Meningitis, Meningoencephalitis and Encephalitis in Bern: an observational study of 258 patients
Anamaria UngureanuJulia van der MeerAntonela BicvicLena S. AbbuehlGabriele ChiffiLéonore JaquesFranziska Suter‐RinikerStephen L. LeibClaudio L. BassettiAnelia Dietmann
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Abstract Background Depending on geographic location causes of encephalitis, meningoencephalitis and meningitis vary substantially. We aimed to identify most frequent causes, clinical presentation as well as long-term outcome of encephalitis, meningoencephalitis and meningitis cases treated in the Inselspital, University Hospital Bern, Switzerland. Methods In this monocentric, observational retro- and prospective cohort study, we performed a retrospective review of clinical patient records for all patients treated during 3 years. Patients were contacted prospectively for a telephone follow-up interview and to fill out questionnaires, especially related disturbances of sleep and wakefulness. Results We included 258 patients: encephalitis (18%), non-bacterial meningoencephalitis (42%), non-bacterial meningitis (27%) and bacterial meningoencephalitis/meningitis (13%). Herpes simplex virus (HSV) was the most frequent cause of encephalitis (18%), tick borne encephalitis virus (TBEV) of non-bacterial meningoencephalitis (46%), enterovirus of non-bacterial meningitis (21%) and Streptococcus pneumoniae of bacterial meningoencephalitis/meningitis (49%). Overall, 35% patients remained without known cause. After a median time of 16 months, 162 patients participated in the follow-up interview, thereof 56% indicated to suffer from neurological long-term sequels such as fatigue and/or excessive daytime sleepiness (34%), cognitive impairment and memory deficits (22%), headache (14%) and epileptic seizures (11%). Conclusions In the largest tertiary care University hospital in Switzerland TBEV was the overall most frequently detected infectious cause, with a clinical manifestation of meningoencephalitis in the majority of cases. Long-term neurological sequels, most importantly cognitive impairment, fatigue and headache were frequently self-reported not only in encephalitis and meningoencephalitis but also viral meningitis survivors up to 40 months after the acute infection.Keywords:
Viral meningitis
Background: Viral infections of the central nervous system are an important cause of morbidity and mortality. Aim: This study was designed to identify the viruses responsible for viral involvement of the CNS and to determine their frequency, circulation pattern, and seasonality. Methods: Detection, by multiplex PCR using FilmArray® Meningitis/Encephalitis panel, of viruses in the cerebrospinal fluid of all patients admitted for suspected viral infection of central nervous system and requiring hospitalization in the various departments of the Mohamed VI University Hospital of Marrakesh. Results: Viral infection was diagnosed in 74 of 984 patients (7.5%). The viruses responsible were identified as enterovirus in 22 cases (26.82%), Cytomegalovirus in 21 cases (25.6%), Herpes simplex virus-1 and Varicella-Zoster virus in 12 cases each (14.63%). Other agents were also reported with lower frequencies namely human herpes virus 6 and herpes simplex virus-2. Although the overall rate of CNS viral infection was significantly higher between the summer and spring seasons, the seasonality of the different viral pathogens was variable. Conclusion: The FilmArray® test can be an aid in the diagnosis of meningitis/meningoencephalitis, especially of viral etiology. Its rational use can improve the management of patients with potentially severe infections without additional cost.
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Abstract Background Cerebrospinal fluid (CSF) analyses are recommended in patients with meningitis and/or encephalitis, but evidence regarding its diagnostic yield is low. We aimed to determine predictors of infectious pathogens in the CSF of adult patients presenting with meningitis, and/or encephalitis. Methods Consecutive patients with meningitis and/or encephalitis form 2011–17 at a Swiss academic medical care center were included in this cross-sectional study. Clinical, neuroradiologic, and laboratory data were collected as exposure variables. Infectious meningitis and/or encephalitis were defined as the composite outcome. For diagnosis of bacterial meningitis the recommendations of the European Society of Clinical Microbiology and Infectious Diseases were followed. Viral meningitis was diagnosed by detection of viral ribonucleic or deoxyribonucleic acid in the CSF. Infectious encephalitis was defined according to the International Encephalitis Consortium (IEC). Meningoencephalitis was diagnosed if the criteria for meningitis and encephalitis were fulfilled. Multinomial logistic regression was performed to identify predictors of the composite outcome. To quantify discriminative power, the c statistic analogous the area under the receiver-operating curve (AUROC) was calculated. An AUROC between 0.7–0.8 was defined as “good”, 08–0.9 as “excellent”, and > 0.9 as “outstanding”. Calibration was defined as “good” if the goodness of fit tests revealed insignificant p -values. Results Among 372 patients, infections were diagnosed in 42.7% presenting as meningitis (51%), encephalitis (32%), and meningoencephalitis (17%). Most frequent infectious pathogens were Streptococcus pneumoniae , Varicella zoster, and Herpes simplex 1&2. While in multivariable analysis lactate concentrations and decreased glucose ratios were the only independent predictors of bacterial infection (AUROCs 0.780, 0.870, and 0.834 respectively), increased CSF mononuclear cells were the only predictors of viral infections (AUROC 0.669). All predictors revealed good calibration. Conclusions Prior to microbiologic workup, CSF data may guide clinicians when infection is suspected while other laboratory and neuroradiologic characteristics seem less useful. While increased CSF lactate and decreased glucose ratio are is the most reliable predictors of bacterial infections in patients with meningitis and/or encephalitis, only mononuclear cell counts predicted viral infections. Trial registration ClinicalTrials.gov identifier NCT03856528 . Registered on February 26th 2019.
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Abstract Background Tick-Borne Encephalitis (TBE) is a viral infection of the Central Nervous System (CNS) caused by Tick-Borne Encephalitis Virus (TBEV). It might take several clinical courses such as: meningitis, meningoencephalitis or meningoencephalomyelitis. The aim this study was to compare the YKL-40 concentration in cerebrospinal fluid (CSF) of patients with different clinical presentations of TBE and patients with excluded meningitis (control group). Methods The concentration of YKL-40 in CSF was determined using Fujirebio tests (Ghent, Belgium) in 32 patients with TBE: group I—patients with meningoencephalitis (n = 16); group II—patients with meningitis (n = 16). The control group (CG) consisted of 17 patients in whom inflammatory process in central nervous system was excluded. Results The concentration of YKL-40 was significantly higher in encephalitis group than in CG after 7 days from the last dose of treatment. The concentration in patients with neuroinflammation had significantly different concentration of YKL-40 compared to patients with no neuroinflammation control groups. ROC curve analysis indicates that: CSF YKL-40 concentration at cut off 783.87 differentiated TBE patients from CG with 100% specificity and 70% sensitivity and CSF YKL-40 concentration at cut off 980.11 differentiated meningitis from meningoencephalitis with 87.5% specificity and 62.5% sensitivity. Conclusions YKL-40 takes part in TBE pathogenesis, its concentration is the highest at the early stage of Central Nervous System involvement and decreases in the convalescent period. As YKL-40 is significantly higher in meningitis than in meningoencephalitis, it might be used as biomarker in differentiation of these clinical forms of TBE.
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This case report describes a 36-week gestational age infant diagnosed with coxsackie B1 meningitis at 20 days of age. A head ultrasound 5 days after diagnosis was consistent with cystic periventricular leukomalacia. The scientific literature does not clearly elucidate differences between bacterial and viral infections in infants. When difficulties arise, it is pertinent to consider a viral etiology for the underlying illness and obtain a detailed maternal and infant history focusing on clinical symptoms, seasonality, geographic location, exposure, and incubation period. Polymerase chain reaction is a rapid and sensitive diagnostic test for the identification of enteroviruses in cerebrospinal fluid, blood, urine, and throat specimens and should be performed as part of the general workup in the evaluation of a febrile infant with sepsis. In retrospect, it may have established an earlier diagnosis of meningitis, consequently preventing the unnecessary use of antibiotics, potentially decreasing the length of hospitalization, and eliminating the need for more detailed investigations to rule out other etiological factors. In addition, treatment with pleconaril may have affected the severity of the encephalitis. This article reviews the pathogenesis, clinical manifestations, and differential diagnoses of enteroviral infections, specifically focusing on the prevention, treatment, and prognosis of the disease and the implications for clinical practice.
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Depending on geographic location, causes of encephalitis, meningoencephalitis and meningitis vary substantially. We aimed to identify the most frequent causes, clinical presentation and long-term outcome of encephalitis, meningoencephalitis and meningitis cases treated in the Inselspital University Hospital Bern, Switzerland.In this monocentric, observational study, we performed a retrospective review of clinical patient records for all patients treated within a 3-year period. Patients were contacted for a telephone follow-up interview and to fill out questionnaires, especially related to disturbances of sleep and wakefulness.We included 258 patients with the following conditions: encephalitis (18%), nonbacterial meningoencephalitis (42%), nonbacterial meningitis (27%) and bacterial meningoencephalitis/meningitis (13%). Herpes simplex virus (HSV) was the most common cause of encephalitis (18%); tick-borne encephalitis virus (TBEV) was the most common cause of nonbacterial meningoencephalitis (46%), enterovirus was the most common cause of nonbacterial meningitis (21%) and Streptococcus pneumoniae was the most common cause of bacterial meningoencephalitis/meningitis (49%). Overall, 35% patients remained without a known cause. After a median time of 16 months, 162 patients participated in the follow-up interview; 56% reported suffering from neurological long-term sequelae such as fatigue and/or excessive daytime sleepiness (34%), cognitive impairment and memory deficits (22%), headache (14%) and epileptic seizures (11%).In the Bern region, Switzerland, TBEV was the overall most frequently detected infectious cause, with a clinical manifestation of meningoencephalitis in the majority of cases. Long-term neurological sequelae, most importantly cognitive impairment, fatigue and headache, were frequently self-reported not only in encephalitis and meningoencephalitis survivors but also in viral meningitis survivors up to 40 months after acute infection.
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Abstract Background Tick-Borne Encephalitis (TBE) is a viral infection of the Central Nervous System (CNS) caused by Tick-Borne Encephalitis Virus (TBEV). It might take several clinical courses such as: meningitis, meningoencephalitis or meningoencephalomyelitis. The aim this study was to compare the YKL-40 concentration in cerebrospinal fluid (CSF) of patients with different clinical presentations of TBE and patients with excluded meningitis (control group). Methods The concentration of YKL-40 in CSF was determined using Fujirebio tests (Ghent, Belgium) in 32 patients with TBE: group I—patients with meningoencephalitis (n = 16); group II—patients with meningitis (n = 16). The control group (CG) consisted of 17 patients in whom inflammatory process in central nervous system was excluded. Results The concentration of YKL-40 was significantly higher in encephalitis group than in CG after 7 days from the last dose of treatment. The concentration in patients with neuroinflammation had significantly different concentration of YKL-40 compared to patients with no neuroinflammation control groups. ROC curve analysis indicates that: CSF YKL-40 concentration at cut off 783.87 differentiated TBE patients from CG with 100% specificity and 70% sensitivity and CSF YKL-40 concentration at cut off 980.11 differentiated meningitis from meningoencephalitis with 87.5% specificity and 62.5% sensitivity. Conclusions YKL-40 takes part in TBE pathogenesis, its concentration is the highest at the early stage of Central Nervous System involvement and decreases in the convalescent period. As YKL-40 is significantly higher in meningitis than in meningoencephalitis, it might be used as biomarker in differentiation of these clinical forms of TBE.
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Viral meningitis
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