MyMedR

A study was undertaken to determine the relationship of presenting features and outcome in primary childhood meningitis at the Paediatric Department, University Hospital, Kuala Lumpur from January 1980 to December 1989. A total of 177 cases of primary childhood meningitis admitted during the study period were analysed retrospectively. One hundred and nine cases (61.6%) had complete recovery, 49 cases (27.7%) recovered with residual complications and 19 cases (10.7%) died. The mean duration of illness of those with complete recovery, residual complications and acute mortality was 4.8 days, 9.6 days and 7.6 days respectively (p < 0.05). Neurological signs were more common in those with mortality and morbidity i.e. 89% and 78% respectively as compared to those who had complete recovery (58%). There was significant correlation between outcome and haemoglobin level on admission (complete recovery 11 gm%, residual complications 10.4 gm%, mortality 9.6 gm% with p < 0.05), mean CSF sugar content (complete recovery 2.2 mmol/l, residual complications 1.5 mmol/l, mortality l.1 mmol/l, p < 0.00001), and mean CSF protein level (complete recovery 168 mg%, residual complications 321 mg%, mortality 344 mg%, p < 0.001). Gram positive organisms were associated with higher mortality and morbidity i.e. 24% and 40%, as compared to gram negative organisms 12% and 31% respectively. There was no significant correlation' between age, sex, peripheral and CSF white cell count with outcome illness. Our data show that prolonged duration of illness, presence of neurological signs, low haemoglobin level, low CSF sugar content, high CSF protein level, and gram positive organisms were associated with poorer outcome of childhood meningitis.

Matched MeSH terms: Meningitis/complications*; Meningitis/microbiology; Meningitis/therapy*

Fulltext Meningitis due to Listeria monocytogenes

Halim AJ, Lim VKE

Med J Malaysia, 1982 Jun;37(2):191-3.

PMID: 6813660

To our knowledge, meningitis due to Listeria monocytogenes has not previously been reported in Malaysia. We describe here two infants with meningitis due to Listeria monocytogenes occurring within a month of each other in the Universiti Kebangsaan Malaysia Paediatric Unit. The incidence of listeriosis in Malaysia is unknown and it is possible that this infection may have been missed in the past.

Matched MeSH terms: Meningitis, Listeria/etiology*

Cryptococcal meningitis (torulosis)

Poopalasingam T

Med J Malaya, 1967 Jun;21(4):337-43.

PMID: 4230501

Matched MeSH terms: Meningitis*

Meningitis due to atypical Mycobacteria

CHAN KE, PATHMANATHAN T

Med J Malaya, 1961 Mar;15:113-6.

PMID: 13878004

Matched MeSH terms: Meningitis/microbiology*

Cryptococcosis in the University Hospital, Kuala Lumpur and review of published cases

Pathmanathan R, Soo-Hoo Tuck Soon

Trans R Soc Trop Med Hyg, 1982;76(1):21-4.

PMID: 7080152

Between January 1974 and June 1980, 85 cases of cryptococcosis were diagnosed in the University Hospital, Kuala Lumpur, Malaysia. The diagnosis was based on positive culture of the organism in 81 cases; the remaining four were diagnosed on histopathological findings. Cerebral cryptococcosis was the most common presentation and Chinese are particularly susceptible (72% of cases). The incidence of the disease is shown to be far greater than previously suspected. Association with compromised host status is uncommon (14%). The local literature is briefly reviewed and the findings discussed.

Matched MeSH terms: Meningitis/etiology; Meningitis/epidemiology

Fulltext Lumbar puncture refusal in febrile convulsion

Ling SG, Boey CC

Singapore Med J, 2000 Oct;41(10):485-8.

PMID: 11281439

A descriptive study was carried out on patients admitted for febrile convulsion over a two-year period to determine rate of lumbar puncture (LP) refusal, factors associated with LP refusal and outcome of such patients. From 77 patients indicated and requested for LP, 19 (25%) patients refused the procedure. Refusal of LP was significantly more common among the Malay ethnic group (p = 0.01) but not significantly associated with age,gender or whether the patient was admitted for a first or recurrent febrile convulsion. Half of the patients who refused LP had to be started empirically on antibiotics for meningitis. Patients who refused LP were also 8.5 times more likely to discharge themselves "at own risk" (AOR), compared to other patients with febrile convulsion (p = 0.004). In conclusion, LP refusal is a common problem in the local setting and is a hindrance to the proper management of patients with fever and seizure. Appropriate measures must be carried out to educate the public, particularly those from the Malay ethnic group on the safety and usefulness of the procedure. Reasons for patients discharging AOR following LP refusal also need to be addressed and problems rectified.

Matched MeSH terms: Meningitis/diagnosis; Meningitis/therapy

Vaccination in Southeast Asia--reducing meningitis, sepsis and pneumonia with new and existing vaccines

Richardson A, Morris DE, Clarke SC

Vaccine, 2014 Jul 16;32(33):4119-23.

PMID: 24907487 DOI: 10.1016/j.vaccine.2014.05.062

Streptococcus pneumoniae, Haemophilus influenzae type b and Neisseria meningitidis are leading causes of vaccine-preventable diseases such as meningitis, sepsis and pneumonia. Although there has been much progress in the introduction of vaccines against these pathogens, access to vaccines remains elusive in some countries. This review highlights the current S. pneumoniae, H. influenzae type b, and N. meningitidis immunization schedules in the 10 countries belonging to the Association of Southeast Asian Nations (ASEAN). Epidemiologic studies may be useful for informing vaccine policy in these countries, particularly when determining the cost-effectiveness of introducing new vaccines.

Matched MeSH terms: Meningitis, Haemophilus/prevention & control; Meningitis, Meningococcal/prevention & control; Meningitis, Pneumococcal/prevention & control

Observations on the laboratory diagnosis of cerebral torulosis (cryptococcosis)

LIM TW, CHAN KE

Med J Malaya, 1962 Mar;16:193-205.

PMID: 14465296

Matched MeSH terms: Meningitis, Cryptococcal*

Treatment of acute bacterial meningitis in children

Sindhu SS

Med J Malaya, 1966 Sep;21(1):90-4.

PMID: 4224885

Matched MeSH terms: Meningitis/drug therapy*

Fulltext Global, regional, and national burden of meningitis and its aetiologies, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019

GBD 2019 Meningitis Antimicrobial Resistance Collaborators

Lancet Neurol, 2023 Aug;22(8):685-711.

PMID: 37479374 DOI: 10.1016/S1474-4422(23)00195-3

BACKGROUND: Although meningitis is largely preventable, it still causes hundreds of thousands of deaths globally each year. WHO set ambitious goals to reduce meningitis cases by 2030, and assessing trends in the global meningitis burden can help track progress and identify gaps in achieving these goals. Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we aimed to assess incident cases and deaths due to acute infectious meningitis by aetiology and age from 1990 to 2019, for 204 countries and territories.

METHODS: We modelled meningitis mortality using vital registration, verbal autopsy, sample-based vital registration, and mortality surveillance data. Meningitis morbidity was modelled with a Bayesian compartmental model, using data from the published literature identified by a systematic review, as well as surveillance data, inpatient hospital admissions, health insurance claims, and cause-specific meningitis mortality estimates. For aetiology estimation, data from multiple causes of death, vital registration, hospital discharge, microbial laboratory, and literature studies were analysed by use of a network analysis model to estimate the proportion of meningitis deaths and cases attributable to the following aetiologies: Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae, group B Streptococcus, Escherichia coli, Klebsiella pneumoniae, Listeria monocytogenes, Staphylococcus aureus, viruses, and a residual other pathogen category.

FINDINGS: In 2019, there were an estimated 236 000 deaths (95% uncertainty interval [UI] 204 000-277 000) and 2·51 million (2·11-2·99) incident cases due to meningitis globally. The burden was greatest in children younger than 5 years, with 112 000 deaths (87 400-145 000) and 1·28 million incident cases (0·947-1·71) in 2019. Age-standardised mortality rates decreased from 7·5 (6·6-8·4) per 100 000 population in 1990 to 3·3 (2·8-3·9) per 100 000 population in 2019. The highest proportion of total all-age meningitis deaths in 2019 was attributable to S pneumoniae (18·1% [17·1-19·2]), followed by N meningitidis (13·6% [12·7-14·4]) and K pneumoniae (12·2% [10·2-14·3]). Between 1990 and 2019, H influenzae showed the largest reduction in the number of deaths among children younger than 5 years (76·5% [69·5-81·8]), followed by N meningitidis (72·3% [64·4-78·5]) and viruses (58·2% [47·1-67·3]).

INTERPRETATION: Substantial progress has been made in reducing meningitis mortality over the past three decades. However, more meningitis-related deaths might be prevented by quickly scaling up immunisation and expanding access to health services. Further reduction in the global meningitis burden should be possible through low-cost multivalent vaccines, increased access to accurate and rapid diagnostic assays, enhanced surveillance, and early treatment.

FUNDING: Bill & Melinda Gates Foundation.

Matched MeSH terms: Meningitis*

Cryptococcus humicolus meningitis: first case report in Malaysia

Ramli SR, Leong MC, Khaithir TM, Aziz MN, Loons LC, Rafia MH

Southeast Asian J. Trop. Med. Public Health, 2012 Sep;43(5):1212-7.

PMID: 23431829

We report a case of Cryptococcus humicolus meningitis complicated by communicating hydrocephalus in an apparently immunocompetent 49-year-old psychiatric patient from a nursing home. He presented with a history of poor oral intake, weight loss, headache, vomiting, blurred vision, frequent falls and unsteady gait for the previous three months. He had a history of chronic cough, productive of whitish sputum for the previous month but no hemoptysis. Cerebrospinal fluid culture was positive for Cryptococcus humicolus. He was treated with intravenous amphotericin B and oral fluconazole and had clinical and microbiological improvement after three weeks of treatment. Unfortunately, the patient acquired nosocomial methicillin-resistant Staphylococcus aureus infection and died due to overwhelming sepsis.

Matched MeSH terms: Meningitis, Fungal/complications*; Meningitis, Fungal/drug therapy; Meningitis, Fungal/microbiology*

Fulltext In Vitro Analysis of Metabolites Secreted during Infection of Lung Epithelial Cells by Cryptococcus neoformans

Liew KL, Jee JM, Yap I, Yong PV

PLoS One, 2016;11(4):e0153356.

PMID: 27054608 DOI: 10.1371/journal.pone.0153356

Cryptococcus neoformans is an encapsulated basidiomycetous yeast commonly associated with pigeon droppings and soil. The opportunistic pathogen infects humans through the respiratory system and the metabolic implications of C. neoformans infection have yet to be explored. Studying the metabolic profile associated with the infection could lead to the identification of important metabolites associated with pulmonary infection. Therefore, the aim of the study was to simulate cryptococcal infection at the primary site of infection, the lungs, and to identify the metabolic profile and important metabolites associated with the infection at low and high multiplicity of infections (MOI). The culture supernatant of lung epithelial cells infected with C. neoformans at MOI of 10 and 100 over a period of 18 hours were analysed using gas chromatography mass spectrometry. The metabolic profiles obtained were further analysed using multivariate analysis and the pathway analysis tool, MetaboAnalyst 2.0. Based on the results from the multivariate analyses, ten metabolites were selected as the discriminatory metabolites that were important in both the infection conditions. The pathways affected during early C. neoformans infection of lung epithelial cells were mainly the central carbon metabolism and biosynthesis of amino acids. Infection at a higher MOI led to a perturbance in the β-alanine metabolism and an increase in the secretion of pantothenic acid into the growth media. Pantothenic acid production during yeast infection has not been documented and the β-alanine metabolism as well as the pantothenate and CoA biosynthesis pathways may represent underlying metabolic pathways associated with disease progression. Our study suggested that β-alanine metabolism and the pantothenate and CoA biosynthesis pathways might be the important pathways associated with cryptococcal infection.

Matched MeSH terms: Meningitis, Cryptococcal/metabolism*; Meningitis, Cryptococcal/microbiology; Meningitis, Cryptococcal/pathology

Fulltext Risk factors for Streptococcus suis infection: A systematic review and meta-analysis

Rayanakorn A, Goh BH, Lee LH, Khan TM, Saokaew S

Sci Rep, 2018 09 06;8(1):13358.

PMID: 30190575 DOI: 10.1038/s41598-018-31598-w

Streptococcus suis (S. suis) is a gram-positive bacterial pathogen in pigs which can cause serious infections in human including meningitis, and septicaemia resulting in serious complications. There were discrepancies between different data and little is known concerning associated risk factors of S. suis. A systematic review and meta-analysis was conducted to investigate on S. suis infection risk factors in human. We searched eight relevant databases using the MeSH terms "Streptococcus suis" OR "Streptococcus suis AND infection" limited in human with no time nor language restriction. Out of 4,999 articles identified, 32 and 3 studies were included for systematic review and meta-analysis respectively with a total of 1,454 Streptococcus suis cases reported. S. suis patients were generally adult males and the elderly. The mean age ranged between 37 to 63 years. Meningitis was the most common clinical manifestation, and deafness was the most common sequelae found among survivors followed by vestibular dysfunction. Infective endocarditis was also noted as among the most common clinical presentations associated with high mortality rate in a few studies. Meta-analyses categorized by type of control groups (community control, and non-S. suis sepsis) were done among 850 participants in 3 studies. The combined odd ratios for studies using community control groups and non-S. Suis sepsis as controls respectively were 4.63 (95% CI 2.94-7.29) and 78.00 (95% CI 10.38-585.87) for raw pork consumption, 4.01 (95% CI 2.61-6.15) and 3.03 (95% CI 1.61-5.68) for exposure to pigs or pork, 11.47, (95% CI 5.68-23.14) and 3.07 (95% CI 1.81-5.18) for pig-related occupation and 3.56 (95% CI 2.18-5.80) and 5.84 (95% CI 2.76-12.36) for male sex. The results were found to be significantly associated with S. suis infection and there was non-significant heterogeneity. History of skin injury and underlying diseases were noted only a small percentage in most studies. Setting up an effective screening protocol and public health interventions would be effective to enhance understanding about the disease.

Matched MeSH terms: Meningitis, Bacterial/microbiology; Meningitis, Bacterial/epidemiology*; Meningitis, Bacterial/prevention & control; Meningitis, Bacterial/transmission

Fulltext Salmonella meningitis in a paediatric patient caused by Salmonella enterica serotype Houtenae

Nimir AR, Ibrahim R, Ibrahim IA

BMJ Case Rep, 2011;2011.

PMID: 22689601 DOI: 10.1136/bcr.04.2011.4096

The authors report a case of a 6-week-old baby girl who was admitted to the paediatric ward due to a high fever for 2 days. The patient experienced three fits which took place while in the ward. A brain sonogram showed subdural heterogeneous collection consistent with focal empyema; however, no hydrocephalus or infarction was detected. An urgent Burr hole procedure was performed to remove the collected pus. Both blood and cerebrospinal fluid (CSF) culture grew Salmonella species which remain sensitive to some antibiotics. This strain was sent to the institute of medical research (IMR) for serotyping. The patient was treated with intravenous combination of ceftriaxone and ciprofloxacin for 3 weeks. One week later, IMR sent results that identified the strain as Salmonella enterica serotype Houtenae. Following antibiotic treatment, repeat ultrasound illustrated an improvement of the subdural empyema, and the gram stain of the CSF specimen failed to isolate bacteria.

Matched MeSH terms: Meningitis, Bacterial/microbiology*

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