BACKGROUND: Scrub typhus is a naturally occurring acute febrile disease caused by Orientia tsutsugamushi. Although it can cause multiple organ dysfunction, central nervous system infections are uncommon.
METHODS: A 17-year-old male presented with a 5-day history of fever and headaches. The MRI of the head revealed thickness and enhancement of the left temporal lobe and tentorium cerebelli, indicating potential inflammation.
METHODS: The patient was diagnosed with a central nervous system infection.
METHODS: Ceftriaxone and acyclovir were administered intravenously to treat the infection, reduce fever, restore acid-base balance, and manage electrolyte disorders.
RESULTS: Despite receiving ceftriaxone and acyclovir as infection therapy, there was no improvement. Additional multipathogen metagenomic testing indicated the presence of O tsutsugamushi infection, and an eschar was identified in the left axilla. The diagnosis was changed to scrub typhus with meningitis and the therapy was modified to intravenous doxycycline. Following a 2-day therapy, the body temperature normalized, and the fever subsided.
CONCLUSIONS: The patient was diagnosed with scrub typhus accompanied by meningitis, and doxycycline treatment was effective.
UNASSIGNED: Rarely reported cases of scrub typhus with meningitis and the lack of identifiable symptoms increase the chance of misdiagnosis or oversight. Patients with central nervous system infections presenting with fever and headache unresponsive to conventional antibacterial and antiviral treatment should be considered for scrub typhus with meningitis. Prompt multipathogen metagenomic testing is recommended to confirm the diagnosis and modify the treatment accordingly.

BACKGROUND: Infectious meningitis/encephalitis (IM) is a severe neurological disease that can be caused by bacterial, viral, and fungal pathogens. IM suffers high morbidity, mortality, and sequelae in childhood. Metagenomic next-generation sequencing (mNGS) can potentially improve IM outcomes by sequencing both pathogen and host responses and increasing the diagnosis accuracy.
METHODS: Here we developed an optimized mNGS pipeline named comprehensive mNGS (c-mNGS) to monitor DNA/RNA pathogens and host responses simultaneously and applied it to 142 cerebrospinal fluid samples. According to retrospective diagnosis, these samples were classified into three categories: confirmed infectious meningitis/encephalitis (CIM), suspected infectious meningitis/encephalitis (SIM), and noninfectious controls (CTRL).
RESULTS: Our pipeline outperformed conventional methods and identified RNA viruses such as Echovirus E30 and etiologic pathogens such as HHV-7, which would not be clinically identified via conventional methods. Based on the results of the c-mNGS pipeline, we successfully detected antibiotic resistance genes related to common antibiotics for treating Escherichia coli, Acinetobacter baumannii, and Group B Streptococcus. Further, we identified differentially expressed genes in hosts of bacterial meningitis (BM) and viral meningitis/encephalitis (VM). We used these genes to build a machine-learning model to pinpoint sample contaminations. Similarly, we also built a model to predict poor prognosis in BM.
CONCLUSIONS: This study developed an mNGS-based pipeline for IM which measures both DNA/RNA pathogens and host gene expression in a single assay. The pipeline allows detecting more viruses, predicting antibiotic resistance, pinpointing contaminations, and evaluating prognosis. Given the comparable cost to conventional mNGS, our pipeline can become a routine test for IM.

暂无摘要。

OBJECTIVE: To analyze the spatiotemporal epidemiological dynamics of meningitis in Brazil, between 2010 and 2019.
METHODS: Descriptive ecological study with cases and deaths due to meningitis in Brazil (2010-2019) in the National Notifiable Diseases Information System (Sistema de Informações de Agravos de Notificação - SINAN). The following analyses were performed: (I) frequency analyses of cases and deaths, prevalence rates, mortality, lethality, Fisher\'s exact test, and chi-square test; (II) Prais-Winstein regression; and (III) Global, Local Moran\'s index, and Kernel density.
RESULTS: 182,126 cases of meningitis were reported in Brazil, of which 16,866 (9.26%) resulted in death, with prevalence rates of 9.03/100,000 inhabitants, mortality of 0.84/100,000 inhabitants, and lethality of 9.26%. There was a noted trend of decreasing prevalence rates (-9.5%, 95% confidence interval - 95%CI -13.92; -4.96, p<0.01) and mortality (-11.74%, 95%CI -13.92; -9.48, p<0.01), while lethality remained stable (-2.08%, 95%CI -4.9; 0.8; p<0.1941). The majority of cases were viral meningitis (45.7%), among 1-9 years old (32.2%), while the highest proportion of deaths was due to bacterial meningitis (68%), among 40-59 years old (26.3%). In the Moran and Kernel maps of prevalence and mortality rates, municipalities in the South, Southeast, and the capital of Pernambuco in the Northeast stood out with high rates; as for lethality, the North, Northeast, and Southeast coastal areas were highlighted.
CONCLUSIONS: A decrease in meningitis cases and deaths was found in this study; however, the lethality rate was higher in areas with lower prevalence, emphasizing the need to enhance actions for identifying, monitoring, and providing health care for cases, as well as expanding vaccination coverage.

A man in his 40s with type 2 diabetes mellitus had persistent right-sided watery nasal discharge for 6 months following cerebrospinal fluid (CSF) leak repair at another hospital, prompting his visit to us due to recurring symptoms. Imaging revealed a CSF leak from the mid-clivus for which revision endoscopic CSF leak repair was done. Regrettably, he developed postoperative meningitis caused by multidrug-resistant (MDR) Klebsiella pneumoniaeManaging this complex case was a challenging task due to the pathogen\'s resistance to conventional drugs and the scarcity of scientific evidence. We initiated a culture-guided combination regimen with ceftazidime, avibactam, aztreonam and tigecycline. This decision stemmed from meticulous literature review and observed antibiotic synergy while testing for this organism.After 4 weeks of vigilant treatment, the patient\'s symptoms improved significantly, and CSF cultures were sterile. We present our approach to effectively confront and manage a challenging instance of postoperative MDR bacterial meningitis.

UNASSIGNED: Meningitis is still a major public health challenge globally. Both the viral and bacterial forms of the disease have been reported worldwide. In 2023, around 200 children with suspected meningitis were admitted to hospital in Halabja Governorate, Iraq. No outbreak of meningitis had been reported previously in that region.
UNASSIGNED: To investigate the aetiology and epidemiology of meningitis among children in Halabja Governorate, Iraq, and expedite clinical management and prevention.
UNASSIGNED: Blood and cerebrospinal fluid specimens were collected from 197 children admitted to Halabja Paediatric and Maternity Teaching Hospital from 1 March to 1 July 2023 and analysed. The sample t-test was used to compare the haematological, serological and biochemical characteristics of the samples.
UNASSIGNED: The majority (76.6%) of the children were aged 2-9 years and 54% were males. The clinical manifestations of the disease were fever (100.0%), headache (89.0%), vomiting (85.7%), and photophobia (72.4%); none of the children had convulsions. The mean values for both neutrophil count and C-reactive protein were statistically significantly raised (P < 0.05) and the red blood cells, white blood cells and neutrophil counts, and lactate dehydrogenase values were statistically significantly raised (P < 0.05). The causative organism was enterovirus (98.5%), with sporadic cases of streptococcal meningitis (1.5%). All the patients recovered fully.
UNASSIGNED: The rapid diagnosis of the disease was crucial to the therapeutic and prevention control measures for the outbreak. Although it is still unclear how and where this outbreak started, contaminated drinking water and transmission among children in nurseries and schools are suspected. Further investigations are recommended to determine the source of the enterovirus and identify the virus species and serotypes.
الخصائص الوبائية لفاشية التهاب السحايا في عام 2023 بين الأطفال في العراق وأسباب تلك الفاشية.
زانا نجم الدين، كرزان صديق، دانا صابر، أمجد قدير، جهاد حماة، أوميد صالح، أوميد رحيم، أزاد قدير.
UNASSIGNED: لا يزال التهاب السحايا يمثل تحديًا كبيرًا للصحة العامة على الصعيد العالمي. وقد رُصد الشكلان الفيروسي والبكتيري لهذا المرض في جميع أنحاء العالم. وفي عام 2023، أُدخِل المستشفيات نحو 200 طفل يُشتبه في إصابتهم بالتهاب السحايا في محافظة حلبجة في العراق. ولم تُرصد سابقًا أيُّ فاشية لالتهاب السحايا في تلك المنطقة.
UNASSIGNED: هدفت هذه الدراسة الى استقصاء أسباب التهاب السحايا وخصائصه الوبائية لدى الأطفال في محافظة حلبجة بالعراق، وتسريع وتيرة العلاج السريري والوقاية.
UNASSIGNED: أُخذت عينات من الدم والسائل النخاعي من 197 طفلًًا أُدخلوا إلى مستشفى حلبجة التعليمي لطب الأطفال والأمومة في الفترة من 1 مارس/ آذار إلى 1 يوليو/ تموز 2023، وخضعت العينات للتحليل. واستُخدم اختبار «تي» للعينة (t-test) لمقارنة الخصائص الدموية والمصلية والكيميائية الحيوية للعينات.
UNASSIGNED: تراوحت أعمار غالبية الأطفال (76.6٪) بين عامين و9 أعوام، وكان 54٪ منهم ذكورًا. وكانت المظاهر السريرية للمرض: الحُمَّى (100.0٪) والصداع (89.0٪) والقيء (85.7٪) ورهاب الضوء (72.4٪)، ولم يُصَب أيٌّ من الأطفال بتشنجات. كما أن القيم الوسطية لكل من عدد العَدِلََات والبروتين المتفاعل سي شهدت زيادة ذات دلالة إحصائية (القيمة الاحتمالية: P < 0.05)، وكذلك فإن أعداد كريات الدم الحمراء وأعداد كريات الدم البيضاء وأعداد العَدِلََات وقِيَم نازعة هيدروجين اللاكتات شهدت زيادة ذات دلالة إحصائية (القيمة الاحتمالية: P < 0.05). وكان الكائن المسبِّب للمرض هو الفيروس المعوي (98.5٪)، مع حالات متفرقة من التهاب السحايا الناجم عن العقديات (1.5٪). وقد تعافى جميع المرضى تعافيًا تامًّا.
UNASSIGNED: كان لسرعة تشخيص المرض دور حاسم في تدابير المكافحة العلاجية والوقائية للفاشية. وعلى الرغم من أن كيفية بدء هذه الفاشية ومكان بدئها لا يزالان غير واضحين، الا أنه يُشتبه في مياه الشرب الملوثة وفي سريان المرض بين الأطفال في دور الحضانة والمدارس. ويُوصََى بإجراء مزيد من التقصِِّّي لتحديد مصدر الفيروس المعوي والتعرف على أنواع الفيروس وأنماطه المصلية.
Épidémiologie et étiologie de la flambée de méningite survenue en 2023 chez les enfants en Iraq.
UNASSIGNED: La méningite reste un problème de santé publique majeur dans le monde. Les deux formes de la maladie, virale et bactérienne, ont été signalées dans le monde entier. En 2023, environ 200 enfants atteints de méningite présumée ont été hospitalisés dans le gouvernorat de Halabja (Iraq). Aucune flambée de méningite n\'avait été enregistrée auparavant dans cette région.
UNASSIGNED: Étudier l\'étiologie et l\'épidémiologie de la méningite chez les enfants du gouvernorat de Halabja, en Iraq, et accélérer la prise en charge clinique et la prévention.
UNASSIGNED: Des échantillons de sang et de liquide céphalo-rachidien ont été prélevés auprès de 197 enfants admis à l\'hôpital universitaire pédiatrique et maternel de Halabja entre le 1er mars et le 1er juillet 2023 et ont été analysés. L\'échantillon t test a été utilisé pour comparer les caractéristiques hématologiques, sérologiques et biochimiques des échantillons.
UNASSIGNED: La majorité des enfants (76,6 %) étaient âgés de deux à neuf ans et 54 % étaient des garçons. Les manifestations cliniques de la maladie étaient la fièvre (100,0 %), les céphalées (89,0 %), les vomissements (85,7 %) et la photophobie (72,4 %). Aucun des enfants n\'a eu de convulsions. Les valeurs moyennes du compte des neutrophiles et de la protéine C réactive augmentaient de manière statistiquement significative (p < 0,05) et les valeurs des globules rouges, des globules blancs et des neutrophiles, et celles de la lactate déshydrogénase s\'élevaient de même de manière statistiquement significative (p < 0,05). L\'agent étiologique était un entérovirus (98,5 %), avec des cas sporadiques de méningite à streptocoque (1,5 %). Tous les patients se sont complètement rétablis.
UNASSIGNED: Le diagnostic rapide de la maladie a été crucial pour les mesures thérapeutiques et préventives visant à contrôler cette flambée. Bien qu\'on ne sache toujours pas comment et où cette flambée a débuté, on suspecte une contamination de l\'eau de boisson et une transmission chez les enfants dans les crèches et les écoles. Des investigations plus poussées sont recommandées pour déterminer la source de l\'entérovirus et identifier les espèces virales et les sérotypes.

暂无摘要。

Although vaccination and antimicrobial treatment have significantly impacted the frequency and outcomes of meningitis in children, meningitis remains a critical can\'t-miss diagnosis for children, where early recognition and appropriate treatment can improve survival and neurologic outcomes. Signs and symptoms may be nonspecific, particularly in infants, and require a high index of suspicion to recognize potential meningitis and obtain the cerebrospinal fluid studies necessary for diagnosis. Understanding the pathogens associated with each age group and specific risk factors informs optimal empirical antimicrobial therapy. Early treatment and developmental support can significantly improve the survival rates and lifelong neurodevelopment of children with central nervous system infections.

UNASSIGNED: Streptococcus suis is one of the porcine pathogens that have recently emerged as a pathogen capable of causing zoonoses in some humans. Patients infected with S. suis can present with sepsis, meningitis, or arthritis. Compared to common pathogens, such as Meningococcus, Streptococcus pneumoniae, and Haemophilus influenzae, S. suis infections in humans have been reported only rarely.
UNASSIGNED: This case report described a 57-year-old man who presented with impaired consciousness and fever following several days of backache. He was a butcher who worked in an abattoir and had wounded his hands 2 weeks prior. The patient was dependent on alcohol for almost 40 years. S. suis was detected in the cerebrospinal fluid by metagenomic next-generation sequencing. Although he received adequate meropenem and low-dose steroid therapy, the patient suffered from bilateral sudden deafness after 5 days of the infection. The final diagnosis was S. suis meningitis and sepsis.
UNASSIGNED: The patient survived with hearing loss in both ears and dizziness at the 60-day follow-up.
UNASSIGNED: We reported a case of S. suis infection manifested as purulent meningitis and sepsis. Based on literature published worldwide, human S. suis meningitis shows an acute onset and rapid progression in the nervous system. Similar to bacterial meningitis, effective antibiotics, and low-dose steroids play important roles in the treatment of human S. suis meningitis.

OBJECTIVE: Central nervous system infections, typified by bacterial meningitis, stand as pivotal emergencies recurrently confronted by neurologists. Timely and precise diagnosis constitutes the cornerstone for efficacious intervention. The present study endeavors to scrutinize the influence of inflammatory protein levels associated with neutrophils in cerebrospinal fluid on the prognosis of central nervous system infectious maladies.
METHODS: This retrospective case series study was undertaken at the Neurology Department of the Second Hospital of Shandong University, encompassing patients diagnosed with infectious encephalitis as confirmed by PCR testing and other diagnostic modalities spanning from January 2018 to January 2024. The quantification of MPO and pertinent inflammatory proteins within patients\' cerebrospinal fluid was accomplished through the utilization of ELISA.
RESULTS: We enlisted 25 patients diagnosed with bacterial meningitis, ascertained through PCR testing, and stratified them into two groups: those with favorable prognoses (n = 25) and those with unfavorable prognoses (n = 25). Following assessments for normality and variance, notable disparities in CSF-MPO concentrations emerged between the prognostic categories of bacterial meningitis patients (P < 0.0001). Additionally, scrutiny of demographic data in both favorable and unfavorable prognosis groups unveiled distinctions in CSF-IL-1β, CSF-IL-6, CSF-IL-8, CSF-IL-18, CSF-TNF-α levels, with correlation analyses revealing robust associations with MPO. ROC curve analyses delineated that when CSF-MPO ≥ 16.57 ng/mL, there exists an 83% likelihood of an adverse prognosis for bacterial meningitis. Similarly, when CSF-IL-1β, CSF-IL-6, CSF-IL-8, CSF-IL-18, and CSF-TNF-α levels attain 3.83pg/mL, 123.92pg/mL, 4230.62pg/mL, 35.55pg/mL, and 35.19pg/mL, respectively, there exists an 83% probability of an unfavorable prognosis for bacterial meningitis.
CONCLUSIONS: The detection of neutrophil extracellular traps MPO and associated inflammatory protein levels in cerebrospinal fluid samples holds promise in prognosticating bacterial meningitis, thereby assuming paramount significance in the prognostic evaluation of patients afflicted with this condition.