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1.
Borrelia burgdorferi (B. b.) was isolated from cerebrospinal fluid from two children with aseptic meningitis. Serology forB. b. was initially negative or borderline and became positive during the subsequent course. Children with aseptic meningitis of unknown origin should be re-evaluated within 1 month to detect possible increasing antibody titres toB. b. Aseptic meningitis may be a stage 1 manifestation of Lyme disease.Abbreviations
B. b.
Borrelia burgdorferi
- CSF
cerebrospinal fluid
- CNS
central nervous system
- ESR
erythrocyte sedimentation rate
- IFA
immunofluorscence assay 相似文献
2.
Garro AC Rutman MS Simonsen K Jaeger JL Chapin K Lockhart G 《The Pediatric infectious disease journal》2011,30(11):990-992
This study determined the prevalence of Lyme meningitis in children with undifferentiated aseptic meningitis from April to December in a Lyme disease-endemic region. Of the 60 children, 8 were seropositive (prevalence 13.3%; 95% confidence interval: 6.3-25.1%), with another probable case having high cerebrospinal fluid antibody titers. Clinicians in endemic regions should evaluate children with undifferentiated aseptic meningitis for Lyme meningitis in appropriate seasons. 相似文献
3.
Lyme borreliosis is currently suspected to be capable of mimicking nearly all known neurologic symptoms and disease entities. The goal of our study is to define the associated anamnestic, clinical and laboratory findings in aseptic meningitis and Lyme borreliosis in childhood by a meta-analysis of recent literature and of our own data. We defined by means of 63 cases derived of 10 publications and own data a list of mainly rather unspecific parameters like insidious onset, fever, mild meningism, encephalitic symptoms and cranial nerve involvement. Mere neurologic presentation without ECM, arthritis or even an anamnestic insect-bite seems to be most frequent. Retrospective studies, however, can not sufficiently characterize the clinical picture of aseptic meningitis in Lyme borreliosis. 相似文献
4.
Interleukin-6 in cerebrospinal fluid of patients with central nervous system infections 总被引:5,自引:0,他引:5
Interleukin(IL)-6 levels were measured in cerebrospinal fluid (CSF) and serum samples from pediatric patients with central nervous system (CNS) infections by means of an enzyme-linked immunosorbent assay. Mean IL-6 concentrations in CSF samples from patients with bacterial meningitis (49017 44 730 pg/ml) were significantly higher than those in patients with aseptic meningitis (10761572 pg/ml) or encephalitis (409835 pg/ml). In aseptic meningitis and encephalitis, IL-6 levels in serum were within the lower ranges (< 100 pg/ml), in contrast with the highly elevated levels found in bacterial meningitis (14 33218 385 pg/ml). In 5 of the 15 patients with encephalitis, elevated levels of IL-6 were observed in the initial CSF samples despite normal findings of routine CSF examinations. Also, sequential CSF samples revealed that there was an increase in the CSF cell count in two of the five patients. These results validated the potential of measuring IL-6 in CSF samples for the purpose of providing additional information on routine laboratory test results. D Central nervous system infection, cerebrospinal fluid, children, enzyme-linked immunosorbent assay, interleukin-6.
M Narita, Department of Pediatrics, Hokkaido University School of Medicine, N 15 W 7, Kita-ku, Sapporo 060, Japan 相似文献
M Narita, Department of Pediatrics, Hokkaido University School of Medicine, N 15 W 7, Kita-ku, Sapporo 060, Japan 相似文献
5.
A prospective hospital-based multicentre study in Lower Saxony allowed to investigate the frequency of acute peripheral facial palsy due to Lyme borreliosis and its clinical and laboratory characteristics. Diagnosis of Lyme Borreliosis was based on detection of IgM antibodies against Borrelia burgdorferi in serum and CSF as well, using an IgM capture ELISA. Between June 1986 and October 1987 27 consecutive cases with acute peripheral facial palsy were studied. Lyme borreliosis is the main cause of peripheral facial palsy in childhood. It was verified serologically in two thirds of the cases. All cases with a positive history for a tick bite and/or an erythema migrans in the head-neck region showed ipsilateral neurological affection suggesting a direct invasion via the affected nerve by Borrelia burgdorferi. Peripheral facial palsy due to Lyme borreliosis represents a monosymptomatic meningoradiculitis. All children with Lyme borreliosis revealed a lymphocytic CSF pleocytosis, whereas in cases of unknown etiology CSF findings usually were normal. Therefore, in any case of facial palsy with an inflammatory CSF syndrome Lyme borreliosis has to be suspected unless proven otherwise. 相似文献
6.
H.-J. CHRISTEN N. BARTLAU F. HANEFELD H. EIFFERT R. THOMSSEN 《Acta paediatrica (Oslo, Norway : 1992)》1990,79(12):1219-1224
ABSTRACT. 27 consecutive cases with acute peripheral facial palsy were studied for Lyme borreliosis. In 16 out of 27 children Lyme borreliosis could be diagnosed by detection of specific IgM antibodies in CSF. CSF findings allow a clear distinction according to etiology. All children with facial palsy due to Lyme borreliosis revealed lymphocytic CSF pleocytosis, whereas in cases of unknown etiology CSF was usually normal. Bilateral facial palsy occurred only in children with Lyme borreliosis. All cases with a positive history of tick bite and/or erythema migrans in the head-neck region showed ipsilateral neurological affection suggesting a direct invasion via the affected nerve by Borrelia burgdorferi. 相似文献
7.
H J Christen N Bartlau F Hanefeld H Eiffert R Thomssen 《Acta paediatrica Scandinavica》1990,79(12):1219-1224
27 consecutive cases with acute peripheral facial palsy were studied for Lyme borreliosis. In 16 out of 27 children Lyme borreliosis could be diagnosed by detection of specific IgM antibodies in CSF. CSF findings allow a clear distinction according to etiology. All children with facial palsy due to Lyme borreliosis revealed lymphocytic CSF pleocytosis, whereas in cases of unknown etiology CSF was usually normal. Bilateral facial palsy occurred only in children with Lyme borreliosis. All cases with a positive history of tick bite and/or erythema migrans in the head-neck region showed ipsilateral neurological affection suggesting a direct invasion via the affected nerve by Borrelia burgdorferi. 相似文献
8.
BACKGROUND: Cerebrospinal fluid (CSF) laboratory tests are frequently collected to help differentiate Lyme meningitis from other causes of aseptic meningitis. Previous studies using Lyme CSF polymerase chain reaction (PCR) have yielded varied results (sensitivity between 10 and 90%). No studies have specifically examined the diagnostic utility of Lyme CSF-PCR in North American children with Lyme meningitis. METHODS: Retrospective chart review of children presenting to a children's hospital in a Lyme-endemic region between October 1999 and September 2004. Patients were included if they had both Lyme serology and Lyme CSF-PCR performed during the same hospital encounter and had documented meningitis. Patients were considered to have Lyme meningitis if they had meningitis and met CDC criteria for Lyme disease. The Lyme CSF-PCR assay amplified a Borrelia burgdorferi DNA flagellin gene sequence. RESULTS: Of 108 patients with meningitis who qualified for the study, 20 patients met criteria for Lyme meningitis and 88 were classified as aseptic meningitis. Positive Lyme CSF-PCR was found in 1 patient (1 of 20, 5%) with Lyme meningitis and one patient classified as aseptic meningitis (1 of 88, 1%). Lyme CSF-PCR had a sensitivity of 5% and a specificity of 99%. The only Lyme meningitis patient with positive Lyme CSF-PCR had the highest CSF white blood cell count and CSF protein values compared with the other Lyme meningitis patients. CONCLUSIONS: This is the first study to evaluate Lyme CSF-PCR exclusively in North American children. This commercially available laboratory test is not generally helpful for identifying Lyme meningitis because of its low sensitivity. 相似文献
9.
E. Schmedding M. Verboven S. Lauwers G. Ebinger N. Rom H. Loeb 《European journal of pediatrics》1986,144(5):497-502
In two children with lymphocytic meningoradiculitis (Bannwarth's syndrome), IgG and IgM antibodies to Borrelia burgdorferi were demonstrated. Clinical and laboratory parameters of the syndrome are described and recent bacteriological and serological findings that link the syndrome to the American Lyme disease are discussed, as well as the effects of antibiotic treatment.Abbreviations BS
Bannwarth's syndrome
- CSF
cerebrospinal fluid
- ECM
erythema chronicum migrans
- Elisa
enzyme-linked immunosorbent assay
- ESR
erythrocyte sedimentation rate
- IF
indirect immunofluoresence
- LM
lymphocytic meningitis
- OB
oligoclonal bands 相似文献
10.
M Jaffe I Srugo E Tirosh A A Colin Y Tal 《American journal of diseases of children (1960)》1989,143(6):682-685
To test the hypothesis that lumbar puncture in viral meningitis results in symptomatic improvement, a group of 48 children was studied. Twenty-six patients had proved aseptic meningitis, and 22 had infections outside the central nervous system. Before and after lumbar puncture each subject was repeatedly scored for symptoms independently by the attending pediatrician and a parent. Marked symptomatic improvement in children with meningitis was demonstrated following lumbar puncture, while no significant change was demonstrated in the control group. The mechanism underlying this improvement is not clear; however, we consider a number of possible explanations. 相似文献
11.
Neurobrucellosis in an eight-year-old child 总被引:1,自引:0,他引:1
An 8-year-old boy, presenting with signs of chronic meningitis, and involvement of cranial nerves, was found to have neurobrucellosis. The diagnosis was rapidly established by an enzyme-linked immunosorbent assay (ELISA) that detected high titres of IgG, IgA and IgM brucella antibodies in CSF and in serum. Brucella melitensis was subsequently isolated both from blood and CSF. Neurobrucellosis, which has been considered to be very rare in childhood, should be suspected in cases of meningitis of obscure aetiology in brucella-endemic areas. Brucella-specific antibodies in serum and CSF should be determined in these cases using sensitive serological techniques. 相似文献
12.
Diagnostic utility of an enzyme linked immunosorbent assay (ELISA) in hospitalised patients with clinical symptoms suggestive
of tuberculous meningitis (94 cases) was studied. CSF Anti-tubercular IgG antibody levels were estimated by ELISA in 44 cases
of proven tuberculous meningitis, 24 proven pyogenic meningitis and in 48 non-tuberculous cases. The cut off dilution was
established at a CSF dilution of 1 :1 (undiluted) with positive and negative controls. The ELISA test had a sensitivity of
97.72% and a specificity of 95.35% using MSE antigen.
When compared with conventional smear examination and culture isolation from specimens, the ELISA test proved statistically
superior in the detection rate or diagnosis of clinically suspected tuberculous meningitis cases (P < 0.05). 相似文献
13.
In a retrospective study, the histories of the non-neonates treated for primary meningitis in the Pediatric Department of Mainz University Hospital between 1986 and 1989 were analyzed with regard to etiological, diagnostic, clinical and epidemiological criteria. In the period studied there were 37 cases of infectious meningitis (11 Neisseria meningitidis (29.7%), 7 H. influenzae (18.9%), 3 S. pneumoniae (8.1%), 16 other (43.2%)), and 117 cases of acute aseptic meningitis syndrome (12 mumps virus (10.3%), 3 Borrelia burgdorferi (7.7%), 3 FSME (2.6%), 2 herpes simplex virus, 91 other (77.8%)). Sixty-six percent of the patients were male. Of the infants with infectious meningitis, 68% were under 5 years old. In contrast, 69% of the children with noninfectious meningitis were aged 5 or older. While 70% of the infectious meningitis cases occurred in fall and winter, 64% of the cases of acute aseptic meningitis syndrome occurred in spring and summer. In differential diagnosis between infectious and acute aseptic meningitis syndrome maximal sensitivity was a CRP value exceeding 0.5 mg/dl, a CSF lactate value of over 3 mmol/l and a CSF cell count of over 2000/3 cells. In none of the cases did a second or third lumbar puncture furnish information additional to that which could have been deduced from physical examination and course of temperature. A second lumbar puncture failed to produce unexpected results, or have consequences for therapy, in any of the 14 cases with noninfectious meningitis. Of 37 infants with infectious disease, one (2.7%) died from the sequelae of pneumococcal meningitis. Recovery was partial in 8 (22.2%) of the 36 surviving infants.(ABSTRACT TRUNCATED AT 250 WORDS) 相似文献
14.
Interpretation of traumatic lumbar puncture. Predictive value in the presence of meningitis 总被引:2,自引:0,他引:2
A L Mehl 《Clinical pediatrics》1986,25(11):575-577
Contamination of cerebrospinal fluid (CSF) with blood was studied prospectively in nine children with aseptic meningitis as the second phase of a study reported in this volume last month. Using criteria defined in the first phase, four of nine patients had recognizably abnormal CSF after experimental contamination with blood. As a third phase of the study, 53 children with bacterial meningitis were reviewed retrospectively to assess if hypothetical contamination of CSF with blood would have disguised their abnormal CSF studies. All but one of these 53 patients had either an abnormal CSF glucose or a positive gram stain (indicators independent of contamination with blood), and none would have gone undiagnosed with hypothetical contamination of up to 200,000 red cells per cubic millimeter. Guidelines for interpretation of laboratory studies following traumatic lumbar puncture are reviewed. 相似文献
15.
Y Waisman Y Lotem M Hemmo T Wietzen B Z Garty M Mimouni 《Pediatric emergency care》1999,15(5):314-317
OBJECTIVE: To review the emergency department management of children with aseptic meningitis and compare the clinical features, laboratory findings, and short-term follow-up of those who were hospitalized or discharged to determine guidelines for discharge. DESIGN: Retrospective chart review study. SETTING: Emergency department of an inner-city teaching, level III, children's hospital during an outbreak of aseptic meningitis from, March through December 1993. METHODS: The medical records of children < or = 18 years of age diagnosed in the emergency department with aseptic meningitis after lumbar puncture were retrospectively reviewed and analyzed. Thirty-four parameters were recorded for each child including demographic (2), epidemiologic (5), clinical (2), laboratory (10), and short-term follow-up data (5). RESULTS: Of the 158 eligible patients, 99 (62.7%) were hospitalized, and 59 (37.3%) were discharged. Compared to the hospitalized group, children who were discharged were significantly older (5.7 years vs. 4.7 years, P < 0.05) and experienced a more benign course, with lower rates of headache (54.7 vs. 85.7%, P < 0.05), vomiting (38.2 vs. 69.7%, P < 0.05), and irritability (1.8 vs. 8.1%, P < 0.05). They also had significantly (P < 0.05) lower mean peripheral and cerebrospinal fluid leukocyte counts (13,233 vs. 11,498/mm3 and 293.91 vs. 105.29/mm3, respectively). Interestingly, 30 (50.8%) of children in the discharged group had over 50% polymorphonuclears in their cerebrospinal fluid (CSF) cell count. The hospitalization rate during the day was significantly (P < 0.05) lower than that for the evening and night shifts (51.5 vs. 66.7%, respectively). In the discharged group, symptoms of headache, fever, and vomiting resolved after an average of 3.05 days, 2.25 days, and 1.3 days, respectively. The average hospitalization time was 3.5 days. There were no significant complications in either group. More important, in neither group were there any misdiagnoses of bacterial meningitis as aseptic meningitis. During the study period, the ambulatory management of the 59 patients cost $51,625 less than the hospitalization of an equal number of children. CONCLUSION: It is feasible, clinically safe and less costly to treat a subgroup of children with aseptic meningitis in an ambulatory setting. Although absolute criteria for ambulatory follow-up could not be defined, age >1 year, a nontoxic clinical appearance, normal white blood cell count, mild cerebrospinal fluid pleocytosis (even with a high percentage of polymorphonuclear cells), negative CSF Gram stain, and a reliable family setting could serve as guidelines for decision-making regarding emergency department discharge. Further prospective research is needed to better specify these criteria. 相似文献
16.
One hundred seventy-seven cases of neonatal meningitis treated at the University of Texas Medical Branch at Galveston over a 15-year period (1974-1988) were reviewed. Over this period, the incidence of bacterial meningitis decreased, the incidence of aseptic meningitis remained stable, and the diagnosis of enteroviral meningitis increased in frequency. During 1984-1988, enterovirus was the most common cause of meningitis in neonates older than seven days and accounted for one third of all cases of neonatal meningitis. Half of all neonates with bacterial meningitis had negative blood cultures. We recommend that 1) diagnostic lumbar puncture remain part of the routine assessment of the neonate with suspected sepsis, and 2) CSF be cultured for enterovirus as well as for bacteria when a neonate older than seven days presents with suspected sepsis. 相似文献
17.
A major activator of antigen presenting cells (APC) is gamma interferon a product of activated T-lymphocytes. CNS is not well studied and represents a unique system with respect to the immune reactions. Neopterin is an indirect marker of gamma interferon deliberation and may give some new information on the role of APC in CNS. Neopterin in serum and cerebrospinal fluid (CSF) was determined by specific RIA in children who were lumbar punctured to exclude meningitis. Neopterin was found in various concentrations in serum and CSF of all patients (n = 47). Bacterial meningitis (group 3) was diagnosed in 12 and aseptic meningitis in 18 children (group 2). CSF was drawn in 17 children with febrile convulsions (group 1). Elevated serum neopterin in childhood was only reported in children with an atypical PKU, while data on CSF neopterin were published only in a few cases of adults with CNS involvement. The results show that the APC is stimulated rapidly in childhood similar as in adults following severe viral or bacterial infections. Furthermore neopterin in CSF is not only explained by alteration of the blood-brain barrier but also it may reflect local intrathecal response with activation of accessory cells (APC) in the CNS itself. Between the stimulation of the cellular immune system indicated by increased levels of neopterin and the severity of the disease seems to be a positive correlation. 相似文献
18.
《Archives de pédiatrie》2021,28(7):537-543
BackgroundThe neurological effects of Lyme borreliosis in children are varied and their clinical progression is not widely reported in the French literature. We carried out a retrospective study to describe the clinical characteristics of Lyme neuroborreliosis in children in southwest France and their clinical progression at 6 months.MethodsThis study was carried out at Toulouse University Hospital during the period 2006–2017 using patient records. Case definition was based on the combined French clinical and laboratory diagnostic criteria.ResultsIn total, 26 children were included. The median age was 8 years (4–14 years). The different neurological symptoms reported were: meningoradiculitis (62%), which was usually associated with facial palsy (54%); isolated facial palsy (15%); isolated meningitis (8%); polyradiculoneuritis (4%); benign intracranial hypertension (4%) and myelomeningoradiculitis (4%). The most common functional symptoms were headaches (54%), the perception of asthenia (42%), neck pain (27%), and a loss of appetite (19%). Patients with laboratory meningitis (84%) often had no signs of meningism or headaches (38%).ConclusionThe majority of the cases involved meningoradiculitis but other, less common, neurological conditions have been described. The clinical signs suggestive of meningitis are not very marked and might delay the diagnosis. 相似文献
19.
神经元特异性烯醇化酶对脑膜炎患儿的诊断价值 总被引:2,自引:0,他引:2
目的探讨脑脊液神经元特异性烯醇化酶(CSF-NSE)对脑膜炎患儿的诊断价值。方法采用ELISA对18例化脓性脑膜炎(化脑)、13例结核性脑膜炎(结脑)及25例病毒性脑膜炎(病脑)及18例正常儿童CSF-NSE进行测定。结果与对照组比较,化脑及结脑患儿CSF-NSE水平均显著升高(P均<0.05);病脑患儿无显著性差异(P>0.05);化脑及结脑患儿CSF-NSE水平较病脑患儿显著升高(P<0.05);化脑、结脑、病脑患儿CSF-NSE与其CSF白细胞数及蛋白水平均无相关性(P>0.05)。结论CSF-NSE测定可作为鉴别化脑和病脑的重要参考指标之一,也可作为评价脑膜炎患儿病情严重程度及预后的生化指标。 相似文献
20.
ABSTRACT: OBJECTIVE: We aimed to audit the regional management of central nervous system (CNS) infection in children. METHODS: The study was undertaken in five district general hospitals and one tertiary paediatric hospital in the Mersey region of the UK. Children admitted to hospital with a suspected CNS infection over a three month period were identified. Children were aged between 4 weeks and 16 years old. Details were recorded from the case notes and electronic records. We measured the appropriateness of management pathways as outlined by national and local guidelines. RESULTS: Sixty-five children were identified with a median age of 6 months (range 1 month to 15 years). Ten had a CNS infection: 4 aseptic meningitis, 3 purulent meningitis, 3 encephalitis [2 with herpes simplex virus (HSV) type 1]. A lumbar puncture (LP) was attempted in 50 (77%) cases but only 43 had cerebrospinal fluid (CSF) available for analysis. Of these 24 (57%) had a complete standard set of tests performed. Fifty eight (89%) received a third generation cephalosporin. Seventeen (26%) also received aciclovir with no obvious indication in 9 (53%). Only 11 (65%) of those receiving aciclovir had CSF herpes virus PCR. Seventeen had cranial imaging and it was the first management step in 14. Treatment lengths of both antibiotics and aciclovir were highly variable: one child with HSV encephalitis was only treated with aciclovir for 7 days. CONCLUSIONS: The clinical management of children with suspected CNS infections across the Mersey region is heterogeneous and often sub-optimal, particularly for the investigation and treatment of viral encephalitis. National guidelines for the management of viral encephalitis are needed. 相似文献