Rates of spectacle wear in early childhood in the Netherlands

BACKGROUND: Refractive errors are relatively common all around the world. In particular, early onset myopia is associated with a significant burden in later life. Little is known about refractive errors in preschool children. The aim of this study was to assess the prevalence of spectacle wear, visual acuity and refractive errors in young Dutch children. METHODS: We analyzed data of three prospective population-based studies: 99,660 3- to 5-year-olds undergoing vision screening at preventive child healthcare organizations, 6934 6-year-olds from the Generation R study, and 2974 7-year-olds from the RAMSES study. Visual acuity was measured with Landolt-C or LEA charts, spectacle wear was assessed, and refractive errors at age 6 and 7 were measured with cycloplegic refraction. RESULTS: The prevalence of spectacle wear ranged from 1.5 to 11.8% between 3 to 7 years with no significant gender differences. Among children with spectacle wear at 6 years (N = 583) and 7 years (N = 350) 29.8 and 34.6% had myopia respectively, of which 21.1 and 21.6% combined with astigmatism; 19.6 and 6.8% had hyperopia, 37.2 and 11.1% hyperopia and astigmatism, and 12.5 and 32.7% astigmatism only. CONCLUSIONS: Spectacle wear in European children starts early in preschool and increases to a relatively frequent visual aid at school age. Advocating early detection and monitoring of refraction errors is warranted in order to prevent visual morbidities later in life

Zoonotic bacterial meningitis in adults: clinical characteristics, etiology, treatment and outcome

In this thesis, we describe the clinical characteristics, etiology, treatment and outcome of zoonotic bacterial meningitis. Each chapter describes meningitis patients infected by a specific zoonotic pathogen, such as Streptococcus equi, Streptococcuis suis, Capnocytophaga canimorsus, Campylobacter fetus and Leptospira. We combine cases identified in a nationwide prospective cohort study of adult bacterial meningitis patients with a literature review on meningitis caused by each zoonotic pathogen. Zoonotic pathogens are an uncommon cause of bacterial meningitis, but occur more frequently in individuals with specific risk factors, such as professional contact with pigs for Streptococcuis suis meningitis, and dog bites in alcoholic men for Capnocytophaga canimorsus meningitis. Zoonotic bacterial meningitis patients usually present with classic signs of meningitis including headache, fever and neck stiffness. However, CSF analysis often only shows a mildly elevated CSF leukocyte count, which may lead to confusion with viral meningitis. An immunocompromised state is associated with a worse prognosis in most pathogens causing zoonotic meningitis. Sequelae differ per pathogen, with hearing loss being the most frequent sequel, which mainly occurs in Streptococcus suis meningitis. The thesis concludes with an overview of the clinical characteristics, etiology, treatment and outcome of zoonotic bacterial meningitis. We also added a description of rare zoonotic pathogens that were not identified in our cohort study, such as Bacillus anthracis and Francisella tularensis to the description of meningitis caused by the formerly mentioned zoonotic pathogens

Acute cerebellitis in adults: a case report and review of the literature

Contains fulltext : 182354.pdf (publisher's version ) (Open Access)BACKGROUND: Acute cerebellitis is a rare disease with the majority of cases described in children. Little is known about the clinical characteristics and outcome in adults. CASE PRESENTATION: A 37-year-old Caucasian woman presented with headache, nausea, and photophobia, and was diagnosed as having a migraine attack. Two days later, she subsequently returned with aggravated headache, dysarthria and horizontal nystagmus. Magnetic resonance imaging (MRI) showed a swollen cerebellum and hydrocephalus and the patient was diagnosed with acute cerebellitis. Cerebrospinal fluid (CSF) examination showed an elevated leukocyte count and protein. Blood serology showed the presence of immunoglobulin M and immunoglobulin G for both Epstein-Barr virus and cytomegalovirus. The patient was treated with dexamethasone and discharged to a rehabilitation center, where she fully recovered. We searched the literature for adult cases of acute cerebellitis. Including our patient, we identified 35 patients with a median age of 36 years. The etiology was unknown in 34% of cases. The most common clinical presentation consisted of headache, nausea/vomiting and ataxia. Six patients presented with only headache and nausea and subsequently returned with cerebellar signs. In 9 cases, the cerebellitis was complicated by hydrocephalus. Half of the patients ended up with neurological sequelae, while follow-up MRI was abnormal in 71%. CONCLUSION: Acute cerebellitis in adults is a rare disorder which mainly presents with headache, nausea/vomiting and ataxia. To diagnose cerebellitis, imaging of the brain (preferably MRI) is required and CSF examination may be necessary to narrow the differential diagnosis. The treatment depends on the widely diverse etiology, and treatment with steroids is recommended in the case of cerebellar oedema and hydrocephalus. Neurosurgical intervention may be necessary to prevent brain herniation

Hypointensity of the Basal Ganglia in Adults with Glucose Transporter Protein Type 1 Deficiency Syndrome: A Novel Magnetic Resonance Imaging Finding.

Contains fulltext : 218874.pdf (Publisher’s version ) (Closed access)1 januari 202

Streptococcus gallolyticus meningitis in adults: report of five cases and review of the literature

We describe the incidence and patient characteristics of Streptococcus gallolyticus meningitis. We identified S. gallolyticus meningitis in a nationwide cohort of patients with community-acquired bacterial meningitis, and performed a systematic review and meta-analysis of all reported adult cases in the literature. Five cases were identified (0.3%) in a cohort of 1561 episodes of bacterial meningitis. In one patient, bowel disease (colon polyps) was identified as a predisposing condition for S. gallolyticus infection, whereas no patients were diagnosed with endocarditis. In a combined analysis of our patients and 37 reported in the literature, we found that the median age was 59 years. Predisposing factors were present in 21 of 42 patients (50%), and mainly consisted of immunosuppressive therapy (seven patients), cancer (four patients), and alcoholism (four patients). Colon disease was identified in 15 of 24 patients (63%) and endocarditis in five of 27 patients (18%). Co-infection with Strongyloides stercoralis was identified in 14 of 34 patients (41%), ten of whom were infected with human immunodeficiency virus or human T-lymphotropic virus. Outcomes were described for 37 patients; eight died (22%) and one (3%) had neurological sequelae. S. gallolyticus is an uncommon cause of bacterial meningitis, with specific predisposing conditions. When it is identified, consultation with a cardiologist and gastroenterologist is warranted to rule out underlying endocarditis or colon disease. Stool examinations for Strongyloides stercoralis should be performed in patients who have travelled to or originate from endemic area

Capnocytophaga canimorsus Meningitis: Three Cases and a Review of the Literature

Bacterial meningitis is a disease with a high morbidity and mortality. It may be caused by the zoonotic pathogen Capnocytophaga canimorsus, which is part of the commensal oral flora in dogs and cats. We report three cases of C. canimorsus meningitis in a nationwide cohort study of bacterial meningitis patients and performed a review of the literature. Three episodes of C. canimorsus meningitis were identified in three patients included in a nationwide cohort study from 2006 through 2014. The calculated annual incidence was 0.03 per million adults. When combined with the literature, 33 patients were identified of which 28 were male (85%). The median age was 63 years, and 13 (42%) were immunocompromised, which consisted of alcoholism in 7 (21%). Animal contact could be established in 29 of 30 patients (93%) and consisted of dog bites in 22 of 29 (76%). One patient died (3%) and 8 had neurological sequelae upon discharge (25%), most often hearing loss (n = 6, 19%). Capnocytophaga canimorsus meningitis is associated with dog bites. Although mortality is relatively low, survivors often have neurological sequela

Methotrexate-induced toxic leukoencephalopathy: an uncommon stroke mimic

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Suspected leptospiral meningitis in adults: report of four cases and review of the literature

Leptospirosis is a widespread zoonotic disease characterised by headache and fever. These symptoms are often suggestive of meningitis, but only a proportion of patients have leptospiral meningitis. We report episodes of leptospiral meningitis in patients admitted to a tertiary referral centre in the Netherlands, in whom lumbar puncture was performed, and conducted a literature search of adult cases of leptospiral meningitis to describe clinical characteristics and outcome. Between 2011 and 2014, 19 patients with leptospirosis were identified. Seven underwent a lumbar puncture for suspected meningitis (37%), of which six had been in contact with fresh water in a tropical area. Four patients with suspected meningitis (57%) had cerebrospinal fluid pleocytosis indicative of leptospiral meningitis and presented with headache, fever and neck stiffness. In a review of the literature we identified 366 patients with leptospiral meningitis with a median age of 33 years (range 17-77). Risk factors for leptospirosis were identified in 32 of 33 patients. Typical cerebrospinal fluid abnormalities consisted of a mildly elevated leukocyte count (median 206 leukocytes/mm3, range 6-2072) with a lymphocytic predominance (median 95%). Outcome was generally favourable, with a mortality rate of 3% and neurological sequelae in 5% of the survivors. Leptospirosis in the Netherlands has a low incidence. In the case of suspected meningitis and a history of visiting tropical areas or direct or indirect contact with animal urine, leptospiral meningitis should be considered. Cerebrospinal fluid examination is vital for the differential diagnosis of leptospirosis. Outcome is generally favourable in patients with leptospiral meningitis treated with antibiotic