Posts filed under ‘Infecciones del SNC’

Infecciones por Staphylococcus aureus meticilino resistente adquirido en la comunidad: hospitalización y riesgo de letalidad en 10 centros pediátricos de Argentina

Arch Argent Pediatr 2018;116(1):e47-e53 / e47

Dra. Ángela Gentilea, Dra. Julia Bakira, Dra. Gabriela Ensinckb, Dr. Aldo Cancellarac, Dr. Enrique V. Casanuevad, Dra. Verónica Firpoe, Dr. Martín Carusof, Dra. María F. Lucióna, Dr. Alejandro Santillán Iturresg, Dra. Fabiana Molinah, Dr. Héctor J. Abatei, Dra. Andrea Gajo Ganej, Dr. Santiago López Papuccib y Grupo de Trabajo de Staphylococcus aureus*

Introducción.

Las infecciones por Staphylococcus aureus meticilino resistente adquirido en la comunidad (SAMR-C) son prevalentes en Argentina y el mundo; pueden tener evolución grave.

Objetivos

Estimar tasa de hospitalización y factores de riesgo de letalidad de la infección por SAMR-C.

Métodos

Estudio analítico transversal. Se incluyeron todos los pacientes ≤ 15 años con infección por Staphylococcus aureus adquirido en la comunidad (SA-C) hospitalizados en 10 centros pediátricos, entre enero/2012-diciembre/2014.

Resultados

Del total de 1141 pacientes con infección por SA-C, 904 (79,2%) fueron SAMR-C. La tasa de hospitalización de casos de SAMR-C (por 10 000 egresos) en < 5 años fue 27,6 en 2012, 35,2 en 2013 y 42,7 en 2014 (p= 0,0002). El grupo de 2-4 años fue el más afectado: 32,2, 49,4 y 54,4,  respectivamente (p= 0,0057).

Las presentaciones clínicas fueron infección de piel y partes blandas (IPPB): 66,2%; neumonía:11,5%; sepsis/bacteriemia: 8,5%; osteomielitis: 5,5%; artritis: 5,2%; absceso de psoas: 1,0%; pericarditis/endocarditis: 0,8%; meningitis: 0,6%; otras: 0,7%.

La resistencia antibiótica fue, para eritromicina, 11,1%; clindamicina, 11,0%; gentamicina, 8,4%; trimetoprima-sulfametoxazol: 0,6%. Todas las cepas fueron sensibles a vancomicina.

La letalidad fue 2,2% y los factores de riesgo asociados fueron [OR (IC 95%)] edad ≥ 8 años (2,78; 1,05-7,37), neumonía (6,37; 2,37-17,09), meningitis (19,53; 2,40-127,87) y sepsis/bacteriemia (39,65; 11,94-145,55).

Conclusiones

La tasa de infección por SAMR-C fue alta; la tasa de hospitalización aumentó en 2013-14; el grupo de 2-4 años fue el más afectado. Presentaron mayor riesgo de letalidad los ≥ 8 años y las clínicas de neumonía, meningitis y sepsis.

PDF

https://www.sap.org.ar/docs/publicaciones/archivosarg/2018/v116n1a16.pdf

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October 6, 2018 at 5:42 pm

Long-term outcomes of patients with Streptococcus suis infection in Viet Nam: A case-control study

Journal of Infection February 2018 V.76 N.2 P.159–167

Hightlights

  • Severe hearing and vestibular impairment persists in many S. suis survivors.
  • Hearing function tends to only improve in the first 3 months post discharge.
  • Vestibular dysfunction shows little recovery during the follow-up time period.
  • Survivors reported significantly lower health status and quality of life.
  • Appropriate patient management strategies are needed to reduce disease impact.

Objectives

Streptococcus suis is a zoonotic cause of severe meningitis and sepsis in humans. We aimed to assess the long-term outcomes in patients who survived S. suis infection, in particular the progress and impact of vestibulocochlear sequelae.

Methods

This case-control study evaluated outcomes of S. suis infection at discharge and 3 and 9 months post-discharge for 47 prospectively enrolled cases and at 11–34 months for 31 retrospectively enrolled cases. Outcomes in patients were compared to 270 controls matched for age, sex and residency.

Results

The prevalence ratio (PR) of moderate-to-complete hearing loss was 5.0(95%CI 3.6–7.1) in cases at discharge, 3.7(2.5–5.4) at 3 months, 3.2(2.2–4.7) at 9 months, and 3.1(2.1–4.4) in retrospective cases compared to controls. Hearing improvement occurred mostly within the first 3 months with a change in hearing level of 11.1%(95%CI 7.0–15.1%) compared to discharge. The PR of vestibular dysfunction was 2.4(95%CI 1.7–3.3) at discharge, 2.2(1.4–3.1) at 3 months, 1.8(1.1–2.5) at 9 months, and 1.8(1.1–2.6) for retrospective cases compared to controls. Cases also indicated more problems with mobility, self-care and usual activities.

Conclusions

Both hearing and vestibular impairment were common and persist in cases. Appropriate patient management strategies are needed to reduce the incidence and impact of these sequelae.

FULL TEXT

https://www.journalofinfection.com/article/S0163-4453(17)30311-0/fulltext

PDF

https://www.journalofinfection.com/article/S0163-4453(17)30311-0/pdf

 

 

September 29, 2018 at 7:43 pm

Streptococcus pyogenes and invasive central nervous system infection.

SAGE Open Med Case Rep. 2018 May 31;6:2050313X18775584.

Randhawa E1, Woytanowski J1, Sibliss K2, Sheffer I2.

1 Division of Internal Medicine, Department of Medicine, Drexel University College of Medicine, Hahnemann University Hospital, Philadelphia, PA, USA.

2 Division of Infectious Disease & HIV Medicine, Department of Medicine, Drexel University College of Medicine, Hahnemann University Hospital, Philadelphia, PA, USA.

Abstract

Streptococcus pyogenes is a Gram-positive beta-hemolytic bacteria, also known as group A streptococci, that causes a range of infections. The most common presentation is acute pharyngitis; however, it is also implicated in skin and soft tissue infections, and less commonly bacteremia, osteomyelitis, pneumonia, otitis media and sinusitis. Group A streptococci infections of the central nervous system are exceedingly rare in the antibiotic era. The mechanism of infection is typically contiguous spread from existing infection or via direct inoculation. We present a case of an 81-year-old female with a past medical history of dementia, transient ischemic attacks, type 2 diabetes mellitus, hypertension, descending thoracic aortic aneurysm status post-stent placement in 2008, hepatitis C and hyperlipidemia who initially presented after being found unresponsive at home. Her initial symptoms were primarily of altered mentation and on evaluation was found to be in septic shock with suspicion of meningoencephalitis. Her initial workup included a computed tomography of head which was remarkable for left and right mastoid effusions. A lumbar puncture was performed with cloudy purulent fluid, an elevated white blood cell count, low glucose and elevated protein. The patient was initially started on broad spectrum coverage and soon had 4/4 blood cultures and cerebrospinal fluid cultures growing Streptococcus pyogenes. Empiric vancomycin, ceftriaxone and ampicillin were administered but switched to penicillin G in the setting of elevated total bilirubin and septic shock with multi-organ failure and narrowed to ampicillin-sulbactam based on sensitivities. Unfortunately, the patient deteriorated further due to septic shock and multi-organ failure and later died in the medical intensive care unit.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5985606/pdf/10.1177_2050313X18775584.pdf

September 20, 2018 at 4:22 pm

Neisseria meningitidis Antimicrobial Resistance in Italy, 2006 to 2016

Antimicrobial Agents and Chemotherapy September 2018 V.62 N.9

Paola Vacca, Cecilia Fazio, Arianna Neri, Luigina Ambrosio, Annapina Palmieri and Paola Stefanelli

The aim of this study was to evaluate the antimicrobial susceptibilities of 866 Neisseria meningitidis invasive strains during 11 years of surveillance in Italy.

Two and six strains were resistant to ciprofloxacin and rifampin, respectively. Forty-five percent were penicillin intermediate, associated with hypervirulent serogroup C clonal complex 11.

All of the strains were susceptible to cephalosporins.

FULL TEXT

https://aac.asm.org/content/62/9/e00207-18?etoc=

PDF

https://aac.asm.org/content/aac/62/9/e00207-18.full.pdf

August 29, 2018 at 3:43 pm

Viral meningitis in the UK: time to speed up

LANCET INFECTIOUS DISEASES September 2018 V.18 N.9 P.930-931

COMMENT

Matthijs C BrouwerDiederik van de Beek

The differential diagnosis in patients with suspected CNS infection ranges from life-threatening disease (bacterial meningitis or herpes encephalitis) to typically less concerning disease (viral meningitis), or benign or no disease.1,  2 In the diagnostic work-up of these patients, clinical characteristics fail to differentiate between CNS infections and other diagnoses, and cerebrospinal fluid (CSF) analysis is the main contributor to the final diagnosis.3 In view of the urgent nature of this testing in patients with suspected bacterial meningitis, physicians are advised to carry out lumbar puncture without delay…

FULL TEXT

https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(18)30287-1/fulltext?dgcid=raven_jbs_etoc_email

PDF

https://www.thelancet.com/action/showPdf?pii=S1473-3099%2818%2930287-1

– – –

LANCET INFECTIOUS DISEASES September 2018 V.18 N.9 P.992-1003

ARTICLE

Incidence, aetiology, and sequelae of viral meningitis in UK adults: a multicentre prospective observational cohort study

Fiona McGill, PhDMichael J Griffiths, DPhilLaura J Bonnett, PhDProf Anna Maria Geretti, PhDBenedict D Michael, PhDNicholas J Beeching, FRCPDavid McKee, FRCPPaula Scarlett, DCRIan J Hart, PhD …

Background

Viral meningitis is increasingly recognised, but little is known about the frequency with which it occurs, or the causes and outcomes in the UK. We aimed to determine the incidence, causes, and sequelae in UK adults to improve the management of patients and assist in health service planning.

Methods

We did a multicentre prospective observational cohort study of adults with suspected meningitis at 42 hospitals across England. Nested within this study, in the National Health Service (NHS) northwest region (now part of NHS England North), was an epidemiological study. Patients were eligible if they were aged 16 years or older, had clinically suspected meningitis, and either underwent a lumbar puncture or, if lumbar puncture was contraindicated, had clinically suspected meningitis and an appropriate pathogen identified either in blood culture or on blood PCR. Individuals with ventricular devices were excluded. We calculated the incidence of viral meningitis using data from patients from the northwest region only and used these data to estimate the population-standardised number of cases in the UK. Patients self-reported quality-of-life and neuropsychological outcomes, using the EuroQol EQ-5D-3L, the 36-Item Short Form Health Survey (SF-36), and the Aldenkamp and Baker neuropsychological assessment schedule, for 1 year after admission.

Findings

1126 patients were enrolled between Sept 30, 2011, and Sept 30, 2014. 638 (57%) patients had meningitis: 231 (36%) cases were viral, 99 (16%) were bacterial, and 267 (42%) had an unknown cause. 41 (6%) cases had other causes. The estimated annual incidence of viral meningitis was 2·73 per 100 000 and that of bacterial meningitis was 1·24 per 100 000. The median length of hospital stay for patients with viral meningitis was 4 days (IQR 3–7), increasing to 9 days (6–12) in those treated with antivirals. Earlier lumbar puncture resulted in more patients having a specific cause identified than did those who had a delayed lumbar puncture. Compared with the age-matched UK population, patients with viral meningitis had a mean loss of 0·2 quality-adjusted life-years (SD 0·04) in that first year.

Interpretation

Viruses are the most commonly identified cause of meningitis in UK adults, and lead to substantial long-term morbidity. Delays in getting a lumbar puncture and unnecessary treatment with antivirals were associated with longer hospital stays. Rapid diagnostics and rationalising treatments might reduce the burden of meningitis on health services.

Funding

Meningitis Research Foundation and UK National Institute for Health Research.

FULL TEXT

https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(18)30245-7/fulltext?dgcid=raven_jbs_etoc_email

PDF

https://www.thelancet.com/action/showPdf?pii=S1473-3099%2818%2930245-7

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August 25, 2018 at 11:13 am

Meningococcal disease and control in China: Findings and updates from the Global Meningococcal Initiative (GMI)

Journal of Infection May 2018 V.76 N.5 P.429–437

Reviews

Junhong Li, Zhujun Shao, Gang Liu, Xilian Bai, Ray Borrow, Min Chen, Qinglan Guo, Yue Han, Yixing Li, Muhamed-Kheir Taha, Xihai Xu, Xin Xu, Huizhen Zheng

Highlights

  • MD epidemiology is changing in China with the decline of MenA and rise of MenB, MenC and MenW.
  • MD prevention strategies in China include sentinel surveillance and immunization.
  • Conjugate vaccines reduce carriage rates and impart herd protection.
  • Improvements in disease surveillance and laboratory techniques are needed across China.
  • Universal SOPs for outbreak management should be defined and implemented globally.

Abstract

The Global Meningococcal Initiative (GMI) is a global expert group, including scientists, clinicians and public health officials from a wide range of specialities. The goal of the GMI is to prevent meningococcal disease worldwide through education, research, and co-operation. The Chinese GMI roundtable meeting was held in June 2017. The GMI met with local experts to gain insight into the meningococcal disease burden in China and current prevention and vaccination strategies in place. China experienced five epidemics of serogroup A meningococcal disease (MenA) between 1938 and 1977, with peak incidence of 403/100,000 recorded in 1967. MenA incidence rates have significantly declined following the universal introduction of the MenA polysaccharide vaccine in China in the 1980s. Further, surveillance data indicates changing meningococcal epidemiology in China with the emergence of new clones of serogroup B from serogroup C clonal complex (cc) 4821 due to capsular switching, and the international spread of serogroup W cc11. The importance of carriage and herd protection for controlling meningococcal disease was highlighted with the view to introduce conjugate vaccines and serogroup B vaccines into the national immunization schedule. Improved disease surveillance and standardized laboratory techniques across and within provinces will ensure optimal epidemiological monitoring.

FULL TEXT

https://www.journalofinfection.com/article/S0163-4453(18)30027-6/fulltext

PDF

https://www.journalofinfection.com/article/S0163-4453(18)30027-6/pdf

July 28, 2018 at 7:26 pm

Shotgun Metagenomic Detection of Pathogens: a Micro-Comic Strip

Journal of Clinical Microbiology  August 2018 V.56 N.8

Editorial

Alexander J. McAdam

Next-generation sequencing has made shotgun metagenomic testing of primary clinical specimens for detection of pathogens feasible (1).

These technologies can routinely detect a range of pathogens (bacterial, viral, fungal, and eukaryotic parasites), allowing for hypothesis-free testing, in which test selection does not depend on knowing what pathogens are likely to be present.

Such testing has been applied for detecting infections or colonization of the nervous system (2–4), gastrointestinal tract (5, 6), prosthetic joints (7, 8), and blood or serum (9, 10).

Shotgun metagenomic testing for pathogens is now available for patient testing at a small number of academic and commercial laboratories, and it is expensive compared to other microbiology tests.

Where do the cost of and diversity of pathogens detected by shotgun metagenomic testing fit into the range of available microbiology tests?

FULL TEXT

http://jcm.asm.org/content/56/8/e00799-18?etoc

PDF

http://jcm.asm.org/content/56/8/e00799-18.full.pdf+html

July 28, 2018 at 6:32 pm

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