RESUMEN
Human adenovirus (HAdV) has been recognized as a significant viral pathogen implicated in neurological diseases, particularly in immunocompromised patients. However, its involvement in meningoencephalitis remains unclear. The aim of this study was to investigate HAdV and other viral co-infections in the cerebrospinal fluid (CSF) of patients suspected of having either meningoencephalitis or encephalitis. A total of 373 CSF samples from patients under clinical suspicion of neurological viral infection were included in this study. HAdV was investigated by conventional or multiplex real-time PCR, for different time periods. The frequency of HAdV central nervous system (CNS) infection was 1.08%, predominating in female patients with a predisposing condition, and presented with HAdV encephalitis. HAdV CNS infection was found to occur during the months of autumn and winter. The frequency of HAdV detected in CSF positive samples increased after the change in the diagnostic method from conventional to multiplex real-time PCR. There were no specific NMRI or EEG characteristics and two CSF samples with HAdV encephalitis had normal CSF WBC count. There were two cases of co-infection with HIV; no other co-infections with enterovirus or herpes family viruses were detected. All patients had good outcome. Although HAdV is rarely observable in CNS infectious syndromes, it must be investigated particularly in immunocompromised patients.
Asunto(s)
Adenovirus Humanos/genética , ADN Viral/genética , Encefalitis Viral/diagnóstico , Meningitis Viral/diagnóstico , Meningoencefalitis/diagnóstico , Adenovirus Humanos/clasificación , Adenovirus Humanos/aislamiento & purificación , Anciano , Anciano de 80 o más Años , Estudios Transversales , ADN Viral/líquido cefalorraquídeo , Encefalitis Viral/líquido cefalorraquídeo , Encefalitis Viral/patología , Encefalitis Viral/virología , Femenino , Humanos , Recuento de Leucocitos , Leucocitos/virología , Masculino , Meningitis Viral/líquido cefalorraquídeo , Meningitis Viral/patología , Meningitis Viral/virología , Meningoencefalitis/líquido cefalorraquídeo , Meningoencefalitis/patología , Meningoencefalitis/virología , Persona de Mediana Edad , Estudios Prospectivos , Estaciones del Año , Carga ViralRESUMEN
The cytological and biochemical examination of cerebrospinal fluid (CSF) has been used for the presumed diagnosis of bacterial meningitis until the final microbiological results are achieved. We assessed the ability of CSF lactate in comparison with other CSF parameters to discriminate bacterial and enteroviral community acquired meningitis. We included 1,187 CSF samples of acute community-acquired meningitis, being 662 cases of bacterial and 525 of enteroviral meningitis. Lactate concentration (mg/dL), leukocyte count/mm3, protein (mg/dL), and glucose (mg/dL) were compared between bacterial and viral meningitis. Receiver operator characteristic (ROC) curves were used to assess diagnostic performance. CSF leukocytes, CSF protein and CSF lactate were significantly higher in bacterial meningitis cases (P<0.0001). CSF glucose was significantly lower in bacterial meningitis cases (P<0.0001). CSF lactate showed the best predictive ability with an area under the curve of 0.944 (95% CI 0.929 - 0.959). Considering a cut off of CSF lactate of 30 mg/dL, the sensitivity and specificity for bacterial meningitis were 84.1% and 99%, respectively. In the cytological and biochemical CSF analysis, CSF lactate was the most accurate marker for bacterial meningitis.
Asunto(s)
Infecciones Comunitarias Adquiridas/líquido cefalorraquídeo , Infecciones por Enterovirus/diagnóstico , Ácido Láctico/líquido cefalorraquídeo , Meningitis Bacterianas/diagnóstico , Meningitis Viral/diagnóstico , Biomarcadores/líquido cefalorraquídeo , Infecciones Comunitarias Adquiridas/microbiología , Infecciones Comunitarias Adquiridas/virología , Infecciones por Enterovirus/líquido cefalorraquídeo , Humanos , Meningitis Bacterianas/líquido cefalorraquídeo , Meningitis Viral/líquido cefalorraquídeo , Curva ROC , Sensibilidad y EspecificidadRESUMEN
Abstract Objective: To assess the performance of cerebrospinal fluid (CSF) lactate as a biomarker to differentiate bacterial meningitis from viral meningitis in children, and to define an optimal CSF lactate concentration that can be called significant for the differentiation. Methods: Children with clinical findings compatible with meningitis were studied. CSF lactate and other conventional CSF parameters were recorded. Results: At a cut-off value of 3 mmol/L, CSF lactate had a sensitivity of 0.90, specificity of 1.0, positive predictive value of 1.0, and negative predictive value of 0.963, with an accuracy of 0.972. The positive and negative likelihood ratios were 23.6 and 0.1, respectively. When comparing between bacterial and viral meningitis, the area under the curve for CSF lactate was 0.979. Conclusions: The authors concluded that CSF lactate has high sensitivity and specificity in differentiating bacterial from viral meningitis. While at a cut-off value of 3 mmol/L, CSF lactate has high diagnostic accuracy for bacterial meningitis, mean levels in viral meningitis remain essentially below 2 mmol/L.
Resumo Objetivo: Estudar o desempenho do lactato no líquido cefalorraquidiano como biomarcador para diferenciar a meningite bacteriana da meningite viral em crianças, e definir uma concentração de lactato ótima no líquido cefalorraquidiano que possa ser significativa para a diferenciação. Métodos: Foram estudadas crianças com achados clínicos compatíveis com meningite. O nível de lactato no líquido cefalorraquidiano e outros parâmetros convencionais do líquido cefalorraquidiano foram registrados. Resultados: Em um valor de corte de 3 mmol/L, o lactato no líquido cefalorraquidiano apresentou uma sensibilidade de 0,90, especificidade de 1,0, valor preditivo positivo de 1,0, valor preditivo negativo de 0,963, com uma precisão de 0,972. Os índices de probabilidade positivo e negativo foram 23,6 e 0,1, respectivamente. Para comparação entre a meningite bacteriana e viral, a área abaixo da curva do lactato no líquido cefalorraquidiano foi 0,979. Conclusões: Concluímos que o lactato no líquido cefalorraquidiano possui alta sensibilidade e especificidade na diferenciação da meningite bacteriana da meningite viral. Embora em um valor de corte de 3 mmol/L o lactato no líquido cefalorraquidiano possua alta precisão de diagnóstico da meningite bacteriana, os níveis médios na meningite viral permanecem basicamente abaixo de 2 mmol/L.
Asunto(s)
Humanos , Masculino , Femenino , Lactante , Preescolar , Niño , Meningitis Bacterianas/diagnóstico , Ácido Láctico/líquido cefalorraquídeo , Meningitis Viral/diagnóstico , Valores de Referencia , Biomarcadores/líquido cefalorraquídeo , Estudios Prospectivos , Sensibilidad y Especificidad , Meningitis Bacterianas/líquido cefalorraquídeo , Diagnóstico Diferencial , Meningitis Viral/líquido cefalorraquídeoRESUMEN
OBJECTIVE: To assess the performance of cerebrospinal fluid (CSF) lactate as a biomarker to differentiate bacterial meningitis from viral meningitis in children, and to define an optimal CSF lactate concentration that can be called significant for the differentiation. METHODS: Children with clinical findings compatible with meningitis were studied. CSF lactate and other conventional CSF parameters were recorded. RESULTS: At a cut-off value of 3mmol/L, CSF lactate had a sensitivity of 0.90, specificity of 1.0, positive predictive value of 1.0, and negative predictive value of 0.963, with an accuracy of 0.972. The positive and negative likelihood ratios were 23.6 and 0.1, respectively. When comparing between bacterial and viral meningitis, the area under the curve for CSF lactate was 0.979. CONCLUSIONS: The authors concluded that CSF lactate has high sensitivity and specificity in differentiating bacterial from viral meningitis. While at a cut-off value of 3mmol/L, CSF lactate has high diagnostic accuracy for bacterial meningitis, mean levels in viral meningitis remain essentially below 2mmol/L.
Asunto(s)
Ácido Láctico/líquido cefalorraquídeo , Meningitis Bacterianas/diagnóstico , Meningitis Viral/diagnóstico , Biomarcadores/líquido cefalorraquídeo , Niño , Preescolar , Diagnóstico Diferencial , Femenino , Humanos , Lactante , Masculino , Meningitis Bacterianas/líquido cefalorraquídeo , Meningitis Viral/líquido cefalorraquídeo , Estudios Prospectivos , Valores de Referencia , Sensibilidad y EspecificidadRESUMEN
Meningitis is a disease with a global distribution that constitutes a worldwide burden, with viruses as the primary etiologic agents. The range of viral meningitis severity depends mainly on age, immune status and etiological agent. The aim of this work was to investigate the suspected cases of viral meningitis using molecular techniques to confirm the viral infection. The diagnosed virus was correlated with clinical findings and cytochemical parameters in cerebrospinal liquid (CSF) of patients. CSF of 70 children with the presumptive diagnosis of viral meningitis was analyzed by real time PCR (qPCR). Viruses were identified by qPCR in 44 CSF samples (62.9%). Among them, 31 were identified as Enterovirus (ENTV) (70.4%), six as Human herpes virus 3 (HHV-3) (13.6%), five as Dengue virus (DENV) (11.7%), one as Human herpes virus 1-2 (2.3%) and one as Human herpes virus 5 (2.3%). Patients in the HHV-positive groups had increased percentage of polymorphonuclear neutrophils (PMN) (mean of 81%) while the groups of patients with DENV and ENTV had a mean of 30.9%. This study contributes to the knowledge of the epidemiological distribution of viral agents in CNS infections in children. In addition, it raises the relevance of DENV as an agent of CNS infection, and reinforces the importance for molecular in the cases of CNV infection.
Asunto(s)
Virus del Dengue/patogenicidad , Dengue/epidemiología , Meningitis Viral/epidemiología , Meningitis Viral/etiología , Análisis de Varianza , Brasil/epidemiología , Niño , Preescolar , ADN Viral/genética , ADN Viral/metabolismo , Dengue/líquido cefalorraquídeo , Virus del Dengue/genética , Virus del Dengue/inmunología , Enterovirus/genética , Ensayo de Inmunoadsorción Enzimática , Femenino , Flavivirus/genética , Humanos , Inmunoglobulina M/metabolismo , Lactante , Recién Nacido , Masculino , Meningitis Viral/líquido cefalorraquídeo , Simplexvirus/genéticaRESUMEN
To determine the causes of viral meningitis, we analyzed 22 cerebrospinal fluid samples collected during the 2014-2015 dengue epidemics in Brazil. We identified 3 serotypes of dengue virus (DENV-1, -2, and -3), as well as co-infection with 2 or 3 serotypes. We also detected the Asian II genotype of DENV-2.
Asunto(s)
Virus del Dengue/clasificación , Dengue/epidemiología , Meningitis Viral/epidemiología , Filogenia , Brasil/epidemiología , Niño , Preescolar , Coinfección , Dengue/líquido cefalorraquídeo , Dengue/diagnóstico , Dengue/virología , Virus del Dengue/genética , Virus del Dengue/aislamiento & purificación , Femenino , Genotipo , Humanos , Lactante , Masculino , Meningitis Viral/líquido cefalorraquídeo , Meningitis Viral/diagnóstico , Meningitis Viral/virología , ARN Viral/genética , SerogrupoRESUMEN
INTRODUCTION: Meningitis is the leading infectious syndrome that affects the central nervous system, and most cases are caused by viral infections, mainly enterovirus. The clinical diagnosis for meningitis etiology still presents major challenges. The analysis of polymerase chain reaction (PCR), white blood cells, red blood cells, glucose, protein, and lactate in the cerebrospinal fluid (CSF) provides the first clues to the diagnosis. However, the reference values of some parameters can suffer changes OBJECTIVE: Analyze the laboratory parameters of CSF in patients with enterovirus meningitis, and then, theirrelationship by age group METHODS: A descriptive study was conducted based on data from a CSF reference service, located in São Paulo, Brazil, on 202 individuals who had enterovirus meningitis. Data was analysed by the Shapiro-Wilk and Kruskal-Wallis tests (CI = 95%, p < 0.05) and represented by the median and percentile 25 and 75, respectively RESULTS: The cytological and biochemical parameters of the CSF shows us that proteins had median concentrations of 33.0mg/ dL, glucose of 57.0mg/dl, lactate of 19.0mg/dL and the leukocyte of 119.0 cells/mm³, with a predominance of lymphocytes (42%). It was found that age can cause cytological and biochemical changes in the parameters of CSF. Children younger than 2 years had a range percentage of neutrophils and monocytes different then children aged ≤ 2 and < 6 years, and aged ≤ 6 and < 10 years. The protein concentration range in CSF as well as glucose track can also change according to age CONCLUSION: The parameters of the CSF in patients with enteroviral meningitis showed similar median concentrations to those found in the literature. Age may lead to changes in cytological and biochemical parameters of CSF. CSF protein and glucose concentrations also change according to age.(AU)
INTRODUÇÃO: A meningite é a principal síndrome infecciosa que afeta o Sistema Nervoso Central, e grande parte dos casos são ocasionados por infecções virais, principalmente por enterovirus. O diagnóstico clínico para a verificação da etiologia da meningite ainda apresenta grandes desafios. As análises de Reação em Cadeia da Polimerase (PCR), leucócitos, hemácias, glicose, proteína e lactato no líquido cefalorraquidiano (LCR) fornecem os primeiros indícios para o diagnóstico. No entanto, os valores de referência de alguns parâmetros podem sofrer alterações OBJETIVO: Verificar parâmetros laboratoriais do líquido cefalorraquidiano em indivíduos com meningite por enterovirus e, posteriormente, analisar suas relações por faixa etária MÉTODO: Foi realizado um estudo descritivo, com base nos dados do serviço de referência de coleta de líquido cefalorraquiano, localizado em São Paulo, Brasil. Totalizaram 202 indivíduos que apresentaram meningite por enterovirus. Os dados foram analisados pelo teste de Shapiro-Wilk e Kruskal-Wallis (IC = 95%, p < 0,05) e representados pela mediana e percentil 25 e 75 RESULTADOS: Os parâmetros bioquímicos e citológicos do LCR apresentaram concentrações medianas de proteínas de 33.0 mg/dL, de glicose de 57.0 mg/dL e lactato de 19.0 mg/dL e dos leucócitos de 119.0 células/mm3, com predominância de linfócitos (42%). Verificou-se que a diferença etária pode levar as alterações nos parâmetros citológicos e bioquímicos do LCR. As crianças menores que dois anos apresentaram intervalo de percentual de neutrófilos e monócitos diferentes das crianças com faixa etária de = 2 e < 6 anos e de = 6 e < 10 anos. A faixa de concentração de proteína no LCR, assim como a faixa da glicose também podem sofrer alterações segundo a idade CONCLUSÃO: Os parâmetros bioquimiocitológicos do liquido cefalorraquidiano em indivíduos com meningite por enterovirus apresentaram concentrações medianas similares às encontradas na literatura. A diferença ...(AU)
Asunto(s)
Humanos , Meningitis Viral/líquido cefalorraquídeo , Meningitis Viral/virologíaRESUMEN
Children with cerebrospinal fluid pleocytosis are frequently treated with parenteral antibiotics, but only a few have bacterial meningitis. Although some clinical prediction rules, such as bacterial meningitis score, are of well-known value, the cerebrospinal fluid white blood cells count can be the initial available information. Our aim was to establish a cutoff point of cerebrospinal fluid white blood cell count that could distinguish bacterial from viral and aseptic meningitis. A retrospective study of children aged 29 days to 17 years who were admitted between January 1st and December 31th, 2009, with cerebrospinal fluid pleocytosis (white blood cell > 7 µL-1) was conducted. The cases of traumatic lumbar puncture and of antibiotic treatment before lumbar puncture were excluded. There were 295 patients with cerebrospinal fluid pleocytosis, 60.3% females, medium age 5.0 ± 4.3 years distributed as: 12.2% 1-3 months; 10.5% 3-12 months; 29.8% 12 months to 5 years; 47.5% >5 years. Thirty one children (10.5%) were diagnosed with bacterial meningitis, 156 (52.9%) viral meningitis and 108 (36.6%) aseptic meningitis. Bacterial meningitis was caused by Neisseria meningi tidis (48.4%), Streptococcus pneumoniae (32.3%), other Streptococcus species (9.7%), and other agents (9.7%). cerebrospinal fluid white blood cell count was significantly higher in patients with bacterial meningitis (mean, 4839 cells/µL) compared to patients with aseptic meningitis (mean, 159 cells/µL, p < 0.001), with those with aseptic meningitis (mean, 577 cells/µL, p < 0.001) and with all non-bacterial meningitis cases together (p < 0.001). A cutoff value of 321 white blood cell/µL showed the best combination of sensitivity (80.6%) and specificity (81.4%) for the diagnosis of bacterial meningitis (area under receiver operating characteristic curve 0.837). Therefore, the value of cerebrospinal fluid white blood cell count was found to be a useful and rapid diagnostic test to distinguish between bacterial and nonbacterial meningitis in children.
Asunto(s)
Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Leucocitosis/líquido cefalorraquídeo , Meningitis Bacterianas/diagnóstico , Meningitis Viral/diagnóstico , Biomarcadores/líquido cefalorraquídeo , Diagnóstico Diferencial , Recuento de Leucocitos , Leucocitosis/diagnóstico , Meningitis Bacterianas/líquido cefalorraquídeo , Meningitis Viral/líquido cefalorraquídeo , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Curva ROC , Sensibilidad y EspecificidadRESUMEN
Children with cerebrospinal fluid pleocytosis are frequently treated with parenteral antibiotics, but only a few have bacterial meningitis. Although some clinical prediction rules, such as bacterial meningitis score, are of well-known value, the cerebrospinal fluid white blood cells count can be the initial available information. Our aim was to establish a cutoff point of cerebrospinal fluid white blood cell count that could distinguish bacterial from viral and aseptic meningitis. A retrospective study of children aged 29 days to 17 years who were admitted between January 1st and December 31th, 2009, with cerebrospinal fluid pleocytosis (white blood cell≥7µL(-1)) was conducted. The cases of traumatic lumbar puncture and of antibiotic treatment before lumbar puncture were excluded. There were 295 patients with cerebrospinal fluid pleocytosis, 60.3% females, medium age 5.0±4.3 years distributed as: 12.2% 1-3 months; 10.5% 3-12 months; 29.8% 12 months to 5 years; 47.5% >5 years. Thirty one children (10.5%) were diagnosed with bacterial meningitis, 156 (52.9%) viral meningitis and 108 (36.6%) aseptic meningitis. Bacterial meningitis was caused by Neisseria meningitidis (48.4%), Streptococcus pneumoniae (32.3%), other Streptococcus species (9.7%), and other agents (9.7%). cerebrospinal fluid white blood cell count was significantly higher in patients with bacterial meningitis (mean, 4839cells/µL) compared to patients with aseptic meningitis (mean, 159cells/µL, p<0.001), with those with aseptic meningitis (mean, 577cells/µL, p<0.001) and with all non-bacterial meningitis cases together (p<0.001). A cutoff value of 321white blood cell/µL showed the best combination of sensitivity (80.6%) and specificity (81.4%) for the diagnosis of bacterial meningitis (area under receiver operating characteristic curve 0.837). Therefore, the value of cerebrospinal fluid white blood cell count was found to be a useful and rapid diagnostic test to distinguish between bacterial and nonbacterial meningitis in children.
Asunto(s)
Leucocitosis/líquido cefalorraquídeo , Meningitis Bacterianas/diagnóstico , Meningitis Viral/diagnóstico , Adolescente , Biomarcadores/líquido cefalorraquídeo , Niño , Preescolar , Diagnóstico Diferencial , Femenino , Humanos , Lactante , Recién Nacido , Recuento de Leucocitos , Leucocitosis/diagnóstico , Masculino , Meningitis Bacterianas/líquido cefalorraquídeo , Meningitis Viral/líquido cefalorraquídeo , Valor Predictivo de las Pruebas , Curva ROC , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
We investigated the prevalence of dengue in patients with suspected viral meningitis/meningoencephalitis in a dengue-endemic area. Cerebrospinal fluid analysis showed positive results and a 6.74× greater likelihood of identifying positive fluid in patients who died. Our findings support testing patients with neurologic manifestations for the virus in dengue-endemic areas.
Asunto(s)
Dengue/virología , Encefalitis por Arbovirus/virología , Enfermedades Endémicas , Meningitis Viral/virología , Brasil/epidemiología , Dengue/líquido cefalorraquídeo , Dengue/epidemiología , Encefalitis por Arbovirus/líquido cefalorraquídeo , Encefalitis por Arbovirus/epidemiología , Humanos , Meningitis Viral/líquido cefalorraquídeo , Meningitis Viral/epidemiología , Prevalencia , Estudios RetrospectivosRESUMEN
BACKGROUND: Approximately 40% of HIV infected patients have chronic meningitis at various stages during the infection, 59% are asymptomatic. This is a diagnosis of exclusion and a confounding factor in cerebrospinal fluid (CSF) analysis, any other causes of chronic meningitis by opportunistic or co-infection must be ruled out. The aim of this study was to analyze CSF lactic acid (LA) as an adjuvant biomarker in chronic meningitis due to HIV. METHODS: CSF LA was quantified in 223 CSF samples by the Dimension AR (Dade Behring, Deerfield, IL, USA), distributed into nine groups: 1) HIV positive with an increase in CSF WBCs (n=17); 2) HIV positive with normal CSF (n=20); 3) enterovirus meningitis (n=33); 4) Herpesviridae meningoencephalitis (n=30); 5) fungal meningitis (n=25); 6) tuberculosis (TB) meningitis (n=17); 7) toxoplasmosis (n=18); 8) neurosyphilis (n=6); 9) control group (n=57). RESULTS: CSF LA (median; IQR) was higher in samples with TB meningitis (5.5; 2.9-7.5 mmol/L) and Cryptococcus neoformans meningitis (3.9; 2.7-5.8 mmol/L) compated with samples with HIV chronic meningitis (1.7; 1.4-1.9 mmol/L) and other groups (p ≤ 0.0001). For the diagnosis of HIV chronic meningitis, using a cut-off of 3.5 mmol/L, CSF LA showed high sensitivity and negative predictive value, although low specificity. CONCLUSIONS: CSF LA helps to discriminate between C. neoformans or TB meningitis and HIV chronic meningitis: CSF LA can be included with the methods currently used to identify these specific pathogens, though it does not replace them. It is rapid, inexpensive and easy to perform, and can be used in developing countries.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/líquido cefalorraquídeo , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Infecciones por VIH/complicaciones , Ácido Láctico/líquido cefalorraquídeo , Meningitis Viral/líquido cefalorraquídeo , Meningitis Viral/diagnóstico , Adolescente , Adulto , Biomarcadores/líquido cefalorraquídeo , Niño , Preescolar , Enfermedad Crónica , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Meningitis Viral/complicaciones , Persona de Mediana Edad , Adulto JovenRESUMEN
INTRODUCTION: Neurocysticercosis is an infection of the human central nervous system caused by the metacestode larvae of Taenia solium. Neurocysticercosis is the most common parasitic disease in developing countries. Epilepsy is the most common clinical manifestation. Difficulties in confirming the diagnosis motivated the evaluation of the enzyme-linked immunosorbent assay on cerebral spinal fluid (CSF). METHODS: Twenty-two patients with NCC and 44 control patients were studied. CSF was analyzed using a commercial ELISA kit developed for NCC. Sensitivity and specificity were measured and a multivariate logistic regression was performed. RESULTS: Sensitivity and specificity of ELISA were 31.8% and 100%, respectively, with accuracy of 77.3%. Only the size of the lesions proved to be important for performance of the test. CONCLUSIONS: The results showed that ELISA contributes to the diagnosis of neurocysticercosis if the result is negative or if the patient has a lesion of 2 cm or more.
Asunto(s)
Anticuerpos Antihelmínticos/líquido cefalorraquídeo , Meningitis Viral/diagnóstico , Neurocisticercosis/diagnóstico , Taenia solium/inmunología , Adolescente , Adulto , Animales , Estudios de Casos y Controles , Niño , Preescolar , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Masculino , Meningitis Viral/líquido cefalorraquídeo , Persona de Mediana Edad , Neurocisticercosis/líquido cefalorraquídeo , Sensibilidad y Especificidad , Adulto JovenRESUMEN
INTRODUCTION: Neurocysticercosis is an infection of the human central nervous system caused by the metacestode larvae of Taenia solium. Neurocysticercosis is the most common parasitic disease in developing countries. Epilepsy is the most common clinical manifestation. Difficulties in confirming the diagnosis motivated the evaluation of the enzyme-linked immunosorbent assay on cerebral spinal fluid (CSF). METHODS: Twenty-two patients with NCC and 44 control patients were studied. CSF was analyzed using a commercial ELISA kit developed for NCC. Sensitivity and specificity were measured and a multivariate logistic regression was performed. RESULTS: Sensitivity and specificity of ELISA were 31.8 percent and 100 percent, respectively, with accuracy of 77.3 percent. Only the size of the lesions proved to be important for performance of the test. CONCLUSIONS: The results showed that ELISA contributes to the diagnosis of neurocysticercosis if the result is negative or if the patient has a lesion of 2 cm or more.
INTRODUÇÃO: Neurocisticercose é a infecção do sistema nervoso central causada pela larva metacestódea da Taenia solium. Neurocisticercose é a parasitose mais comum nos países em desenvolvimento. Epilepsia é a sua manifestação clínica mais comum. A dificuldade para confirmar o diagnóstico motivou a avaliação do ensaio imunoenzimático ligado à enzima no líquido cérebro-espinhal. MÉTODOS: Vinte e dois pacientes com NCC e 44 pacientes controles foram estudados. Líquido cérebro-espinhal foi analisado por um kit ELISA comercial desenvolvido para NCC. A sensibilidade e especificidade foram medidas e uma análise multivariada de regressão logística foi realizada. RESULTADOS: A sensibilidade e a especificidade de ELISA foram, respectivamente, 31,8 por cento e 100 por cento, com acurácia de 77,3 por cento. Apenas o tamanho das lesões mostrou-se importante para o desempenho do teste. CONCLUSÕES: Este estudo concluiu que ELISA contribui para o diagnóstico de NCC, caso o teste seja negativo ou caso o paciente seja portador de lesão cuja dimensão seja igual ou maior que dois centímetros.
Asunto(s)
Adolescente , Adulto , Animales , Niño , Preescolar , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Anticuerpos Antihelmínticos/líquido cefalorraquídeo , Meningitis Viral/diagnóstico , Neurocisticercosis/diagnóstico , Taenia solium/inmunología , Estudios de Casos y Controles , Ensayo de Inmunoadsorción Enzimática , Meningitis Viral/líquido cefalorraquídeo , Neurocisticercosis/líquido cefalorraquídeo , Sensibilidad y EspecificidadRESUMEN
Dengue infection is a mosquito-borne disease caused by a flavivirus, and is recognized in over 100 countries with 2.5 billion people living in areas of risk. Neurological manifestations such as encephalitis, myelitis, Guillain-Barré syndrome, cranial nerve palsies, neuromyelitis optica, and encephalomyelitis have been recognized as clinical consequences of dengue infection. Meningitis is a rare complication. We report the case of a 24-year-old woman who presented with fever, headache, and nuchal rigidity without the typical symptoms of dengue infection. Cerebrospinal fluid analysis showed lymphocytic pleocytosis with a normal glucose value and negative bacterial and fungal cultures. The etiology of meningitis was confirmed by positive dengue PCR in the serum. This case report highlights dengue infection as a potential cause of meningitis in endemic areas. Also, meningitis can be the first manifestation of the infection. Dengue should be investigated even in the absence of a typical picture of the infection.
Asunto(s)
Virus del Dengue/genética , Dengue/complicaciones , Meningitis Viral , Adulto , Líquido Cefalorraquídeo/virología , Dengue/diagnóstico , Dengue/virología , Virus del Dengue/clasificación , Virus del Dengue/aislamiento & purificación , Femenino , Humanos , Meningitis Viral/líquido cefalorraquídeo , Meningitis Viral/diagnóstico , Meningitis Viral/virología , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Adulto JovenRESUMEN
BACKGROUND: The differential diagnosis between bacterial and viral meningitis is not easy in some cases. Cerebrospinal fluid (CSF) analysis is essential for establishing this diagnosis. The objectives were to quantitate lactic acid (LA) concentrations in bacterial and viral meningitis, and other central nervous system (CNS) diseases in order to evaluate the diagnostic utility of CSF LA for discriminating bacterial from viral meningitis. METHODS: CSF LA was measured in 139 CSF samples from seven groups: viral meningitis with classic CSF; suspicion of viral meningitis with neutrophils in CSF; bacterial meningitis; non-infectious neurological diseases; chronic meningitis; traumatic lumbar puncture (LP) and normal CSF. RESULTS: CSF LA was higher in bacterial meningitis 8.7 + 5.4 mmol/L compared with viral meningitis (1.9 + 0.6) and the other groups (p < 0.0001). CSF LA in the groups with viral meningitis was not different compared to groups with non-infectious CNS diseases and chronic meningitis. The ability of CSF LA to discriminate bacterial from viral meningitis showed a sensitivity of 80% and specificity of 97%, positive predictive value (PPV) of 94%, and negative predictive value (NPV) of 89%. CONCLUSIONS: CSF LA is a powerful test to discriminate bacterial from viral meningitis with high sensitivity, specificity and predictive values. CSF LA can help in the cases with diagnostic uncertainty.
Asunto(s)
Ácido Láctico/líquido cefalorraquídeo , Enfermedades del Sistema Nervioso/líquido cefalorraquídeo , Adulto , Biomarcadores/líquido cefalorraquídeo , Líquido Cefalorraquídeo/química , Líquido Cefalorraquídeo/citología , Diagnóstico Diferencial , Femenino , Humanos , Recuento de Leucocitos , Estudios Longitudinales , Masculino , Meningitis Bacterianas/líquido cefalorraquídeo , Meningitis Bacterianas/microbiología , Meningitis Viral/líquido cefalorraquídeo , Meningitis Viral/virología , Enfermedades del Sistema Nervioso/microbiología , Enfermedades del Sistema Nervioso/virología , Valor Predictivo de las Pruebas , Estudios Prospectivos , Sensibilidad y Especificidad , Adulto JovenRESUMEN
We used a binomial regression model to determine the relationship between the percent of cerebrospinal fluid (CSF) mononuclear white blood cells and symptom duration in children with proven enteroviral meningitis. The odds of a CSF white blood cell being mononuclear increased by 15.7% (95% confidence interval: -3.8% to 38.0%; P = .11) for each day of symptoms. Fifty percent of patients with symptoms of 1 day or less had predominance of mononuclear cells among CSF white blood cells. These findings suggest that factors other than symptom duration influence the composition and evolution of the CSF white blood cell response to enteroviral infection.
Asunto(s)
Infecciones por Enterovirus/patología , Leucocitos Mononucleares/patología , Meningitis Viral/patología , Adolescente , Recuento de Células , Líquido Cefalorraquídeo/citología , Líquido Cefalorraquídeo/virología , Niño , Preescolar , Estudios Transversales , Enterovirus/genética , Enterovirus/crecimiento & desarrollo , Infecciones por Enterovirus/líquido cefalorraquídeo , Infecciones por Enterovirus/virología , Femenino , Humanos , Lactante , Recién Nacido , Modelos Logísticos , Masculino , Meningitis Viral/líquido cefalorraquídeo , Meningitis Viral/virología , Reacción en Cadena de la Polimerasa , Factores de TiempoRESUMEN
This paper analyzes the diagnosis aid of the dosage of lactate in the cerebrospinal fluid (CSF) in infectious diseases of the central nervous system (CNS). We analyzed prospectively 130 samples of CSF of 116 patients with diagnoses of infectious processes in the CNS. The 130 samples of CSF were divided into five groups: 28 samples of the control group, 40 of bacterial meningitis, 22 of viral meningitis, 16 of fungal meningitis and 24 of patients presenting acquired immune deficiency syndrome (AIDS). The concentration of lactate in the CSF was elevated in the group of patients with bacterial meningitis (average = 46.2 mg/dL), fungal meningitis (average = 27.3 mg/dL) and in the AIDS group (average = 23.5 mg/dL). In the control group and viral meningitis group the lactate content in the CSF presented the reference rates according to the employed method. The lactate dosage in the CSF presented a negative correlation with glycorrhachia and positive correlation with the cellularity and total proteins of the CSF. We conclude that the lactate dosage in the CSF, although unspecific, helps to distinguish the infectious processes of the CNS.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/líquido cefalorraquídeo , Lactatos/líquido cefalorraquídeo , Meningitis/líquido cefalorraquídeo , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Niño , Preescolar , Femenino , Glucosa/líquido cefalorraquídeo , Humanos , Lactante , Recién Nacido , Masculino , Meningitis Bacterianas/líquido cefalorraquídeo , Meningitis Fúngica/líquido cefalorraquídeo , Meningitis Viral/líquido cefalorraquídeo , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
OBJECTIVE: To clarify to what extent Gram stain-negative bacterial meningitis can be distinguished from viral meningitis by assessment of cerebrospinal fluid (CSF) and blood indices and serum C-reactive protein (CRP) in children over 3 months of age. DESIGN: Common CSF indices, blood leukocyte counts, and serum CRP values were compared between patients with bacterial meningitis who had a positive CSF bacterial culture but a negative Gram stain and patients with viral meningitis. POPULATION: Three hundred twenty-five consecutive patients with CSF culture-proven bacterial meningitis, for whom Gram stain was negative in 55 cases, and 182 children with proven or presumed viral meningitis. RESULTS: Significant differences between patients with bacterial and viral meningitis were found in all indices with large overlap in all except serum CRP. In patients with bacterial meningitis, the mean CSF glucose concentration, protein concentration, leukocyte count, blood leukocyte count, and serum CRP were 2.9 mmol/L (52 mg/dL), 1.88 g/L, 4540 x 10(6)/L, 18.0 x 10(9)/L, and 115 mg/L; and in those with viral meningitis, mean values were 3.3 mmol/L (59 mg/dL), 0.52 g/L, 240 x 10(6)/L, 10.6 x 10(9)/L, and <20 mg/L, respectively. Of the tests investigated in this study, only serum CRP was capable of distinguishing Gram stain-negative bacterial meningitis from viral meningitis on admission with high sensitivity (96%), high specificity (93%), and high negative predictive value (99%). CONCLUSION: Exclusion of bacterial meningitis with only the conventional tests is difficult. Combined with careful physical examination and CSF analyses, serum CRP measurement affords substantial aid.
Asunto(s)
Proteína C-Reactiva/análisis , Bacterias Gramnegativas , Meningitis Bacterianas/diagnóstico , Meningitis Viral/diagnóstico , Adolescente , Antígenos Virales/análisis , Líquido Cefalorraquídeo/microbiología , Líquido Cefalorraquídeo/virología , Niño , Preescolar , Diagnóstico Diferencial , Humanos , Lactante , Recuento de Leucocitos , Meningitis Bacterianas/sangre , Meningitis Bacterianas/líquido cefalorraquídeo , Meningitis Viral/sangre , Meningitis Viral/líquido cefalorraquídeo , Estudios ProspectivosRESUMEN
OBJECTIVES: Cerebrospinal fluid glutamine and glutamate concentrations were measured by CZE-LIFD in normal and meningitis sick children. DESIGN AND METHODS: A derivatization procedure for glutamine was optimized using CZE-LIFD. Cytochemical and bacteriological analysis were made to 152 CSF from children suspicious of suffering meningitis. RESULTS: CSF-glutamine concentration was lower in children with viral and bacterial meningitis. In addition, the group infected with Haemophilus influenzae had the lowest concentrations. By contrast, glutamate concentration was higher in children with meningitis. Glutamine concentration increased as the clinical condition of the patient improved. CONCLUSIONS: Lower concentrations of glutamine in children with bacterial meningitis might be due to the use of this amino acid for bacterial growth while higher concentrations of glutamate might be due to cell destruction. The results indicate that CZE-LIFD is an alternative tool for the determination of amino acids in CSF.