Objective: Bacterial meningitis is associated with significant morbidity and mortality if not diagnosed and treated early. Isolation of the causative agent from cerebrospinal fluid culture is the gold standard for the diagnosis of this condition; however, it takes several days for results to be available. The FilmArray™ Meningitis/Encephalitis (ME) panel is a nucleic acid-based test that allows simultaneous detection of 14 bacterial, viral, and fungal pathogens in the cerebrospinal fluid with a rapid turnaround time. Our aim was to evaluate the diagnostic performance of the ME panel in detecting bacterial pathogens in the cerebrospinal fluid of adult patients with suspected bacterial meningitis in a tertiary hospital in the Philippines. Methods: We performed a retrospective review of hospital records of adult patients with suspected bacterial meningitis who were admitted at our institution and underwent diagnostic testing with the FilmArray™ ME panel from January 1, 2018 to July 31, 2019. Overall percent agreement, sensitivity, and specificity for individual bacterial pathogens included in the panel were determined. Results: A total of 88 cerebrospinal fluid samples were included in the analysis of diagnostic accuracy. The ME panel demonstrated 93.2% overall agreement, 50% sensitivity for E. coli, and 99–100% specificity in comparison with CSF culture in detecting bacterial pathogens that are included in the ME panel. Conclusion The results show that the FilmArray™ ME panel has high diagnostic accuracy and can be utilized in the rapid diagnosis and targeted treatment of patients with suspected bacterial meningitis.
Meningitis, Bacterial ; Central Nervous System Infections

PURPOSE: To compare the effect of different etiologies in children with central nervous system (CNS) infections on the incidence of initial and hospital-acquired hyponatremia (IH and HAH) (plasma sodium concentration, PNa <135 mEq/L). METHODS: Children with CNS infections during the period between 2011 and 2012 were evaluated retrospectively. Patients were classified into 4 groups: group A, aseptic meningitis; group B, viral meningoencephalitis; group C, bacterial meningitis; group D, tuberculous meningitis. All patients had measured the initial PNa and were retested serially. By the sodium concentration of IV fluid, children were divided into 2 groups: group-I of <0.45% saline in dextrose, and group-II of > or =0.45% saline in dextrose. RESULTS: Of 244 children with CNS infections (group A: 185, group B: 33, group C: 23, and group D: 3), 55 patients (22.5%) revealed IH- or HAH-hyponatremia. IH and HAH was found in 13.1% (32/244) and 9.4% (23/244), respectively. The incidence of IH was significantly higher in group-C (30.4%, P=0.010) than in group-A (9.2%) or group-B (21.2%). HAH was more frequent in group-B (27.3%, P<0.001) and in group-D (66.7%, P=0.001) than in group-A (4.9%) or in group-C (13.0%). Of the patients in group-I, 28.6% (8/28) developed more common HAH compared with 6.9% (15/216) of children in group-II (P<0.001). CONCLUSION: IH and HAH were relatively common in children with CNS infections and their incidences were distinctly different among patients from different etiologies. It seems that the administration of hypertonic saline can help to reduce the incidence of HAH among children with CNS infections. election.
Central Nervous System Infections* ; Central Nervous System* ; Child* ; Glucose ; Humans ; Hyponatremia* ; Incidence ; Meningitis ; Meningitis, Aseptic ; Meningitis, Bacterial ; Meningoencephalitis ; Retrospective Studies ; Sodium ; Tuberculosis, Meningeal

Infectious diseases of the central nervous system (CNS) cause inflammatory processes within the brain and spinal cord that can lead to morbidity and mortality in a high proportion of patients. Pharmacological strategies to dampen inflammation have been investigated, and steroids are one of the adjunctive treatments for bacterial meningitis, tuberculous meningitis, and herpes simplex virus encephalitis. In this paper, we review the recent literature that provides guidelines for the use of steroids in combination with appropriate antimicrobial therapy, and we discuss how systemic steroid treatment is an important aspect of treatment regimens for CNS infectious diseases.
Brain ; Central Nervous System Infections ; Central Nervous System ; Communicable Diseases ; Encephalitis ; Humans ; Inflammation ; Meningitis, Bacterial ; Mortality ; Simplexvirus ; Spinal Cord ; Steroids ; Tuberculosis ; Tuberculosis, Meningeal

Infection still remains a major cause of morbidity and mortality in systemic lupus erythematosus (SLE). Patients with SLE are well known to have an increased risk of various opportunistic infections, which can be fatal. Central nervous system (CNS) infections such as meningitis are rare complications to SLE. On occasion, nonspecific neurologic manifestations of infectious meningitis in SLE patients can be confused with neuropsychiatric lupus. Listeria monocytogenes is a less-commonly identified organism causing meningitis in SLE patients. Here, we describe a case of Listeria monocytogenes meningitis presenting with bilateral abducens nerve (sixth cranial nerve) palsy in a patient with SLE, who was successfully treated with systemic antibiotics.
Abducens Nerve ; Abducens Nerve Diseases ; Anti-Bacterial Agents ; Central Nervous System ; Humans ; Listeria ; Listeria monocytogenes ; Lupus Erythematosus, Systemic ; Meningitis ; Meningitis, Listeria ; Neurologic Manifestations ; Opportunistic Infections ; Paralysis

Since the implementation of conjugate Haemophilus influenzae serotype b (Hib) vaccine, the rate of infections caused by Hib has dramatically decreased, and the proportion of infections caused by non-type b H. influenzae has increased. Cerebral venous sinus thrombosis (CVST) is rare; however, it should be considered as a potential complication of bacterial meningitis. Herein, we report about a child who developed CVST after being diagnosed with H. influenzae serotype f meningitis.
Bacteremia ; Central Nervous System Infections ; Cerebrospinal Fluid ; Child ; Haemophilus influenzae type b ; Haemophilus influenzae ; Haemophilus ; Humans ; Influenza, Human ; Meningitis ; Meningitis, Bacterial ; Meningitis, Haemophilus ; Sepsis ; Serogroup ; Sinus Thrombosis, Intracranial

Advances in the antimicrobials lower the mortality rate in most infectious diseases. But bacterial infections of the CNS is still one of the life-threatening infections. Untreated acute bacterial meningitis is fatal in 70% to 100% of patients. With appropriate antibacterial therapy, the case-fatality rate had been greatly reduced with death occurring principally in the very young the very old, or those with potentially lethal underlying diseases. Early recognition and antimicrobial therapy is mostly desirable. The causes of acute bacterial meningitis vary with age and the clinical setting under which the infection occurs. Empirical antibiotic treatment was started immediately on suspicion of the bacterial meningitis prior to etiologic diagnosis. The most effective and least toxic bactericidal drugs should be selected on the basis of known or predicted susceptibility of the bacterial cause of the disease. After the identification of the specific organism and determination of susceptibilities, effective antimicrobial was administered parenterally at maximum dose. The third-generation cephalosporins(cefotaxime, ceftriaxone, and ceftzidime) offer new advantages in the treatment of meningitis because they are active at the CSF concentraions obtainable. Newer antimicrobials(monobactam and newer quinolones) with improved access and an appropriately focused spectrum for CNS infections will become available.
Bacterial Infections* ; Ceftriaxone ; Central Nervous System* ; Communicable Diseases ; Diagnosis ; Humans ; Meningitis ; Meningitis, Bacterial ; Mortality

BACKGROUND: The aim of this study was to clarify to what extent bacterial meningitis could be distinguished from aseptic or tuberculous meningitis through C-reactive protein (CRP) in adults. METHODS: We retrospectively analyzed the medical records of 91 patients aged 15~81 years who had been hospitalized for acute meningitis and underwent lumbar puncture due to suspected central nervous system infection. RESULTS: We included 50 patients with aseptic meningitis, 23 patients with acute bacterial meningitis, and 18 patients with tuberculous meningitis. Blood CRP was higher in bacterial meningitis. None of the patients with bacterial meningitis had a CRP value of under 20 mg/dl. The CRP values were under 20 mg/dl in 92% of the patients with aseptic meningitis and in 73% of those with tuberculous meningitis. Taking a CRP level of above 20 mg/dl as a positive discriminatory factor for bacterial meningitis, the sensitivity and specificity were 1.0, 0.88. To better predict whether a patient has bacterial or nonbacterial meningitis, we developed a canonical discriminant function equation using CRP and CSF parameter, and finally concluded that blood CRP was a good predictive indicator that differentiated bacterial meningitis from aseptic or tuberculous meningitis at admission. CONCLUSIONS: The CRP measurement, is easily performed and inexpensive. We believe it is worth analyzing CRP whenever meningitis is suspected, it can also limit the unnecessary use of antibiotics.
Adult* ; Anti-Bacterial Agents ; C-Reactive Protein* ; Central Nervous System Infections ; Cerebrospinal Fluid ; Diagnosis, Differential* ; Discriminant Analysis ; Humans ; Medical Records ; Meningitis* ; Meningitis, Aseptic ; Meningitis, Bacterial ; Retrospective Studies ; Sensitivity and Specificity ; Spinal Puncture ; Tuberculosis, Meningeal

Authors report on the general features of postoperative central nervous system infection in patients undergoing neurosurgical procedures. The postoperative central nervous system infection was defined was defined as 1) emergence of purulent material from any site that had been exposed to surgical field, and/or 2) development of meningitis during postoperative recovery period. The materials were obtained from 50 cases of postoperative central nervous system infection out of 1,232 cases of operations that had been performed in neurosurgical department of Seoul National University Hospital during the last three years. Various predisposing factors, associated problems, and therapeutic aspects are discussed. General features of hospital infection are also considered.
Anti-Bacterial Agents ; Causality ; Central Nervous System Infections* ; Central Nervous System* ; Cross Infection ; Humans ; Meningitis ; Neurosurgical Procedures ; Seoul ; Wound Infection

A retrospective study involved 110 patients (72 males, 38 females, aged from 1 - 76 years) who underwent surgery for brain abscesses at ViÖt -§øc Hospital from January 1990 to December 1993. 79 patients with brain abscesses were found bacteria in culture. The bacteria were not identified in 31 patients. Results: Rate of bacterial isolation in brain abscesses is quite high. Among these, streptococci make up 37.7%, staphylococci 23.8%, and anaerobic bacteria 17.5%. Streptococci and staphylococci are cause of more than 90% of secondary brain abscesses due to localized infection. Postoperative antibiotics reduced significantly the bacterial isolation rate, comparison with that rate of 87.5% on patients who have not used antibiotics before operation. Rate of recurrence is 7.6% in the patients who were isolated bacteria and 25.8% in the patients who were not identified bacteria.
Brain Abscess ; Central Nervous System Bacterial Infections ; Bacterial Infections

PURPOSE: The aim of this study was to investigate the causative organisms, clinical manifestations, and prognosis of pediatric patients with bacterial meningitis in Daejeon and Chungcheong area, occurred from 2006 to 2010. METHODS: We retrospectively reviewed medical records of patients aged between 1 month and 15 years, diagnosed with bacterial meningitis at 8 university or general hospitals in Daejeon and Chungcheong area. The bacterial meningitis was defined by isolation of organism from cerebrospinal fluid(CSF). The data was collected from January 2006 to December 2010, and analyzed including patient's demographics, causative organisms, clinical presentation, laboratory findings and complications. RESULTS: During the 5-year study period, 24 patients were diagnosed with CSF culture-proven bacterial meningitis. The most common causative organism was Streptococcus pneumoniae (S. pneumoniae, 37.5%), and the others were group B streptococcus (GBS, 20.8%), Escherichia coli (E. coli, 16.7%), Neisseria meningitidis (N. meningitidis, 8.3%), Haemophilus influenzae (H. influenzae, 4.2%), respectively. They initially complained of fever (95.8%), vomiting (83.3%), anorexia (45.8%), seizure (29.2%), headache (20.8%). The leukocyte counts exceeding 1,000/mm3 in CSF was observed in 14 patients (58.3%). In 15 patients (62.5%), the glucose concentration in CSF was less than 50 mg/dL, 18 patients showed that the protein concentration in CSF was more than 100 mg/dL. Long-term neurologic sequelae were observed in 4 patients (16.7%) and described as hearing disturbance (2 patients), hemiparesis (1 patient) and endocrine dysfunction (1 patient). Ten patients (41.7%) showed abnormal neuroradiologic findings and the most common abnormalities was subdural effusion (25.0%). CONCLUSION: Compared to the previous study performed between 2001 and 2005, S. pneumonia continued to be the leading cause of the pediatric bacterial meningitis in Daejeon and Chungcheong area. The frequency of pneumococcal meningitis was not decreased, despite of the introduction of conjugated pneumococcal vaccination. On the other hand, H. influenzae meningitis was notably decreased.
Anorexia ; Demography ; Escherichia coli ; Fever ; Glucose ; Haemophilus influenzae ; Hand ; Headache ; Hearing ; Hospitals, General ; Humans ; Influenza, Human ; Leukocyte Count ; Medical Records ; Meningitis ; Meningitis, Bacterial* ; Meningitis, Pneumococcal ; Neisseria meningitidis ; Paresis ; Pneumonia ; Prognosis ; Retrospective Studies ; Seizures ; Streptococcus ; Streptococcus pneumoniae ; Subdural Effusion ; Vaccination ; Vomiting