Anthrax is a zoonotic, acute infectious disease caused by Bacillus anthracis. Anthrax meningitis is one of the most dangerous types of anthrax, mostly secondary to cutaneous, intestinal, and pulmonary anthrax, and is a central nervous system infectious disease that is extremely lethal in the absence of timely treatment. This article reviews the clinical characteristics, pathogenesis, diagnosis and treatment of anthrax meningitis, in order to provide some reference for the clinical diagnosis and treatment of anthrax meningitis in China, and to provide reference for the further development of anthrax meningitis research.
Objective To investigate the clinical manifestations,diagnosis and treatment of extensively drug-resistant tuberculosis (XDR-TB)meningitis. Methods One case of primary tuberculousis meningitis infected with multidrug-resistant mycobacteria was analyzed retrospectively.Relevant literatures were also reviewed by retrieving information through Wanfang Database and Pubmed using key words "multiple drug resistant tuberculosis meningitis","MDR tuberculosis meningitis","multiple drug resistant TBM","mul-drug resistant tuberculous meningitis","extensively drug resistant tuberculosis meningitis","XDR TBM","extensively drug resistant TBM" both in Chinese and English. Results A 24-year-old male patient,complained of headache,vomiting for 5 days,aggravated with mental abnormalities for 10 hours,with no history of pulmonary tuberculosis,was hospitalized in the Affiliated Hospital of Zunyi Medical College.The chest plain film was normal.Craniocerebral CT scan showed mild-hydrocephalus and cisterna ambiens stenosis.The patient died after undergoing anti-TB treatments with isoniazid(INH)0.3g iv qd,INH 0.3g po qd,rifampicin(RFP)0.45g qd,pyrazinamide(PZA)1.5g qd,ethambutol(EMB)0.75g qd,and dexamethasone(DEX)15mg qd.He was diagnosed as XDR-TB meningitis(as drug-resistant to isoniazid,rifampicin,streptomycin,ciprofloxacin,paminosalicylic acid,kanamycin,and protionamide ).Mycobacteria tuberculosis was isolated from his cerebrospinal fluid after 3 months.Five cases in 4 literatures were retrieved through Wanfang database and Pubmed among which 2 cases were initial treated,3 cases was unknown about initial treatment or re-treatment. Conclusions XDR-TB meningitis is rare in clinical practice with serious condition,rapid progress and high mortality rate.It is necessary to acquire drug susceptibility test results as soon as possible and adjust treatments according different conditions.A molecular drug susceptibility test may be helpful in the future.
ObjectiveTo systematically review the quality of evidence-based guidelines (EBGs) on medication therapy for neonatal bacterial meningitis, and compare differences and similarities of the drugs recommended, in order to provide references for clinical application. MethodsDatabases such as the TRIP, PubMed, CNKI, VIP, WanFang, CBM, National Guideline Clearinghouse and Guidelines International Network were searched to collect evidence-based guidelines on medication therapy for neonatal bacterial meningitis. Methodological quality of included studies was assessed according to the AGREE Ⅱ instrument, and the differences and similarities among recommendations were compared. ResultsA total of 4 EBGs were included. Among them, one guideline was developed by the America and three guidelines were by the UK. Only one guideline was developed specially for neonates, while the rest were for neonates and children of different ages. According to the AGREE Ⅱ instrument, "scope and purpose", "stakeholder involvement", "rigor of development", "clarity and presentation", "applicability" and "editorial independence" were scored more than 60%. The recommendations of different guidelines were basically the same, only with conflicts in some areas. ConclusionAlthough most guidelines concerning neonatal bacterial meningitis are of high quality, grading levels of evidence and strength of recommendation should be unified.
Objective To comprehensively observe, recognize, learn and understand the clinical features of tuberculous meningitis (TBM). Methods We retrospectively analyzed the general data, clinical manifestations, clinical examinations and treatment prognosis of 152 patients with TBM who were hospitalized in the Second Affiliated Hospital of Zunyi Medical College between January 2016 and February 2017. Results The mean age of the 152 patients with TBM was (43.9±20.4) years old, the ratio of male to female was 1.45:1, and the average length of hospital stay was (20.0±18.9) days. The clinical manifestations were mainly headache [95.4% (145/152)], nausea and vomiting [42.8% (65/152)], and fever [61.8% (94/152)]. The main co-morbidities were secondary pulmonary tuberculosis [52.0% (79/152)], hematogenous disseminated tuberculosis [37.5% (57/152)], and tuberculous pleurisy [30.9% (47/152)]. The positive rate of γ-interferon release test was 90.8% (129/142), and the brain pressure of lumbar puncture was elevated. The typical biochemical changes of cerebrospinal fluid were " low glucose, low chlorine, and high protein”. The positive rate of tuberculosis smear was extremely low, and the positive rate of GeneXpert MTB/RIF in cerebrospinal fluid was 21.9% (7/32). The TBM patiens were prone to combine with hypoproteinemia, the proportion reached 29.6% (45/152), and the proportion of hyponatremia reached 45.3% (69/152). Treated with early diagnosis and treatment, 92.1% (140/152) improved and discharged. Conclusions TBM patients are mainly young and middle-aged with various clinical manifestations and less respiratory symptoms; and are easy to be combined with pulmonary tuberculosis and other extrapulmonary tuberculosis. γ-interferon release test and cerebrospinal fluid GeneXpert MTB/RIF can be used for the auxiliary diagnosis of tuberculosis. Early detection, early diagnosis and treatment, rational and regular chemotherapy, strengthening symptomatic supportive treatment, and improving the precise diagnosis and treatment of TBM, can improve its clinical prognosis.
Cryptococcosis, mainly caused by Cryptococcus neoformans/gattii species complexes, is a lethal infection in both immunosuppressive and immunocompetent populations. With the upgrade of detection methods and the increase of clinical knowledge, the incidence rate of cryptococcosis is increasing, and it has become one of the most important fungi threatening human health. In recent years, great progress has been made in this field, including the taxonomy and nomenclature of Cryptococcus spp., laboratory diagnostic methods and antifungal susceptibility tests, as well as the characteristics and treatments of cryptococcosis. This article reviews the above contents, in order to improve the clinical and laboratory understanding of the Cryptococcus spp., and realize the timely diagnosis and early treatment of cryptococcosis.
Objective To investigate the clinical features of tuberculous meningoencephalitis.Methods The clinical characteristics and laboratory results of 126 cases who were diagnosed as tuberculous meningoencephalitis fromJanuary 2000 to April 2009 were analyzed retrospectively. Results The clinical manifestations of tuberculous meningoencephalitis included fever, headache, vomitting, hemiparalysis,paraplegia, mental anomaly, hypopsia, deafness, diplopia, muscular spasms, coma, and incomplete oculomotor palsy, etc. Vomitting which was characteristic symptom of tuberculous meningoencephalitis was found in 25 cases( 19. 8% ) . The diagnosis was confirmed more than eightweeks after the onset of the disease in 31 cases ( 24. 6% ) . The inhospital mortality rate of tuberculous meningoencephalitis was 14. 3% ( 18 /126) . The inhospital mortality rate of re-treatment patients was 42. 9% ( 6 /14) . In 41 patients with poor prognosis ( death or therapy failure) , 68. 3% ( 28/41) cases were complicated with military tuberculosis, which was higher than the overall occurrence of 41. 3% ( 52/126) . Conclusions Strict diagnostic criteria and atypicalsymptoms lead to delayed diagnosis, delayed treatment, and high mortality in patients with tuberculous meningoencephalitis, particularly in patients with military tuberculosis and re-treatment patients. There is still no effective treatment which have a significant impact on the prognosis.
Objective To analyze the predictive value of serum copeptin, pentraxin 3 (PTX3), and soluble programmed cell death ligand 1 (sPD-L1) for poor prognosis in children with neonatal purulent meningitis. Methods Children with neonatal purulent meningitis admitted to the Department of Pediatrics, the Second Hospital of Handan between September 2020 and February 2023 were selected. According to the Gesell developmental scale score, the children were separated into a good prognosis group and a poor prognosis group. The correlation between serum levels of copeptin, PTX3, sPD-L1 and the prognosis of neonatal purulent meningitis were analyzed using Spearman correlation coefficient. The correlation of serum levels of copeptin, PTX3, and sPD-L1 with white blood cell count (WBC) and procalcitonin (PCT) were analyzed using Pearson correlation analysis. The area under the curve (AUC) of serum copeptin, PTX3, and sPD-L1 in predicting the prognosis of neonatal purulent meningitis were obtained by plotting the receiver operator characteristic curve. The factors affecting the prognosis of neonatal purulent meningitis were analyzed using multiple logistic regression analysis. Results A total of 107 children were included. Among them, 79 cases had good prognosis and 28 cases had poor prognosis. The serum levels of copeptin, PTX3, sPD-L1, WBC and PCT in the poor prognosis group were obviously higher than those in the good prognosis group (P<0.05). The levels of serum copeptin, PTX3, and sPD-L1 were positively correlated with the prognosis, WBC, and PCT of neonatal purulent meningitis (P<0.05). The results of logistic regression analysis showed that copeptin, PTX3, and sPD-L1 were risk factors affecting the prognosis of neonatal purulent meningitis (P<0.05). The AUC for predicting the prognosis of neonatal purulent meningitis with the combination of serum copeptin, PTX3, and sPD-L1 was 0.976, and the combined predictive value of the three was better than predicting separately (P<0.05). Conclusions Copeptin, PTX3, and sPD-L1 are abnormally upregulated in the serum of children with poor prognosis of neonatal purulent meningitis. The combination of the three can improve the predictive value for poor prognosis of neonatal purulent meningitis.
ObjectiveTo analyze the curative effect and prognosis of drug resistant tuberculosis meningitis (TBM). MethodsRetrospective analysis was carried out on the clinical data of thirty-two cases of drug resistant tuberculous meningitis patients hospitalized from January 2010 to December 2015. And the prognosis of the patients was evaluated by meliorated Rankin Scale (mRS). ResultsThirty-one cases (96.9%) were improved in 32 patients with drug resistant TBM, and 1 case (3.1%) was ineffective. After treatment, one patient had hormone-related glaucoma and osteoporosis, and one patient had drug Cushing syndrome. Twenty-seven patients (84.4%) had an mRS score equal to or less than 2 points. ConclusionDrug resistant TBM is difficult to diagnose in the early stage, and the curative effect is satisfying with active anti-tuberculosis treatment.
Objective To explore the predictive factors for long-term adverse prognosis in patients with tuberculosis meningitis. Methods We retrospectively analyzed the clinical data (general clinical data, laboratory test results, and imaging findings) of hospitalized cases of tuberculosis meningitis admitted to West China Hospital of Sichuan University from 00:00:00 on August 1st, 2011 to 23:59:59 on July 31st, 2012. We collected data of prognosis results after 6 years of illness by telephone follow-up, and quantified outcome measures by modified Rankin Scale (mRS) score (0–6 points). According to the mRS score, the cases obtaining 0 points≤mRS<3 points were divided into the good prognosis group and the cases obtaining 3≤mRS≤6 points were divided into the poor prognosis group, logistic regression analysis was executed to find the independent risk factors affecting long-term poor prognosis. Results A total of 119 cases were included, including 63 males and 56 females; the average age was (35±17) years. Among them, 53 patients had poor prognosis and 66 patients had good prognosis. After univariate analysis, the age (t=–3.812, P<0.001), systolic blood pressure at admission (t=–2.009, P=0.049), Glasgow Coma Scale score (t=3.987, P<0.001), Medical Research Council (MRC) staging system (Z=–4.854, P<0.001), headache (χ2=4.101, P=0.043), alter consciousness (χ2=10.621, P=0.001), cognitive dysfunction (χ2=4.075, P=0.044), cranial nerve palsy (χ2=5.853, P=0.016), peripheral nerve dysfunction (χ2=14.925, P<0.001), meningeal irritation (χ2=7.174, P=0.007), serum potassium (t=3.080, P=0.003), cerebrospinal fluid protein content (Z=–2.568, P=0.010), cerebrospinal fluid chlorine (t=2.543, P=0.012), hydrocephalus (χ2=11.766, P=0.001), and cerebral infarction (χ2=6.539, P=0.012) were associated with long-term poor prognosis of tuberculosis meningitis. Multivariate analysis showed that age [odds ratio (OR)=1.061, 95% confidence interval (CI) (1.027, 1.096), P<0.001], peripheral nerve dysfunction [OR=3.537, 95%CI (1.070, 11.697), P=0.038], MRC Stage Ⅱ[OR=9.317, 95%CI (1.692, 51.303), P=0.010], MRC Stage Ⅲ [OR=43.953, 95%CI (3.996, 483.398), P=0.002] were the independent risk factors for long-term poor prognosis of tuberculosis meningitis. Hydrocephalus [OR=2.826, 95%CI (0.999, 8.200), P=0.050] might be an independent risk factor for long-term poor prognosis of tuberculosis meningitis. Conclusions Age, MRC staging system (Stage Ⅱ, Stage Ⅲ) and peripheral neurological dysfunction are chronic poor-prognostic independent risk factors for tuberculosis meningitis. Hydrocephalus may be associated with long-term adverse prognosis of tuberculosis meningitis
Objective To retrospectively analyze the clinical information of a series of patients with cryptococcal neoformans meningitis in order to improve the diagnosis and treatment level. Methods Fifteen patients with etiological diagnosis as cryptococcal neoformans meningitis from January 2004 to December 2009 in the Affiliated Shengjing Hospital of China Medical University were included in the study. The clinical manifestations, treatment and prognosis of those patients were retrospectively analyzed. Results Seven of the total 15 patients were misdiagnosed with misdiagnosis rate of 46.7%. Twelve patients were treated by combination of amphotericin B/Lipo-AMB and fluconazole intravenously infusion, and then followed by the maintenance therapy of fluconazole orally administration, of which 7 were cured, 3 were improved, and 2 died. Five patients undergoing lumbar cisterna drainage were all cured. The follow-up study showed that 4 cases were accompanied by auditory or/and visual dysfunction within 1 to 5 years after hospital discharge. Three cases died that were not treated with anti-fungal drugs. Conclusion The misdiagnosis rate of cryptococcal neoformans meningitis is high. The keys to reduce mortality are raising vigilance, early diagnosis, rational use of antifungal drugs, and effectively lowering the intracranial pressure. The integrated therapy of amphotericin B/Lipo-AMB and fluconazole is effective and safe. Lumbar cisterna drainage can effectively lower the intracranial hypertension, quickly relieve symptoms and improve prognosis.