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Objective To investigate the value of neutrophil extracellular traps (NETs) markers in the cerebrospinal fluid and plasma in differential diagnosis of tuberculous meningitis and purulent meningitis. Methods Twenty patients with tuberculous meningitis were selected in the tuberculous meningitis group, 30 patients with purulent meningitis were included in the septic meningitis group, and 20 patients with normal cerebrospinal fluid who required lumbar puncture surgery for differential diagnosis were selected as the normal control group. ELISA was used to detect NETs markers [neutrophil elastase (NE) -DNA complex, myeloperoxidase (MPO) -DNA complex] in cerebrospinal fluid and plasma of each group. We drew receiver operating characteristic (ROC) curves to evaluate the value of cerebrospinal fluid and plasma NETs markers in differential diagnosis of tuberculous meningitis and purulent meningitis. Results The levels of MPO-DNA complexes and NE-DNA complexes in the cerebrospinal fluid of the normal control group, tuberculous meningitis group, and purulent meningitis group increased sequentially (all P<0. 05) . The level of plasma NE-DNA complex was higher in the purulent meningitis than in the tuberculous meningitis group and normal control group there was no statistically significant difference between tuberculous meningitis group and normal control group; there was no statistically significant difference in the levels of MPO-DNA complexes in the plasma among these three groups. The area under the ROC curve (AUC) of cerebrospinal fluid NE-DNA complex and MPO-DNA complex in distinguishing tuberculous meningitis and purulent meningitis was 0. 961 and 0. 945, respectively, with sensitivities of 92. 36% and 89. 44%, and specificities of 88. 35% and 85. 29%, respectively. The AUC of plasma NE-DNA complex and MPO-DNA complex in distinguishing tuberculous meningitis and purulent meningitis was 0. 720 and 0. 709, respectively, with the sensitivities of 84. 62% and 80. 49%, and the specificities of 80. 18% and 73. 55%, respectively. Conclusions The levels of MPODNA complex and NE-DNA complex in cerebrospinal fluid and NE-DNA complex in plasma of patients with tuberculous meningitis decrease in comparison with those of patients with purulent meningitis. Detection of cerebrospinal fluid NETs markers may help in the differential diagnosis of tuberculous meningitis and purulent meningitis. [ABSTRACT FROM AUTHOR]

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The patient, a male newborn, was admitted to the hospital 2 hours after birth duc to prematurity (gestational agc 27+5 weeks) and respiratory distress occurring 2 hours postnatally. After admission, the infant developed fever and elevated C-reactive protein levels. On the fourth day after birth, metagenomic next-generation sequencing of cerebrospinal fluid indicated a positive result for Mycoplasma hominis (9 898 reads). On the eighth day, a retest of cerebrospinal fluid metagenomics confirmed Mycoplasma hominis (56 806 reads). The diagnosis of purulent meningitis caused by Mycoplasma hominis was established, and the antibiotic treatment was switched to moxifloxacin [5 mg/(kg⋅day)] administered intravenously for a total of 4 weeks. After treatment, the patient's cerebrospinal fluid tests returned to normal, and he was discharged as cured on the 76th day after birth. This article focuses on the diagnosis and treatment of neonatal Mycoplasma hominis purulent meningitis, introducing the multidisciplinary diagnosis and treatment of the condition in extremely preterm infants. [ABSTRACT FROM AUTHOR]

Neutrophils, the most abundant type of white blood cells, are pivotal in fighting bacterial infections due to their immunological and anti-infection capabilities. In recent years, scientists have discovered a novel mechanism known as neutrophil extracellular traps, which are fibrous networks primarily released by neutrophils that combat bacterial infections. There is a growing interest in studying NETs and their role in human infectious diseases, particularly in neonates susceptible to bacterial infections. NETs and their components have been found in various samples from neonatal-infected patients, providing a new route for early diagnosis of neonatal infectious diseases. This paper aims to summarize the studies on NETs in adult diseases and mainly discuss NETs in neonatal sepsis, necrotizing enterocolitis, and purulent meningitis, to provide scientific evidence for early monitoring, diagnosis, and treatment of neonatal infections.

ABSTRACT: Mycobacterium iranicum is characterized by rapid growth and orange-pigmented scotochromogenic colonies. However, it is uncommon for M. iranicum to invade the central nervous system. A man nearly 60 years old was referred to our hospital because of a seizure and unconsciousness. After admission, the patient had fever and dizziness without obvious abnormalities in the cerebrospinal fluid, except for an increase in neutrophils. Metagenomic next-generation sequencing and DNA testing were positive for M. iranicum. The patient was treated with imipenem, minocycline, moxifloxacin, and linezolid, and he gradually recovered during follow-up.

Background. Purulent meningitis remains an important cause of mortality and morbidity among children worldwide. An immediate diagnosis of the causative microorganism is critical to significantly improving the outcome of this condition. Case. In this study, we collected cerebrospinal fluid (CSF) samples from four patients clinically diagnosed with purulent meningitis. Patients with purulent meningitis may present with a variety of clinical symptoms or laboratory results. Infectious microorganisms including Pseudomonas aeruginosa, Staphylococcus aureus, Streptococcus pneumonia, and Haemophilus influenzae were identified in the CSF samples via metagenomic nextgeneration sequencing (mNGS). Conclusions. mNGS is effective for the immediate detection of pathogens, which can in turn facilitate prompt diagnosis and treatment among individuals with purulent meningitis, especially if conventional CSF results (such as CSF culture and polymerase chain reaction) are negative. [ABSTRACT FROM AUTHOR]

• Rare Mycobacterium iranicum meningitis can cause fever, headache, and epilepsy. • Metagenomic next-generation sequencing is the key to diagnosing purulent meningitis. • Β-Lactam, quinolones, and tetracycline can treat M. iranicum meningitis. Mycobacterium iranicum is characterized by rapid growth and orange-pigmented scotochromogenic colonies. However, it is uncommon for M. iranicum to invade the central nervous system. A man nearly 60 years old was referred to our hospital because of a seizure and unconsciousness. After admission, the patient had fever and dizziness without obvious abnormalities in the cerebrospinal fluid, except for an increase in neutrophils. Metagenomic next-generation sequencing and DNA testing were positive for M. iranicum. The patient was treated with imipenem, minocycline, moxifloxacin, and linezolid, and he gradually recovered during follow-up. [ABSTRACT FROM AUTHOR]

Zongwei Zhang, Hainan Wen, Hui Wang, Pan Zhang, Jing Li, Yueyi Liang, Yanchao Liu, Lihong Sun, Shoujun Xie Department of Clinical Laboratory, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, People’s Republic of ChinaCorrespondence: Shoujun Xie, Department of Clinical Laboratory, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, People’s Republic of China, Tel +86 15633142883, Email shoujunxie69@163.comAbstract: Hypervirulent Klebsiella pneumoniae (hvKP), an emerging pathotype derived from K. pneumoniae, frequently causes invasive infections of multiple organs and is associated with both high disability and fatality rates. In this study, a case of meningitis in a young infant caused by hvKP is presented. Cytological and biochemical examinations of the cerebrospinal fluid (CSF) revealed purulent meningitis, a diagnosis that was confirmed by a positive CSF culture result. The pathogen was identified as hvKP through analysis of positive virulence-associated genes. Meanwhile, hvKP was also isolated from stool samples of both the infant and her father. Antimicrobial susceptibility, capsular typing, and multilocus sequence typing (MLST) of three isolates from the infant’s CSF and stool and her father’s stool samples were analyzed. The three K. pneumoniae isolates were susceptible to all antibiotics except ampicillin and were identified as capsular serotype K2 and sequence type 86. These genetic relatedness analyses indicated that the strain isolated from the infant’s CSF might have originated from her father’s stool via familial transmission. This case is the first report of meningitis in an infant due to hvKP transmitted within a family.Keywords: hvKP, purulent meningitis, infant, familial transmission

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A case of suppurative meningitis complicated with acute cerebral infarction caused by Streptococcus suis was reported to provide reference for the diagnosis and treatment of Streptococcus suis infection. The diagnosis, treatment, follow-up and epidemiological materials in the case of suppurative meningitis complicated with acute cerebral infarction caused by Streptococcus suis in Heyuan People’s Hospital were reviewed, and the relevant literature was reviewed. The clinical manifestations of this case were headache and fever, which progressed rapidly. After effective anti-infection treatment, the patient improved and discharged from the hospital, but there was profound hearing impairment.

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.

Abstract 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.

As a determinant human pathogen, Klebsiella pneumoniae is known to cause rare K. pneumoniae liver abscess syndrome (KLAS) which was more common in Asia in early-stage and reported increasingly outside Asia now. Patients with KLAS who have septic metastatic ocular or central nervous system (CNS) lesions are associated with high morbidity and mortality. Relatively infrequent adult community-acquired K. pneumoniae meningitis have been documented and most were with poor prognosis. In this paper, we reported a case of KLAS presenting purulent meningitis as disease onset. While negative results were obtained in the bacterial culture of CSF, blood, or liver pus, metagenomic next-generation sequencing (mNGS) of CSF, and blood samples which were synchronously performed demonstrated Klebsiella pneumoniae as the pathogenic microorganism (13,470 and 5,318 unique reads, respectively). The ultimately cured patient benefited from rapid pathogen diagnosis, early percutaneous drainage of the abscess, and prompt appropriate antibiotic administration. Our case highlights the importance of clinicians using mNGS for early pathogen diagnosis of this disease.

Introduction: Among elderly diabetic patients with comorbid conditions, the clinical characteristics of suppurative meningitis may not be typical, which is easy to cause misdiagnosis and delayed treatment. Case presentation: In this report, we described the case of a 65-year-old elderly diabetic male who developed purulent meningitis after tooth extraction. The patient developed repeated infections (fever, headache and other symptoms) and was diagnosed with pyogenic meningitis by combining clinical manifestations and cerebrospinal fluid testing. The patient was treated with intracranial pressure reduction, nutritional support and anti-infection drugs, and recovered and was discharged after 15 days. Conclusions: The atypical clinical presentation and insidious onset of the disease in this patient could easily lead to missed diagnosis and misdiagnosis. We emphasize that we should be vigilant with purulent meningitis and active treatment and prevention should be implemented in this subgroup of patients. During treatment, active anti-infection and nutritional support should be provided on the basis of blood glucose control. [ABSTRACT FROM AUTHOR]

Abstract 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.

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 <.05 were further analyzed by multivariate logistic regression. 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 <2 mmol/L, periventricular leukomalacia, punctate white matter lesions, and pyogenic intraventricular empyema. Children with hydrocephalus had a lower cure rate of meningitis (31.3% vs 75.4%), and poor discharge outcomes. In addition, they had longer length of hospital stay and higher hospital cost. Conclusions: Female sex, cerebrospinal fluid glucose <2 mmol/L, periventricular leukomalacia, punctate white matter lesions, and pyogenic intraventricular empyema were identified as risk factors for hydrocephalus in neonatal purulent meningitis. Children with hydrocephalus had poor discharge outcomes and increased financial burden on their families. [ABSTRACT FROM AUTHOR]

Objective  To evaluate the diagnostic yield of the multiplex polymerase chain reaction (PCR) method in cerebrospinal fluid (CSF) for the diagnosis of purulent meningitis (PM) in children. Methods  PM was diagnosed according to the European Society for Clinical Microbiology and Infectious Diseases guideline (2016). Patients with PM between May 2015 and October 2018 were included. The multiplex PCR method was used to detect eight common identified bacteria in PM. Its sensitivity and specificity were compared with bacteria culture. Results  A total of 106 cases were enrolled. Pathogenic bacteria were identified in 27 (25.5%) cases by culture and in 37 (34.9%) cases by multiplex PCR assay. The top three bacteria were Streptococcus pneumoniae , Escherichia coli K1, and Streptococcus agalactiae. When using culture as the gold standard, the multiplex PCR assay showed a sensitivity of 100, 88.9, and 75.0% for S. agalactiae , S. pneumoniae , and E. coli K1, respectively, and a specificity of more than 91.3% for all three bacteria. For detectable bacteria, the positive rate of the multiplex PCR assay (36.6%, 37/101) was significantly higher than that of the bacteria culture (21.8%, 22/101). When combining the two methods, etiology was identified in 42.5% (45/106) of the patients. Conclusion   Streptococcus pneumoniae , E. coli K1, and S. agalactiae were the predominant pathogens causing pediatric PM. As a rapid method with high sensitivity and specificity, the multiplex PCR assay in CSF could be used as an adjunctive approach with bacteria culture for the pathogen identification of PM. [ABSTRACT FROM AUTHOR]

The patient, a male newborn, was admitted to the hospital 2 hours after birth due to prematurity (gestational age 27 +5 weeks) and respiratory distress occurring 2 hours postnatally. After admission, the infant developed fever and elevated C-reactive protein levels. On the fourth day after birth, metagenomic next-generation sequencing of cerebrospinal fluid indicated a positive result for Mycoplasma hominis (9 898 reads). On the eighth day, a retest of cerebrospinal fluid metagenomics confirmed Mycoplasma hominis (56 806 reads). The diagnosis of purulent meningitis caused by Mycoplasma hominis was established, and the antibiotic treatment was switched to moxifloxacin [5 mg/(kg·day)] administered intravenously for a total of 4 weeks. After treatment, the patient's cerebrospinal fluid tests returned to normal, and he was discharged as cured on the 76th day after birth. This article focuses on the diagnosis and treatment of neonatal Mycoplasma hominis purulent meningitis, introducing the multidisciplinary diagnosis and treatment of the condition in extremely preterm infants.

Objective: To investigate levels of inflammatory markers and matrix metalloproteinase-9 (MMP-9) in serum and cerebrospinal fluid of children with central nervous system infection and its clinical significance. Methods: 198 children with meningitis admitted to our hospital from August 2017 to June 2018 were divided into infection group. They were divided into purulent meningitis (PM=107) and viral meningitis (VM=91) according to different causes. 58 healthy children were selected as control group (Normal Control, NC=58) during the same period. The levels of procalcitonin (PCT) in serum and cerebrospinal fluid (CF) were detected by double antibody sandwich immunofluorescence assay; the levels of C -reactive protein (CRP) in serum and cerebrospinal fluid were detected by immunofluorescence analyzer; the levels of Tumor necrosis factor-alpha (TNF-alpha) and MMP-9 in serum and cerebrospinal fluid were detected by enzyme-linked immunosorbent assay (ELISA) before and after treatment in three groups of children; the serum White was analyzed by electrochemiluminescence automatic immunoanalyzer. Protein and cerebrospinal fluid albumin content, and calculate albumin index. Results: Compared with the control group, the levels of CRP, PCT, TNF-琢and MMP-9 in serum and cerebrospinal fluid of the patients in the Huanao group and the diseased brain group were significantly higher (P<0.05), and the levels of CRP, PCT, TNF-琢and MMP-9 in the serum and cerebrospinal fluid of the patients in the Huanao group were significantly higher than those in the diseased brain group (P<0.05). Compared with the control group, PCT levels in serum and cerebrospinal fluid of children in the Huanao group decreased before treatment, 72 hours after treatment and 1 week after treatment (P<0.05). There was no significant difference in PCT levels in serum and cerebrospinal fluid between the two groups before and after treatment (P>0.05). CRP, PCT, TNF-alpha and MMP-9 levels in the cerebrospinal fluid of children in the Huanao group and the sick cerebrospinal group were similar to those of children with albumin index positive correlation. Conclusion: The levels of inflammatory markers and MMP-9 in serum and cerebrospinal fluid can be used to differentiate suppurative meningitis from viral meningiti. [ABSTRACT FROM AUTHOR]

Objective To investigate the diagnostic value of soluble Triggering receptor expressed on myeloid cells-1 (sTREM-1), IL-6 and IL-10 in cerebrospinal fluid in children with purulent meningitis. Methods A total of 62 children with central infection were diagnosed and admitted to the Children's Hospital of Kunming Medical University from January 2019 to January 2020, of which 30 were in the purulent meningitis. (PM) group and 32 were in the viral meningitis (VM) group served as a control group, the levels of sTREM-1, IL-6, IL-10 and WBC in cerebrospinal fluid were measured and analyzed,and the ROC curve of receiver operating characteristics was used to study the diagnostic efficacy of sTREM-1, IL-6, IL-10, and WBC. Results The levels of sTREM-1, IL-6 and IL-10 in the cerebrospinal fluid of the PM group were significantly higher than those in the VM group, and there were statistical significance between the two groups (P < 0.01) . The WBC in the cerebrospinal fluid of the PM group was higher than that of the VM group, the difference was statistically significant (P < 0.05); the area under the ROC curve for sTREM-1, IL-6,IL-10,WBC and sTREM-1 + IL-6 + IL-10 in diagnosis of PM were 0.867,0.754,0.781,0.651 and 0.921,respectively. The sensitivity of these makers were 78.5%,67.9%,60.7%,32.3% respectively; the specificity were 83.9%,77.4%,83.9%,96.4% respectively; the positive predictive value were 81%,73%,76%,56% respectively and the negative predictive value81%, 73%,68%,91% respectively while the cut-off values were 285 pg/mL, 137.16 pg/mL, 21.97 pg/mL, 18× 106 /L. Conclusion sTREM-1, IL-6 and IL-10 in CSF have certain diagnostic value in the differential diagnosis of PM and VM. A combination of the three marks can improve clinical diagnostic value [ABSTRACT FROM AUTHOR]

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<0.05). The effective treatment rate of the combination group was significantly higher compared with that of the monotherapy group (P=0.006). CSF protein at T1, T2 T3, and CSF sugar concentrations and BDNF levels at T1 were significantly lower in the combination group than in the monotherapy group (P<0.05) while the CSF sugar concentrations at T2, T3 were higher in the combination group than in the monotherapy group (P<0.05). Taken together, these observations suggest that ceftriaxone combined with dexamethasone was superior compared with that of ceftriaxone alone for the treatment of infantile PM, and that this combination therapy may improve the effective treatment rate and accelerate patient rehabilitation. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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.

A retrospective analysis was conducted of 290 case histories in children hospitalized in Kyiv Municipal Children’s Clinical Infectious Diseases Hospital in 2010–2015 with the diagnosis of meningitis. Among them — 73 case histories of children of the first three years of life. It was found that the feature of the disease was the prevalence of meningitis of purulent meningococcal (33 %) and unidentified (55 %) origin and predominance in clinical symptoms of general infectious and meningeal syndromes in purulent meningitis and cerebral signs in aseptic meningitis. It is noted that in 85 % of children, meningitis was severe, in 75 % — complicated. In the structure of meningitis complications in children of the first 3 years of life, cerebral edema prevails.

This study was aimed to investigate the changes of matrix metalloproteinase-2 (MMP-2) and matrix metalloproteinase inhibitor-1 (TIMP-1) in cerebrospinal fluid (CSF) of neonates with purulent meningitis. 195 cases (n=195) were divided into PM group (neonatal purulent meningitis), VM group (neonatal virus meningitis) and control group (healthy neonates). The expression levels of MMP-2 and TIMP-1 were detected by ELISA while the level of PCT was determined by chemiluminescence analyzer. The levels of MMP-2 and TIMP-1 in CSF and PCT in serum were compared in three groups and the correlation was discussed. The level of MMP-2 in CSF in 3 groups were statistically significant (F=16.126, P<0.05) similarly the level of TIMP-1 in CSF of 3 groups were statistically significant (F=16.093, P<0.05). The serum level of PCT in PM group was 14.73±2.14ng/l, in VM group was 9.06±1.05ng/l and in control group it was 0.37±0.12ng/l. The levels of MMP-2 and TIMP-1 in CSF were positively correlated with the serum level of PCT in both PM and VM group. The expression of MMP-2, TIMP-1 and serum PCT in CSF of newborns with purulent meningitis was increased. The findings suggest that MMP-2, TIMP-1 and PCT are involved in the occurrence and development of neonatal purulent meningitis. [ABSTRACT FROM AUTHOR]

Neutrophils, the most abundant type of white blood cells, are pivotal in fighting bacterial infections due to their immunological and anti-infection capabilities. In recent years, scientists have discovered a novel mechanism known as neutrophil extracellular traps, which are fibrous networks primarily released by neutrophils that combat bacterial infections. There is a growing interest in studying NETs and their role in human infectious diseases, particularly in neonates susceptible to bacterial infections. NETs and their components have been found in various samples from neonatal-infected patients, providing a new route for early diagnosis of neonatal infectious diseases. This paper aims to summarize the studies on NETs in adult diseases and mainly discuss NETs in neonatal sepsis, necrotizing enterocolitis, and purulent meningitis, to provide scientific evidence for early monitoring, diagnosis, and treatment of neonatal infections., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 Published by Elsevier Ltd.)

Objective: To investigate the clinical value of PCR16pRNA combined with nucleotide sequencing method in the detection of purulent meningitis pathogens. Methods: Cerebrospinal fluid (CSF) specimens of 43 children with purulent meningitis in Shanghai Children's Medical Center from April 2016 to February 2017 were selected, all specimens were cultured simultaneously, which were detected by PCR 16sRNA sequencing combined with nucleotide sequencing. The detection results were recorded, and the sensitivity and specMrity of &eo>tection method were statistically analyzed, and the sensitivity and specificity of CSF culture and PCR/ 16sRNA combined nucleotide sequencing were compared with CSF culture test results as gold standard. Results: The sensitivity of CSF culture was 21.7%, the specificity was 100.0%, the sensitivity of PCR 16sRNA was 69.6%. the specificity was 95.0%. and the difference of sensitivity between the two methods was statistically significant (P<0.05). but there was no significant difference between the two methods (PKI.05). PCR 16sRNA combined with nucleotide sequencing could detect cerebrospinal fluid culture negative pathogens. Conclusion: PCR 16sRNA combined with nucleotide sequencing has higher sensitivity, it can detect cerebrospinal fluid culture negative pathogens, and less affected by antibiotics.lt can provide the early cluneal pathogen diagnosis of purulent meningitis, reduce mortality and morbidity. [ABSTRACT FROM AUTHOR]

Objective To discuss how the clinical pharmacists participated in the treatment of pediatric purulent meningitis and conducted drug monitoring. Methods Clinical pharmacists involved the whole process of treatment for a purulent meningitis infant with renal insufficiency, evaluated medication history, conducted therapeutic drug monitoring and designed an individualized medication treatment plan with clinical physicians. Results Clinical pharmacists assisted clinicians with their pharmacy expertise, and developed individualized drug dosing regimen to achieve effective therapy and medication safety. Conclusion Clinical pharmacists play an important role in providing individualized pharmaceutical care for patients, optimizing the treatment plan and improving the rational drug use. [ABSTRACT FROM AUTHOR]

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<0.05). The levels of TIMP-1 in cerebrospinal fluid were 374.55±36.04 ng/ml in the purulent meningitis group, 176.61±21.06 ng/ml in the viral encephalitis group and 7.72±2.44 ng/ml in the control group. The serum levels of PCT were 14.56±2.21 ng/ml in the purulent meningitis group, 9.04±1.17 ng/ml in the viral encephalitis group and 0.38±0.14 ng/ml in the control group. The level of MMP-2 in cerebrospinal fluid of pediatric patients in the purulent meningitis group was positively correlated with the level of serum PCT (r=0.582, p<0.05); the level of TIMP-1 in cerebrospinal fluid of pediatric patients in the viral encephalitis group was positively correlated with the level of serum PCT (r=0.635, p<0.05). In conclusion, MMP-2 and TIMP-1 were positively correlated with the levels of serum PCT, suggesting that MMP-2, TIMP-1 and PCT were involved in the occurrence and development of neonatal purulent meningitis. [ABSTRACT FROM AUTHOR]

The article analyzes the clinical features of autonomic dysfunction and state of compensatory-adaptive mechanisms in patients with purulent meningitis in the dynamics of the disease. We found that in patients with purulent meningitis at the height of the disease dominance of cerebral, meningeal symptoms combined with some objective evidence of autonomic dysfunction and reduced power of heart rate variability with the presence of autonomic imbalance towards vagotonia. In the dynamics in patients with purulent meningitis against the background of conventional treatment clinical signs of autonomic dysfunction prevail from the 2nd week, they persist at discharge in 72.7 % of patients, combining with imbalanced parameters of neurohumoral regulation, in the form of reduced power of spectral parameters of heart rate variability with presence of autonomic imbalance towards vagotonia.

This study investigated the possible correlation between the degree of hearing impairment caused by neonatal purulent meningitis and the levels of CD64 and PCT in cerebrospinal fluid of patients, and assessed the prognostic value of such levels. We recorded data from 156 cases of neonatal purulent meningitis retrospectively. All the patients received brainstem response audiometry, and cerebrospinal fluid samples were collected within the first day after admission through lumbar puncture. Flow cytometry was used to detect CD64 levels and enzyme-linked fluorescent assay was used to detect PCT levels. The children with hearing impairment were followed up for 1 year and brainstem response audiometry was performed again in them. We found that 43.59% of the children showed different degrees of hearing impairment, and 55% of them did not fully recover. The levels of PCT and CD64 in cerebrospinal fluid of children with hearing impairment were significantly higher than those of children with normal hearing (P<0.01). The levels of PCT and CD64 in mild, moderate and severe hearing impaired children increased gradually with higher degrees of impairment, and the differences between groups were significant (P<0.01). During the follow-up, it was found that the levels of PCT and CD64 in children correlated well with the degree of hearing recovery, and the differences between groups were significant (P<0.01). In our study, approximately 1/4 children with purulent meningitis showed long-term hearing impairment. Based on our analyses, the levels of CD64 and PCT in cerebrospinal fluid can be used to predict the degree and long-term prognosis of hearing impairment caused by purulent meningitis in children. [ABSTRACT FROM AUTHOR]

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