Bilateral sensorineural hearing loss (SNHL) is a relatively well-recognized complication of bacterial meningitis, but is a rare initial manifestation in acute cryptococcal meningitis. We report a case of cryptococcal meningitis initially presenting with bilateral SNHL. Cryptococcal meningitis should be included in the differential diagnosis of abrupt-onset bilateral SNHL.
Diagnosis, Differential ; Hearing Loss, Sensorineural* ; Meningitis, Bacterial ; Meningitis, Cryptococcal*

We report herein a case of meningitis due to Streptococcus viridans that occurred after epidural nerve block. The low virulence of S. viridans resulted in milder clinical symptoms and signs than are usually observed for bacterial meningitis, thus mimicking viral meningitis. The infection may have originated from the oral cavity of the medical personnel, and so S. viridans infection should be included in the differential diagnosis of meningitis subsequent to spinal manipulation.
Diagnosis, Differential ; Manipulation, Spinal ; Meningitis ; Meningitis, Bacterial ; Meningitis, Viral ; Mouth ; Nerve Block ; Streptococcus ; Viridans Streptococci

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

Encephaloceles are congenital defects in the skull through which menings and brain tissues herniated. Basal encephaloceles are found in 1 in 40,000 live births. Transsphenoidal basal encephaloceles are very rare, accounting for only 5% of all basal encephaloceles. Currently, most encephaloceles are diagnosed antenatally and present at birth. Postnatally, infants may present with CSF rhinorrhea, recurrent meningitis, headache, hypothalamic- pituitary dysfunction. Some, particularly trasnssphenoidal encephaloceles are often clinically occult and diagnosis of the disease may be postponed up to adulthood. Surgical indications and approaches for transsphenoidal encephaloceles have been remained controversial. We report a case of CSF rhinorrhea and recurrent meningitis caused by transsphenoidal encephalocele.
Brain ; Congenital Abnormalities ; Diagnosis ; Encephalocele* ; Headache ; Humans ; Infant ; Live Birth ; Meningitis ; Meningitis, Bacterial* ; Parturition ; Skull

The usefullness of the nitroblue tetrazolium (NBT) test as an aid in the differential diagnosis of various meningitis was evaluated in infancy and childhood. 36 cases of patients with various meningitis who were admitted to the department of pediatrics in Severance Hospital from June, 1975 to March, 1976 and 8 cases of healthy children as control were the subject of this study. The following results were observed; the mean proportion of NBT-positive neutrophils was 4.0?2.0% in healthy control group, 17.0?.7% in patients with bacterial meningitis, 6.0?.3% in tuberculous menigitis, and 5.o?,1% in aspetic meningitis. And we couclued that NBT test is useful in differenciating various form of meningitis.
Child ; Diagnosis, Differential* ; Humans ; Meningitis ; Meningitis, Bacterial ; Neutrophils ; Nitroblue Tetrazolium ; Pediatrics

PURPOSE: This study was launched to classify subjects of the CSF examination and improve early diagnosis of meningitis and its treatment in children who have had a first febrile seizure. METHODS: From March 1995 to September 2003, children aged 3 months to 5 years who had had treatment for febrile seizure were analyzed as to their age at first seizure, type of seizure, CSF examination, and prevalence of meningitis. RESULTS:The largest age group distribution among the 780 children was 356(45.6%) children who were under 18 months. One hundred ninteen(15.3%) patients received the CSF examination, and out of those 68(19.1%) were less than 18 months old. Twenty five(3.2%) children were diagnosed with meningitis; those less than 18 months old were 15(4.2%). Two(0.2%) were diagnosed as bacterial meningitis. Out of 780 patients 599(76.8%) were simple febrile seizure patients. Out of 32(5.3%) who received the CSF examination, nine were diagnosed as meningitis. In complex febrile seizure, 86(52.1 %) out of 165(21.2%) received CSF examinations and 16(9.7%) of those were diagnosed as meningitis. Thus, there was a higher prevalence of meningitis in children presenting complex febrile seizure. CONCLUSION: To diagnose meningitis with the CSF examination in the first febrile seizure, the patient's general condition, such as clinical symptoms and types of seizure, are more important than the ages of the patients. We suggest that experienced physicians should be concerned with doing an early diagnosis of meningitis and thus reduce the number of CSF examinations of children with febrile seizures.
Cerebrospinal Fluid ; Child ; Early Diagnosis ; Humans ; Infant ; Meningitis ; Meningitis, Bacterial ; Prevalence ; Seizures ; Seizures, Febrile*

PURPOSE: To identify the factors associated with differential diagnosis of neonatal bacterial meningitis at the earliest opportunities possible and to evaluate the value of the bacterial meningitis score especially in neonates. METHODS: We conducted a single-center, retrospective study of neonates diagnosed meningitis at our hospital between January 2000 and March 2014. We compared the general characteristics, clinical manifestations, laboratory findings, bacterial meningitis scores between the bacterial group and the aseptic group. RESULTS: Bacterial meningitis differs significantly from aseptic meningitis in platelet count, the cerebrospinal fluid polymorphonuclear leukocyte count, and the serum protein including also the albumin (P<0.05). Except two infants, the bacterial meningitis score over 2 accurately predict bacterial meningitis in the other 11 infants. CONCLUSION: The bacterial meningitis score appears highly useful to identify neonatal infants with bacterial meningitis. However, its diagnostic and prognostic value is just ‘adjunctive’, because low score cannot rule out bacterial meningitis.
Cerebrospinal Fluid ; Diagnosis, Differential ; Humans ; Infant ; Infant, Newborn* ; Meningitis* ; Meningitis, Aseptic ; Meningitis, Bacterial* ; Neutrophils ; Platelet Count ; Retrospective Studies

BACKGROUND: The enteroviruses are the most common etiologic agent of aseptic meningitis in adults and children. The incidence of enteroviral meningitis in childhood meningitis is up to 80%, but in adults is not known, worldwidely. In Korea, where tuberculosis is endemic, the rapid and accurate diagnostic method for enteroviral meningitis is required especially because early differential diagnosis of viral meningitis from tuberculous meningitis is very important. The aims of this study were the demonstration of enteroviruses from cerebrospinal fluid (CSF) of adult patients with aseptic meningitis by PCR/Southern hybridization and the verification of the usefulness of PCR/southern hybridization as a rapid diagnostic tool. METHODS: From July 1992 to June 1995, total 34 CSF samples (10 from children, 24 from adults) of patients with aseptic meningitis were studied. As a control group, 15 patients with tuberculous meningitis and 15 patients with bacterial meningitis were studied. Viral RNA was extracted from CSF, reverse transcriptied into cDNA and amplified. The PCR products were Southern hybridizied with enteroviruses-specific digoxigenin-labelled probe. RESULTS: 16/24(66.7%) samples of adult patients with aseptic meningitis were positive for enteroviruses, while in child patients with aseptic meningitis, 9/10(90%) samples were positive. And in one patient, PCR was positive from asymptomatic, onset-7th day CSF sample. CONCLUSION: Enteroviruses were the most common causative organisms of adult aseptic meningitis in Korea. And, this study showed the usefulness of PCR/Southern hybridization of enteroviruses from CSF for etiologic diagnosis of adult aseptic meningitis in subclinical, asymptomatic period.
Adult* ; Cerebrospinal Fluid* ; Child ; Diagnosis ; Diagnosis, Differential ; DNA, Complementary ; Enterovirus* ; Humans ; Incidence ; Korea ; Meningitis ; Meningitis, Aseptic* ; Meningitis, Bacterial ; Meningitis, Viral ; Polymerase Chain Reaction ; RNA, Viral ; Tuberculosis ; Tuberculosis, Meningeal

PURPOSE: The widespread introduction of bacterial conjugate vaccines has decreased the risk of cerebrospinal fluid (CSF) pleocytosis due to bacterial meningitis (BM) in children. However, most patients with CSF pleocytosis are hospitalized and treated with parenteral antibiotics for several days. The bacterial meningitis score (BMS) is a validated multivariate model derived from a pediatric population in the postconjugate vaccine era and has been evaluated in several studies. In the present study, we examined the usefulness of BMS in South Korean patients. METHODS: This study included 1,063 patients with CSF pleocytosis aged between 2 months and 18 years. The BMS was calculated for all patients, and the sensitivity and negative predictive value (NPV) of the test were evaluated. RESULTS: Of 1,063 patients, 1,059 (99.6%) had aseptic meningitis (AM). Only four patients (0.4%) had BM. The majority of patients (98%) had a BMS of < or =1, indicating a diagnosis of AM. The BMS was 0 in 635 patients (60%) and 1 in 405 patients (38%). All four BM patients had a BMS of > or =4. CONCLUSION: To our knowledge, this is the first study to investigate the diagnostic strength of the BMS in South Korea. In our study, the BMS showed 100% sensitivity and 100% NPV. Therefore, we believe that the BMS is a good clinical prediction rule to identify children with CSF pleocytosis who are at a risk of BM.
Anti-Bacterial Agents ; Cerebrospinal Fluid* ; Child* ; Decision Support Techniques ; Diagnosis ; Humans ; Korea ; Leukocytosis* ; Meningitis, Aseptic ; Meningitis, Bacterial* ; Vaccines, Conjugate

PURPOSE: Despite the advent of new and more potent antibiotics, mortality and morbidity rates due to bacterial meningitis remain stagnant. Rapid detection of microorganism and early antibiotics treatment are the most important prognostic factors of bacterial meningitis. For early diagnosis of bacterial meningitis biochemical markers such as lactic dehydrogenase, lactic acid, C-reactive proteia have been measured in cerebrospinal fluid. Ferritin is a large, spherical molecule with propensity for oligomer formation, which causes low concentration in cerebrospinal fluid. METHODS: From May 1996 to July 1999, cerebrospinal fluid(CSF) ferritin was serially measured in 84 children who were admitted to Chonnam Natuional University Hospital Pediatric Department for evaluation of the diagnostic value of CSF ferritin in bacterial meningitis. They were divided into three groups-control(20), aseptic(40), bacterial(24)-according to inclusion criteria for each group. RESULTS: CSF ferritin level in bacterial meningitis(52.94+/-3.19ng/mL) was much higher than those of aseptic(5.26+/-2.07ng/mL), and control(3.01+/-2.52ng/mL) groups(P<0.05). CSF ferritin level of 9.20ng/mL was suggested as a cut-off value for bacterial meningitis on ROC curve(sensitivity: 92 %, specificity:81%). CSF ferritin levels were positively correlated with CSF WBC(r=0.699) and protein(r=0.734) and negatively correlated with CSF glucose(r=-0.609) (P<0.01). CONCLUSION: CSF ferritin could be a good indicator for bacterial meningitis in children.
Anti-Bacterial Agents ; Biomarkers ; Cerebrospinal Fluid* ; Child* ; Early Diagnosis ; Ferritins* ; Humans ; Jeollanam-do ; Lactic Acid ; Meningitis* ; Meningitis, Bacterial ; Mortality ; Oxidoreductases