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Meningeal involvement in Wegener's granulomatosis is associated with localized disease.

Meningeal involvement is a rare occurrence in Wegener's Granulomatosis (WG). A Medline search uncovered only 48 previously reported cases. Here we describe the clinical features of meningeal involvement in WG and to evaluate the association with systemic disease extension. Through a systematic literature review of papers concerning meningeal involvement in WG, we collected and analysed data about sex, age, disease extension, symptoms, cerebrospinal fluid examination, imaging, ANCA and histology about previously reported patients. Headache is almost always the first symptom of meningeal involvement in WG. Later in the course of the disease other abnormalities may develop. Among them cranial nerve palsy, seizures and encephalopathy are the most frequent. Diagnosis is obtained by neuroimaging, which may disclose two distinct patterns of meningeal thickening: diffuse or focal. 62.9% of patients tests positive for ANCA. Histology typically shows necrotizing granulomatosis. Meningeal involvement is by far more frequent in the setting of localized WG. Meningitis is a rare complication of WG. It usually develops in patients with localized disease who are more likely to have destructive lesions of the upper airways. It may be recognized by a constellation of clinical and radiological findings and by histological signs of necrotizing granulomatosis, with little or no vasculitis.

Adult↗

PubMed2006

[Analysis by questionnaire survey concerning example such as purulent meningitis and severe infectious diseases--relation among patient background factor, sequelae, and infecting organism].

Concerning major causative organisms of purulent meningitis, i. e., Haemophilus influenzae and Streptococcus pneumoniae, a questionnaire was sent to medical institutions all over Japan with the aim of investigating the patient background factors, sequelae and causal relationship with the causative organisms. Responses from 84 institutions in various parts of Japan were summarized and the following conclusions were drawn. 1. The diagnostic names of 227 patients for whom the questionnaire could be recollected were as follows: Purulent meningitis 138 cases (patient under 15 years old; 134 cases); purulent meningitis and sepsis, 58 cases; sepsis, 28 cases; and others, 3 cases. The causative organisms for the patients with meningitis and meningitis + sepsis were as follows: Haemophilus influenzae, 132 patients; and Streptococcus pneumoniae, 44 patients. 2. With respect to age distribution among the patients with meningitis and those with meningitis + sepsis, the number of the patients of the age younger than 1 year old was more than twice larger than that of one-year-old patients. The percentage of the cases in which sequelae remained was 35.9% among the cases caused by Streptococcus pneumoniae and 13.4% among the cases caused by Haemophilus influenzae. A significant difference was observed between the bacterial strains (p=0.0025). 3. The major initial symptoms observed were high fever, vomiting, consciousness disorder, drowsiness and poor sucking. The percentage of the patients with remaining sequelae was significantly high among the patients who exhibited convulsion in the early stage after the onset. 4. As to the relationship with administration of dexamethasone, sequelae remained in 40.0% (10/25) of the patients who did not receive dexamethasone, and 17.3% (23/133) of the patients who received the drug. The percentage of the patients with remaining sequelae was significantly low among the patients who received dexamethasone (p=0.0043).

Adolescent↗

PubMed1992

[Study of meningeal carcinomatosis: diagnosis and treatment].

Thirty-four patients with meningeal carcinomatosis were treated at The Center for Adult Diseases, Osaka, from 1984 through 1990. The major origin of meningeal carcinomatosis was carcinoma of the lung (14 cases) and breast (8 cases). The most frequent histological type of carcinoma was adenocarcinoma (23 cases). Twenty cases still had active lesions and/or primary lesions in the lung, liver or bone at the time of diagnosis of the meningeal carcinomatosis. The primary lesions were treated surgically in 22 cases, with chemotherapy in 4 cases and with radiotherapy in 2 cases. Metastatic brain tumors were treated by surgical removal followed by chemo-radiotherapy in 12 cases, and with radiotherapy alone in 2 cases. The interval from the time of diagnosis of the primary lesion to the time of diagnosis of the meningeal carcinomatosis varied from one month to eight years, and the interval between surgical removal of metastatic brain tumors and the diagnosis of meningeal carcinomatosis ranged from 0 to 3 years. With regard to the diagnosis of meningeal carcinomatosis, positive cytology was seen in initial standard lumbar puncture in 32 of the 34 patients. CT scan showed abnormal findings in 28 of the 34 patients, including ventricular dilatation only (12 cases), and small enhancing lesions along the CSF space (12 cases). The EEG showed abnormal patterns in 14 of 15 cases. Intrathecal chemotherapy with methotrexate alone or combined methotrexate with cytosine arabinoside via the Ommaya reservoir or standard lumbar puncture alternately with or without radiation therapy was successful as treatment, and 22 of 29 treated patients showed symptomatic improvement of the meningeal irritation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗

PubMed1991

Cerebrospinal fluid N-acetyl neuraminic acid estimation for early diagnosis and differentiation of bacterial meningitis.

Cerebrospinal fluid (CSF) analysis for free, bound and total N-Acetyl Neuraminic Acid (NANA) as well as serum NANA was done in 68 patients of bacterial meningitis, of which 37 cases were of pyrogenic meningitis and 31 of tuberculous meningitis. Ten patients were included in the control group. The free NANA levels were increased in only pyogenic meningitis, independent of protein levels but the bound form increased with the increase in CSF proteins. The increase of free NANA in CSF of pyogenic meningitis patients was not related to the cell count or sugar content in CSF or to the duration or severity of illness. This finding can be of great help in differentiating cases of pyogenic meningitis, particularly partially treated patients, who may have ambiguous pictures of CSF analysis, from the cases of tuberculous meningitis.

Bacterial Infections↗

PubMed1990

[The characteristics of suppurative meningitis morbidity caused by Streptococcus pneumoniae and Haemophilus influenza type B].

Of the 1,018 patients with purulent bacterial meningitis, hospitalized at the 2nd Clinical Infectious Hospital in Moscow during the period of 1980-1987, the diagnosis was confirmed in 54.7%; of these, meningitis of pneumococcal etiology was established in 44.8% and meningitis caused by H. influenzae, type b, in 23.8% of the patients. In meningitis of pneumococcal etiology high risk groups included mainly adults, especially those over 50 years, and children under 3 years of age. In meningitis of H. influenzae etiology high risk groups included mainly young children under 2 years of age. Meningitis of pneumococcal etiology was characterized by considerable death rate (on the average, 20%), while in meningitis of H. influenzae etiology death rate was 3 times lower. Pneumococci of serotypes 1, 3, 6, and 19 were found to be of the highest etiological importance for adults and pneumococci of serotypes 19, 6, 12, and 1, for children. In recent years greater etiological role of serotype 42 in adults was noted. The study of the spread of meningitides of different etiology is a high-priority task for this country.

Age Factors↗

PubMed1987

Screening for complement deficiencies in unselected patients with meningitis.

Two hundred and nine patients consecutively admitted to hospital with a tentative diagnosis of meningitis were screened for complement deficiency by measuring classical and alternative pathway serum haemolytic complement activity and the plasma concentration of C3d. Abnormal test results were followed up by quantitative immunochemical measurements of individual complement components. No patients with homozygous complement deficiency were found in our material. One patient with pneumococcal meningitis with probable heterozygous C2-deficiency was identified. Patients with purulent meningitis of various etiologies or meningococcal disease had significantly increased plasma C3d concentration at admission compared to patients with serous meningitis or without meningitis. Furthermore, increased plasma level of C3d at admission in patients with purulent meningitis or meningococcal disease was associated with an increased lethality. Our findings do not support the hypothesis that complement deficiency is commonly associated with sporadically occurring meningococcal disease or purulent meningitis.

Adolescent↗

PubMed1986

[Meningitis following lumbar puncture in bacteremia?].

We report on two infants with bacteremia and the clinical signs of meningitis who developed overt meningitis following an extended period after the first lumbar puncture, in which inconspicuous (cytological and bacteriological) cerebrospinal fluid were found. The causative infective agents of bacteremia and meningitis were identical. The iatrogenic induction of meningitis by the procedure of lumbar puncture in the presence of a bacteremia is imaginable, but has not been proven. Diagnostic consequences are: Every lumbar puncture for bacterial meningitis has to be complemented with a simultaneous blood culture. Lumbar puncture should be repeated when clinical signs of meningitis persists in children, especially in infants with positive blood culture and with inconspicuous cerebrospinal fluid findings in the initial lumbar puncture. Such children should be hospitalized for clinical observation. Therapeutical consequences are presently unclear. Proven recommendations are lacking for the different possible procedures after initial lumbar puncture in children with suspicion of a bacteremia: for instance no therapy or one single antibiotic dose given i.v. immediately following the lumbar puncture or the same treatment as in proven meningitis until microbiological results are obtained.

Humans↗

PubMed1983

[Mortality of rare purulent meningitis, (Staphylococcus, Listeria Pseudomonas, Proteus, Klebsiella, E. coli, Salmonella). An epidemiologic study using the literature from the last 30 years].

3056 cases of purulent meningitis caused by seven rare microorganisms (Staphylococci, Listeria, Pseudomonas, Proteus, Klebsiella, E. coli, Salmonella) were collected from the West European and North American literature of the last 30 years. The average lethality has been calculated for the periods ranging from 1948 to 1962 and from 1963 to 1979 in order to compare the results due to the use of penicillin and older antibiotics with those accomplished with ampicillin and the aminoglycosides. After 1963 the death-rate of each type of meningitis decreased considerably (except for Salmonella meningitis): the lethality of the whole group fell from 48% to 33%, in the subgroup of gram-negative meningitis from 55% to 38%, and in the group of neonatal gram-negative meningitis from 67% to 52%. The best results were seen in Proteus meningitis where lethality decreased from 55% to 15%. In E. coli meningitis there was a reduction from 60% to 43% only. Using the chi-square test all these differences were highly significant (p less than 0.001).

Adolescent↗

PubMed1984

Bacterial meningitis in the elderly.

To assess the implications of meningitis in a more mature population, we reviewed the records of patients with meningitis: 71 aged 50 years and older and 138 patients aged 15 to 49 years. Among the older population, 54 (76%) had bacterial, nine (13%) had granulomatous, and eight (11%) had aseptic meningitis. Among the cases of bacterial meningitis in the older age group, Streptococcus pneumoniae accounted for 24% (13/54) and enteric bacilli accounted for 17% (9/54). Serious complications occurred in 38 elderly patients (70%) with bacterial meningitis, and mortality occurred in 24 (44%). In the younger age group with bacterial meningitis, the complication rate and mortality were 41% (13/32) and 13% (4/32), respectively. Meningitis in the elderly is likely to be bacterial and to cause greater morbidity and mortality.

Adolescent↗

PubMed1982

Haemophilus influenzae meningitis in school-aged children.

The relative frequency of meningitis caused by Haemophilus influenzae in school-age children was determined by reviewing etiologic diagnoses in children 6 to 15 years old admitted to four hospitals from 1974 to 1978. Sixty-five (45%) of 145 patients had aseptic meningitis and 29 (20%) had bacterial meningitis. Thirty-two (22%) of the patients had received antibiotic therapy before diagnosis, and 19 (13%) could not be classified. Six (21%) of the 29 patients with bacterial meningitis had H influenzae meningitis. Although aseptic disease was the most common type of meningitis, initial antibiotic therapy for presumed bacterial meningitis in school-aged children should include adequate coverage for H influenzae.

Adolescent↗

PubMed1985

The incidence of bacterial meningitis in the Netherlands--a comparison of three registration systems, 1977-1982.

Data on the incidence of bacterial meningitis (BM) in the Netherlands are important for a cost-benefit analysis of new effective vaccines. During the period 1977-1982 we compared the notifications of meningococcal meningitis, diagnoses on discharge from hospital of all causes of BM (Stichting Medische Registratie, Medical Registration Foundation; SMR) and bacteriological data (Netherlands Reference Laboratory for Bacterial Meningitis; RBM). Notifications of meningococcal meningitis were 42% lower than SMR-data. RBM-registration of meningococcal, haemophilus and pneumococcal meningitis was 20% lower than SMR. Reviewing patient-records we found that these diseases had not been reported in 16% (RBM) and 11% (SMR) of cases. We estimate the incidence of BM during an endemic period at 8.0 per 100 000 population per year, to which the meningococcus contributes 20-25%. In children under 5 years of age the age-specific incidence of haemophilus meningitis is 22/100 000.

Adolescent↗

PubMed1998

High human immunodeficiency virus type 1 RNA load in the cerebrospinal fluid from patients with lymphocytic meningitis.

Thirty-seven matched cerebrospinal fluid (CSF) and plasma samples from 34 human immunodeficiency virus type 1 (HIV-1)-infected patients with suspected meningitis were analyzed for levels of HIV-1 RNA and markers of inflammation. Patients with tuberculous (n = 9) or cryptococcal (n = 6) meningitis had the highest CSF virus loads, which in many cases exceeded the levels in plasma, compared with patients with meningococcal meningitis (n = 3), aseptic meningitis (n = 8), tuberculoma (n = 2), or AIDS dementia complex (n = 4) or with normal lumbar punctures (n = 3). CSF virus load correlated significantly with the number of infiltrating lymphocytes (r = .60, P < .001) but not with plasma virus load, the levels of beta2-microglobulin in the CSF, or the integrity of the blood-brain barrier. These data suggest significant intrathecal HIV-1 replication in patients with lymphocytic meningeal infections such as tuberculous and cryptococcal meningitis.

AIDS Dementia Complex↗

PubMed2006

Interferon gamma quantification in cerebrospinal fluid compared with PCR for the diagnosis of tuberculous meningitis.

PURPOSE: To assess the utility of interferon gamma (INF-gamma) levels in cerebrospinal fluid (CSF), for the diagnosis of tuberculous meningitis (TBM), and compare these results with aPCR technique. METHODS: We studied CSF samples from patients with proven or probable TBM and a control group, composed by patients with other causes of meningitis and without meningitis. INFgamma levels were measured by radioimmunoassay. A PCR technique was performed using IS6110 primers. RESULTS: Of the 127 patients studied, 20 (15.6%) had TBM, 59 (46%) had meningitis of another aetiology and 49 (38.4%) had were HIV and non-HIV patients with normal CSF. The area below the ROC curve for interferon gamma levels in the diagnosis of TBM was 0.94. A cut-off of 6.4 IU/mL yielded a sensitivity of 70% and a specificity of 94%. False positive results were observed in 7 of the 59 patients (11.8%) with non-TB meningitis, (patients with herpetic meningoencephalitis and meningitis due to intracellular microorganisms). INF-gamma sensitivity was higher than PCR (70% vs. 65%). Both tests performed together showed higher sensitivity (80%) and specificity (92.6%). CONCLUSION: CSF INF-gamma levels (> 6.4 IU/mL) are very valuable in TBM diagnosis. PCR and INF-gamma could be simultaneously used to increase the diagnostic yield.

Adolescent↗

PubMed1982

Bacterial meningitis--ten years experience.

Between January 1968 and December 1977, 635 cases of acute bacterial meningitis were admitted to hospitals in the Birmingham Area Health Authority. The epidemiology of these cases was analysed and compared with the 270 cases which were admitted to the regional infectious diseases unit at East Birmingham Hospital (E.B.H.). In children and young adults the meningococcus was the commonest causative organism while over the age of 25 pneumococcal meningitis predominated. Although Haemophilus influenzae was the second commonest infecting organism it was a rare cause of meningitis in school children and adults, only four cases presenting in these age groups in the Birmingham Area. A detailed analysis was made of the symptoms, signs, laboratory investigations and clinical course of the 270 cases treated at E.B.H. The mortality in the patients with pneumococcal meningitis was 30%. In the meningococcal group it was 3.5% and in the haemophilus groups 7.7%. An analysis of the various treatment regimes employed in the 270 E.B.H. patients supports the view that a single antibiotic is sufficient for the therapy of most forms of bacterial meningitis. Intrathecal antibiotic administration is unnecessary in pyogenic meningitis caused by meningococci, pneumococci or H. influenzae.

Adolescent↗

PubMed2002

Dexamethasone in adults with bacterial meningitis.

BACKGROUND: Mortality and morbidity rates are high among adults with acute bacterial meningitis, especially those with pneumococcal meningitis. In studies of bacterial meningitis in animals, adjuvant treatment with corticosteroids has beneficial effects. METHODS: We conducted a prospective, randomized, double-blind, multicenter trial of adjuvant treatment with dexamethasone, as compared with placebo, in adults with acute bacterial meningitis. Dexamethasone (10 mg) or placebo was administered 15 to 20 minutes before or with the first dose of antibiotic and was given every 6 hours for four days. The primary outcome measure was the score on the Glasgow Outcome Scale at eight weeks (a score of 5, indicating a favorable outcome, vs. a score of 1 to 4, indicating an unfavorable outcome). A subgroup analysis according to the causative organism was performed. Analyses were performed on an intention-to-treat basis. RESULTS: A total of 301 patients were randomly assigned to a treatment group: 157 to the dexamethasone group and 144 to the placebo group. The base-line characteristics of the two groups were similar. Treatment with dexamethasone was associated with a reduction in the risk of an unfavorable outcome (relative risk, 0.59; 95 percent confidence interval, 0.37 to 0.94; P=0.03). Treatment with dexamethasone was also associated with a reduction in mortality (relative risk of death, 0.48; 95 percent confidence interval, 0.24 to 0.96; P=0.04). Among the patients with pneumococcal meningitis, there were unfavorable outcomes in 26 percent of the dexamethasone group, as compared with 52 percent of the placebo group (relative risk, 0.50; 95 percent confidence interval, 0.30 to 0.83; P=0.006). Gastrointestinal bleeding occurred in two patients in the dexamethasone group and in five patients in the placebo group. CONCLUSIONS: Early treatment with dexamethasone improves the outcome in adults with acute bacterial meningitis and does not increase the risk of gastrointestinal bleeding.

Acute Disease↗

PubMed2002

Sequelae after bacterial meningitis in childhood.

The neurological outcome of bacterial meningitis in children was evaluated retrospectively. Data were obtained from a large study on children aged between 1 month and 15 y who initially visited the emergency department of Sophia Children's Hospital, Rotterdam, The Netherlands with meningeal signs. This study presents data from 103 patients in whom bacterial meningitis was diagnosed. Neisseria meningitidis was the dominant pathogen of meningitis. We found a 2% case-fatality rate in children with bacterial meningitis and a 13% rate of sequelae among survivors: 7% hearing impairment and 7% neurological sequelae. Children with bacterial meningitis caused by Streptococcus pneumoniae and those with acute focal neurological symptoms tended to have the worst prognosis.

Adolescent↗

PubMed1995

Childhood bacterial meningitis in Southwestern Greece: a population-based study.

During the 5-year period from 1990 through 1994, we investigated the incidence of childhood bacterial meningitis (beyond the neonatal period) in southwestern Greece. Thirty-seven cases of bacterial meningitis were identified. Fifty-one percent of the cases were caused by Neisseria meningitidis, 41% by Haemophilus influenzae type b (Hib), and 8% by Streptococcus pneumoniae. Fifty-eight percent and 73% of cases of meningococcal and Hib meningitis, respectively, involved children younger than 2 years of age. The average yearly incidences of meningococcal and Hib meningitis were 9.7 and 8 cases, respectively, per 100,000 children < 5 years of age. The main difference between findings in this study and those in other studies in Western European countries is the lower incidence of Hib meningitis observed in our area. This low incidence of Hib meningitis cannot be attributed to the use of vaccine because the Hib vaccine was first introduced in May 1994 and used infrequently through December 1994.

Adolescent↗

PubMed1979

Diagnosis of bacterial meningitis by gas-liquid chromatography. II. Analysis of spinal fluid.

The feasibility of gas-liquid chromatographic analysis of spinal fluid from dogs with experimental meningitis and from patients with meningitis was evaluated. Normal canine and human spinal fluid contained consistent levels of palmitic and stearic acids, glucose, and trace amounts of glycerol. Pneumococcal meningitis in dogs and humans was characterized by a complex fatty-acid pattern in spinal fluid similar to that seen in pneumococcal cells. Spinal fluid from dogs with Haemophilus influenzae meningitis yielded several saturated fatty acids as well as rhamnose, xylose, and glucosamine; four of five spinal fluid specimens from patients with H. influenzae meningitis gave similar results. Fatty-acid profiles of spinal fluid from dogs with staphylococcal meningitis were complex, with branched-chain and straight-chain fatty acids. Spinal fluid specimens from Neisseria meningitidis-infected dogs yielded 16- and 18-carbon fatty acids and sialic acid. Gas-liquid chromatographic analysis of spinal fluid proved valuable as a tool for identifying bacterial infections and differentiating between common spinal fluid pathogens.

Animals↗