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Fetal and neonatal medicine
Published in Jagdish M. Gupta, John Beveridge, MCQs in Paediatrics, 2020
Jagdish M. Gupta, John Beveridge
4.42. Which of the following is/are true of neonatal urinary tract infection?It is more common in twins.It is commonly associated with fever and failure to thrive.It may be complicated by neonatal meningitis.It may be a factor contributing to neonatal jaundice.It is more likely if the mother has a urinary tract infection.
Infection
Published in Janet M Rennie, Giles S Kendall, A Manual of Neonatal Intensive Care, 2013
Janet M Rennie, Giles S Kendall
The traditional signs of this disease, namely a bulging fontanelle, head retraction and a high-pitched cry, are the signs of established meningitis. Ideally, the disease should be treated before these signs appear. The mortality and long-term neurological morbidity of such babies is high, and every effort should be made to detect neonatal meningitis on the basis of the early and non-specific signs of infection listed on p. 191. For this reason it is important always to have a low threshold for carrying out a LP in sick babies. Basically, there has to be a very good reason not to perform a LP when sepsis is suspected.
Headache associated with central nervous system infection
Published in Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby, Headache in Clinical Practice, 2018
Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby
Bacterial meningitis remains a deadly disease. Rapid assessment is essential and can be life-saving. Bacterial infections present typically with fever, headache, and neck stiffness; the most common causes are listed in Table 15.3. The most common organisms, which cause approximately 80% of all cases of acute bacterial meningitis in adults in the United States, are H. influenzae, N. meningitidis and S. pneumoniae.4,5 In children, as a result of immunization, meningitis due to H. influenzae type B is less common than it used to be. E. coli and Listeria are together responsible for approximately 10% of bacterial meningitis. Neonatal meningitis is caused by Group B streptococci, Listeria, and E. coli and other Gram-negative organisms.4,6,10 If a CSF leak is present secondary to a skull fracture, pneumococcus is the most common causative organism, followed by skin flora.5 Neurosurgical patients may be affected with a wide variety of organisms, particularly Gram-negative rods.56 Patients who are receiving chemotherapy and are immunosuppressed, those who have lymphoma, leukaemia, and malnutrition, and those with AIDS, may be infected with unusual pathogens. Mycobacterium tuberculosis causes both subacute and chronic meningitis, while Cryptococcus, Nocardia, Candida, Histoplasma, and coccidiomycosis are common causes of chronic meningitis. Faced with immunocompromised patients, such as those with acquired immunodeficiency from malnutrition, HIV infection, leukaemia, lymphoma, or anticancer treatments, a search for more unusual pathogens is mandatory. Bacterial meningitis may complicate sinusitis, skull fractures, mastoiditis, or local cranial infections, as well as being a manifestation of a primary infection in any site, such as may be seen in osteomyelitis or pneumonia. When a bacterial infection is present, the CNS contains a purulent exudate that is reflected in highly active CSF with neutrophils, protein, and a low glucose compared with a contemporaneous blood glucose level (Table 15.2). The normal WBC count ranges from 0 to 5 mononuclear cells (lymphocytes and monocytes) per mm3 in uninfected adult CSF.3 Normal uninfected adult CSF should contain no polymorphonuclear leukocytes; however, an occasional polymorphonuclear leukocyte may be seen with a cytocentrifuge. In bacterial meningitis, there are 10-10000 WBCs/mm3 in the CSF, with a predominance of polymorphonuclear leukocytes. The LA test has a specificity of 96% for S. pneumoniae and 100% for N. meningitis. It has a sensitivity of 69–100% for the detection of S. pneumoniae and a sensitivity of 33–70% for the detection of bacterial antigens of N. meningitis in CSF. The Limulus amebocyte lysate assay is a rapid diagnostic test for the detection of Gram-negative endotoxin in CSF and thus for making a diagnosis of Gram-negative bacterial meningitis. This test is reported to have a sensitivity of 99.5% and a specificity of 86–99.8%.9
The contributions of multidrug resistant clones to the success of pandemic extra-intestinal Pathogenic Escherichia coli
Published in Expert Review of Anti-infective Therapy, 2023
Johann DD Pitout, Gisele Peirano, Rebekah DeVinney
E. coli is divided into three pathotypes [13] namely i). Commensal flora: Isolates that are normal flora of the gastro-intestinal tract (GIT) of humans and animals. ii). Diarrheagenic E. coli: Isolates that cause GIT infections. iii). Extra-intestinal pathogenic E. coli (ExPEC): Isolates that cause infections outside the GIT. The ExPEC pathotype consists of the following sub-pathotypes [13] namely a). Uropathogenic E. coli (UPEC) that is mainly responsible for urinary tract infections (UTIs). b). Neonatal meningitis E. coli (NMEC) that is mainly responsible for central nervous infections among neonates. c). Sepsis-associated pathogenic E. coli (SPEC) that are linked with bloodstream infections. d). Avian-pathogenic E. coli (APEC) that causes infections in birds.
Treatment options for neonatal infections in the post-cefotaxime era
Published in Expert Review of Anti-infective Therapy, 2022
Susannah Franco, Daniel Rampersad, Daniel Mesa, Margaret R. Hammerschlag
Cefotaxime achieves the most reliable CSF-to-serum ratio of any third- or fourth-generation cephalosporin in neonates with meningitis with an average ratio of 33–57% [12] based on data in 32 preterm and term neonates between less than 1 week and 4 weeks of age [28]. Data for cefepime are scarce; only one study has assessed CSF-to-serum ratios in neonatal meningitis and shows wide variations among neonates, with ratios between 3% and 88% [29]. These data are based on nine neonates in their first 3 days of life, two of which were preterm neonates weighing 1.3 and 1.7 kilograms who achieved CSF-to-serum ratios of 88% and 30%. The average CSF penetration for cefepime determined by the review by Pacifici et al. in 2011 based only on these data is 26% with a large standard deviation of 30% [12]. Due to the limited data, we have reported the range of ratios in Table 2 rather than the average and standard deviation. Preterm and VLBW neonates have more immature blood–brain barriers and likely achieve higher cephalosporin CSF-to-serum ratios versus term neonates, but data statistically confirming this do not yet exist for cefepime or other cephalosporins [29].
Escherichia coli: a rare cause of meningitis in immuno-competent adult
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Maryam Zafar, Abubakar Tauseef, Muhammad Sohaib Asghar, Narmin Khan, Nabeeha Farooqui, Mustafa Dawood, Tanvir Alam, Durre Naman
Escherichia coli is one of the most common causative pathogens of neonatal meningitis but the presence of E-coli in an immunocompetent adult, causing meningitis is rare, with an annual incidence of less than 1 case per year [1]. Diabetes mellitus, alcoholism, cirrhosis, HIV infection, malignancies are some of the risk factors to develop E-coli meningitis. A distant source is usually identified, either from the urinary or digestive tract. In most of the cases, E-coli meningitis responds to ceftriaxone, gentamicin, ampicillin, penicillin G and amoxicillin, and meropenem [2].The mortality rate is higher in E-coli meningitis patients as compared to other pathogens [3].