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: 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

The meningitis occur within a closed anatomic space, so they have many similar clinical features and characteristic CSF abnormalities. But the temporal profile of many meningitis is distinctive from aseptic meningitis with spontaneous remission to bacterial or tuberculous meningitis with fatal outcome without treatment. Therefore early accurate differential diagnosis is required. The development of diagnostic tools and treatment, and increase of immunodeficient state and resistant pathogens have changed the distribution of main pathogens of meningitis from the past. Therefore we analyzed 241 medical records with final diagnosis as 'infectious meningitis' to evaluate the distribution of pathogens in Korea and any differential points of clinical, laboratory, and radiologic, profile according to etiology. 1. The etiologic distributions were followings, Aseptic meningitis in 100 patient(41.5%), tuberculous meningitis in 58 patients(24.1%), bacterial meningitis in 48 patients(19.9%), and fungal in 16 patients(6.6%). 2. The intense seasonal occurrence was noted in aseptic meningitis with summer. 3. Fever and headache were noted in almost all patients Altered mental status were noted in 39.6% of bacterial meningitis, 53.41% of tuberculous meningitis but not in fungal and aseptic meningitis. Meningeal irritation signs were noted in less patients(25%) with fungal meningitis but in more with aseptic, bacterial or tuberculous meningitis m 52-66.7%. Most of all focal neurologic signs were present in bacterial or tuberculous meningitis. 4. Many immunocompromized patients had fungal meningitis, three of which showed normal CSF leukocyte counts And it pointed up the importance of intensive etiologic evaluation in immunodeficient patients with clinically suspected symptoms of meningitis. 5. CSF findings at admission were following. CSF leukocytes were mean 206-258/yL in aseptic, tuberculous or fungal meningitis. But in bacterial meningitis leukocyte counts were greater than 1,000/mL in mom than half of patients. The differential counts of leukocytes were monocyte predominant except in bacterial meningitis. The reductions of CSF sugar were noted in bacterial, tuberculous, or fungal meningitis. Characteristically all patients with extremely low CSF sugar(less than 10mg/dL) had bacterial meningitis. 6. The most frequent pathologic findings in neuroimaging study were hydrocephalus(20patients: 9.1%) and meningeal enhancement(19patient,: 8.6%). Small enhancing mass(8patients: 3.6%.) and focal infarction(8patients: 3.6%) were noted less frequently. These abnormal radiologic findings were noted in 2 patients(2.0%) with aseptic meningitis, 15 patients(38.7%) with bacterial meningitis, 29 patients(50.0%) with tuberculous meningitis and 5 patients(35.7%) with fungal meningitis.
Adult* ; Diagnosis ; Diagnosis, Differential ; Fatal Outcome ; Fever ; Headache ; Humans ; Korea ; Leukocyte Count ; Leukocytes ; Medical Records ; Meningitis* ; Meningitis, Aseptic ; Meningitis, Bacterial ; Meningitis, Fungal ; Monocytes ; Neuroimaging ; Neurologic Manifestations ; Remission, Spontaneous ; Seasons ; Tuberculosis, Meningeal

Advances in neonatal intensive care have improved the chances for survival of extremely low birth weight (ELBW) infants. However, ELBW infants are at high risk of meningitis and resulting neurologic complications. The most common organisms associated with neonatal bacterial meningitis include Listeria monocytogenes, Escherichia coli, and Group B Streptococcus. Bacillus cereus (B. cereus), an organism commonly found in soil, vegetation, and daily products, can sometimes cause meningitis owing to preformed toxins. We report a rare case of meningoencephalitis caused by B. cereus that resulted in a detrimental neurological outcome in an ELBW infant.
Bacillus cereus* ; Escherichia coli ; Humans ; Infant ; Infant, Extremely Low Birth Weight* ; Infant, Low Birth Weight ; Infant, Newborn ; Intensive Care, Neonatal ; Listeria monocytogenes ; Meningitis ; Meningitis, Bacterial ; Meningoencephalitis* ; Soil ; Streptococcus

BACKGROUND: Postoperative bacterial meningitis (PBM) is a serious potential complication after neurosurgery. Early diagnosis and introduction of antimicrobial therapy are necessary to reduce the rate of fatal outcomes from PBM. However, PBM is not easily differentiated from postoperative aseptic meningitis (PAM), which usually has favorable clinical outcomes. Serum procalcitonin (S-PCT) has been found to be a useful marker for distinguishing community-acquired bacterial from viral meningitis. We investigated the predictive performance of S-PCT for PBM in patients who underwent neurosurgery. MATERIALS AND METHODS: Between September 2009 and August 2010, we prospectively collected data from patients who underwent neurosurgery and had cerebrospinal fluid (CSF) pleocytosis within 14 days of surgery. Based on the CSF culture results, patients were categorized as either PBM or PAM cases. We compared the laboratory test results including S-PCT levels between PBM and PAM cases, and investigated the predictive performance of S-PCT for PBM. RESULTS: During the study period, PBM and PAM occurred in 14 and 64 patients, respectively. There was no significant difference in CSF profiles between PBM and PAM cases. S-PCT level > or = 0.15 ng/mL (50.0% vs. 20.0%, P = 0.07) and C-reactive protein (CRP) level > or = 2.5 mg/dL (75.0% vs. 46.5%, P = 0.16) tended to be more frequent in PBM than in PAM cases. A blood white blood cell (B-WBC) count > or = 9,500/mm3 was more frequently found in PBM cases (85.7% vs. 50.8%, P = 0.02) than in PAM cases. For the diagnosis of PBM, an S-PCT level > or = 0.15 ng/mL had a specificity of 80.0%. The combined criteria of a CRP level > or = 2.5 mg/dL, B-WBC count > or = 9,500/mm3, and an S-PCT level > or = 0.15 ng/mL had the highest specificity (92.6%) of all the criteria. An S-PCT level > or =0.15 ng/mL had low sensitivity (50.0%), and the combined criteria of CRP level > or = 2.5 mg/dL, B-WBC count > or = 9,500/mm3, and S-PCT level > or = 0.15 ng/mL had an improved sensitivity of 85.7%. However, the sensitivity did not significantly differ from that of a B-WBC count > or = 9,500/mm3 (85.7%). CONCLUSIONS: S-PCT showed limited performance for the diagnosis of postoperative meningitis. However, it could be a useful adjunct for the improvement of diagnostic sensitivity when used in combination with other inflammatory markers.
Adenosine Deaminase ; C-Reactive Protein ; Early Diagnosis ; Fatal Outcome ; Humans ; Leukocytes ; Leukocytosis ; Meningitis ; Meningitis, Aseptic ; Meningitis, Bacterial ; Meningitis, Viral ; Neurosurgery ; Prospective Studies ; Sensitivity and Specificity

In systemic lupus erythematosus (SLE) patients, immunosuppressive treatment with cytotoxic drugs or corticosteroids, proteinuria, renal insufficiency, and active SLE itself are known as risk factors for serious bacterial infections and opportunistic infections. Several opportunistic infections such as toxoplasmosis, nocardiosis, and cryptococcal meningitis have been reported to occur in patients with SLE and these can mimic neuropsychiatric lupus. Listeria monocytogenes is one of the pathogens of bacterial meningitis that is less commonly identified than Neisseira meningitidis and Streptococcus pneumoniae in adults, and shows the clinical manifestations, such as headache, fever, nausea, vomiting, neck stiffness, mental changes and seizures similar to symptoms and signs of neuropsychiatric lupus. We report a case of Listeria monocytogenes meningitis in a patient with SLE who was admitted because of headache, nausea, vomiting and poor oral intake.
Adrenal Cortex Hormones ; Adult ; Bacterial Infections ; Fever ; Headache ; Humans ; Listeria monocytogenes* ; Listeria* ; Lupus Erythematosus, Systemic* ; Meningitis, Bacterial ; Meningitis, Cryptococcal ; Meningitis, Listeria* ; Nausea ; Neck ; Nocardia Infections ; Opportunistic Infections ; Proteinuria ; Renal Insufficiency ; Risk Factors ; Seizures ; Streptococcus pneumoniae ; Toxoplasmosis ; Vomiting

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*

BACKGROUND: There have been an increasing number of reports about infection-related complications after epidural block, and the analysis of these previous reports may offer valuable information for the prevention and treatment of such complications. METHODS: We searched for complications about infection that was related to epidural blockade procedures by using the Medline Search program. We analyzed the types of infection-related complications as well as the potential risk factors, the time course from symptom development to treatment, the causative organisms and the treatment outcomes. RESULTS: Seventeen cases were identified. The types of complications were epidural abscess, subdural abscess, spinal arachnoiditis, bacterial meningitis and aseptic meningitis. Five patients received a single block and twelve patients received a continuous block with catheterization. The most common site of epidural catheterization was the lumbar area and eight patients had indwelling catheters for less than fifteen days. Eight patients had a diabetes mellitus as a risk factor and fourteen patients showed less than seven days from the development of symptoms to treatment. Eleven patients received laminectomy and intravenous antibiotics as a treatment and eight patients had full recovery without neurological deficit. CONCLUSIONS: Early diagnosis and treatment is essential for the favorable outcome of infection-related complication after epidural block. In addition, absolute sterile technique should always be performed and patient education concerning these potential complications must be accompanied.
Abscess ; Anti-Bacterial Agents ; Arachnoid ; Arachnoiditis ; Catheterization ; Catheters ; Catheters, Indwelling ; Diabetes Mellitus ; Early Diagnosis ; Epidural Abscess ; Humans ; Laminectomy ; Meningitis, Aseptic ; Meningitis, Bacterial ; Patient Education as Topic ; Risk Factors

No abstract available.
Meningitis, Cryptococcal*

Primary disorders of the nervous system admitted to the Pediatric ward of Seoul National University Hospital during 10 years from January 1969 till December 1978 were analysed to observe particularly the annual change of the incidence. Total number of the diseases of the nervous system was 1522, about 20.2% of the total admitted patients during this period. Annual incidence of the diseases of the nervous system was decreasing. It is mainly due to decreased incidence of the infectious diseases, such as tuberculous meningitis, encephalitis and encephalopathy. The most common deseases of the nervous system during the 10 years were tuberculous meningitis 370 cases (24.3%), aseptic meningitis 122 cases (8.0%), grand mal epilepsy 102 cases (6.7%), unspecified convulsion 79 cases (5.2%), bacterial meningitis 77 cases (5.1%), infectious polyneuritis 68 cases (4.5%), encephalitis 63 cases (4.1%), febrile convulsion 59 cases (3.9%), and unspecified encephalopathy 57 cases (3.7%) in the order of frequency. The incidences of tuberculous meningitis was noted in March, April and May, aseotic meningitis in June, July, August and September, encephalitis in September and October, encephalopathy in June, July, and August, and infectious polyneuritis, in July and August. Mumps meningo encephalities predominantly affected male children. Bacterial meningitis was most common before 2 years of age, especially before 6 months, and tuberculous meningitis during second and third year of life. Aseptic meningitis and mumps meningitis wee mots common at 7 years of age. Encephalopathy occured commonly before one year of age, and Reye's syndrome before four years of age. Unspecified convulsion was commonly observeb before 6 months of age, and febrile convulsion before one year. Infectius ployneuritis was common due to meninitis (76 cases) particularly tuberculous meningitis (50 cases), the next was encephalopathy, unspecified (31 cases).
Child ; Communicable Diseases ; Encephalitis ; Epilepsy, Tonic-Clonic ; Humans ; Incidence* ; Male ; Meningitis ; Meningitis, Aseptic ; Meningitis, Bacterial ; Mumps ; Nervous System* ; Neuritis ; Reye Syndrome ; Seizures ; Seizures, Febrile ; Seoul ; Tuberculosis, Meningeal