Background: Viruses are by far the most common cause of meningitis in children. Objectives:The aim of this study is to describe the epidemiology of viral/aseptic meningitis (AM) in children (2 months -15 years) in Shiraz. Materials and Methods: This is a cross-sectional prospective-descriptive study from May 2001 to May 2002 in Nemazi and Dastgheib Hospitals, Shiraz. EV meningitis was diagnosed using RT -PCR on Aseptic CSF samples. Mumps meningitis (MM) is defined (clinically) by simultaneous presence of parotitis and meningitis and negative PCR for EV. Clinical data were extracted from hospital archive files. Results: During the study period, 688 CSF samples (from 598 patients) were analyzed. Among these samples, there were 218 (36.4%) cases of meningitis. Twenty seven (12.38%) were bacterial [Streptococcus pneumonia (11 cases), H. Influenzae (8 cases), Neisseria meningitidis (5 cases) and other organisms (3 cases)]. The rest of the cases (191 patients) were considered as AM. RT -PCR for detection of EV was carried out on 53.4% (102 out of 191) accessible aseptic CSF samples. Among these cases, only 12.7% (13 out of 102) were positive for EV. Twenty patients (19.6%) with negative (Enteroviral) PCR, had parotitis and were considered as MM. Other causes of AM were found in 8 (7.8%) cases (Brain Abscess and Guillain-Barre syndrome, each one in 2 cases, Partially treated bacterial meningitis, TB Meningitis, Leukemic meningitis and Varicella encephalitis each were detected in one case). Conclusions: The cause of AM was found in 40.15 % (41 out of 102) of patients. Although at the time of this study (2001 -2002) MM was the most common form of AM in children in Shiraz, Enteroviral Meningitis (EVM) was relatively close to it in prevalence (13 Enteroviral vs. 20 MM).
Background: Infectious diseases are commonly missed or misdiagnosed. Errors in diagnosing infectious diseases not only affect the patient but also the community health.Objectives: To describe our investigation on the most common errors in diagnosing infectious diseases and their causes according to the physicians' reports.Methods: Between August 2018 and February 2019, specialist physicians and residents across Mashhad, Iran were invited to participate in a survey to report errors they had made or witnessed regarding the diagnosis of infectious diseases.Results: Overall, 465 cases were reported by 315 participants. The most common infectious diseases affected by diagnostic errors were upper respiratory tract infections (URTIs) (n = 69, 14.8%), tuberculosis (TB) (n = 66, 14.1%), pleuro-pulmonary infections (n = 54, 11.6%), central nervous system (CNS) infections (n = 51, 10.9%), and urinary tract infections (n = 45, 9.6%). Errors occurred most frequently in generating a diagnostic hypothesis (n = 259, 55/7%), followed by history taking (n = 200, 43%), and physical examination (n = 191, 41/1%). Errors related to the diagnosis of TB (odds ratio [OR]: 2.4, 95% confidence interval [CI]:0.9–5.7; P value: 0.047) and intra-abdominal infections (OR: 7.2, 95% CI: 0.9–53.8; P value: 0.02) were associated with more-serious outcomes.Conclusion: A substantial proportion of errors in diagnosing infectious diseases moderately or seriously affect patients' outcomes. URTIs, TB, and pleuropulmonary infections were the most frequently reported infectious diseases involved in diagnostic error while errors related to the diagnosis of TB and intraabdominal infections were more frequently associated with poor outcomes. Therefore, contagious and potentially life-threatening infectious diseases should always be considered in the differential diagnosis of patients who present with compatible clinical syndromes.
BackgroundThe highest incidence of meningitis occurs during the neonatal period and (then) infancy. Although Bacterial agents are the most dangerous cause of neonatal and childhood meningitis yet viruses especially, enteroviruses (EV), are by far the most common cause of meningitis in this age group.ObjectivesThe aim of the current study was to evaluate the role of EVs in neonatal and childhood meningitis in the Mashhad city of Iran.Materials and MethodsThis was a descriptive study that was performed at Imam Reza hospital in a period of six months (March to September 2007), during which all of the cerebral spinal fluid (CSF) samples from the neonatal intensive care unit (NICU) and pediatrics ward were collected and real time-polymerase chain reaction (RT-PCR) for EVs was done on these samples. Clinical data were collected retrospectively from hospital files.ResultsWe collected 58 CSF samples (35 neonates and 23 children) during six months. Pleocytosis of CSF was seen in 51.1% of the subjects (28% of neonates, and 66.6% of infants and children). Enteroviruses PCR was positive in 37.1% (13) of neonates and 34.7% (8) of children. Pleocytosis of CSF was seen in 23% and 75% of EV positive neonates and children, respectively. Polymorphonuclear (PMN) dominance (PMN > 50%) of CSF was seen in 50% and 33% of EV positive neonates and children, respectively. There were three cases of bacterial meningitis in our group; EV PCR result was positive for one of these subjects. Concomitant bacterial infection (meningitis and sepsis) was seen in 9.5% (two cases) of EV positive CSFs in our study. Almost half of the available neonates (four of nine) with pure enteroviral meningitis (EVM) were discharged (in good condition) with final diagnosis of culture negative sepsis (CNS) and mean length of hospital stay (MLOS) of 4.3 days. One (12.5%) of the neonates with EVM, who had a very low birth weight (< 1500 mg), was expired, and two (25%) cases were discharged with brain damage and final diagnosis of severe asphyxia. The MLOS for children with pure EVM was 1.6 days (one to four days); they didn't have any sign of brain damage or mortality. Qualitative c-reactive protein (CRP) of serum was negative in 72.7% and 37.5% of EV positive neonates and children, respectively. The mean white blood cell count and PMN percentage in the peripheral blood was 11416/mm3 and 60.8% for EV positive neonates, and 14500/mm3 and 77.1% for EV positive children, respectively. Hyponatremia, due to possible syndrome of inappropriate antidiuretic hormone (SIADH), was seen in 30% of neonates and 57% of children with EVM.ConclusionsEnteroviruses were a common cause (> 30%) of meningitis in our study group. Concomitant bacterial infection is not rare in neonates and children with EVM. Many of the neonates (50%) and almost all of the children with EVM did not require prolonged hospitalization. Both normal CSF and PMN dominancy of CSF was common in neonates and children with EVM. Positive qualitative CRP of serum (up to two plus) was common especially in children with ...
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