Traumatic Lumbar Punctures in Neonates: Test Performance of the Cerebrospinal Fluid White Blood Cell Count

In a recent study of 345 febrile infants younger than 90 days with identifiable enteroviral disease, none had bacterial meningitis.18 There is growing evidence that the risk of bacteremia may be decreased in the setting of other identifiable viral syndromes as well.19,20 Furthermore, as in the case of scenario 1, early discharge would occur only in patients with bacterial meningitis who appeared clinically well at 24 hours and had negative 24-hour CSF cultures. In 2002, EV was diagnosed by RT-PCR in 63 % of children hospitalized with neurological diseases in the region of Monastir [17]. A second metric that can be used for quality control is that the EV RT-PCR assay should be negative in approximately 98% of patients over 2 months of age who lack CSF pleocytosis, and in approximately 70% of patients under 2 months of age without pleocytosis. B, Expanded views of the phylogenetic tree, which show the relationships between sequences of coxsackievirus A9 (CVA9), echovirus 11 (E11), E18, CVB4, CVB5, E6, and E30 over the most recent period. It causes meningitis by escaping local host defenses and phagocytic mechanisms, either through choroid plexus seeding from bacteremia or through direct extension from sinusitis or otitis media. In addition, the authors comment on the high costs of their extensive diagnostic approach and that hopefully future multi-array method may reduce the overall expense for such extensive evaluations. In the remaining two cases enterovirus RNA was detected only in the SC assay.

To investigate the possibility that the patient’s encephalitis was caused by an autoimmune response to the enterovirus, serum (on two occasions) and CSF (on one occasion) were evaluated for the presence of nervous system autoantibodies (laboratory of J Dalmau, University of Pennsylvania, Philadelphia, PA). Meningitis as a complication of KD usually occurs early in the course of the disease and improves after KD treatment, which is mainly IVIG therapy [19]. influenzae Type b Initiative website provides a useful overview of the use of vaccination in the developing world ( In contrast, in a patient with recurrent VZV myelopathy, anti-VZV IgG antibody in CSF was detected only during acute episodes, but not during symptom free intervals [5]. Cerebrospinal fluid (CSF) Laboratory findings were analyzed using the SPSS statistics software (version 10 for Microsoft windows). To conceptualize CSF changes during infection, we framed 2 simple models of the exchange of HIV and lymphocytes between the blood and CNS compartments [ 9 , 14 ]. She initially appeared to respond to steroids and multidrug anti-TB therapy, but her signs and symptoms worsened when steroids were tapered and she ultimately developed hydrocephalus requiring VP shunting.

Briefly, SPR measurements and ligand immobilization procedures were conducted with a 760-nm light beam emitted in a fully automatic, Biacore 2000 system (GE-Healthcare GmbH, Uppsala, Sweden), equipped with four flow cells. Chemokines mediate their action via cell surface receptors that are members of the rhodopsin superfamily of seven transmembrane-spanning G-protein-linked molecules. ↵* Corresponding author. [3] examined the clinical and economic impact of the AMTD2 test on the diagnosis of tuberculosis. By the 22nd day, the motor and sensory functions recovered considerably and the patient was discharged. Interestingly, of the 28 patients who tested EV RT-PCR positive without CSF pleocytosis, 25 (89%) were in the ≤2 months age group (Table ). In June 2010, he had fever, pancytopenia and bone marrow aplasia, probably due to EBV-associated X-linked lymphoproliferative disorder (XLP).

Given her clinical presentation, lack of evidence of an infectious etiology on CSF studies, and the temporal relationship with TMP-SMX use, a diagnosis of aseptic meningitis was made. For neonates with LPs with < 500 RBC/mm3, we calculated the ROC curve for the unadjusted WBC count. Others have suggested that the level of PCT in CSF did not differ between bacterial and viral meningitis (Shimetani, Shimetani, & Mori, 2001). Furthermore, the sample size of negative controls could have been larger than 49, but it could unfortunately not be achieve during the time period and in clinical setting of the study. pneumoniae, N. Further studies are needed to determine whether antiviral agents or immune modulators such as IVIG or corticosteroids have a role in treatment. Patients will typically report a prodromal illness of pain, pruritus, burning, or parasthesias. In addition, the various parameters examined in the cerebral spinal fluid (CSF) are less discriminative in children than in adults, especially in enterovirus meningitis where the CSF parameters may be similar to bacterial meningitis values. Although boys accounted for 52% of infants with aseptic meningitis, girls with UTI were more likely than boys with UTI to have aseptic meningitis (17.6% vs. A 76-year-old female with a history of hypertension, hyperlipidemia, diabetes mellitus, and migraine presented with confusion and agitation. The peak seasons for HPeV and EV infection were spring and summer, respectively. IV Acyclovir 10mg/kg IV q 8 hrs IV Rocephin 2g IV BID (CNS penetration dose) IV Vancomycin 1 gm IV q 24hrs Infectious Disease Consult Blood Cultures, Procalcitonin level (Neg x2, 50%,) HSV 1&2, Adenoviruses, among others...