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30 ud af 30 tidsskrifter valgt, søgeord (meningitis; encephalitis; hjerneabsces; brain abscess; neuroborreliose; neuroborreliosis; spinalvÃ¦ske; spinal fluid; lumbalpunktur; lumbar puncture) valgt, emner højest 60 dage gamle, sorteret efter nyeste først. Opdateret for 1 time siden.
22 emner vises.
The American Journal of Tropical Medicine and Hygiene: Most Recent Articles, 4.12.2019
Tilføjet 05.12.2019 14:40
Serologic Evidence of Zoonotic Alphaviruses in Humans from an Indigenous Community in the Peruvian Amazon
Alphaviruses (Togaviridae, Alphavirus) are arthropod-borne single-stranded RNA pathogens that cause febrile and neurologic disease in much of Latin America. However, many features of Alphavirus epidemiology remain unknown. In 2011, we undertook a cross-sectional study in Nueva Esperanza, an indigenous community in the Peruvian Amazon. Here, we present the first serologic evidence of Mayaro (MAYV), Venezuelan equine encephalitis (VEE) complex alphavirus, Una (UNAV), and Madariaga (MADV) viruses reported in humans (24%, 16%, 13%, and 1.5%, respectively) from an Amazonian indigenous community in Peru. Hunting activity and cohabiting with hunters were the main risk factors for Mayaro seroconversion, but only hunting was associated with UNAV seropositivity. Our results suggest that alphavirus infection in this region is common, but we highlight the high UNAV seroprevalence found and corroborate the low MADV prevalence reported in this region. Furthermore, MAYV-neutralizing antibodies were also detected in stored samples from wild animals (18%) hunted by Nueva Esperanza inhabitants and another mestizo community located close to Iquitos. Further serological surveys of VEE complex alphaviruses, UNAV, and MADV in wild animals and assessing the ability of the MAYV seropositive species to transmit the virus will be relevant.
Latest Results for BMC Infectious Diseases, 2.12.2019
Tilføjet 02.12.2019 16:47
Clinical prediction and diagnosis of neurosyphilis in HIV-negative patients: a case-control study
Early diagnosis and treatment of neurosyphilis is of great significance for regression. There is no gold standard for the diagnosis of neurosyphilis. We did this study to explore the factors associated with the clinical diagnosis of neurosyphilis and assess their accuracy for the diagnosis of neurosyphilis.
We retrospectively reviewed 100 cases of syphilis patients who underwent lumbar puncture at a major dermatology hospital in Guangzhou, China between April 2013 and November 2016. Fifty patients who were clinically diagnosed with neurosyphilis were selected as case group. Control group consisted of 50 general syphilis patients who were matched with age and gender. The records of patients were reviewed to collect data of socio-demographic information, clinical symptom, and laboratory indicators. Multivariable logistic regression was used to explore diagnostic indictors, and ROC analysis was used to assess diagnostic accuracy.
Neurological symptoms (odds ratio (OR) = 59.281, 95% CI:5.215–662.910, P = 0.001), cerebrospinal fluid (CSF) Treponema pallidum particle agglutination (TPPA) titer (OR = 1.004, 95% CI:1.002–1.006, P
Latest Results for BMC Infectious Diseases, 29.11.2019
Tilføjet 29.11.2019 21:01
Meningitis gone viral: description of the echovirus wave 2013 in Germany
Aseptic meningitis epidemics may pose various health care challenges.
We describe the German enterovirus meningitis epidemics in the university hospital centers of Düsseldorf, Cologne and Berlin between January 1st and December 31st, 2013 in order to scrutinize clinical differences from other aseptic meningitis cases.
A total of 72 enterovirus (EV-positive) meningitis cases were detected in our multicenter cohort, corresponding to 5.8% of all EV-positive cases which were voluntarily reported within the National Enterovirus surveillance (EVSurv, based on investigation of patients with suspected aseptic meningitis/encephalitis and/or acute flaccid paralysis) by physicians within this period of time. Among these 72 patients, 38 (52.8%) were enterovirus positive and typed as echovirus (18 pediatric and 20 adult cases, median age 18.5 years; echovirus 18 (1), echovirus 2 (1), echovirus 30 (31), echovirus 33 (1), echovirus 9 (4)). At the same time, 45 aseptic meningitis cases in our cohort were excluded to be due to enteroviral infection (EV-negative). Three EV-negative patients were tested positive for varicella zoster virus (VZV) and 1 EV-negative patient for herpes simplex virus 2. Hospitalization was significantly longer in EV-negative cases. Cerebrospinal fluid analysis did not reveal significant differences between the two groups. After discharge, EV-meningitis resulted in significant burden of sick leave in our pediatric cohort as parents had to care for the children at home.
Voluntary syndromic surveillance, such as provided by the EVSurv in our study may be a valuable tool for epidemiological research. Our analyses suggest that EV-positive meningitis predominantly affects younger patients and may be associated with a rather benign clinical course, compared to EV-negative cases.
Latest Results for BMC Infectious Diseases, 29.11.2019
Tilføjet 29.11.2019 21:01
Characteristics and outcome of influenza-associated encephalopathy/encephalitis among children in a tertiary pediatric hospital in Italy, 2017–2019
Influenza is the most frequent cause of acute upper respiratory tract infections during winter season. Although rare, neurological manifestations are known to occur during influenza infection and approximatively three-quarters of cases are in children. In this study, we aimed to characterize the burden and clinical spectrum of influenza-associated encephalopathy and encephalitis in children admitted at a tertiary pediatric hospital in Italy over two influenza seasons (2017–2019).
We retrospectively analyzed clinical, laboratory, instrumental data and outcome of patients discharged with ICD9-CM 487.0 code.
Fifteen children (13.1% of those discharged with a diagnosis of influenza infection in the study period), had influenza-associated central nervous system (CNS) manifestations. Eight patients (53.3%) were diagnosed as influenza encephalitis, 7 (46.7%) as influenza encephalopathy. Median age was 27 months. In children under 2 years of age (40% of all cases) altered consciousness was the most frequent neurological manifestation while respiratory symptoms were present at admission in all cases. Younger children also required intensive care support more frequently. Five subjects (33.3%) presented comorbidity. None of the patients had received seasonal influenza vaccination. The median time from onset of respiratory signs to onset of neurological manifestations was 24 h. Cerebrospinal fluid (CSF) analysis was normal in most patients and polymerase chain reaction for influenza virus RNA on CSF, when performed, was negative in all samples. Neuroradiological investigations, performed in 5 children, reported cortical and subcortical white matter signal alterations. Oseltamivir was administered only in 2 cases. Fourteen patients recovered without sequelae, and only a 2-year-old girl had minimal impairment in fine motor skills at discharge.
All children presenting acute neurological features during influenza season should be evaluated for influenza-associated CNS complications even if the respiratory involvement is mild. Absence of underlying diseases or other risk factors are not protective factors against CNS influenza-associated complications. The lack of CSF pleocytosis does not exclude CNS involvement. Children under 2 years of age are at higher risk of requiring intensive care support.
Latest Results for BMC Infectious Diseases, 28.11.2019
Tilføjet 28.11.2019 23:53
High prevalence of group B streptococcus ST17 hypervirulent clone among non-pregnant patients from a Hungarian venereology clinic
Although Streptococcus agalactiae is the leading causative agent of neonatal sepsis and meningitis, recently it is increasingly isolated from non-pregnant adults. The relation between its presence in the genitourinary tract and manifested clinical symptoms of STD patients remains an open question. In this study, a complex epidemiological investigation of GBS isolates from a venerology clinic was performed.
Ninety-six GBS isolates were serotyped and their genetic relatedness determined by PFGE. MLST was also performed for a subset of 20 isolates. The antibiotic susceptibility was tested with agar dilution. Surface proteins and the ST-17 hypervirulent clone was detected by PCR.
The serotype prevalence was the following: V (29.2%), III (27.1%), Ia (22.9%), IV (10.4%), II (5.2%) and Ib (4.2%). A strong association was demonstrated between surface protein genes and serotypes. All isolates were fully susceptible to penicillin, but erythromycin and clindamycin resistance was high (41.7 and 35.4%, respectively), and 8 phenotypically macrolide sensitive isolates carried the ermB gene.
21.9% of all strains belonged to the hypervirulent ST17 clone, most being of serotype III and all were rib +. We found a few serotype IV isolates belonging to several STs and one serotype V/ST110 strain, containing a 44-bp deletion in the atr allele.
The presence of silent ermB genes is of worry, as their expression upon macrolide exposure could lead to unforeseen therapeutic failure, while clindamycin is used for intrapartum antibiotic prophylaxis, in case of penicillin allergy. The other alarming result is the high prevalence of ST17 among these strains from STD patients, who could be sources of further infections.
This is the first report from Hungary providing both serotyping and genotyping data of GBS isolates. These results could be helpful for vaccine production as the major vaccine candidates are capsular antigens or surface proteins.
Clinical Infectious Diseases Advance Access, 27.11.2019
Tilføjet 28.11.2019 14:24
Long-term mortality and epilepsy in patients after brain abscess: A nationwide population-based matched cohort study
AbstractBackgroundTo determine long-term risks of mortality and new-onset epilepsy after brain abscess.MethodsUsing nationwide population-based medical registries, we examined all patients with first-time brain abscess in Denmark, 1982-2016. Comparison cohorts individually matched on age, sex and residence were identified, as were siblings of all study participants. Next, we computed cumulative incidences and hazard rate ratios (HRRs) with 95% CIs of mortality and new-onset epilepsy among study populations.ResultsWe identified 1,384 brain abscess patients (37% females) with a median follow-up time of 5.9 years (IQR 1.1-14.2). The 1-year, 2-5 year, and 6-30 year mortality of patients after brain abscess was 21%, 16% and 27% as compared to 1%, 6% and 20% for population controls. Cox regression analyses adjusted for Charlson comorbidity index score showed 1-year, 2-5 year, and 6-30 year HRRs of 17.5 (13.9-22.0), 2.61 (2.16-3.16) and 1.94 (1.62-2.31). The mortality in brain abscess patients was significantly increased regardless of sex or age group except among subjects 80 years or older, and in both previously healthy individuals and immuno-compromised persons.Among the 30-day survivors of brain abscess (median follow up 7.6 years [IQR 2.2-15.5]), new-onset epilepsy occurred in 32% compared to 2% in matched population controls. Cause-specific Cox regression analysis adjusted for stroke, head trauma, alcohol abuse, and cancer showed 1-year, 2-5 year, and 6-30 year HRRs for new-onset epilepsy of 155 (78.8-304), 37.7 (23.0-59.9), and 8.93 (5.62-14.2).ConclusionsBrain abscess is associated with an increased long-term risk of mortality and new-onset epilepsy for several years after infection.
Latest Results for BMC Infectious Diseases, 27.11.2019
Tilføjet 28.11.2019 02:11
Clinical diversity of invasive cryptococcosis in AIDS patients from central China: report of two cases with review of literature
Although antiretroviral therapy (ART) has greatly improved the prognosis of acquired immunodeficiency syndrome (AIDS) patients globally, opportunistic infections (OIs) are still common in Chinese AIDS patients, especially cryptococcosis.
We described here two Chinese AIDS patients with cryptococcal infections. Case one was a fifty-year-old male. At admission, he was conscious and oriented, with papulonodular and umbilicated skin lesions, some with ulceration and central necrosis resembling molluscum contagiosum. The overall impression reminded us of talaromycosis: we therefore initiated empirical treatment with amphotericin B, even though the case history of this patient did not support such a diagnosis. On the second day of infusion, the patient complained of intermittent headache, but the brain CT revealed no abnormalities. On the third day, a lumbar puncture was performed. The cerebral spinal fluid (CSF) was turbid, with slightly increased pressure. India ink staining was positive, but the cryptococcus antigen latex agglutination test (CrAgLAT: IMMY, USA) was negative. Two days later, the blood culture showed a growth of Cryptococcus neoformans, and the same result came from the skin culture. We added fluconazole to the patient’s treatment, but unfortunately, he died three days later.
Case two was a sixty-four-year-old female patient with mild fever, productive cough, dyspnea upon movement, and swelling in both lower limbs. The patient was empirically put on cotrimoxazole per os and moxifloxacin by infusion. A bronchofibroscopy was conducted with a fungal culture, showing growth of Cryptococcus laurentii colonies. Amphotericin B was started thereafter but discontinued three days later in favor of fluconazole 400 mg/d due to worsening renal function. The patient became afebrile after 72 h of treatment with considerable improvement of other comorbidities and was finally discharged with continuing oral antifungal therapy.
Our cases illustrate that cryptococcal disease is an important consideration when treating immunocompromised individuals such as AIDS patients. Life threatening meningitis or meningoencephalitis caused by C. neoformansmay still common in these populations and can vary greatly in clinical presentations, especially with regard to skin lesions. Pulmonary cryptococcosis caused by C. laurentii is rare, but should also be considered in certain contexts. Guidelines for its earlier diagnosis, treatment and prophylaxis are needed.
AIDS - Published Ahead-of-Print, 19.11.2019
Tilføjet 25.11.2019 15:18
Presence of EBV DNA in Cerebrospinal Fluid is Associated with Greater HIV RNA and Inflammation
This study aimed to investigate whether cerebrospinal fluid (CSF) EBV or CMV DNA was associated with viral, inflammatory and neuronal damage biomarkers in people living with HIV (PLWH).
Epstein-Barr virus (EBV) and Cytomegalovirus (CMV) can infect several cells, replicate in the central nervous system and affect blood-brain barrier (BBB) integrity.
EBV, CMV DNA and HIV RNA were measured on CSF, through RT-PCR, from PLWHs undergoing lumbar punctures for clinical reasons (excluding oncho-haematological comorbidities). Immune-enzymatic assays evaluated BBB inflammation and damage. Patients were stratified according to plasma HIV RNA levels in viremic (≥50 copies/mL) and aviremic (
The Journal of Infectious Diseases Advance Access, 22.11.2019
Tilføjet 23.11.2019 09:27
The Effects of Japanese Encephalitis Vaccine and Accelerated Dosing Scheduling on the Immunogenicity of the Chimeric Yellow Fever Derived Tetravalent Dengue Vaccine (CYD-TDV): A Phase II, Randomized, Open-label, Single Center Trial in Adults Aged 18 to 45 years in the United States
AbstractDengue is a global health problem requiring an effective, safe dengue vaccine. We report the results of a phase II, randomized, open-label, single center trial in adults aged 18 to 45 years in the United States designed to explore the effects of the Chimeric Yellow Fever-Derived Tetravalent Dengue Vaccine (CYD-TDV, Dengvaxia) when administered on its designated schedule (months 0, 6 and 12) or on an accelerated dosing schedule (months 0, 2 and 6) and/or given prior to, or concomitantly with, a vaccine against Japanese Encephalitis (JE). Based on DENV serotype-specific neutralizing antibody (NAb), the accelerated dosing schedule was comparable to the 0, 6, and 12-month schedule. Giving JE vaccine concurrently with CYD-TDV did not result in an increase in overall NAb titers. Immunophenotyping of peripheral blood mononuclear cells (PBMCs) revealed an increase in activated CD8+ T cells after CYD-TDV vaccination, a phenomenon which was greatest for the JE vaccine primed. We conclude that an accelerated dosing schedule of CYD-TDV results in essentially equivalent dengue serotype-specific NAb titers as the currently used schedule and there may be an early benefit in antibody titers and activated CD8+ T cells by the administration of the JE vaccine prior to CYD-TDV vaccination.(Trial Registered at ClinicalTrials.gov: NCT01943825)
The Journal of Infectious Diseases Advance Access, 21.11.2019
Tilføjet 22.11.2019 11:48
Evaluation of a Single-Dose Nucleoside-Modified Messenger RNA Vaccine Encoding Hendra Virus-Soluble Glycoprotein Against Lethal Nipah virus Challenge in Syrian Hamsters
AbstractIn the absence of approved vaccines and therapeutics for use in humans, Nipah virus continues to cause fatal outbreaks of encephalitis and respiratory disease in Bangladesh and India on a near-annual basis. We determined that a single dose of a lipid nanoparticle nucleoside-modified messenger RNA vaccine encoding the soluble Hendra virus glycoprotein protected up to 70% of Syrian hamsters from lethal NiV challenge, despite animals having suboptimally primed immune responses before challenge. These data provide a foundation from which to optimize future messenger RNA vaccination studies against NiV and other highly pathogenic viruses.
Emerging Infectious Diseases Journal, 21.11.2019
Tilføjet 22.11.2019 11:48
Distribution of Japanese Encephalitis Virus, Japan and Southeast Asia, 2016–2018
Emerging Infectious Diseases Journal, 15.11.2019
Tilføjet 16.11.2019 07:27
Streptococcus suis–Associated Meningitis, Bali, Indonesia, 2014–2017
Latest Results for BMC Infectious Diseases, 11.11.2019
Tilføjet 11.11.2019 15:10
Streptococcus Oralis meningitis from right sphenoid Meningoencephalocele and cerebrospinal fluid leak
Streptococcus oralis belongs to the Streptococcus mitis group and is part of the normal flora of the nasal and oropharynx (Koneman et al., The Gram-positive cocci part II: streptococci, enterococci and the ‘Streptococcus-like’ bacteria. Color atlas and textbook of diagnostic microbiology, 1997). Streptococcus oralis is implicated in meningitis in patients with decreased immune function or from surgical manipulation of the central nervous system. We report a unique case of meningitis by Streptococcus oralis in a 58-year-old patient with cerebral spinal fluid leak due to right sphenoid meningoencephalocele.
A 58-year-old female presented in the emergency department due to altered mental status, fevers, and nuchal rigidity. Blood cultures were positive for Streptococcus oralis. Magnetic resonance stereotactic imaging of head with intravenous gadolinium showed debris in lateral ventricle occipital horn and dural thickening/enhancement consistent with meningitis. There was also a right sphenoidal roof defect, and meningoencephalocele with cerebrospinal fluid leak as a result. The patient was treated with ceftriaxone and had endoscopic endonasal repair of defect. She had complete neurologic recovery 3 months later.
Cerebrospinal fluid leak puts patients at increased risk for meningitis. Our case is unique in highlighting Streptococcus oralis as the organism implicated in meningitis due to cerebrospinal fluid leak.
JAMA Current Issue, 5.11.2019
Tilføjet 10.11.2019 18:52
The Relationship Between Herpes Zoster, Syphilis and Chickenpox
The significance of herpes zoster is still a matter for speculation. While technically a disease of the skin, the condition is one that has always been of interest to the neurologist and to the general practitioner. Originally regarded as occurring along the distribution of peripheral nerves, it has been recognized, since the epoch-marking discoveries of Henry Head, as having a segmental distribution. Certain aspects of the disease, particularly its relationship to syphilis, have recently been discussed by Brown and Dujardin. These observers noted that herpes zoster was distinctly more prevalent among a group of soldiers under observation for syphilis than it was among an unselected group of patients from the civilian population of the district. Among the syphilitics, zoster occurred in a proportion of four cases per thousand, while among the general population the disease occurred only in the proportion of one case per thousand. It was noted, too, that in the syphilitics the herpes had a predilection for the lumbar and sacral ganglions corresponding to the well known observation that spinal syphilis is more likely to attack the lower segments. In connection with these cases of zoster, the authors studied the changes in the spinal fluid and found that there was frequently a lymphocytosis occasionally accompanied by an increase in globulin, and in the case of the syphilitics sometimes accompanied by a positive Wassermann reaction. The authors assume that zoster is an infectious process, and that syphilis acts simply by producing local conditions which predispose the ganglions of the spinal cord to infection with the agent producing the disease.
Emerging Infectious Diseases Journal, 7.11.2019
Tilføjet 07.11.2019 22:25
Rhombencephalitis and Myeloradiculitis Caused by European Subtype of Tick-Borne Encephalitis Virus
The American Journal of Tropical Medicine and Hygiene: Most Recent Articles, 6.11.2019
Tilføjet 07.11.2019 05:41
Impact of Antibiotic Resistance on Treatment of Pneumococcal Disease in Ethiopia: An Agent-Based Modeling Simulation
Antimicrobial resistance (AMR) is a growing threat to global health. Although AMR endangers continued effectiveness of antibiotics, the impact of AMR has been poorly estimated in low-income countries. This study sought to quantify the effect of AMR on treatments for pediatric pneumococcal disease in Ethiopia. We developed the DREAMR (Dynamic Representation of the Economics of AMR) model that simulate children younger than 5 years who acquire pneumococcal disease (pneumonia, meningitis, and acute otitis media) and seek treatment from various health facilities in Ethiopia over a year. We examined the AMR levels of three antibiotics (penicillin, amoxicillin, and ceftriaxone), treatment failures, and attributable deaths. We used the cost-of-illness method to assess the resulting economic impact of AMR from a societal perspective by estimating the direct and indirect treatment costs and productivity losses. Findings showed that AMR against antibiotics that were used to treat pneumococcal disease led to 195,763 treatment failures per year, which contributed to 2,925 child deaths annually in Ethiopia. Antimicrobial resistance resulted in a first-line treatment failure rate of 29.4%. In 1 year, the proportion of nonsusceptible Streptococcus pneumoniae bacteria increased by 2.1% and 0.5% for amoxicillin and penicillin, and reduced by 0.3% for less commonly used ceftriaxone. Annual costs of AMR to treat pneumococcal disease were around US$15.8 million, including US$3.3 million for ineffective first-line treatments, US$3.7 million for second-line treatments, and US$8.9 million for long-term productivity losses. Antibiotic stewardship to reduce misuse and overuse of antibiotics is essential to maintain the effectiveness of antibiotics, and lessen the health and economic burden of AMR.
The American Journal of Tropical Medicine and Hygiene: Most Recent Articles, 6.11.2019
Tilføjet 07.11.2019 05:41
Intravenous Steroid Days and Predictors of Early Oral Steroid Administration in Tuberculous Meningitis: A Retrospective Study
Intravenous (IV) dexamethasone is recommended for 14 days in stage 1 and 28 days in stage 2/3 tuberculous meningitis (TBM). We used a different steroid protocol. We shifted TBM patients to oral steroids after 48 hours of sustained improvement on IV steroids (oral group). Patients who worsened after shifting to oral steroids were reinitiated on IV steroids. Once they showed a consistent improvement for 48 hours, the IV steroids were overlapped with oral steroids for 7–10 days to taper off IV steroids (overlap group). We compared total IV steroid days in our patients with the recommended treatment and identified predictors that favored the oral group. This was a retrospective study. We included 98 patients with TBM (66 in the overlap group and 32 in the oral group) from January 2013 to July 2018. The median IV steroid days were 9 days (interquartile range of 4–12; 2–3.5 days in the oral group and 10–11.5 days in the overlap group). The mortality rate was 6.1%. The logistic regression model showed that TBM patients with basal exudate, tuberculoma, and modified Rankin scale (mRS) < 3 had a higher probability for going to the oral group. We conclude that total IV steroid days can be reduced in TBM patients by our method of steroid use. Presence of basal exudates and tuberculoma may favor early shifting from IV to oral steroid, whereas higher mRS may require a relatively longer course of IV steroid.
Clinical Infectious Diseases Advance Access, 3.11.2019
Tilføjet 04.11.2019 04:32
Cryptococcal Antigenemia in HIV therapy-experienced Ugandans with Virologic Failure
AbstractBackgroundDetectable serum or plasma cryptococcal antigen (CrAg) precedes symptomatic cryptococcal meningitis. The World Health Organization (WHO) recommends CrAg screening for HIV infected people with CD4
Clinical Infectious Diseases Advance Access, 30.10.2019
Tilføjet 30.10.2019 23:15
Model-based meta-analysis of rifampicin exposure and mortality in Indonesian tuberculosis meningitis trials
AbstractBackgroundIntensified antimicrobial treatment with higher rifampicin doses may improve outcome of tuberculous meningitis, but the desirable exposure and necessary dose are unknown. Our objective was to characterize the relationship between rifampicin exposures and mortality in order to identify optimal dosing for tuberculous meningitis.MethodsAn individual patient meta-analysis was performed on data from three Indonesian randomized controlled phase II trials comparing oral rifampicin 450mg (~10mg/kg) to intensified regimens including 750-1350mg orally, or a 600mg intravenous infusion. Pharmacokinetic data from plasma and CSF was analyzed with nonlinear mixed-effects modeling. Six-month survival was described with parametric time-to-event models.ResultsPharmacokinetic analyses included 133 individuals (1150 concentration measurements, 170 from CSF). The final model featured two disposition-compartments, saturable clearance and autoinduction. Rifampicin CSF concentrations were described by a partition coefficient (5.5% [95%CI 4.4-6.4]) and half-life for distribution plasma to CSF (2.1 h [1.3-2.9]). Higher CSF protein concentration increased the partition coefficient. Survival of 148 individuals (58 died, 15 drop-outs) was well described by an exponentially declining hazard, with lower age, higher baseline Glasgow Coma Scale score and higher individual rifampicin plasma exposure reducing the hazard. Simulations predicted an increase in 6-month survival from ~50% to ~70% upon increasing the oral rifampicin dose from 10 to 30mg/kg, and that higher doses would further increase survival.ConclusionsHigher rifampicin exposure substantially decreased the risk of death, and the maximal effect was not reached within the studied range. We suggest a rifampicin dose of at least 30mg/kg to be investigated in phase III clinical trials.
Emerging Infectious Diseases Journal, 29.10.2019
Tilføjet 29.10.2019 20:35
Tick-Borne Encephalitis Virus, United Kingdom
Clinical Infectious Diseases Advance Access, 23.10.2019
Tilføjet 24.10.2019 03:27
Risk Factors for Brain Abscess: A Nationwide, Population-Based, Nested Case-Control Study
AbstractBackgroundKnowledge on risk factors for brain abscess is limited and relies on single-center cohort studies.MethodsWe accessed nationwide medical registries to conduct a population-based, nested case-control study of risk factors for brain abscess. We applied risk-set sampling for the selection of population controls (1:10), who were individually matched by age, sex, and area of residence. Conditional logistic regression was used to compute adjusted odds ratios (aOR) with 95% confidence intervals (CIs). Population-attributable fractions were calculated.ResultsWe identified 1384 brain abscess patients in Denmark from 1982 through 2016, and 13 839 matched population controls. The median age of patients was 50 years (interquartile range 33–63) and 37% were female. Cases often had Charlson comorbidity scores >2 (16%), compared with controls (3%). Our calculated aORs were 2.15 (95% CI 1.72–2.70) for head trauma; 19.3 (95% CI 14.3–26.0) for neurosurgery; 4.61 (95% CI 3.39–6.26) for dental infections; 2.57 (95% CI 1.71–3.84) for dental surgery; 3.81 (95% CI 3.11–4.67) for ear, nose, and throat infection; 2.85 (95% CI 2.21–3.70) for ear, nose, and throat surgery; 15.6 (95% CI 9.57–25.4) for congenital heart disease; 1.74 (95% CI 1.33–2.29) for diabetes mellitus; 2.22 (95% CI 1.58–3.11) for alcohol abuse; 2.37 (95% CI 1.53–3.68) for liver disease; 2.04 (95% CI 1.30–3.20) for kidney disease and 8.15 (95% CI 3.59–18.5) for lung abscess or bronchiectasis. The aORs were 4.12 (95% CI 3.37–5.04) for solid cancer; 8.77 (95% CI 5.66–13.6) for hematological cancer; 12.0 (95% CI 6.13–23.7) for human immunodeficiency virus; and 5.71 (95% CI 4.22–7.75) for immunomodulating treatments. Population-attributable fractions showed were substantial contributors to the occurrence of brain abscess neurosurgery (12%); solid cancer (11%); ear, nose, and throat infections (7%); and immunomodulating treatments (5%).ConclusionsImportant risk factors included neurosurgery; cancer; ear, nose, and throat infections; and immunomodulating treatments.
Latest Results for BMC Infectious Diseases, 21.10.2019
Tilføjet 21.10.2019 15:57
A case report of multiple cerebral abscess formation complicating serogroup B Neisseria meningitidis meningitis
Invasive meningococcal disease (IMD) presenting with meningitis causes significant mortality and morbidity. Suppurative complications of serogroup B meningococcal sepsis are rare and necessitate urgent multidisciplinary management to mitigate long-term morbidity or mortality.
We present a rare case of invasive meningococcal disease in a 28-month old boy complicated by multiple abscess formation within a pre-existing antenatal left middle cerebral artery territory infarct. Past history was also notable for cerebral palsy with right hemiplegia, global developmental delay and West syndrome (infantile spasms). Two craniotomies were performed to achieve source control and prolonged antimicrobial therapy was necessary. The patient was successfully discharged following extensive multidisciplinary rehabilitation.
Longstanding areas of encephalomalacia in the left MCA distribution may have facilitated the development of multiple meningococcal serogroup B abscess cavities in the posterior left frontal, left parietal and left temporal lobes following an initial period of cerebritis and meningitis. A combination of chronic cerebral hypoperfusion and some degree of pre-existing necrosis in these areas, may also have facilitated growth of Neisseria meningitidis, leading ultimately to extensive cerebral abscess formation following haematogenous seeding during meningococcemia. In this case report we review similar cases of cerebral abscess or subdural empyema complicating serogroup B meningococcal meningitis.