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עמוד בית
Thu, 30.05.24

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January 2023
Doron Carmi MD MHA, Ziona Haklai MA, Ethel-Sherry Gordon PhD, Ada Shteiman MSC, Uri Gabbay MD MPH

Background: Bacterial meningitis (BM) remains a considerable cause of morbidity.

Objectives: To evaluate BM incidence rate trends in diverse age groups.

Methods: We conducted a retrospective cohort study based on the Israeli national registry. Inclusion criteria were acute admissions 2000 to 2019 with primary diagnosis of BM. Predefined age groups were neonates (≤ 30 days), infants (31 days to 1 year), younger children (1 ≤ 5 years), older children (5 ≤ 18 years), and adults (≥ 18 years). Average annual incidence rates per 100,000/year were calculated for the entire period and by decade. Incidence rates for neonates and infants were calculated per 100,000 live births (LB).

Results: There were 3039 BM cases over 2 decades, 60% were adults. The overall BM incidence rate was 2.0/100,000/year, neonates, 5.4/100,000/year LB, infants 17.6/100,000/year LB. First year of life incidence rate (neonates and infants combined) was 23.0/100,000/year, younger children 1.5/100,000/year, older children 0.9/100,000/year, and adults 1.8/100,000/year. All age groups presented a decrease in incidence rate (last decade vs. previous) except neonates, which increased by 34%. Younger and older children presented the most considerable decrease: 48% and 37% (last decade vs. previous).

Conclusions: Adults showed the highest number of BM cases. The incidence rate was highest during the first year of life (neonates and infants combined). All age groups, except neonates, showed a decreasing trend. Younger and older children presented the most considerable decrease, most likely attributable to vaccination. The observed increase in BM incidence rate in neonates may influence whether preventive strategy is considered.

November 2021
Yaniv Faingelernt MD, Eugene Leibovitz MD, Baruch Yerushalmi MD, Eytan Damari MD, Eyal Kristal MD, Raouf Nassar MD, and Dana Danino MD
March 2020
Ori Hassin MD, Dana Danino MD, Ruth Schreiber MD, Eugene Leibovitz MD and Nahum Amit, MD
April 2018
Vitaly Finkelshtein MD, Yair Lampl MD, Mordechai Lorberboym MD, Andrew Kanner MD, Dominique Ben-Ami Raichman MD, Ron Dabby MD and Amir Tanay MD
February 2017
Avishay Tzur MD,Yair Sedaka MD, Yariv Fruchtman MD, Eugene Leibovitz, MD, Yuval Cavari MD, Iris Noyman MD, Shalom Ben-Shimol MD, Ilan Shelef MD and Isaac Lazar MD
November 2015
February 2014
Godfrey M. Rwegerera, Wahhab Chowdhury MPhil Path, Mpho A. Setime and Sandro Vento
September 2012
N. Watemberg, I. Sarouk, and P. Fainmesser

Background: Since clinical signs of meningeal irritation in infants may be absent or misleading, the American Academy of Pediatrics in 1996 recommended that a lumbar puncture be performed in young children following a febrile seizure. Recent evidence supports a conservative approach in children who do not look ill at the time of the physician's assessment. Moreover, seizures as the presenting or sole symptom of bacterial meningitis are very rare.

Objectives: To assess physicians’ compliance with the Academy’s recommendations and to determine the incidence of meningitis among febrile seizure patients, including those who did not undergo the puncture.

Methods: We conducted a retrospective analysis of the number of punctures obtained in febrile seizure patients aged 6–24 months, focusing on the clinician's indications for performing the procedure and on the clinical course of children who did not undergo the puncture.

Results: Among 278 patients (84% simple febrile seizure), 52 (18.7%) underwent the procedure. It was performed in 38% of 45 complex febrile seizure cases and in 48% of 91 infants younger than 12 months of age. Aseptic meningitis occurred in two infants, both with post-ictal apathy. Bacterial meningitis was not found and in none of the patients who did not undergo the puncture was meningitis later diagnosed.

Conclusions: Compliance with the Academy’s recommendations was low, as emergency room physicians based their decision whether to obtain a lumbar puncture solely on clinical grounds. No case of bacterial meningitis was detected among 278 young children with a febrile seizure, including those who did not undergo the puncture.
 

July 2012
O. Megged, M. Bar-Meir and Y. Schlesinger
Background: The incidence of invasive disease due to Haemophilus influenzae has decreased since the implementation of vaccination against serotype B.

Objectives: To describe the epidemiology, clinical and microbiological characteristics of patients with H. influenzae meningitis or bacteremia in the vaccine era in Israel.

Methods: We reviewed the medical records of all patients admitted to Shaare Zedek Medical Center between 1997 and 2010 who had blood or cerebrospinal fluid culture positive for H. influenzae.

Results: The study group comprised 104 patients – 57 children and 47 adults. Overall, 21 (20%) of the infections were due to serotype b. The children had shorter hospitalizations (6 vs. 12 days, P = 0.005) and lower mortality rate (5% vs. 28%, P = 0.003) as compared to the adults. Bacteremic pneumonia was the most common diagnosis in adults (45% vs. 28% in children, P = 0.08) while meningitis was more common in children (17% vs. 3.5%, P = 0.09). There was a seasonal pattern, with infections being more common during the winter and spring.

Conclusions: Invasive H. influenzae disease is uncommon but still exists in both children and adults. The disease course tends to be more severe in adults. Even in the global vaccination era, serotype b constitutes a significant portion of invasive disease.
April 2010
O. Waisbourd-Zinman, E. Bilavsky, N. Tirosh, Z. Samra and J. Amir

Background: Streptococcus pneumoniae is now the predominant pathogen causing meningitis. The resistance of S. pneumoniae to penicillin and third-generation cephalosporins has grown steadily.

Objectives: To assess the antibiotic susceptibility of S. pneumoniae isolated from the cerebrospinal fluid of children with meningitis, and determine the antibiotic regimen appropriate for suspected bacterial meningitis in Israel.

Methods:  The study group included 31 children with 35 episodes of meningitis hospitalized from 1998 to 2006. S. pneumoniae isolates from the cerebrospinal fluid were tested for susceptibility to penicillin and ceftriaxone.

Results: Of the 35 isolates, 17 (48.6%) showed resistance to penicillin (minimum inhibitory concentration ≥ 0.12 µg/ml). Only 3 isolates (8.6%) showed intermediate resistance to ceftriaxone (≥ 0.5 and < 2 μg/ml), and none showed complete resistance (MIC[1] ≥ 2 μg/ml). The rates of antibiotic resistance were higher in children who were treated with antibiotics prior to admission (penicillin 88.9% vs. 34.6%, P = 0.007; ceftriaxone 22.2% vs. 3.8%, P = 0.156).

Conclusions:  The rate of penicillin resistance is high in children with S. pneumoniae meningitis in Israel, especially in those treated with oral antibiotics prior to admission. Resistance to ceftriaxone is infrequent though not negligible. On the basis of these findings, current recommendations to empirically treat all children with suspected bacterial meningitis with ceftriaxone in addition to vancomycin until the bacterial susceptibility results become available are justified also in Israel.






[1] MIC = minimum inhibitory concentration


November 2009
S. Malnick, M. Somin, N. Beilinson, A. Basevitch, G. Bregman and O. Zimhony
We report four cases of Strongyloides hyperinfection among Ethiopian immigrants, of which three were fatal. Many immigrants from countries in which Strongyloides is endemic settle in developed countries. A high index of suspicion will lead to earlier diagnosis and treatment of this disease. Testing for Strongyloides infestation in this susceptible population by enzyme-linked immunosorbent assay serology, stool testing or duodenal aspiration may prevent the fatal complications of hyperinfection
July 2009
S. Reisfeld-Zadok, A. Elis, M. Szyper-Kravitz, M. Chowers and M. Lishner
July 2008
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