Posts filed under ‘Infecciones del SNC’

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

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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

Global etiology of bacterial meningitis: A systematic review and meta-analysis.

PLoS One. 2018 Jun 11;13(6):e0198772.

Oordt-Speets AM1, Bolijn R1, van Hoorn RC1, Bhavsar A2, Kyaw MH3.

Abstract

Bacterial meningitis is a global public health concern, with several responsible etiologic agents that vary by age group and geographical area. The aim of this systematic review and meta-analysis was to assess the etiology of bacterial meningitis in different age groups across global regions.

PubMed and EMBASE were systematically searched for English language studies on bacterial meningitis, limited to articles published in the last five years. The methodological quality of the studies was assessed using a customized scoring system.

Meta-analyses were conducted to determine the frequency (percentages) of seven bacterial types known to cause meningitis: Escherichia coli, Haemophilus influenzae, Neisseria meningitidis, Streptococcus pneumoniae, group B Streptococcus agalactiae, Staphylococcus aureus, and Listeria monocytogenes, with results being stratified by six geographical regions as determined by the World Health Organization, and seven age groups.

Of the 3227 studies retrieved, 56 were eligible for the final analysis. In all age groups, S. pneumoniae and N. meningitidis were the predominant pathogens in all regions, accounting for 25.1-41.2% and 9.1-36.2% of bacterial meningitis cases, respectively. S. pneumoniae infection was the most common cause of bacterial meningitis in the ‘all children’ group, ranging from 22.5% (Europe) to 41.1% (Africa), and in all adults ranging from 9.6% (Western Pacific) to 75.2% (Africa).

E. coli and S. pneumoniae were the most common pathogens that caused bacterial meningitis in neonates in Africa (17.7% and 20.4%, respectively). N. meningitidis was the most common in children aged ±1-5 years in Europe (47.0%).

Due to paucity of data, meta-analyses could not be performed in all age groups for all regions. A clear difference in the weighted frequency of bacterial meningitis cases caused by the different etiological agents was observed between age groups and between geographic regions.

These findings may facilitate bacterial meningitis prevention and treatment strategies.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5995389/pdf/pone.0198772.pdf

July 19, 2018 at 3:39 pm

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

LANCET June 2018

Fundamento

La meningitis viral se reconoce cada vez más, pero se sabe poco acerca de la frecuencia con la que ocurre o las causas y los resultados en el Reino Unido. El objetivo fue determinar la incidencia, las causas y las secuelas en adultos del Reino Unido para mejorar el tratamiento de los pacientes y ayudar en la planificación de los servicios de salud.

Métodos

Realizaron un estudio de cohorte observacional prospectivo multicéntrico de adultos con sospecha de meningitis en 42 hospitales en toda Inglaterra. Anidado en este estudio, en la región noroeste del Servicio Nacional de Salud (NHS) (ahora parte de NHS England North), se realizó un estudio epidemiológico. Los pacientes eran elegibles si tenían 16 años o más, tenían meningitis clínicamente sospechada y se les realizó una punción lumbar o, si la punción lumbar estaba contraindicada, tenían sospecha clínica de meningitis y un patógeno apropiado identificado en el hemocultivo o en la PCR de sangre. Se excluyeron las personas con dispositivos ventriculares. Calculamos la incidencia de meningitis viral utilizando datos de pacientes de la región noroeste solo y usamos estos datos para estimar el número de casos estandarizados de población en el Reino Unido. Resultados de calidad de vida autoinformados y resultados neuropsicológicos de los pacientes, utilizando el EuroQol EQ-5D-3L, la Encuesta de salud de forma abreviada de 36 elementos (SF-36) y el cronograma de evaluación neuropsicológica de Aldenkamp y Baker, durante 1 año después de la admisión .

Recomendaciones

1126 pacientes se inscribieron entre el 30 de septiembre de 2011 y el 30 de septiembre de 2014. 638 (57%) pacientes tuvieron meningitis: 231 (36%) casos fueron virales, 99 (16%) fueron bacterianos y 267 (42%) tuvieron una causa desconocida 41 (6%) casos tuvieron otras causas. La incidencia anual estimada de meningitis viral fue de 2.73 por 100 000 y la de meningitis bacteriana fue de 1.24 por 100 000. La mediana de la estancia hospitalaria de los pacientes con meningitis viral fue de 4 días (IQR 3-7), aumentando a 9 días (6-12) en aquellos tratados con antivirales. La punción lumbar previa dio como resultado que se identificara más pacientes con una causa específica que aquellos que tuvieron una punción lumbar tardía. En comparación con la población del Reino Unido correspondiente a la edad, los pacientes con meningitis viral tuvieron una pérdida media de 0-2 años de vida ajustados por calidad (SD 0 · 04) en ese primer año.

Interpretación

Los virus son la causa más común de meningitis en adultos del Reino Unido y conducen a una morbilidad sustancial a largo plazo. Los retrasos en la punción lumbar y el tratamiento innecesario con antivirales se asociaron con estancias hospitalarias más prolongadas. Los diagnósticos rápidos y los tratamientos de racionalización pueden reducir la carga de la meningitis en los servicios de salud.

Fondos

Meningitis Research Foundation e Instituto Nacional de Investigaciones sobre la Salud del Reino Unido.

FULL TEXT

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

PDF

https://www.thelancet.com/pdfs/journals/laninf/PIIS1473-3099(18)30245-7.pdf

July 6, 2018 at 8:21 am

Zika virus infection: epidemiology, clinical manifestations and diagnosis

Current Opinion in Infectious Diseases: October 2016 – Volume 29 – Issue 5 – p 459–466

Calvet, Guilherme Amaral; Santos, Flavia Barreto dos; Sequeira, Patricia Carvalho

Purpose of review

Zika virus (ZIKV) is an arbovirus previously believed to cause only a mild and self-limiting illness. Recently, it has emerged as a new public health threat that caused a large outbreak in French Polynesia in 2013–2014 and since 2015 an explosive outbreak in Brazil, with an increase in severe congenital malformations (microcephaly) and neurological complications, mainly Guillain–Barré syndrome (GBS). Since then, it has spread through the Americas. On 1 February 2016, the WHO declared the ZIKV epidemic in Brazil a Public Health Emergency of International Concern. We reviewed the epidemiology of ZIKV infection, clinical presentations and diagnosis. We highlighted the clinical features and nonvector borne transmission of the virus.

Recent findings

Association between ZIKV infection and severe foetal outcomes, including microcephaly and other birth defects; increased rate of GBS and other neurological complications due to the ongoing ZIKV outbreak; increased evidence to date of ZIKV being the only arbovirus linked to sexual transmission; the challenge of ZIKV diagnosis; and the need for a specific point-of care test in epidemic scenarios.

Summary

The findings illustrate the emergence of a viral disease with the identification of new associated disorders, new modes of transmission, including maternal–foetal and sexual transmission.

FULL TEXT

https://journals.lww.com/co-infectiousdiseases/Fulltext/2016/10000/Zika_virus_infection___epidemiology,_clinical.6.aspx?WT.mc_id=HPxADx20100319xMP

PDF (CLIC en ARTICLE as PDF)

June 30, 2018 at 10:51 am

Elizabethkingia in Children: A Comprehensive Review of Symptomatic Cases Reported From 1944 to 2017

Clinical Infectous Diseases July 2918 V.67 N.1 P.144-149

EDITOR’S CHOICE

Eric J Dziuban; Jessica L Franks; Marvin So; Georgina Peacock; David D Blaney

Una revisión exhaustiva de la literatura de casos de infección por Elizabethkingia en niños caracteriza la epidemiología, la demografía, la presentación clínica y los resultados.

Se informaron casos de 1944-2017 (n = 283) que demostraron una alta mortalidad que disminuyó en las últimas décadas y una morbilidad sustancial entre los sobrevivientes, especialmente los neonatos.

Elizabethkingia species often exhibit extensive antibiotic resistance and result in high morbidity and mortality, yet no systematic reviews exist that thoroughly characterize and quantify concerns for infected infants and children.

We performed a review of literature and identified an initial 902 articles; 96 articles reporting 283 pediatric cases met our inclusion criteria and were subsequently reviewed. Case reports spanned 28 countries and ranged from 1944 to 2017.

Neonatal meningitis remains the most common presentation of this organism in children, along with a range of other clinical manifestations. The majority of reported cases occurred as isolated cases, rather than within outbreaks. Mortality was high but has decreased in recent years, although neurologic sequelae among survivors remains concerning.

Child outcomes can be improved through effective prevention measures and early identification and treatment of infected patients.

FULL TEXT

https://academic.oup.com/cid/article/67/1/144/4683708

PDF (CLIC en PDF)

June 28, 2018 at 4:08 pm

Minireview – Nipah Virus Infection

J. Clin. Microbiol. June 2018 56:10 e01875-17

Brenda S. P. Ang, Tchoyoson C. C. Lim, and Linfa Wang

Nipah virus, a paramyxovirus related to Hendra virus, first emerged in Malaysia in 1998.

Clinical presentation ranges from asymptomatic infection to fatal encephalitis.

Malaysia has had no more cases since 1999, but outbreaks continue to occur in Bangladesh and India.

In the Malaysia-Singapore outbreak, transmission occurred primarily through contact with pigs, whereas in Bangladesh and India, it is associated with ingestion of contaminated date palm sap and human-to-human transmission.

Bats are the main reservoir for this virus, which can cause disease in humans and animals.

There are currently no effective therapeutics, and supportive care and prevention are the mainstays of management.

abstract

http://jcm.asm.org/content/56/6/e01875-17.abstract

PDF

http://jcm.asm.org/content/56/6/e01875-17.full.pdf+html

June 12, 2018 at 7:37 am

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