A comparative study between children and adults with bacterial neuroinfections

Abstract Introduction: Bacterial meningitis is an acute purulent infection of the meninges. There are significant differences in the etiological spectrum, clinical course and outcome of bacterial meningitis in the age groups, and their recognition is important for early diagnosis and adequate therapy. Aim: The study aims to determine the differences in the etiology and clinical presentation of bacterial meningitis between children and adults. Materials and methods: The study included 90 patients (25 children and 65 adults) with bacterial neuroinfection admitted to St George University Hospital, Plovdiv between January 1, 2016 and September 31, 2019. We applied epidemiological and clinical analysis, microbiological and statistical methods. Results: In adults, the most common etiological agent was Streptococcus pneumoniae (20%), followed by Staphylococcus spp. (18.5%), Listeria monocytogenes (12.3%), Streptococcus spp. (3.1%), Haemophilus influenzae (3.1%), Klebsiella pneumoniae (1.5%), and Mycobacterium tuberculosis (1.5%). The etiological structure in children was different: Neisseria meningitidis (20%), Streptococcus pneumoniae (16%), Klebsiella pneumoniae (8%), Enterococcus faecium (8%), Streptococcus salivarius (4%), and Mycobacterium tuberculosis (4%). In 40% of the cases, both children and adults, the causative agent was not identified. Conclusions: Regarding the clinical presentation, a statistical significance between the age groups was found with headache and alterations in consciousness, more commonly seen in adults, while vomiting, ear pain was more common in children (p<0.05). Concomitant otitis, sinusitis, pneumonia, and sepsis were often observed. The mortality rate was much higher in adults (43%) when compared with children (8%)

Lethality among Patients with HIV/AIDS Monitored in the Clinic of Infectious Diseases in St George University Hospital, Plovdiv, 2010–2014

Background: The introduction of complex antiretroviral therapy has resulted in signifi cant decrease in the mortality rate of HIV positive patients, but it still remains unacceptably high, especially in some groups of patients. Aim: To investigate the death rate in patients with HIV/AIDS, lethality and mortality in co-infection, and the most common causes and predictors of fatal outcome, focused on early diagnosis and appropriate therapy. Materials and methods: The study included 53 deceased patients with HIV/AIDS, monitored at the Clinic of Infectious Diseases in St George University Hospital, Plovdiv between 01.01.2010 and 31.12.2014. The methods of research included clinical analysis, laboratory tests, microbiological and serological tests (HCV, HBV, toxoplasmosis), ELISA, PCR. Statistical analysis was performed by descriptive statistics, the Student’s t-test, the method of Van der Ward, and regression analysis (logistic regression). Results: During the study period 316 patients with HIV/AIDS were monitored, 53 of them with lethal outcome. Lethality was 16.7% for the whole group; in intravenous drug users - 13.8%; in co-infected patients: HIV/M. tuberculosis - 46%, in HIV/HCV - 17.8%. Lethality and mortality in HIV(+) patients with co-infections in populations of diff erent age, gender, duration since starting сАRТ and degree of immunodefi ciency (according to CD4, VL) was compared with the lethality and mortality in patients with these conditions from the general population. Conclusions: Fatal outcome in patients with HIV/AIDS was most commonly associated with co-infections HIV/M. tuberculosis and HIV/HCV. Predictors of a fatal outcome are pulmonary tuberculosis, advanced immunodefi ciency with VL> 500 000 c/μL and CD4 <100/mm3, absence or non-systemic antiretroviral therapy