The Presence of Viral Meningitis without Pleocytosis among Pediatric Patients » Herpes Secrets

A repeat LP showed 130 WBC/μL with 85% neutrophils, 120 RBC/μL, protein of 157 mg/dL, and glucose of 36 mg/dL. A total of 149 children were infected with EV. Clinical data was retrospectively extracted from the hospital files (deputy of research committee approval code 86013). Overall, we collected 58 CSF samples (35 neonates and 23 children) during six months. We determined length of stay by calculating the number of days each patient was in the hospital at midnight. Microscopic and biochemical analysis of the CSF samples namely fungi and bacteria cultures and determination of glucose and proteins levels were carried out. We ensured complete capture of children with bacterial meningitis by cross-checking each institution’s microbiology logs and by including all patients with CSF cultures growing bacterial pathogens (5 patients with bacterial meningitis were not identified by ICD-9 codes).

Records were retrospectively analysed of infants under four months of age admitted to hospital between 1977 and 1987 with viral CSF cultures: those with enteroviruses isolated from CSF (group 1) were compared with those with enteroviruses isolated only from non-CSF sites (group 2). Of the 1,706 specimens submitted for EV RT-PCR during the three study seasons, 570 (33.4%) tested positive and 1,136 (67%) tested negative. Approval was granted by the Human Ethics Committee of the Western Sydney Area Health Service. Patients were distributed as follows: 19 (12%) were neonates (median age, 21 days; range, 9–28 days), 27 (17%) were infants (median age, 40 days; range, 30–458 days), 57 (37%) were children (median age, 6 years; range, 2–15 years), and 53 (34%) were adults (median age, 31 years; range, 17–57 years). The purpose of this study was to explore the usefulness of BMS in South Korean patients, and to introduce BMS as a CPR. Viral CSF culture consisted of one culture tube each of MRC-5 fibroblasts, human neonatal kidney cells, and primary African green monkey kidney cells. P value less than 0.05 was regarded as statistical significance.


We collected data from the medical records regarding patient demographics, medical history, symptoms at presentation to the ED, vital signs at triage, ED physical examination findings, presence of concomitant diseases, and ED disposition. viral meningitis, respectively (p < 0.001 for all comparisons): white cell count (median 1333 vs. Consequently, they require emergency care, including the administration of appropriate antimicrobial therapy as soon as possible once bacterial meningitis is suspected or proven. A detailed history and physical examination can provide a clue to the etiologic diagnosis. Protein levels were 2.97 g/l, glucose 3.2 mmol/l (contemporary plasma values were not available), white cell count (WCC) 145 (lymphocytes 97%, atypical cells 2%, polymorphonuclear cells 1%), red blood cells (RBC) 11 440. Five had symptoms of fever, chills, nausea, and vomiting. The infection may give rise to different symptoms by affecting organs such as the skin, joints, heart muscle or nervous system [3] - [5] . Enteroviruses may cause up to 90% of aseptic meningitis cases for which a specific etiology is identified. In general, patients with aseptic meningitis syndrome are alert and complain of severe headache, primarily when they turn their eyes to one side or the other or flex their necks. Levels of CSF glucose rose with increasing levels of serum glucose (Figure 1 ). Prior studies either did not perform viral testing, only tested a small subset of patients for viral co-infection, or did not evaluate children during the enterovirus season3-8. To complete the CME questions you must have an account in the Vanderbilt CME database. Two patients were treated with intravenous methylprednisolone; the other 2 children were observed carefully without any special therapy. In endemic areas, dengue infection should be considered as a probable etiological agent of meningitis. Areas under receiver-operator-characteristic curves (AROCs) for the resultant score were 0.98 for the derivation set and 0.90 and 0.97, respectively, for validation sets from Columbus and Boston. The concentrations of IFN-γ and IL-1 differed significantly only between the mumps group and control. Resolution occurs several days after drug discontinuation and the clinical and cerebrospinal fluid profile (neutrophilic pleocytosis) do not allow DIAM to be distinguished from infectious meningitis. In this situation, it is better to initiate treatment before the results of the CSF culture are available. Given the significant morbidity and mortality associated with acute bacterial meningitis in the United States and throughout the world, accurate information is necessary regarding the important etiological agents and populations at risk to initiate public health measures and ensure appropriate management. The publisher's final edited version of this article is available at J Neurol Sci See other articles in PMC that cite the published article. The cell count ranges from 10 to 1000 cells/mm3, but is usually less than 300 cells/mm3 (Meyers and Gurtman 1990). A description of 7 consecutive patients admitted for various forms of neurological impairment. This article has been cited by other articles in PMC.

Benign afebrile cluster convulsions with gastroenteritis: an observational study

Patients having cerebrovascular diseases followed by fever were also excluded as structural lesion in the brain could be a reason for the altered mental state. All rights reserved. Neuroimaging was performed on 91% of the patients, with 2 findings of cerebral edema (1 fatal in a 28-year-old Asian woman) and 1 case of acute necrotizing encephalopathy (in a 55-year-old white man). CSF analyses showed no bacterial or viral pathogen or pleocytosis. For example, changes in mental status from baseline are commonly seen even when the main process does not involve the central nervous system (CNS) [6]; this is the consequence of altered neural function in the form of cognitive and behavioral changes which permits the diagnosis of delirium [4]. potential vaccine benefits. Neurological examination showed poor mental status and obvious lethargy.

Favorable outcome was defined as either seizure-free or fewer than two seizure episodes per month after treatment. The family denied any toxic ingestion and denied use of salicylates. An MRI scan of the brain revealed an ill‐defined T2 hyperintense area in the brainstem which was reported as an area of infarction secondary to cerebrovascular ischaemia. Frontotemporal signs with aphasia, personality changes, and focal seizures are significant features of HSE, however no pathognomonic clinical feature has yet been identified. To avoid preexisting diagnoses (ie, visits for follow-up of an existing condition), all diagnostic codes were the first event documented within the previous year or previous 30 days for that individual (Table 1). From the available studies, however, 2 key biomarkers with potential have emerged, namely S100B and NSE. In 25 patients (10.5%), the final diagnosis could not be made in spite of the extensive investigations available in our center.


Neurol India 2012;60:168-73. In a recently published animal study by Jang et al.,[45] elevated levels of alpha-synuclein, loss of 17% dopaminergic neurons in the substantia nigra and persistent inflammation in areas of the brain infected with H5N1 influenza strain have been reported. Studies have shown that higher loads also begin to clinically impact the immune system, with invasion and killing of B- and T-lymphocytes, including Natural Killer Cells, and inhibition of lymphocyte transformation and mitogenesis. Encephalitis. In some cases, AVMs bleed. Nonspecific EEG abnormalities are seen in 90% to 98% of patients, which is usually a nonspecific slow background activity. potential benefits is silenced by the vaccine industry and all its obedient propagandists.

Neurons, due to their high lipid content and high metabolism, are susceptible to damage and destruction during hypoxic-ischemic states and by toxins and drug metabolites. Try a simple one step command without miming or demonstrating non-verbally such as “stick our your tongue” or “close your eyes”, or simple 2 step commands  such as “show me two fingers”. In a recent analysis of the National Health and Nutrition Evaluation Survey (NHANES), the seroprevalence of hepatitis E in the USA was estimated at 6%, despite the rarity of reported cases of hepatitis E [3]. Pediatrics 81:789-794. View Full Text PDF Listings View primary source full text article PDFs. Diffusion-weighted magnetic imaging of the brain disclosed a focal hyperintense lesion in the corpus callosum which showed a low coefficient in the apparent diffusion coefficient mapping. All this stopped when these symptoms came up: – (.

The refusal two decades ago by vaccine manufacturers, government health agencies and medical organizations to seriously investigate reports of vaccine-associated brain injury and immune system dysfunction, including autistic behaviors, is reaping tragic consequences today. Usually HIV-meningoencephalitis occurs a few weeks or months after the person first contracts HIV infection. Take precautions for increased intracranial pressure during intubation. These uncontrolled observational studies provide no information on the concurrent background rates of encephalopathy. BDNF expression in the CSF was correlated with CSF interleukin (IL)-6 levels as well as with blood platelet counts and neurological prognoses in those with bacterial meningitis. Diffusion-weighted magnetic imaging of the brain disclosed a focal hyperintense lesion in the corpus callosum which showed a low coefficient in the apparent diffusion coefficient mapping. We present a case of apparent hepatic encephalopathy secondary to pancreatic carcinoma with liver involvement that presented as hepatic encephalopathy mimicking WNE.

While treatment for most viral CNS infections is supportive, certain inflammatory CNS diseases have drastically different outcomes depending on appropriate and timely treatment and therefore must be distinguished quickly from other viral causes. Intracranial hemorrhage, bacterial meningitis, and metabolic disturbance were the major causes of acute symptomatic seizures in children aged 1-12 months. Zdravev stipulated that otogenous brain abscesses not only need to be surgically evacuated but, when causing cerebral herniation, may benefit from lowering body temperature. It is generally safe, and serious adverse reactions are uncommon. It predominately affects young children during the summer season. However, these conditions were ruled out for our patient based on the clinical profile, as there was no history of seizure, hypoglycemia, alcohol and drug use, renal dysfunction, malnutrition or trauma.