Coxsackie B virus
Peter M. Lydyard, Michael F. Cole, John Holton, William L. Irving, Nino Porakishvili, Pradhib Venkatesan, Katherine N. Ward in Case Studies in Infectious Disease, 2010
Meningitis is a medical emergency, and appropriate diagnostic tests must be initiated as soon as possible to expedite effective therapy (if available). Initial investigations should include blood cultures and a lumbar puncture (although this is contraindicated if there is evidence of raised intracranial pressure) to obtain a sample of CSF. Laboratory examination of the CSF usually allows distinction between bacterial and viral meningitis. In the former, CSF protein is grossly raised, CSF glucose is reduced to less than half of the blood sugar level, and the predominant cellular infiltrate is with polymorphonuclear leucocytes (PMNs) (Figure 2A). Gram staining of centrifuged CSF, that is the pellet, will often reveal the presence of bacteria. In viral meningitis, CSF protein is only marginally raised, CSF glucose is usually normal, and the predominant cellular infiltrate is with mononu-clear cells, that is lymphocytes and monocytes (Figure 2B) (although an early predominance of PMNs can sometimes be seen very early in the course of viral meningitis). A Gram stain will be negative.
Bacterial Meningitis
Thomas T. Yoshikawa, Shobita Rajagopalan in Antibiotic Therapy for Geriatric Patients, 2005
Attempts to facilitate the diagnosis of bacterial meningitis have been sought. These include the use of bacterial antigen testing in CSF utilizing a variety of techniques such as latex agglutination or coagglutination to detect S. pneumoniae, H. influenzae type B, N. meningitidis (all five serotypes), £. coli, and S. agalactiae. However, these tests are relatively expensive and are not routinely necessary since Gram stains are frequently positive. Instead, the antigen testing should be reserved for situations where prior antibiotic therapy may have changed the yield of Gram stains or cultures or where bacterial meningitis seems very likely from the CSF results, but no organism has been identified on culture. In the latter situation, a stored tube of CSF may prove useful (26).
Communicable diseases
Liam J. Donaldson, Paul D. Rutter in Donaldsons' Essential Public Health, 2017
In cases where meningitis does develop, symptoms are fever, headache, neck stiffness and photophobia. A haemorrhagic rash that does not blanch under pressure (e.g. if a glass is rolled over it) often accompanies this. Septacaemia can occur with or without the typical signs of meningitis; it causes flu-like symptoms and general malaise and can rapidly lead to deterioration and death. A very high level of clinical suspicion is necessary and skill in the recognition of septicaemia and shock in primary care. So too is parental education to ensure that the dangers of rapid deterioration in a sick child or teenager are a reason to seek urgent medical help; awareness of the significance of the rash and the glass test is also important.
Neuro-ophthalmic Complications of Immune-Checkpoint Inhibitors
Published in Seminars in Ophthalmology, 2021
Loulwah Mukharesh, Bart K Chwalisz
Aseptic meningitis may present with headaches, fevers, neck stiffness, nausea, vomiting, and photophobia. Neuro-ophthalmic manifestations may include papilledema and pseudo-abducens palsy as sequelae of increased intracranial pressure. Notably, patients’ level of consciousness should be preserved in meningitis, in distinction to encephalitis or meningoencephalitis. Evaluations of these patients require a lumbar puncture to measure opening pressure, confirm inflammation and exclude an infectious etiology.19 Additional investigations should include MRI brain with and without contrast to evaluate for leptomeningeal/pachymeningeal enhancement and other CNS etiologies such as abscesses, encephalitis, demyelination, vasculitis, or metastasis. The onset of aseptic meningitis secondary to ICIs is variable, occurring either after 2–3 cycles20 of ICI or up to 14 cycles,21 and classically have normal neuroimaging.22 Treatment of one case of pembrolizumab-induced aseptic meningitis with intravenous corticosteroids resulted in clinical improvement.19
Study of cerebrospinal fluid levels of lactate, lactate dehydrogenase and adenosine deaminase in the diagnosis and outcome of acute meningitis
Published in Neurological Research, 2022
Lovelina Singh, Mahendra Javali, Anish Mehta, R. Pradeep, R. Srinivasa, P. T. Acharya
Due to the severe mortality and morbidity rates of meningitis, different laboratory tests have been established for rapid and early diagnosis of the disease. Some laboratory tests like the determination of CSF lactate, LDH, and ADA are particularly important as they can delimit the diagnostic uncertainty [11,12]. The mechanism of increase in CSF lactate concentration in meningitis patients is not clear, but it has been associated with anaerobic glycolysis of brain tissue because of decreased cerebral blood flow and oxygen uptake.1,2Adenosine deaminase is an enzyme that leads to hydrolytic deamination of adenosine to inosine and ammonia. ADA is being widely used in the diagnosis of pericardial and peritoneal effusions, tuberculous pleural effusion, and tuberculous meningitis [13]. LDH is an enzyme found in nearly all living cells. High levels of lactate dehydrogenase in cerebrospinal fluid are often associated with BM, and in the case of viral meningitis, high LDH, in general, indicates the presence of encephalitis and poor prognosis [14,15].
Next-generation DNA sequencing analysis of two Streptococcus suis ST28 isolates associated with human infective endocarditis and meningitis in Gunma, Japan: a case report
Published in Infectious Diseases, 2019
Toshimasa Hayashi, Hiroyuki Tsukagoshi, Tsuyoshi Sekizuka, Daisuke Ishikawa, Michiko Imai, Masahiro Fujita, Makoto Kuroda, Nobuhiro Saruki
A 21-year-old Japanese man engaged in pig farming with no medical history was accidentally exposed in the face to a large volume of sludge mixed with pig’s excrement on April 14. The patient developed a fever of 38 °C on April 16, began vomiting on April 17, and developed a severe headache on April 18. Meningitis was strongly suspected, and the patient was examined in hospital. Even though he experienced no disturbance of consciousness or nerve paralysis, bacterial meningitis was strongly suspected on the basis of the lumbar puncture findings showing a polymorphonuclear leukocyte count of 1856/μL, a mononuclear cell count of 133/μL and glucose concentration of 13 mg/dL (cerebrospinal fluid glucose/blood glucose = 0.35). S. suis was detected in cerebrospinal fluid and blood cultures at the time of hospitalization using Apistrep 20. Treatment was commenced with ceftriaxone and vancomycin. After confirming the pathogen and drug susceptibility, treatment was switched to four million units of penicillin G infused every four hours. Due to penicillin G-induced vasculitis, treatment from the fifth day onward was with 2 g ampicillin via intravenous infusion every 4 hours. Treatment was carried out for a total of 14 days. No abnormalities were detected in a screening test for hearing impairment on April 26. The patient was discharged without complication on May 15.
Related Knowledge Centers
- Fever
- Inflammation
- Meninges
- Vomiting
- Spinal Cord
- Headache
- Brain
- Acute
- Chronic Condition
- Neck Stiffness