scholarly journals Population based surveillance 1997-2016 indicates a varied pattern of HSV CNS infection in young infants

2017 ◽  
Vol 53 ◽  
pp. 50-50
Keyword(s):  
Population Based ◽  
Cns Infection ◽  
Young Infants ◽  
Varied Pattern

scholarly journals Enteroviral and Herpes Simplex Virus  Central Nervous System Infections in Infants <90 Days Old: A Paediatric Investigators’ Collaborative Network on Infections in Canada (PICNIC) Study

2020 ◽  
Author(s):  
Dara Petel ◽  
Michelle Barton ◽  
Christian Renaud ◽  
Lynda Ouchenir ◽  
Jason Brophy ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Herpes Simplex Virus ◽  
Herpes Simplex ◽  
Cns Infection ◽  
Collaborative Network ◽  
Cns Infections ◽  
Young Infants ◽  
Csf Pleocytosis ◽  
Simplex Virus

Abstract Background The relative contribution of viruses to central nervous system (CNS) infections in young infants is not clear. For viral CNS infections, there are limited data on features that suggest HSV etiology or on predictors of unfavorable outcome. Methods In this cross-sectional retrospective study, seven centers from the Pediatric Investigators Collaborative Network on Infections in Canada identified infants <90 days of age with CNS infection proven to be due to enterovirus (EV) or herpes simplex virus (HSV) January 1, 2013 through December 31, 2014. Results Of 174 CNS infections with a proven etiology, EV accounted for 103 (59%) and HSV for 7 (4%). All HSV cases and 41 (40%) EV cases presented before 21 days of age. Four HSV cases (57%) and 5 EV cases (5%) had seizures. Three (43%) HSV and 23 (23 %) EV cases lacked cerebrospinal fluid (CSF) pleocytosis. HSV cases were more likely to require ICU admission (p=0.010), present with seizures (p=0.031) and have extra-CNS disease (p<0.001). Poor long-term outcomes were more common in infants who had seizures. Conclusions Viruses accounted for approximately two-thirds of proven CNS infections in the first 90 days of life. Empiric therapy for HSV should be considered in suspected CNS infections in the first 21 days even in the absence of CSF pleocytosis unless CSF parameters are suggestive of bacterial meningitis.

scholarly journals Retrospective Evaluation of Infants Aged 1 to 60 Days with Residual Cerebrospinal Fluid (CSF) Tested Using the FilmArray Meningitis/Encephalitis (ME) Panel

2018 ◽  
Vol 56 (7) ◽  
pp. e00277-18 ◽  
Author(s):  
Anne J. Blaschke ◽  
Kristen M. Holmberg ◽  
Judy A. Daly ◽  
Amy L. Leber ◽  
Jennifer Dien Bard ◽  
...  
Keyword(s):  
Clinical Laboratory ◽  
Bacterial Pathogen ◽  
Rapid Identification ◽  
Outcome Data ◽  
Cns Infection ◽  
Conventional Pcr ◽  
Viral Pathogen ◽  
Young Infants ◽  
Potential Impact ◽  
Enteroviral Meningitis

ABSTRACT In pediatric practice it is common for infants under 2 months of age to undergo evaluation for sepsis when they are ill, often including lumbar puncture to assess for central nervous system (CNS) infection. The FilmArray Meningitis/Encephalitis (ME) panel is a newly approved test for rapid identification of CNS pathogens. Our objective was to study the epidemiology of CNS infection in young infants and the potential impact of rapid multiplex PCR on their care. A performance evaluation of the FilmArray ME panel was conducted from February 2014 to September 2014 at 11 sites. FilmArray ME panel results were compared to reference standards but not shared with providers. In our study, medical records for infants (aged 1 to 60 days) enrolled at three sites were reviewed for clinical, laboratory, and outcome data. A total of 145 infants were reviewed. The median age was 25 days. Most of the infants were hospitalized (134/145 [92%]) and received antibiotics (123/145 [85%]), and almost half (71/145 [49%]) received acyclovir. One infant had a bacterial pathogen, likely false positive, identified by the FilmArray ME panel. Thirty-six infants (25%) had a viral pathogen detected, including 21 enteroviruses. All infants with enteroviral meningitis detected by the FilmArray ME panel and conventional PCR were hospitalized, but 20% were discharged in less than 24 h when conventional PCR results became available. The FilmArray ME panel may play a role in the evaluation of young infants for CNS infection. Results may be used to guide management, possibly resulting in a decreased length of stay and less antimicrobial exposure for infants with low-risk viral infection detected.

SUSPECT VALUE OF NON-CSF VIRAL CULTURES IN THE DIAGNOSIS OF ENTEROVIRAL CNS INFECTION IN YOUNG INFANTS

2008 ◽  
Vol 34 (10) ◽  
pp. 876-884 ◽  
Author(s):  
George M. Johnson ◽  
Gary A. McAbee ◽  
Elizabeth D. Seaton ◽  
Steven M. Lipson
Keyword(s):  
Cns Infection ◽  
Young Infants

scholarly journals Neurosyphilis: An Unresolved Case of Meningitis

2015 ◽  
Vol 2015 ◽  
pp. 1-6
Author(s):  
Shagufta Ahsan ◽  
Joesph Burrascano
Keyword(s):  
Skin Rash ◽  
Population Based ◽  
Secondary Syphilis ◽  
Cns Infection ◽  
Disseminated Infection ◽  
Penicillin Therapy

Neurosyphilis can cause both symptomatic and asymptomatic meningitis. However the epidemiology of modern neurosyphilis is not well defined because of the paucity of population-based data. The majority of neurosyphilis cases have been reported in HIV-infected patients. Here we present a case of early neurosyphilis/symptomatic syphilitic meningitis in a non-HIV patient who presented with rash but was mistakenly treated for early latent or secondary syphilis. Syphilis presenting with a skin rash and an extremely high RPR titer could indicate CNS infection rather than simply secondary syphilis because rash is a nonspecific manifestation of disseminated infection. Given the effectiveness of penicillin therapy, why is the rate of syphilis continuing to increase? Is it due to a failure of prevention or could it be also because of failure to diagnose and treat syphilis adequately, as in this case?

scholarly journals Group B Streptococcal disease in England (1998 – 2017): a population based observational study

2020 ◽  
Author(s):  
Seilesh Kadambari ◽  
Caroline L Trotter ◽  
Paul T Heath ◽  
Michael J Goldacre ◽  
Andrew J Pollard ◽  
...  
Keyword(s):  
Group B Streptococcus ◽  
Population Based ◽  
Attributable Mortality ◽  
Live Births ◽  
New Methods ◽  
Young Infants ◽  
Disease Outcomes ◽  
Group B Streptococcal Disease ◽  
Group B ◽  
Recorded Diagnosis

Abstract Background and Objectives Group B Streptococcus (GBS) is the leading cause of sepsis and meningitis in infants &lt;90 days. In this study, the burden of GBS disease and mortality in young infants in England was assessed. Methods Using linked hospitalisation records from every National Health Service (NHS) hospital from 1 April 1998 to 31 March 2017, we calculated annual GBS incidence in infants aged &lt;90 days and, using regression models, compared their perinatal factors, rates of hospital-recorded disease outcomes and all-cause infant mortality rates with those of the general infant population. Results 15,429 infants aged &lt;90 days had a hospital-recorded diagnosis of GBS, giving an average annual incidence of 1.28 per 1000 live births (95% CI 1.26-1.30) with no significant trend over time. GBS-attributable mortality declined significantly from 0.044 (95%CI 0.029–0.065) per 1000 live births in 2001 to 0.014 (95%CI 0.010–0.026) in 2017 (annual percentage change -6.6, 95%CI -9.1 to -4.0). Infants with GBS had higher relative rates of visual impairment (HR 7.0 95% CI 4.1-12.1), cerebral palsy (HR 9.3 95% CI 6.6-13.3), hydrocephalus (HR 17.3 95% CI 13.8-21.6) and NEC (HR 18.8 95% CI 16.7-21.2) compared with those without GBS. Conclusions Annual rates of GBS disease in infants have not changed over 19 years. The reduction in mortality is likely multifactorial and due to widespread implementation of antibiotics in at-risk mothers and babies as well as advances in managing acutely unwell infants. New methods for prevention, such as maternal vaccination, must be prioritised.

scholarly journals Positive Impact of Routine Testing for Enterovirus and Parechovirus on Length of Hospitalization and Antimicrobial Use among Inpatients ≤6 Months of Age

2020 ◽  
Vol 59 (1) ◽  
pp. e02106-20
Author(s):  
Brian R. Lee ◽  
Anjana Sasidharan ◽  
Chris J. Harrison ◽  
Rangaraj Selvarangan
Keyword(s):  
Kansas City ◽  
Positive Impact ◽  
Antibiotic Use ◽  
Hospital Charges ◽  
Cns Infection ◽  
Antimicrobial Use ◽  
Imaging Data ◽  
Rt Pcr ◽  
Young Infants ◽  
Length Of Hospitalization

ABSTRACTEnterovirus (EV) and parechovirus (PeV) are leading viral causes of central nervous system (CNS) infection among hospitalized neonates and young infants, yet testing for PeV is not routinely performed. The goal of our study was to determine how EV and PeV CSF RT-PCR testing impacted the duration of antibiotic use and the length of hospitalization (LOS) in children ≤6 months old with suspected CNS infection. This retrospective cohort study at Children’s Mercy Kansas City evaluated data from patients ≤6 months old for whom routine CSF EV and PeV reverse transcription-PCR (RT-PCR) testing was performed during January 2011 to December 2018. Electronic data were abstracted from the electronic medical record, including demographics, systemic antimicrobial use, imaging data, herpes simplex virus (HSV) testing, and overall hospital charges. Among 1,926 patients, 345 (17.9%) were RT-PCR positive for EV and 172 (8.9%) were positive for PeV. A significantly shorter LOS was observed for patients with EV (51.6 h; P < 0.001) and PeV (66.3 h; P = 0.048) compared to patients that tested negative for both viruses (74.1 h). Discontinuation of empirical antibiotic therapy following test result availability occurred more frequently for PeV patients (57.8%; P = 0.03) and EV patients (65.4%; P < 0.001) than RT-PCR-negative patients (48.5%). Routine EV/PeV RT-PCR testing of cerebrospinal fluid (CSF) samples in children impacted care of hospitalized neonates and young infants. Rapid and prompt diagnosis has the potential to reduce antibiotic usage, length of stay, and patient charges.

scholarly journals Neurodevelopmental Outcomes of Infants Younger Than 90 Days Old Following Enterovirus and Parechovirus Infections of the Central Nervous System

2021 ◽  
Vol 9 ◽  
Author(s):  
María de Ceano-Vivas ◽  
M. Luz García ◽  
Ana Velázquez ◽  
Fernando Martín del Valle ◽  
Ana Menasalvas ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Motor Function ◽  
Psychomotor Development ◽  
Fine Motor ◽  
Cns Infection ◽  
Neurological Development ◽  
Neurodevelopmental Outcomes ◽  
Cns Infections ◽  
Young Infants

Enteroviruses (EVs) and human parechoviruses (HPeVs) are a major cause of central nervous system (CNS) infection in young infants. They have been implicated in neurodevelopmental delay, however limited data are available. The aim of this study is to describe the clinical outcome of young infants and to assess and compare the medium-term neurodevelopment following CNS infections caused by EV and HPeV. A multicentre observational ambispective study was conducted between May 2013 and March 2018. Children under 3 months of age with EV or HPeV CNS infection excluding encephalitis were included. Infants were contacted 1 year after the acute infection and their neurological development was evaluated using the Ages and Stages Questionnaire-3 (ASQ-3). If any area assessed was abnormal during the first round of tests, a second round was completed 6 to 12 months later. Forty-eight young infants with EV and HPeV CNS infection were identified: 33 (68.8%) were positive for EV and 15 (31.3%) for HPeV. At first assessment 14 out of 29 EV (48.3%) and 3 out of 15 HPeV (20%) positive cases presented some developmental concern in the ASQ-3 test. EV-positive infants showed mild and moderate alteration in all domains analyzed and HPeV-positive infants showed mild alterations only in gross and fine motor domains. Significant alterations in communication were observed in EV-positive but not in HPeV-positive infants (31 vs. 0%, p = 0.016). At second assessment 4 out of 13 EV-positive patients (30.8%) showed mild to moderate concerns in communication and gross motor function domains and 3 out of 13 (23.1%) showed significant concern in fine motor function. Although CNS infections without associated encephalitis are generally assumed to be benign our study shows that at a median age of 18 months almost half of the EV-infected infants (48.3%) and 20% of HPeV-positive infants presented some developmental concern in the ASQ-3 test. We recommend monitor the neurological development of infants during the first years of life after HPeV CNS infection and especially after EV CNS infection, even in mild cases, for an early intervention and stimulation of psychomotor development if necessary.

scholarly journals Enteroviral and Herpes Simplex Virus  Central Nervous System Infections in Infants <90 Days Old: A Paediatric Investigators’ Collaborative Network on Infections in Canada (PICNIC) Study

2020 ◽  
Author(s):  
Dara Petel ◽  
Michelle Barton ◽  
Christian Renaud ◽  
Lynda Ouchenir ◽  
Jason Brophy ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Herpes Simplex Virus ◽  
Herpes Simplex ◽  
Cns Infection ◽  
Collaborative Network ◽  
Cns Infections ◽  
Young Infants ◽  
Csf Pleocytosis ◽  
Simplex Virus

Abstract Background The relative contribution of viruses to central nervous system (CNS) infections in young infants is not clear. For viral CNS infections, there are limited data on features that suggest HSV etiology or on predictors of unfavorable outcome. Methods In this cross-sectional retrospective study, seven centers from the Pediatric Investigators Collaborative Network on Infections in Canada identified infants <90 days of age with CNS infection proven to be due to enterovirus (EV) or herpes simplex virus (HSV) January 1, 2013 through December 31, 2014. Results Of 174 CNS infections with a proven etiology, EV accounted for 103 (59%) and HSV for 7 (4%). All HSV cases and 41 (40%) EV cases presented before 21 days of age. Four HSV cases (57%) and 5 EV cases (5%) had seizures. Three (43%) HSV and 23 (23 %) EV cases lacked cerebrospinal fluid (CSF) pleocytosis. HSV cases were more likely to require ICU admission (p=0.010), present with seizures (p=0.031) and have extra-CNS disease (p<0.001). Poor long-term outcomes were more common in infants who had seizures. Conclusions Viruses accounted for approximately two-thirds of proven CNS infections in the first 90 days of life. Empiric therapy for HSV should be considered in suspected CNS infections in the first 21 days even in the absence of CSF pleocytosis unless CSF parameters are suggestive of bacterial meningitis.

scholarly journals A case series of neonatal human parecho-virus encephalitis with a seasonality and endemicity

2021 ◽  
Vol 8 (8) ◽  
pp. 1428
Author(s):  
Favas Kudukkan ◽  
Bindu Athoor ◽  
Fysal Neliyathodi ◽  
Sheela P. Haweri
Keyword(s):  
White Matter ◽  
Tertiary Care ◽  
Case Series ◽  
White Matter Lesions ◽  
Specific Pattern ◽  
Cns Infection ◽  
Tertiary Care Centre ◽  
Virus Encephalitis ◽  
Young Infants ◽  
History Of

Human parecho viruses are small, non-enveloped, single stranded RNA viruses within parechovirus genus of the large picornaviridae family. In new-born it can cause gastroenteritis, sepsis and encephalitis. We report case series of parecho-virus encephalitis admitted to a tertiary care centre, Perinthalmanna. Parechoviral encephalitis is an endemic disease seasonally present (May-July) in certain regions of Northern part of Kerala. HPeV are viruses that cause CNS infection in the neonatal period, resulting in white matter lesions that can be visualised with MRI. In a retrospective study, 4 newborn babies of neonatal HPeV encephalitis diagnosed on the basis of clinical and radiological findings with a seasonality were assessed. HPeV encephalitis needs to be in differential diagnosis when neonates and young infants present with seizure and sepsis. HPeV infection must be considered in infants with specific pattern of white matter change but no convincing history of a perinatal hypoxic-ischaemic insult.

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