitis in children, which can effectively improve the detection rate of bacteria in cerebrospinal fluid of suppurative meningitis. It is a means that is worthy of popularization and application. [ABSTRACT FROM AUTHOR]

Background. The diagnosis of tuberculous meningitis (TBM) especially in children is challenging. New tests are urgently needed for the diagnosis of the disease, especially in resource-limited settings. Methods. We collected cerebrospinal fluid (CSF) samples from children presenting with symptoms requiring investigation for meningitis at a tertiary hospital in Cape Town, South Africa. Children were later classified as TBM or no TBM using published case definitions. Using a multiplex platform, we investigated the concentrations of biomarkers comprising a previously established 3-marker biosignature (VEGF, IL-13, and LL-37) and other potentially useful host biomarkers as diagnostic candidates for TBM. Findings. Out of 47 children, age, 3 months to 13 years, 23 were diagnosed with TBM and six (16%) were HIV-infected. We validated the previously identified CSF biosignature (sensitivity of 95.7% (95% CI, 79.0-99.2%) and specificity of 37.5% (95% CI, 21.2-57.3%)). However, substitution of IL-13 and LL-37 with IFN-γ and MPO, respectively, resulted in improved accuracy (area under the ROC curve AUC=0.97, 95% CI, 0.92-1.00, up to 91.3% (21/23) sensitivity and up to 100% (24/24) specificity). An alternative four-marker biosignature (sICAM-1, MPO, CXCL8, and IFN-γ) also showed potential, with an AUC of 0.97. Conclusion. We validated a previously identified CSF biosignature and showed that refinement of this biosignature by incorporation of other biomarkers diagnosed TBM with high accuracy. Incorporation of these biomarkers into a point-of-care or bedside diagnostic test platform may result in the improved management of TBM in children. [ABSTRACT FROM AUTHOR]

This multicenter prospective cohort study describes the impact of human parechovirus meningitis on gross-motor neurodevelopment of young children. Gross-motor function was measured using Alberta Infant Motor Scale. Of a total of 38 eligible children < 10 months of age at onset, nine cases had clinical evidence of meningitis and polymerase chain reaction positive for human parechovirus in cerebrospinal fluid; 11 had no meningitis and polymerase chain reaction positive for human parechovirus in nasopharyngeal aspirate, blood, urine, or feces; and in 18, no pathogen was identified (reference group).The children with human parechovirus meningitis showed more frequent albeit not statistically significant suspect gross-motor function delay (mean Z-score (standard deviation) - 1.69 (1.05)) than children with human parechovirus infection-elsewhere (- 1.38 (1.51)). The reference group did not fall in the range of suspect gross-motor function delay (- 0.96 (1.07)). Adjustment for age at onset and maternal education did not alter the results.Conclusion: Six months after infection, children with human parechovirus meningitis showed more frequent albeit not statistically significant suspect gross-motor function delay compared to the population norm and other two groups. Longitudinal studies in larger samples and longer follow-up periods are needed to confirm the impact and persistence of human parechovirus meningitis on neurodevelopment in young children. What is Known: • Human parechovirus is progressively becoming a major viral cause of meningitis in children. • There is keen interest in the development of affected infants with human parechovirus meningitis. What is New: • This study describes prospectively gross-motor functional delay in children with both clinical evidence of meningitis and polymerase chain reaction positive for human parechovirus in cerebrospinal fluid. • It shows the importance of screening young children for developmental delay in order to refer those with delay for early intervention to maximize their developmental potential. [ABSTRACT FROM AUTHOR]

Abstract Background China's immunization program is one of the oldest and largest in the world. Rates of vaccine-preventable diseases (VPD) are comparable to those in high-income countries. The program's evolution has been characterized by ambitious target setting and innovative strategies that have not been widely described. Methods We reviewed national and provincial health department archives; analyzed disease surveillance, vaccination coverage, and serosurvey data from 1950 through 2016; and, conducted in-depth interviews with senior Chinese experts involved early VPD control efforts. Results Widespread immunization began in the 1950s with smallpox, diphtheria, and Bacillus-Calmette Guerin vaccines, and in the 1960s with pertussis, tetanus, polio, measles, and Japanese encephalitis (JE) vaccines. The largest drops in absolute VPD burden occurred in the 1970s with establishment of the Rural Cooperative Medical System and a cadre of trained peasant health workers whose responsibilities included vaccinations. From 1970 to 1979, incidence per 100,000 population dropped 48% from 3.3 to 1.75 for diphtheria, 50% from 152.2 to 49.4 for pertussis, 77% from 2.5 to 0.6 for polio, 60% from 450.5 to 178.3 for measles, and 72% from 18.0 to 5.1 for JE, averting an average of 4 million VPD cases each year. Until the early 1980s, vaccines were delivered through annual winter campaigns using a coordinated ' rush-relay' system to expedite transport while leveraging vaccine thermostability. Establishment of the cold chain system during in the 1980s allowed bi-monthly vaccination rounds and more timely vaccination resulting in rates of diphtheria, pertussis, measles and meningitis falling over 90% from 1980 to 1989, while polio and JE rates fell 40–50%. In the 1990s, progress stalled as financing for public health was weakened by broad market reforms. Large investments in public health and immunizations by the central government since 2004 has led to further declines in VPD burden and increased equity. During 2011–2016, the incidence per 100,000 population was <2.0 for measles and <0.2 for pertussis, JE, meningococcal meningitis, and hepatitis A. From 1992 to 2014, the prevalence of chronic hepatitis B infection in children <5 years fell from 9.7% to 0.3%, a 97% decline. China was certified polio-free in 2000 and diphtheria was last reported in 2006. Conclusions Long-term political commitment to immunizations as a basic right, ambitious targets, use of disease incidence as the primary metric to assess program performance, and nationwide scale-up of successful locally developed strategies that optimized use of available limited resources have been critical to China's success in controlling vaccine-preventable diseases. [ABSTRACT FROM AUTHOR]

Background Leucine-rich alpha-2 glycoprotein (LRG) is a novel biomarker for inflammatory diseases. We evaluated the levels of LRG, interleukin (IL)-6, and tumor necrosis factor (TNF)-α in the cerebrospinal fluid (CSF) of children with meningitis. Methods CSF samples from 10 patients with bacterial meningitis (BM) and 10 with aseptic meningitis (AM) were evaluated. Samples from 10 patients with febrile status (FS) were used as controls. LRG levels were measured using a two-site enzyme immunoassay. IL-6 and TNF-α levels were measured using a multiplex bead-based assay. CSF examination of patients with BM at the convalescent stage was also conducted. Results LRG and TNF-α levels in patients with BM, and IL-6 levels in patients with BM and AM showed significant increase compared with those in FS. Patients with BM at the convalescent stage showed significantly diminished LRG and IL-6 levels. LRG and IL-6 levels in CSF were indicated to be effective predictors for BM (LRG, AUC = 0.91; IL-6, AUC = 0.85). Only LRG levels showed a significant difference between patients with BM and AM (AUC = 0.78, P  = 0.034). Conclusions LRG level could be a sensitive inflammatory biomarker for inflammatory diseases of the central nervous system, comparable with IL-6 level. [ABSTRACT FROM AUTHOR]

BACKGROUND: Meningitis remains a major cause of mortality and morbidity in patients in many countries of the world including Ethiopia. Information on clinical outcomes of meningitis, susceptibility of the causative microorganism to rationalize treatment and associated risk factors is scare. The objective of this study was to assess the risk factors and clinical outcomes of meningitis among children in Felege Hiwot Referral Hospital, Bahir Dar, Northwest Ethiopia. METHOD: A retrospective cross sectional study was conducted in Felege Hiwot Referral Hospital from January 2016 to May 2016. Data were checked for completeness, inconsistencies and entered into SPSS for windows version 20.0. Lottery method was used to select charts. One hundred seventy-nine pediatric patient files were used in the study. RESULT: About 15% children with meningitis developed poor outcomes: developed complication, referred to higher facility, died and left against medical advice. In this study, season of admission [AOR= 5 (1.191, 20.991)], immunization status [AOR= 20.912 (3.325, 131.502)], clinical presentations [AOR= 8.779 (1.599, 48.192)] and corticosteroid administration [AOR= 8.215 (1.220, 55.328)] were the determinant factors for clinical outcome of meningitis. CONCLUSION: In this study, about 15% of children with meningitis developed poor outcomes. The determinant factors for poor outcome of meningitis were: season of admission, immunization status, clinical presentations and corticoid administration. Creating community awareness about risk factors of meningitis, early diagnosis and treatment of cases, improving vaccination coverage and use of corticosteroids are recommended to improve the clinical outcome of children affected with meningitis. [ABSTRACT FROM AUTHOR]

Introduction: Community acquired bacterial meningitis (CABM) is responsible for high mortality and disabling sequelae. Introduction of pneumococcal conjugate vaccine (PCV-10) and haemophilus influenzeatype b (Hib) has changed the epidemiological and clinical features of patients presenting with CABM as it is shown in different literatures over the last decade. The aim of this study was to assess the clinical and epidemiologic features and outcomes of CABM after the introduction of PCV-10 in Gondar University Hospital (GUH). Methods: This is a retrospective study among children between 2 months and 14 years of age discharged from Gondar University Hospital. All patient records discharged with a diagnosis of meningitis at GUH were reviewed from September 2011 - September 2013. The data was collected using a structured questionnaire from the patient record charts and analysis was done using SPSS-20. Results: 80 cases (1.6%) of CABM out of 4996 admissions were identified. There were 60 (75%) cases of CABM using WHO criteria of cerebrospinal fluid leukocytosis (CSF) > 100cells/mm3, or 10-100cells/mm3 with either hypoglycorrhea or increased protein; and 20 (25%) with culture confirmation. S. Pneumoniae was the most frequent pathogen identified in 14 (70%) children. The most common age group were infants 2-12 month old (n = 32, 40%). Children with adverse outcomes had shown a higher frequency of being older children (p = 0.045), loss of consciousness (p = 0.046), seizure at admission (p < 0.01), and a positive CSF culture (p = 0.03). Conclusion: Introduction of PCV-10 has shown a decreased admission rate, mortality, and neurologic sequelae due to CABM. [ABSTRACT FROM AUTHOR]

Introduction Widespread introduction of pneumococcal conjugated vaccines (PCVs) impacted on invasive pneumococcal disease (IPD). However, IPD reduction may not be similar in all outcomes within IPD. We assessed PCV7/PCV13 impact on pneumococcal meningitis, bacteremic pneumonia (BP) and other (non-meningitis, non-pneumonia) IPD episodes in children <5 years in Israel. Methods A prospective, population-based, active nationwide surveillance. All pneumococcal invasive episodes with positive blood/CSF cultures, July 2000 through June 2016, were included. Three sub-periods were defined: pre-PCV (2000–2008), PCV7 (2009–2011) and PCV13 (2014–2016). Incidence rate ratios (IRRs) were calculated. Results Overall, 4321 episodes were recorded; 456 (10.6%) meningitis, 1478 (34.2%) pneumonia and 2387 (55.2%) other-IPD. In the pre-PCV period, proportion of serotypes in PCV13, but not in PCV7 (mainly serotypes 1, 5 and 19A) was higher in BP (43.3%) compared with other-IPD episodes (32.8%, p < 0.001) and similar to that of meningitis (37.6%, p = 0.1). The proportion of episodes in children <12 months was higher in meningitis (52.1%) compared with pneumonia (23.2%) and other-IPD episodes (39.5%; p < 0.001 for both). The declines of the 3 entities were not similar; Meningitis rate non-significantly declined by 24% (IRR = 0.76; 95% CI 0.57–1.01), while BP and other-IPD rates significantly declined by 57% and 70%, respectively. In contrast to other entities, BP did not decline significantly after PCV7 introduction but started to decline only after PCV13 introduction. Rates of meningitis, pneumonia and other-IPD caused by PCV13-serotypes (VT13) substantially declined by 88%, 95% and 97%, respectively, comparing PCV13 and the pre-PCV periods. However, diseases caused by non-VT13 increased by 256%, 302% in meningitis and pneumonia, respectively, but only 116% in other-IPD. Conclusions Following PCV7/PCV13 introduction, rates of episodes caused by VT13 were substantially reduced in all 3 groups. However, differences in age distribution, serotype replacement and specific serotype decrease suggest different pathogenesis and host susceptibility between the 3 entities. [ABSTRACT FROM AUTHOR]

Purpose: Recurrent meningitis in children is a rare condition. However, its early recognition is important in order to prevent serious complications. This study aims to review cases of recurrent meningitis in children.Methods: This is a retrospective study that included children diagnosed with recurrent meningitis and who were followed at child neurology clinic at the Jordan University Hospital from January 2001 to June 2017.Results: Thirteen patients were included (nine males and four females). Age of first episode of meningitis ranged from 2 months to 9.5 years. The delay in diagnosis of the underlying cause after the first episode ranged from 6 months to 2.5 years. Underlying causes included inner ear malformation in one patient, skull fractures in two, and dermal sinuses (thoracic spinal and occipital dermal sinus) in two patients. No identifiable cause was found in eight patients. Streptococcus pneumoniae was identified in four (31%) patients, Staphylococcus aureus in two (15%), and no organism was isolated in seven (54%). Three patients (23.1%) developed neurological sequel including developmental delay, limb spasticity, and epilepsy. Two patients had sensorineural hearing loss related to meningitis, and two patients had sensorineural hearing loss mostly related to their original disease.Conclusion: A detailed history, examination, and thorough investigations are necessary to determine the underlying cause of recurrent meningitis. In addition, in patients with positive CSF bacterial culture, finding the underlying etiology is very likely. [ABSTRACT FROM AUTHOR]

Aim: Meningitis may complicate neonatal sepsis, but there is scant evidence to inform the decision to perform a lumbar puncture (LP) and considerable variation in practice. We investigated whether inflammatory markers - C-reactive protein (CRP) and immature-to-total neutrophil ratio (ITR) - were predictive of meningitis or significant cerebrospinal fluid (CSF) pleocytosis and useful in guiding the decision to perform a LP.Methods: We studied all inpatients in a single tertiary neonatal unit who were <6 months of age who had a LP performed between March 2011 and October 2014. We categorised CSF results as follows: (i) culture-positive meningitis; (ii) probable culture-negative meningitis but meeting a priori criteria for significant CSF leucocytosis; or (iii) no evidence of meningitis. CRP and ITR obtained within 48 h of LP were analysed. We assessed the test performance of CRP and ITR by area under receiver operating characteristic curves.Results: A total of 757 (male 471, 62.2%) infants were included. The median (interquartile range) gestational age was 38.4 weeks (30-40.3), and birthweight was 2940 g (1330-3560). Ten (1.3%) infants had culture-positive meningitis; 71 (9.4%) were classified as probable culture-negative meningitis and 676 (89.3%) as non-meningitis. The area under receiver operating characteristic curve for culture-positive and probable culture-negative meningitis was 0.43 for CRP (95% confidence interval 0.36-0.51) and 0.58 for ITR (0.51-0.65). At a CRP threshold of 30 mg/L, there was a positive likelihood ratio (LR) of 0.77 and a negative LR of 1.44.Conclusions: CRP and ITR perform poorly in identifying infants with confirmed or probable meningitis. The decision to perform an LP should be more focused on clinical grounds and/or a positive blood culture and less on inflammatory or haematological markers in isolation. [ABSTRACT FROM AUTHOR]

Introduction: Timely diagnosis and prompt initiation of therapy in pyogenic meningitis decreases morbidity and mortality. Measurement of Cerebrospinal Fluid (CSF) C-Reactive Protein (CRP) may help in the early diagnosis of pyogenic meningitis. Aim: To evaluate the usefulness of CSF CRP (by immunoturbidimetric method) in the rapid diagnosis of pyogenic (acute and partially treated meningitis) and to differentiate the same from other forms of meningitis. Materials and Methods: This cross-sectional study was conducted in the department of Paediatrics of a tertiary care teaching hospital from November 2013 to October 2015. CRP in the CSF of suspected meningitis cases was measured by using the immunoturbidimetric method. All data were analysed by using appropriate software (SPSS 24/Microsoft Excel 2016). ANOVA was used for analysis. ROC curves were constructed, and diagnostic odds ratios were calculated. Results: Of 198 cases, 31 were acute bacterial meningitis, 61 were partially treated meningitis, 10 were tubercular, 57 were aseptic, and 39 were without meningitis. A statistically significant difference in the CSF CRP level (mg/dL) between groups was found {F (4,193)=59. 470, p<0.001}. Sensitivity and specificity of CSF CRP for acute bacterial meningitis was 87.1% and 94.87%, respectively; and for partially treated meningitis was 88.52% and 94.84%, respectively. The cut-off value of CSF CRP for both acute bacterial and partially treated meningitis was evaluated as ≥0.62 mg/dL and ≥0.55 mg/dL, respectively. Conclusion: CSF CRP measurement seems to be a valid early diagnostic test for pyogenic meningitis. It also helps in differentiating pyogenic from other forms of meningitis. The cut off value of CSF CRP for both acute bacterial and partially treated meningitis was ≥0.62 mg/dL and ≥0.55 mg/dL, respectively. [ABSTRACT FROM AUTHOR]

Background: Childhood bacterial meningitis is a neurological exigency. Accurate, early, rapid diagnosis and treatment is essential to decrease its morbidity and mortality. Aim of study: This is a retrospective study comparing real-time polymerase chain reaction (RT-PCR), with standard bacterial culture for the diagnosis of bacterial meningitis during cerebrospinal fluid (CSF) examination. Materials and methods: RT-PCR was used for the detection of three most common causes of bacterial meningitis (Streptococcus pneumonia, Haemophilus influenza type b, and Neisseria meningitides) in 100 CSF samples from children aged 2 months to 12 years admitted to Al-Elwiya Pediatric Teaching Hospital during the period from January 2016 to January 2017. Results: Growth was detected in 6% CSF cultures of patients included in the study and Streptococcus pneumoniae was the most prominent isolated bacteria. RT-PCR was positive in 43% CSF samples from which S. pneumoniae was identified in all samples. PCR and culture showed concordance in 6% positive and 57% negative samples. Using culture as a reference method, the sensitivity, specificity, and positive and negative predictive values for PCR on CSF samples were 100 %, 60.64%, 13.93% and 100 %, respectively. RT-PCR was positive in 37% CSF samples whereas culture was negative. Conclusion: RT-PCR is a rapid and sensitive test for the diagnosis of bacterial meningitis. The findings of this retrospective study recommend the use of RT-PCR for the diagnosis of children with a clinical suspicion of bacterial meningitis and as a complement to culture, especially, those who received previous antibiotic treatment before lumbar puncture. [ABSTRACT FROM AUTHOR]

Introduction: Bacterial meningitis is a medical emergency requiring a fast and reliable diagnosis. Molecular methods such as real-time PCR (rt-PCR) offer an attractive alternative. Thus, this study aims to establish multiplex rt-PCRs detecting N. meningitidis, S. pneumoniae and H. influenzae b from cerebrospinal fluid in Tunisian children beyond neonatal age. Methodology: Using bioinformatic tools and experimentation, we validated the specificity and optimal criteria of PCRs for primers and probes of plyA (S. pneumoniae), ctrA and sodC (N. meningitidis) and bexA genes (H. influenzae b). We performed one multiplex RT-PCR for detection of S. pneumoniae and N. meningitidis targeting plyA and ctrA, sodC genes respectively, simultaneously with a singleplex RT-PCR for H. influenzae b. The sensitivity and specificity of our methods were assessed. Then, we tested our methods for 122 CSF samples collected from suspected meningitis cases between 2014 and 2016 in Bechir Hamza Children's Hospital of Tunis. Results: Our results have shown the sensitivity of the designed PCRs was up to 10-4 DNA dilution and the specificity was 100%. PCR evaluation has shown 51 positive samples: 38 of pneumococcal cases, 12 meningococcal cases, 1 case of H. influenzae b with 8.57% and 50% of supplementary positive cases rates respectively. Conclusions: Our assay proved to be very sensitive, specific and rapid for bacterial meningitis diagnosis. In the recent context of Hib vaccination, the possibility of detecting S. pneumoniae and N. meningitidis separately constitute an attractive opportunity. Nevertheless, simultaneous detection of Hib remains relevant in specific clinical context and for epidemiologic study. [ABSTRACT FROM AUTHOR]

Cronobacter is a group of opportunistic pathogen responsible for necrotizing enterocolitis, meningitis and septicaemia especially to infant and neonate, with high lethality ranging in 40%–80%. Some of them are able to survive in infant milk formula and still possesses capability of pathogenicity and virulence, biofilm formation, and high resistance to elevated osmotic pressure, low pH, heat, oxidation and desiccation. The genus Cronobacter consists of a diverse group of Gram-negative bacteria and comprises seven species: C. sakazakii , C. turicensis , C. malonaticus , C. universails , C. muytjensii , C. condiment and C. dublinensis with the three subspecies dublinensis , lausannensis and lactatidi . Sub-lethal treatments on Cronobacter strains including heat shock, acid shock, ethanol shock and desiccation would enhance its tolerance to adverse environments. Here, we discuss the stress resistance, rapid detection and disinfection methods of Cronobacter spp. in recent literature. [ABSTRACT FROM AUTHOR]

Background: although lumbar puncture is a safe procedure in experienced hands, some parents fear having it performed in their children and refuse consent. The factors associated with this refusal are unclear and any differences between consenting and non-consenting parents might provide clues as to how to address them. Objective: this study aimed to predict the underlying factors that affect parent's refusal of consent for lumbar puncture in their children with meningitis in southern Saudi Arabia. Methods: We conducted a cross-sectional study, of 750 children with meningitis, who visited either the emergency department or the pediatric wards in three teaching hospitals (Khamis Mushait Maternity and Children Hospital, Abha Maternity and Children Hospital and Military Hospital (Khamis Mushait) in the southern region of Saudi Arabia from 20th February 2016to 6th January Results: his study included 751 patients with meningitis. Their ages ranged between one month and 13 years (3.9±3.3 years); 42.7% presented with other symptoms (cough, sore throat, dyspnea and pneumonia); 28.7% had fever, 10% vomiting, 12.1% dyspnea, and 6.5% convulsions. Fifty-one per cent of children were accompanied by their fathers, 41.9% by their mothers and 6.9% by others. Accompanying people were asked for consent for lumbar puncture in their children; 44.3% disagreed and 55.7% agreed. Factors influencing disagreement were relative's opinions (35.1%), media (30.4%) and their previous experience (12.3%). Conclusion: based on the results of this study, the main reason for refusal of consent for LP in the children of the majority of parents was fear of side effects such as paralysis, as well as lack of awareness about the usefulness of LP in diagnosis and treatment of children. Informing parents of affected children is very important in the counseling for such diagnostic tests. Therefore, it seems that it is necessary to pay more attention for training in national health plans. [ABSTRACT FROM AUTHOR]

Extraintestinal pathogenic Escherichia coli (ExPEC) is the leading cause of bloodstream and other extraintestinal infections in human and animals. The greatest challenge encountered by ExPEC during an infection is posed by the host defense mechanisms, including lysozyme. ExPEC have developed diverse strategies to overcome this challenge. The aim of this study was to characterize the molecular mechanism of ExPEC resistance to lysozyme. For this, 15,000 transposon mutants of a lysozyme-resistant ExPEC strain NMEC38 were screened; 20 genes were identified as involved in ExPEC resistance to lysozyme—of which five were located in the gene cluster between galF and gnd, and were further confirmed to be involved in O-specific polysaccharide biosynthesis. The O-specific polysaccharide was able to inhibit the hydrolytic activity of lysozyme; it was also required by the complete lipopolysaccharide (LPS)-mediated protection of ExPEC against the bactericidal activity of lysozyme. The O-specific polysaccharide was further shown to be able to directly interact with lysozyme. Furthermore, LPS from ExPEC strains of different O serotypes was also able to inhibit the hydrolytic activity of lysozyme. Because of their cell surface localization and wide distribution in Gram-negative bacteria, O-specific polysaccharides appear to play a long-overlooked role in protecting bacteria against exogenous lysozyme. [ABSTRACT FROM AUTHOR]

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Primary clinical features of rash and neurological complications due to varicella zoster virus (VZV) reactivation are rare in a healthy population, especially in immunocompetent children. Early diagnosis and prompt treatment are delayed often due to their rarity. We present four immunocompetent children with VZV reactivation resulting in aseptic meningitis and herpes zoster affecting multiple cranial and spinal nerves. We reviewed the clinical manifestations, laboratory findings, treatment options and outcome of aseptic meningitis associated VZV reactivation. All patients presented with the typical skin lesion of VZV reactivation and definitive laboratory findings of central nervous system infection, without systemic inflammation. Initial manifestations of VZV reactivation included Ramsay Hunt syndrome, herpes zoster ophthalmicus, and herpes zoster affecting the left thoracic dermatomes 4-5. Intravenous acyclovir was administered and all patients recovered fully without any significant sequelae. VZV reactivation can lead to various neurological complications in immunocompetent children. Early recognition and treatment with acyclovir are important for improving the outcome of neurologic complications of VZV reactivation. [ABSTRACT FROM AUTHOR]

The ubiquitous and opportunistic pathogen Cronobacter sakazakii is responsible for severe meningitis, sepsis, and necrotizing enterocolitis in neonates and infants associated with ingestion of contaminated powdered infant formula (PIF). The current ISOmethod for isolation and detection of Cronobacter spp. is laborious, time-consuming and expensive. In this study, a multiplexed lateral flow test strip was developed to rapidly detect and simultaneously serotype O1 and O2 C. sakazakii serotypes. The assay is based on two monoclonal antibodies (MAb) that specifically bind to the lipopolysaccharides (LPS) of these pathogens. The test strip provides results very quickly; C. sakazakii could be detected in pure culture within 15 min with a sensitivity of 107 CFU/ml. After non-selective enrichment for 18 h as low as one Cronobacter cell per g PIF could be detected. Moreover, the established lateral flow assay (LFA) offers excellent specificity showing no cross-reactivity with other C. sakazakii serotypes, Cronobacter species or Enterobacteriaceae tested. These characteristics, together with several advantages such as speed, simplicity in performance, low analysis cost, and no requirement of specialized skills or sophisticated equipment make the developed multiplexed LFA suitable for reliable detection and serotyping of C. sakazakii serotypes O1 and O2. [ABSTRACT FROM AUTHOR]

Purpose: Neurenteric cysts are rare congenital remnants formed by a failure of separation between endoderm and ectoderm in utero. Methods: We describe a case of a 7-month-old male with a large cervical neurenteric cyst presenting with intermittent neck stiffness and irritability. Results: This cyst was resected, recurred, and required repeat surgery. The patient's postoperative course included aseptic meningitis and hydrocephalus requiring ventriculoperitoneal shunt and later management of tethered cord, necessitating detethering. Conclusion: Unique features of this case include the presence of intermittent pain symptoms, which may be attributable to cyst filling and emptying. Hydrocephalus is an uncommon finding that may be secondary to aseptic meningitis from cyst rupture. Tethered cord is also an unusual entity that can accompany this diagnosis, warranting additional imaging work-up and monitoring. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the impact of 13-valent pneumococcal conjugate vaccine on pneumococcal meningitis in children. Methods Children younger than 15 years of age attending 27 hospitals in the Region of Madrid with confirmed pneumococcal meningitis were identified in a prospective surveillance study, from 2007 to 2015. Clinical data, neurological sequelae, pneumococcal vaccination status, serotyping and antibiotic susceptibility were recorded. Results One hundred and four cases of pneumococcal meningitis were identified, 63 during the period of routine 7-valent pneumococcal conjugate vaccine immunisation (May 2007–April 2010) and 41 during the period of 13-valent pneumococcal conjugate vaccine immunisation (May 2010–April 2015). When both periods were compared, a 62% (95% CI: 45–75%) decrease in the incidence of pneumococcal meningitis was observed, from 2.19 cases per 100,000 inhabitants in the PCV7 period to 0.81 per 100,000 inhabitants in the PCV13 period (p = 0.0001), mainly due to an 83% (95% CI: 30–96%) reduction in cases caused by serotype 19A. Isolates not susceptible to cefotaxime (MIC > 0.5 μg/L) decreased from 27% to 8%, (p = 0.02). Mean patient ages rose from 28.7 months to 38.5 months (p < 0.05). Case fatality rate across both periods was 5%. An unfavourable outcome (death or neurological sequelae) occurred in 27% of patients, while the rate was similar in both periods. There was no increase in meningitis caused by pneumococcal serotypes not included in 13-valent pneumococcal conjugate vaccine throughout the years of the study. Conclusions Immunisation with 13-valent pneumococcal conjugate vaccine has reduced the rate of pneumococcal meningitis in children less than 15 years, with a near-elimination of cefotaxime-resistant isolates, but morbidity has remained unchanged. A shift of pneumococcal meningitis towards slightly higher age groups was also observed. [ABSTRACT FROM AUTHOR]

Group BStreptococcus(GBS), a leading cause of neonatal sepsis and meningitis, asymptomatically colonizes up to 30% of women and can persistently colonize even after antibiotic treatment. Previous studies have shown that GBS resides inside macrophages, but the mechanism by which it survives remains unknown. Here, we examined the ability of 4 GBS strains to survive inside macrophages and then focused on 2 strains belonging to sequence type (ST)-17 and ST-12, to examine persistence in the presence of antibiotics. A multiple stress medium was also developed using several stressors found in the phagosome to assess the ability of 30 GBS strains to withstand phagosomal stress. The ST-17 strain was more readily phagocytosed and survived intracellularly longer than the ST-12 strain, but the ST-12 strain was tolerant to ampicillin unlike the ST-17 strain. Exposure to sub-inhibitory concentrations of ampicillin and erythromycin increased the level of phagocytosis of the ST-17 strain, but had no effect on the ST-12 strain. In addition, blocking acidification of the phagosome decreased the survival of the ST-17 strain indicating a pH-dependent survival mechanism for the ST-17 strain. Congruent with the macrophage experiments, the ST-17 strain had a higher survival rate in the multiple stress medium than the ST-12 strain, and overall, serotype III isolates survived significantly better than other serotypes. These results indicate that diverse GBS strains may use differing mechanisms to persist and that serotype III strains are better able to survive specific stressors inside the phagosome relative to other serotypes. [ABSTRACT FROM AUTHOR]

We report three cases of patients with developmental-delay from neonatal herpetic encephalitis and/or meningitis who presented years later with acute retinal necrosis due to herpes simplex virus. The diagnosis was delayed in all cases due to the patients’ inability to verbalize their ocular complaints and cooperate with eye examinations. This case series documents the clinical course, pathophysiologic mechanism, and treatment of acute retinal necrosis in this patient population. Clinicians should understand the importance of prudent consideration of acute retinal necrosis in patients with a history of neonatal herpetic encephalitis and/or meningitis presenting with a red eye. [ABSTRACT FROM PUBLISHER]

The aim of this study was to compare an in-house real-time PCR assay, with bacterial culture as the reference, for the diagnosis of late onset group B Streptococcal (GBS) disease. This was a retrospective review. All children aged 7-90 days presenting to four paediatric centres that had a blood or CSF sample tested by GBS PCR were included. Of 7,686 blood and 2,495 cerebrospinal fluid (CSF) samples from patients of all ages received for PCR testing, 893 and 859 samples were eligible for the study, respectively. When compared to culture, the sensitivity of blood PCR was 65% (13/20) in comparison to the CSF PCR test which was 100% (5/5). Ten of 23 PCR-positive blood samples and 17 of 22 PCR-positive CSF samples were culture negative. The median threshold Ct values for culture-positive/PCR-positive CSF samples was lower than that of culture-negative/PCR-positive CSF samples ( p = 0.08). Clinical details of 17 available cases that were culture negative/PCR positive were reviewed; seven were deemed to be definite cases, eight were probable and two were possible. The results showed that detection of GBS by PCR is useful for CSF samples from infants aged 7-90 days with suspected meningitis; however, analysis of blood samples by PCR is of limited value as a routine screening test for late onset GBS sepsis and should not replace bacterial culture. [ABSTRACT FROM AUTHOR]

Children are more susceptible than adults to acquire central nervous system (CNS) infections. This study assesses the validity of routine cerebrospinal fluid (CSF) culture with the meningitis/encephalitis (ME) FilmArray to detect etiological agents in CNS infections. Based on CSF culture, only 5/40 samples were positive in suspected meningitis, whereas 24/40 samples were positive with the ME FilmArray (p = 0.01). Sensitivity and specificity of conventional culture method were 55.81 and 100%. Overall disability adjusted life years in the study cohort was 1,603.5. Conventional culture with clinical suspicion alone is not enough to obtain an etiological diagnosis of meningitis. The implementation of novel diagnostic techniques is crucial. [ABSTRACT FROM AUTHOR]

Haemophilus influenzae serotype b (Hib) was a major cause of meningitis in children until Hib conjugate vaccine was introduced into the routine infant immunization program and Hib disease in children was almost eliminated. In Alaska, northern Canada and other countries with Indigenous peoples, H. influenzae serotype a (Hia) has emerged as a significant cause of pneumonia, meningitis and septic arthritis especially in children under 24 months of age. A joint government initiative between the Public Health Agency of Canada (PHAC) and the National Research Council of Canada (NRC) was carried out to assess whether an Hia vaccine could be developed for the common good. The initiative included strategic partnerships with clinician researchers in Thunder Bay, Ontario who provide health services to Indigenous people and the Artic Investigations Program (AIP) of the United States Centers for Disease Control and Prevention (CDC) in Alaska. This government initiated and funded research identified that the development of an Hia vaccine is possible and ongoing surveillance that includes strain characterization is essential to understand the potential spread of Hia in North America and around the world. [ABSTRACT FROM AUTHOR]

Introduction. Cerebral venous thrombosis (CVT) is a rare cerebrovascular condition involving multiple etiologies. Diagnosis of CVT is usually overlooked or delayed due to highly varied symptomatology, modes of onset and neuroimaging signs; furthermore, the same cause cannot be found in more than 15% of the cases, individual result being hard to predict, while the disease can complicate despite anticoagulant treatment. Material and methods. We present a typical case of meningitis that in day 10 of illness associated an uncommon symptomatology suggesting cerebral venous sinus thrombosis (CVST). Results. It should be noted that imaging examination can neither confirm nor exclude a thrombosis. A case whose development worsens progressively and for which there is no imaging exam to support a particular therapeutic conduct hampers the decision-making process for the physician. Discussion. The issue raised focuses on the assumption that anticoagulant medication may be beneficial to the patient or, on the contrary, it may be in the detriment of the physician who is uncertain about the diagnosis, due to subsequent unfavorable development of patient clinical status. Conclusions. That human rational thinking, exercised in years of experience, cannot yet be technologized, let alone replaced by a robot, and the existence of sets of rules for treatment incapable to ever cover the variety of features encountered in practice must always be doubted. [ABSTRACT FROM AUTHOR]

Introduction: Accurate etiological diagnosis of meningitis is important, but difficult in resource-limited settings due to prior administration of antibiotics and lack of viral diagnostics. We aimed to develop and validate 2 real-time multiplex PCR (RT-PCR) assays for the detection of common causes of community-acquired bacterial and viral meningitis in South African children. Methods: We developed 2 multiplex RT- PCRs for detection of S. pneumoniae, N. meningitidis, H. influenzae, enteroviruses, mumps virus and herpes simplex virus. We tested residual CSF samples from children presenting to a local paediatric hospital over a one-year period, whose CSF showed an abnormal cell count. Results were compared with routine diagnostic tests and the final discharge diagnosis. We calculated accuracy of the bacterial RT-PCR assay compared to CSF culture and using World Health Organisation definitions of laboratory-confirmed bacterial meningitis. Results: From 292 samples, bacterial DNA was detected in 12 (4.1%) and viral nucleic acids in 94 (32%). Compared to CSF culture, the sensitivity and specificity of the bacterial RT-PCR was 100% and 97.2% with complete agreement in organism identification. None of the cases positive by viral RT-PCR had a bacterial cause confirmed on CSF culture. Only 9/90 (10%) of patients diagnosed clinically as bacterial meningitis or partially treated bacterial meningitis tested positive with the bacterial RT-PCR. Discussion: In this population the use of 2 multiplex RT-PCRs targeting 6 common pathogens gave promising results. If introduced into routine diagnostic testing, these multiplex RT-PCR assays would supplement other diagnostic tests, and have the potential to limit unnecessary antibiotic therapy and hospitalisation. [ABSTRACT FROM AUTHOR]

Posterior instrumented fusion of the cervical spine is a common surgical procedure in the treatment of cervical subluxation, fractures, and stenosis. Although malpositions are commonly seen, it is rare to observe the malposition of the rod or interconnection because of hardware failure. A 62-year-old woman with spastic tetraparesis as a sequel to pediatric meningitis with C1-C2 cervical subluxation and myelomalacia had undergone laminectomy of C1 and C1 lateral mass and C2 bilateral pedicular screw fixation. Three years after the stabilization, she presented with complaints of headache, neck pain, and difficulty walking. There was no history of trauma during that period. A previously unrecorded and unusual migration of a rod through the thoracic subarachnoid space was detected. In this study, we report a case of atlantoaxial stabilization using the screw-rod technique that was followed by rod migration to the thoracic subarachnoid space, and outline the subsequent management of the case. Failure of bony fusion can result in micromotion and subsequent migration of fixation device components. Routine radiographic follow-up could be used to identify migration events. [ABSTRACT FROM AUTHOR]

Purpose: Meningitis is relatively common in infants and young children and can cause permanent brain damage. The aim of this study was to determine whether meningitis is associated with fatty acids in cerebrospinal fluid (CSF). Methods: CSF samples from children between 3 months and 6 years of age admitted to the Tabriz public hospitals who met clinical criteria of meningitis were collected at enrollment. A total of 81 samples were analyzed for fatty acid profile by gas-liquid chromatography. Results: Children with a purulent meningitis demonstrated a higher percentage of oleic acid ( p < 0.05, >10 %) and lower percentages of omega-3 polyunsaturated fatty acids ( p < 0.001, <−40 %) than aseptic meningitis and nonmeningitis groups did. There was an inverse relationship between CSF long-chain omega-3 fatty acids and the total number of leukocytes and differential counts of neutrophils and lymphocytes in the purulent meningitis group. Moreover, significantly lower omega-3 fatty acids ( p = 0.001, −37 %) and higher ratio of n-6/n-3 ( p = 0.02, −29 %) were found in patients with purulent meningitis with sepsis than in those with meningitis and no sepsis. Conclusions: This study provides evidence that purulent meningitis and its complication with sepsis are associated with important disturbances in CSF fatty acids, mainly deficiency in long-chain omega-3 polyunsaturated fatty acids. [ABSTRACT FROM AUTHOR]

Fever of unknown origin (FUO) in children is frequently caused by infectious diseases. Angiostrongylus cantonensis, while a primary cause of eosinophilic meningitis, is rarely a cause of FUO. We present 2 pediatric cases of FUO caused by Angiostrongylus cantonensis acquired in Houston, Texas, outside its usual geographic distribution. [ABSTRACT FROM AUTHOR]

Background: Purulent meningitis (PM) usually caused by a variety of pyogenic infection, is a kind of central nervous system infectious disease mostly common in children. It is easily misdiagnosed and its symptoms are varied. Excessive application of broad-spectrum antibiotics results in increased sickness and death of infants and young children. In this study, clinical data of 430 cases of PM in infants were analyzed to summarize the clinical experiences so as to achieve early diagnosis and early treatment of PM. Results: Male-to-female ratio was 1.61:1, and the median age of incidence was 0.42 years. May was the modal month of onset (11.7%). Main clinical manifestations were fever (89.3%), vomiting (67.2%), mental fatigue (62.1%), anterior fontanelle full/bulging/high tension (54.2%), convulsion (52.6%), and meningeal irritation sign (24.7%). Cerebrospinal fluid (CSF) bacterial culture was done for 420 cases, of which 1.2% cases were positive. Blood culture was done for 146 cases of which 15.1% were positive. 175 (40.7%) cases had complications, among which 133 cases (76.0%) were subdural effusion, 21 cases (12.0%) were epilepsy. Conclusion: Infantile PM is common in Spring, and May is the modal month of onset. The CSF/blood pathogen detection rate is very low and it is difficult to find evidence of cause. Fever, vomiting, mental fatigue and anterior fontanelle full/bulging/high tension, convulsion are the main clinical manifestations on which diagnosis depends. For those children diagnosed as PM and still having recurrent fever and prominent anterior fontanelle after treatment, clinicians should consider the probability of subdural effusion and treat them with brain imaging test on time. [ABSTRACT FROM AUTHOR]

Background: A substantial reduction in bacterial meningitis has occurred in the UK following successful implementation of immunisation programmes. Most childhood meningitis in developed countries is now caused by viruses. Long-term trends in paediatric viral meningitis in England have not previously been reported. The objective of this study is to report on epidemiological trends over time in childhood viral meningitis in England.Methods: In this population-based observational study, we used routinely collected hospital discharge records from English National Health Service hospitals from 1968-2011 to analyse annual age-specific admission rates for viral meningitis, including specific viral aetiologies, in children younger than 15 years.Findings: We analysed hospital discharge records from Jan 1, 1968, to Dec 31, 2011. Hospital admission rates for viral meningitis from Jan 1, 1968, to Dec 31, 1985, varied annually, with a mean of 13·5 admissions per 100 000 children aged less than 15 years, per year (95% CI 13·0-14·0). Admission rates declined during the late 1980s, and the mean number of admissions from 1989-2011 was 5·2 per 100 000 per year (5·1-5·3). This decrease was entirely in children aged 1-14 years. Admission rates for infants aged less than 1 year increased since 2005, to 70·0 per 100 000 (63·7-76·2) in 2011, which was driven by an increase in admission of infants aged 90 days or less. In 1968-85, the majority of cases in children were in those aged 1-14 years (22 150 [89%] of 24 920 admissions). In 2007-11, 1716 (72%) of 2382 cases were in infants. Admissions for mumps-related meningitis almost disappeared following introduction of the measles-mumps-rubella (MMR) vaccine in 1988. Admissions with a specified viral aetiology have increased since 2000.Interpretation: Trends in viral meningitis admissions have changed substantially over the past 50 years, and probably reflect the impact of the MMR vaccine programme and the use of more sensitive diagnostic techniques.Funding: None. [ABSTRACT FROM AUTHOR]

Background: An outbreak of pneumococcal meningitis among non-infant children and adults occurred in the Brong-Ahafo region of Ghana between December 2015 and April 2016 despite the recent nationwide implementation of a vaccination programme for infants with the 13-valent pneumococcal conjugate vaccine (PCV13). Methods: Cerebrospinal fluid (CSF) specimens were collected from patients with suspected meningitis in the Brong-Ahafo region. CSF specimens were subjected to Gram staining, culture and rapid antigen testing. Quantitative PCR was performed to identify pneumococcus, meningococcus and Haemophilus influenzae. Latex agglutination and molecular serotyping were performed on samples. Antibiogram and whole genome sequencing were performed on pneumococcal isolates. Results: Eight hundred eighty six patients were reported with suspected meningitis in the Brong-Ahafo region during the period of the outbreak. In the epicenter district, the prevalence was as high as 363 suspected cases per 100,000 people. Over 95% of suspected cases occurred in non-infant children and adults, with a median age of 20 years. Bacterial meningitis was confirmed in just under a quarter of CSF specimens tested. Pneumococcus, meningococcus and Group B Streptococcus accounted for 77%, 22% and 1% of confirmed cases respectively. The vast majority of serotyped pneumococci (80%) belonged to serotype 1. Most of the pneumococcal isolates tested were susceptible to a broad range of antibiotics, with the exception of two pneumococcal serotype 1 strains that were resistant to both penicillin and trimethoprim-sulfamethoxazole. All sequenced pneumococcal serotype 1 strains belong to Sequence Type (ST) 303 in the hypervirulent ST217 clonal complex. Conclusion: The occurrence of a pneumococcal serotype 1 meningitis outbreak three years after the introduction of PCV13 is alarming and calls for strengthening of meningitis surveillance and a re-evaluation of the current vaccination programme in high risk countries. [ABSTRACT FROM AUTHOR]

Escherichia coli K1 meningitis continues to be a major threat to neonatal health. Previous studies demonstrated that outer membrane protein A (OmpA) of E. coli K1 interacts with endothelial cell glycoprotein 96 (Ecgp96) in the blood-brain barrier to enter the central nervous system. Here we show that the interaction between OmpA and Ecgp96 downregulates peroxisome proliferator-activated receptor γ (PPAR-γ) and glucose transporter 1 (GLUT-1) levels in human brain microvascular endothelial cells, causing disruption of barrier integrity and inhibition of glucose uptake. The suppression of PPAR-γ and GLUT-1 by the bacteria in the brain microvessels of newborn mice causes extensive pathophysiology owing to interleukin 6 production. Pretreatment with partial or selective PPAR-γ agonists ameliorate the pathological outcomes of infection by suppressing interleukin 6 production in the brain. Thus, inhibition of PPAR-γ and GLUT-1 by E. coli K1 is a novel pathogenic mechanism in meningitis, and pharmacological upregulation of PPAR-γ and GLUT-1 levels may provide novel therapeutic avenues. [ABSTRACT FROM AUTHOR]

The article presents several case studies of diseases among children. Topics include a 7-month-old girl who was diagnosed with severe hyponatremia with urinary malformation and pyelonephritis, a 6-year-old child who was successfully treated for the child's isolated splenic rupture with severe hemophilia A, and a 9-year-old boy who develops Staphylococcus xylosus meningitis after being bitten by a dog.