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Guidelines 1 Diagnostik og behandling af Lyme neuroborreliose (2021)
Denne vejledning er tiltænkt diagnostik og behandling af formodet Lyme neuroborreliose hos voksne. Vejledningen er udarbejdet som et supplement til Borrelia klaringsrapport (2014). 2 Lumbalpunktur, blodfortyndende behandling og akut bakteriel meningitis (2019)
Rapport og anbefaling vedrørende ulemper og fordele ved henholdsvis at undlade eller gennemføre lumbalpunktur for patienter i blodfortyndende behandling mistænkt for akut bakteriel meningitis. 3 Encefalitis 2018
Arbejdsgruppe: Anne-Mette Lebech, Birgitte Rønde Hansen, Christian Brandt, Hans Rudolph von Lüttichau, Jacob Bodilsen, Jannick Helweg-Larsen, Lothar Wiese, Lykke Larsen, Trine Mogensen. 4 Viral meningitis (2018)
Udgiver: Dansk Selskab for Infektionsmedicin 2018 Arbejdsgruppe: Anne-Mette Lebech, Birgitte Rønde Hansen, Christian Brandt, Hans Rudolph von Lüttichau, Jacob Bodilsen, Jannik Helweg-Larsen, Lothar Wiese, Lykke Larsen, Trine Mogensen. 5 Akut bakteriel meningitis (2018)
Udgiver: Dansk Selskab for Infektionsmedicin Arbejdsgruppe: Anne-Mette Lebech, Birgitte Rønde Hansen, Christian Brandt, Hans Rudolf von Lüttichau, Jacob Bodilsen, Lothar Wiese, Lykke Larsen, Trine Mogensen. Links 1 Tværregional vejledning vedrørende akut bakteriel (purulent) meningitis hos voksne
2 Vejledning om forebyggelse ved tilfælde af Meningokoksygdom
Nye artikler 1 The clinical characteristics and therapeutic outcomes of adult patients with community-acquired spontaneous bacterial meningitis with a fulminant clinical course in Taiwan BMC Infectious Diseases, 8.12.2023 Tilføjet 8.12.2023 Abstract Purpose To examine the clinical characteristics of adult patients with community-acquired spontaneous bacterial meningitis (CASBM) with a fulminant clinical course. Materials and methods The clinical features and therapeutic outcomes of 127 adult CASBM patients were analyzed. The patients were divided into two groups as those with and without a fulminant clinical course. Fulminant clinical course was defined as meningitis presenting initially with marked consciousness disturbance (Glasgow Coma Scale score Læs mere Tjek på PubMed2 The clinical characteristics and therapeutic outcomes of adult patients with community-acquired spontaneous bacterial meningitis with a fulminant clinical course in Taiwan BMC Infectious Diseases, 8.12.2023 Tilføjet 8.12.2023 Abstract Purpose To examine the clinical characteristics of adult patients with community-acquired spontaneous bacterial meningitis (CASBM) with a fulminant clinical course. Materials and methods The clinical features and therapeutic outcomes of 127 adult CASBM patients were analyzed. The patients were divided into two groups as those with and without a fulminant clinical course. Fulminant clinical course was defined as meningitis presenting initially with marked consciousness disturbance (Glasgow Coma Scale score Læs mere Tjek på PubMed3 Ramsay Hunt syndrome and concurrent varicella‐zoster virus meningitis in Denmark: A nationwide cohort study Pelle T. Petersen, Jacob Bodilsen, Micha P. G. Jepsen, Lykke Larsen, Merete Storgaard, Jannik Helweg‐Larsen, Lothar Wiese, Birgitte R. Hansen, Hans R. Lüttichau, Christian Ø. Andersen, Henrik Nielsen, Christian T. Brandt, The Danish Study Group of Infections of the Brain (DASGIB) Journal of Medical Virology, 7.12.2023 Tilføjet 7.12.2023 4 Diagnosis and management of cryptococcal meningitis in HIV-infected adults Thomas C. McHaleDavid R. BoulwareJohn KasibanteKenneth SsebambuliddeCaleb P. SkipperMahsa Abassi1Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA2Infectious Diseases Institute, Makerere University, Kampala, Uganda, Graeme N. Forrest Clinical Microbiology Reviews, 29.11.2023 Tilføjet 29.11.2023 5 A preclinical model of TB meningitis to determine drug penetration and activity at the sites of disease Faye LanniRosleine Antilus SainteMark Hansen,Paul ParigiFirat KayaKatherine LoMauroBernard SiowRobert J. WilkinsonSean WassermanBrendan K. PodellMartin GengenbacherVéronique Dartois1Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, New Jersey, USA2The Francis Crick Institute, London, United Kingdom3Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa4Department of Medicine, University of Cape Town, Cape Town, South Africa5Department of Infectious Diseases, Imperial College London, London, United Kingdom6Mycobacteria Research Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, USA7Department of Medical Sciences, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA, Jared A. Silverman Antimicrobial Agents And Chemotherapy, 27.11.2023 Tilføjet 27.11.2023 6 A preclinical model of TB meningitis to determine drug penetration and activity at the sites of disease Faye LanniRosleine Antilus SainteMark Hansen,Paul ParigiFirat KayaKatherine LoMauroBernard SiowRobert J. WilkinsonSean WassermanBrendan K. PodellMartin GengenbacherVéronique Dartois1Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, New Jersey, USA2The Francis Crick Institute, London, United Kingdom3Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa4Department of Medicine, University of Cape Town, Cape Town, South Africa5Department of Infectious Diseases, Imperial College London, London, United Kingdom6Mycobacteria Research Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, USA7Department of Medical Sciences, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA, Jared A. Silverman Antimicrobial Agents And Chemotherapy, 15.11.2023 Tilføjet 15.11.2023 7 Leptospirosis-associated meningitis in a patient with sjögren’s syndrome: a case report BMC Infectious Diseases, 11.11.2023 Tilføjet 11.11.2023 Abstract Background Leptospirosis is a zoonotic disease that afflicts both humans and animals. It progresses from flu-like symptoms to more severe hepatic and renal failure, and may also lead to aseptic meningitis. Individuals with autoimmune diseases (ADs) are potentially more susceptible to Leptospirosis. Thus far, limited data has documented the association between Leptospirosis and autoimmune disorders. Case presentation The patient had a definitive pathological diagnosis of Sjögren’s syndrome (SS). Due to recurrent headaches, the patient sought consultation with a neurologist. Lumbar puncture revealed elevated white blood cells and protein levels in the cerebrospinal fluid, along with decreased glucose. Tuberculous meningitis was suspected. Radiographic imaging exhibited meningeal enhancement, ventricular enlargement, and hydrocephalus. The patient commenced treatment with anti-tuberculosis therapy and corticosteroids. Subsequently, high-throughput sequencing (HTS) of cerebrospinal fluid identified the presence of Leptospira interrogans. The patient was ultimately diagnosed with Leptospiral meningitis, and underwent antimicrobial and immunosuppressive therapy, resulting in stabilization of the condition and gradual symptom recovery. Conclusions The case highlights the challenges in diagnosing and managing leptospirosis-related meningitis in the presence of ADs and emphasizes the importance of utilizing HTS for accurate pathogen detection. The potential correlation between leptospirosis and SS warrants further investigation, as does the need for multidisciplinary involvement in treatment strategies for such complex cases. Læs mere Tjek på PubMed8 Leptospirosis-associated meningitis in a patient with sjögren’s syndrome: a case report BMC Infectious Diseases, 9.11.2023 Tilføjet 9.11.2023 Abstract Background Leptospirosis is a zoonotic disease that afflicts both humans and animals. It progresses from flu-like symptoms to more severe hepatic and renal failure, and may also lead to aseptic meningitis. Individuals with autoimmune diseases (ADs) are potentially more susceptible to Leptospirosis. Thus far, limited data has documented the association between Leptospirosis and autoimmune disorders. Case presentation The patient had a definitive pathological diagnosis of Sjögren’s syndrome (SS). Due to recurrent headaches, the patient sought consultation with a neurologist. Lumbar puncture revealed elevated white blood cells and protein levels in the cerebrospinal fluid, along with decreased glucose. Tuberculous meningitis was suspected. Radiographic imaging exhibited meningeal enhancement, ventricular enlargement, and hydrocephalus. The patient commenced treatment with anti-tuberculosis therapy and corticosteroids. Subsequently, high-throughput sequencing (HTS) of cerebrospinal fluid identified the presence of Leptospira interrogans. The patient was ultimately diagnosed with Leptospiral meningitis, and underwent antimicrobial and immunosuppressive therapy, resulting in stabilization of the condition and gradual symptom recovery. Conclusions The case highlights the challenges in diagnosing and managing leptospirosis-related meningitis in the presence of ADs and emphasizes the importance of utilizing HTS for accurate pathogen detection. The potential correlation between leptospirosis and SS warrants further investigation, as does the need for multidisciplinary involvement in treatment strategies for such complex cases. Læs mere Tjek på PubMed9 Leptospirosis-associated meningitis in a patient with sjögren’s syndrome: a case report BMC Infectious Diseases, 9.11.2023 Tilføjet 9.11.2023 Abstract Background Leptospirosis is a zoonotic disease that afflicts both humans and animals. It progresses from flu-like symptoms to more severe hepatic and renal failure, and may also lead to aseptic meningitis. Individuals with autoimmune diseases (ADs) are potentially more susceptible to Leptospirosis. Thus far, limited data has documented the association between Leptospirosis and autoimmune disorders. Case presentation The patient had a definitive pathological diagnosis of Sjögren’s syndrome (SS). Due to recurrent headaches, the patient sought consultation with a neurologist. Lumbar puncture revealed elevated white blood cells and protein levels in the cerebrospinal fluid, along with decreased glucose. Tuberculous meningitis was suspected. Radiographic imaging exhibited meningeal enhancement, ventricular enlargement, and hydrocephalus. The patient commenced treatment with anti-tuberculosis therapy and corticosteroids. Subsequently, high-throughput sequencing (HTS) of cerebrospinal fluid identified the presence of Leptospira interrogans. The patient was ultimately diagnosed with Leptospiral meningitis, and underwent antimicrobial and immunosuppressive therapy, resulting in stabilization of the condition and gradual symptom recovery. Conclusions The case highlights the challenges in diagnosing and managing leptospirosis-related meningitis in the presence of ADs and emphasizes the importance of utilizing HTS for accurate pathogen detection. The potential correlation between leptospirosis and SS warrants further investigation, as does the need for multidisciplinary involvement in treatment strategies for such complex cases. Læs mere Tjek på PubMed10 Ventriculoperitoneal shunt for tuberculous meningitis-associated hydrocephalus: long-term outcomes and complications BMC Infectious Diseases, 30.10.2023 Tilføjet 30.10.2023 Abstract Background Hydrocephalus is a frequent complication of tuberculous meningitis (TBM), and ventriculoperitoneal shunt (VPS) has been shown to improve short-term prognosis for patients with TBM-associated hydrocephalus. However, questions remain about long-term prognosis and shunt-related complications. This study aims to provide a comprehensive assessment of both long-term prognosis and shunt-related complications in patients with TBM-induced hydrocephalus who have undergone VPS treatment. Methods This retrospective study analyzed the clinical data of TBM patients with hydrocephalus treated with VPS at Peking Union Medical College Hospital between December 1999 and February 2023. Both short-term outcomes at discharge and long-term outcomes during follow-up were examined. Prognosis and shunt-related complications were assessed using the modified Rankin Scale (mRS) and the Activity of Daily Living (ADL) score to evaluate neurological function and autonomic living ability, respectively. Results A total of 14 patients with TBM-associated hydrocephalus were included in this study. Of these, 92.9% (13/14) exhibited favorable short-term outcomes, while 57.1% (8/14) showed positive long-term outcomes. Initial results indicated 6 complete recoveries (CR), 7 partial recoveries (PR), and 1 treatment failure. No catheter-related complications were observed initially. Long-term results included 4 CRs, 4 PRs, and 6 treatment failures. A variety of shunt surgery-related complications were noted, including three instances of catheter obstruction, one of incision infection, one of catheter-related infection, one of acute cerebral infarction, and one of transient peritoneal irritation accompanied by diarrhea. Conclusions VPS appears to be an effective and well-tolerated treatment for TBM-associated hydrocephalus, efficiently alleviating acute intracranial hypertension. Nonetheless, continuous long-term monitoring and proactive management are essential to mitigate the risk of catheter-related complications. Læs mere Tjek på PubMed11 Clinical characteristics of tuberculous meningitis in older patients compared with younger and middle-aged patients: a retrospective analysis BMC Infectious Diseases, 20.10.2023 Tilføjet 20.10.2023 Abstract Background Few studies have analyzed the clinical characteristics and adverse factors affecting prognosis in older patients with tuberculous meningitis (TBM). This study aimed to compare the clinical characteristics of TBM in older patients with those in younger and middle-aged patients. Methods This single-center retrospective study extracted data on the clinical features, cerebrospinal fluid changes, laboratory results, imaging features, and outcomes of patients with TBM from patient medical records and compared the findings in older patients (aged 60 years and older) with those of younger and middle-aged patients (aged 18–59 years). Results The study included 197 patients with TBM, comprising 21 older patients aged 60–76 years at onset, and 176 younger and middle-aged patients aged 18–59 years at onset. Fever was common in both older (81%) and younger and middle-aged patients (79%). Compared with younger and middle-aged patients, older patients were more likely to have changes in awareness levels (67% vs. 40%), peripheral nerve dysfunction (57% vs. 29%), changes in cognitive function (48% vs. 20%), and focal seizures (33% vs. 6%), and less likely to have headache (71% vs. 93%), neck stiffness on meningeal stimulation (38% vs. 62%), and vomiting (47% vs. 68%). The Medical Research Council staging on admission of older patients was stage II (52%) and stage III (38%), whereas most younger and middle-aged patients had stage I (33%) and stage II (55%) disease. Neurological function evaluated on the 28th day of hospitalization was more likely to show poor prognosis in older patients than in younger and middle-aged patients (76% vs. 25%). Older patients had significantly higher red blood cell counts and blood glucose levels, and significantly lower serum albumin and sodium levels than those in younger and middle-aged patients. The cerebrospinal fluid protein levels, nucleated cell counts, glucose levels, and chloride levels did not differ significantly by age. Conclusion In patients with TBM, older patients have more severe clinical manifestations, a higher incidence of hydrocephalus and cerebral infarction, and longer hospital stays than younger and middle-aged patients. Older patients thus require special clinical attention. Læs mere Tjek på PubMed12 Clinical characteristics of tuberculous meningitis in older patients compared with younger and middle-aged patients: a retrospective analysis BMC Infectious Diseases, 19.10.2023 Tilføjet 19.10.2023 Abstract Background Few studies have analyzed the clinical characteristics and adverse factors affecting prognosis in older patients with tuberculous meningitis (TBM). This study aimed to compare the clinical characteristics of TBM in older patients with those in younger and middle-aged patients. Methods This single-center retrospective study extracted data on the clinical features, cerebrospinal fluid changes, laboratory results, imaging features, and outcomes of patients with TBM from patient medical records and compared the findings in older patients (aged 60 years and older) with those of younger and middle-aged patients (aged 18–59 years). Results The study included 197 patients with TBM, comprising 21 older patients aged 60–76 years at onset, and 176 younger and middle-aged patients aged 18–59 years at onset. Fever was common in both older (81%) and younger and middle-aged patients (79%). Compared with younger and middle-aged patients, older patients were more likely to have changes in awareness levels (67% vs. 40%), peripheral nerve dysfunction (57% vs. 29%), changes in cognitive function (48% vs. 20%), and focal seizures (33% vs. 6%), and less likely to have headache (71% vs. 93%), neck stiffness on meningeal stimulation (38% vs. 62%), and vomiting (47% vs. 68%). The Medical Research Council staging on admission of older patients was stage II (52%) and stage III (38%), whereas most younger and middle-aged patients had stage I (33%) and stage II (55%) disease. Neurological function evaluated on the 28th day of hospitalization was more likely to show poor prognosis in older patients than in younger and middle-aged patients (76% vs. 25%). Older patients had significantly higher red blood cell counts and blood glucose levels, and significantly lower serum albumin and sodium levels than those in younger and middle-aged patients. The cerebrospinal fluid protein levels, nucleated cell counts, glucose levels, and chloride levels did not differ significantly by age. Conclusion In patients with TBM, older patients have more severe clinical manifestations, a higher incidence of hydrocephalus and cerebral infarction, and longer hospital stays than younger and middle-aged patients. Older patients thus require special clinical attention. Læs mere Tjek på PubMed13 The application value of metagenomic next-generation sequencing in community-acquired purulent meningitis after antibiotic intervention BMC Infectious Diseases, 13.10.2023 Tilføjet 13.10.2023 Abstract Background Bacteria account for nearly one third of the causes of community-acquired central nervous system infections, and traditional diagnostic methods are based on culture results, which are time-consuming and have a low detection rate leading to delayed diagnosis and treatment. Since metagenomic next-generation sequencing (mNGS) has the advantages of high timeliness and only detecting microbial trace gene fragments, it has been used more widely in recent years. Based on this, we explored whether the application of cerebrospinal fluid (CSF) mNGS is advantageous in patients with community-acquired purulent meningitis, especially in people who have already used antibiotics. Methods This was a retrospective study of 63 patients with community-acquired purulent meningitis admitted to the Department of Neurology of Shanxi Bethune Hospital from March 2018 to November 2022. Data were systematically collected and classified into CSF culture group, blood culture group and CSF mNGS group according to different detection methods, and the total detection rate of each method was calculated. Each group of patients was divided into two subgroups according to whether antibiotics were used before sampling. The detection rates of the three groups were compared within and between groups to explore whether mNGS has advantages over traditional methods and the influence of antibiotic use on detection rates of the three methods. Results Among the 63 patients, the cases of CSF culture, blood culture and CSF mNGS were 56, 46, 44, respectively. The total detection rates of the three methods were 17.86%, 36.96%, 81.82%, with statistical differences (p Læs mere Tjek på PubMed14 Correction: Outcome of acute bacterial meningitis among children in Kandahar, Afghanistan: A prospective observational cohort study Bilal Ahmad Rahim, Niamatullah Ishaq, Ghulam Mohayuddin Mudaser, Walter R. Taylor PLoS One Infectious Diseases, 12.10.2023 Tilføjet 12.10.2023 by Bilal Ahmad Rahim, Niamatullah Ishaq, Ghulam Mohayuddin Mudaser, Walter R. Taylor Læs mere Tjek på PubMed15 Adjunctive Dexamethasone for Tuberculous Meningitis in HIV-Positive Adults Joseph Donovan, Nguyen D. Bang, Darma Imran, Ho D.T. Nghia, Erlina Burhan, Dau T.T. Huong, Nguyen T.T. Hiep, Lam H.B. Ngoc, Dang V. Thanh, Nguyen T. Thanh, Anna L.S. Wardhani, Kartika Maharani, Cakra P. Gasmara, Nguyen H.H. Hanh, Pham K.N. Oanh, Riwanti Estiasari, Do D.A. Thu, Ardiana Kusumaningrum, Le T. Dung, Do C. Giang, Dang T.M. Ha, Nguyen H. Lan, Nguyen V.V. Chau, Nguyen T.M. Nguyet, Ronald B. Geskus, Nguyen T.T. Thuong, Evelyne Kestelyn, Raph L. Hamers, Nguyen H. Phu, Guy E. Thwaites New England Journal of Medicine, 12.10.2023 Tilføjet 12.10.2023 New England Journal of Medicine, Volume 389, Issue 15, Page 1357-1367, October 2023. Læs mere Tjek på PubMed16 Tuberculous Meningitis — New Approaches Needed Sean Wasserman, Thomas S. Harrison New England Journal of Medicine, 12.10.2023 Tilføjet 12.10.2023 New England Journal of Medicine, Volume 389, Issue 15, Page 1425-1426, October 2023. Læs mere Tjek på PubMed17 Comparison of bacterial culture with BioFire® FilmArray® multiplex PCR screening of archived cerebrospinal fluid specimens from children with suspected bacterial meningitis in Nigeria BMC Infectious Diseases, 2.10.2023 Tilføjet 2.10.2023 Abstract Background Diagnosis of bacterial meningitis remains a challenge in most developing countries due to low yield from bacterial culture, widespread use of non-prescription antibiotics, and weak microbiology laboratories. The objective of this study was to compare the yield from standard bacterial culture with the multiplex nested PCR platform, the BioFire® FilmArray® Meningitis/Encephalitis Panel (BioFire ME Panel), for cases with suspected acute bacterial meningitis. Methods Following Gram stain and bacterial culture on cerebrospinal fluid (CSF) collected from children aged less than 5 years with a clinical suspicion of acute bacterial meningitis (ABM) as defined by the WHO guidelines, residual CSF specimens were frozen and later tested by BioFire ME Panel. Results A total of 400 samples were analyzed. Thirty-two [32/400 (8%)] of the specimens were culture positive, consisting of; three Salmonella spp. (2 Typhi and 1 non-typhi), three alpha hemolytic Streptococcus, one Staphylococcus aureus, six Neisseria meningitidis, seven Hemophilus influenzae, 11 Streptococcus pneumoniae and 368 were culture negative. Of the 368 culture-negative specimens, the BioFire ME Panel detected at least one bacterial pathogen in 90 (24.5%) samples, consisting of S. pneumoniae, N. meningitidis and H. influenzae, predominantly. All culture positive specimens for H. influenzae, N. meningitidis and S. pneumoniae also tested positive with the BioFire ME Panel. In addition, 12 specimens had mixed bacterial pathogens identified. For the first time in this setting, we have data on the viral agents associated with meningitis. Single viral agents were detected in 11 (2.8%) samples while co-detections with bacterial agents or other viruses occurred in 23 (5.8%) of the samples. Conclusions The BioFire® ME Panel was more sensitive and rapid than culture for detecting bacterial pathogens in CSF. The BioFire® ME Panel also provided for the first time, the diagnosis of viral etiologic agents that are associated with meningoencephalitis in this setting. Institution of PCR diagnostics is recommended as a routine test for suspected cases of ABM to enhance early diagnosis and optimal treatment. Læs mere Tjek på PubMed18 Empirical cefepime+vancomycin versus ceftazidime+vancomycin versus meropenem+vancomycin in the treatment of healthcare-associated meningitis: results of the multicenter ephesus study BMC Infectious Diseases, 30.09.2023 Tilføjet 30.09.2023 Abstract Background Herein, we analyzed the efficacy of main antibiotic therapy regimens in the treatment of healthcare-associated meningitis (HCAM). Materials/methods This retrospective cohort study was conducted in 18 tertiary-care academic hospitals Turkey, India, Egypt and Romania. We extracted data and outcomes of all patients with post-neurosurgical meningitis cases fulfilling the study inclusion criteria and treated with empirical therapy between December 2006-September 2018. Results Twenty patients in the cefepime + vancomycin-(CV) group, 31 patients in the ceftazidime + vancomycin-(CFV) group, and 119 patients in the meropenem + vancomycin-(MV) group met the inclusion criteria. The MV subgroup had a significantly higher mean Glasgow Coma Score, a higher rate of admission to the intensive care unit within the previous month, and a higher rate of antibiot herapy within the previous month before the meningitis episode (p 0.05) among the three cohorts. No regimen was effective against carbapenem-resistant bacteria, and vancomycin resulted in an EOT clinical success rate of 60.6% in the methicillin-resistant staphylococci or ampicillin-resistant enterococci subgroup (n = 34). Conclusions Our study showed no significant difference in terms of clinical success and mortality among the three treatment options. All regimens were ineffective against carbapenem-resistant bacteria. Vancomycin was unsuccessful in approximately 40% of cases involving methicillin-resistant staphylococci or ampicillin-resistant enterococci. Læs mere Tjek på PubMed19 Empirical cefepime+vancomycin versus ceftazidime+vancomycin versus meropenem+vancomycin in the treatment of healthcare-associated meningitis: results of the multicenter ephesus study BMC Infectious Diseases, 29.09.2023 Tilføjet 29.09.2023 Abstract Background Herein, we analyzed the efficacy of main antibiotic therapy regimens in the treatment of healthcare-associated meningitis (HCAM). Materials/methods This retrospective cohort study was conducted in 18 tertiary-care academic hospitals Turkey, India, Egypt and Romania. We extracted data and outcomes of all patients with post-neurosurgical meningitis cases fulfilling the study inclusion criteria and treated with empirical therapy between December 2006-September 2018. Results Twenty patients in the cefepime + vancomycin-(CV) group, 31 patients in the ceftazidime + vancomycin-(CFV) group, and 119 patients in the meropenem + vancomycin-(MV) group met the inclusion criteria. The MV subgroup had a significantly higher mean Glasgow Coma Score, a higher rate of admission to the intensive care unit within the previous month, and a higher rate of antibiot herapy within the previous month before the meningitis episode (p 0.05) among the three cohorts. No regimen was effective against carbapenem-resistant bacteria, and vancomycin resulted in an EOT clinical success rate of 60.6% in the methicillin-resistant staphylococci or ampicillin-resistant enterococci subgroup (n = 34). Conclusions Our study showed no significant difference in terms of clinical success and mortality among the three treatment options. All regimens were ineffective against carbapenem-resistant bacteria. Vancomycin was unsuccessful in approximately 40% of cases involving methicillin-resistant staphylococci or ampicillin-resistant enterococci. Læs mere Tjek på PubMed20 Linezolid population pharmacokinetic model in plasma and cerebrospinal fluid among patients with tuberculosis meningitis Journal of Infectious Diseases, 26.09.2023 Tilføjet 26.09.2023 AbstractBackgroundLinezolid is evaluated in novel treatment regimens for tuberculous meningitis (TBM). Linezolid pharmacokinetics have not been characterized in this population, particularly in cerebrospinal fluid (CSF) where exposures may be affected by changes in protein concentration. Linezolid co-administration with high-dose rifampicin, has also not been studied. We aimed to characterize linezolid plasma and CSF pharmacokinetics in adults with TBM.MethodsIn LASER-TBM pharmacokinetic-substudy, the intervention groups received high-dose rifampicin (35mg/kg) plus linezolid 1200mg/day for 28days, then reduced to 600mg/day. Plasma sampling was done on day 3 (intensive) and on day 28 (sparse). A lumbar CSF sample was obtained on both visits.Results30-participants, median(min-max) age and weight of 40(27–56)years and 58(30–96)kg, contributed 247 plasma and 28 CSF observations. Plasma pharmacokinetics was described by one-compartment model with first-order absorption and saturable elimination. Maximal clearance was 7.25L/h, and Km was 27.2mg/L. Rifampicin co-treatment duration did not affect linezolid pharmacokinetics. CSF-Plasma partitioning correlated with CSF total-protein upto 1.2g/L where the partition-coefficient reached maximal value of 37%. Plasma-CSF equilibration half-life was ∼3.5hoursConclusionLinezolid was readily detected in CSF despite high-dose rifampicin co-administration. These findings support continued clinical evaluation of linezolid plus high-dose rifampicin for the treatment of TBM in adults. Læs mere Tjek på PubMed |
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The treatment of persistent symptoms attributed to Lyme disease remains controversial. We assessed whether longer-term antibiotic treatment of persistent symptoms attributed to Lyme disease leads to better outcomes than does shorter-term treatment. PMID: 270289118 Herpes simplex and varicella zoster CNS infections: clinical presentations, treatments and outcomes. Infection 2016; 44(3):337-45
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Lyme borreliosis, caused by spirochaetes of the Borrelia burgdorferi genospecies complex, is the most commonly reported tick-borne infection in Europe and North America. The non-specific nature of many of its clinical manifestations presents a diagnostic challenge and concise case definitions are essential for its satisfactory management. Lyme borreliosis is very similar in Europe and North America but the greater variety of genospecies in Europe leads to some important differences in clinical presentation. These new case definitions for European Lyme borreliosis emphasise recognition of clinical manifestations supported by relevant laboratory criteria and may be used in a clinical setting and also for epidemiological investigations. PMID: 2013225812 Dexamethasone in adults with bacterial meningitis. N Engl J Med 2002; 347(20):1549-56
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