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PubMed1999

[Epidemiology and control of bacterial meningitis in children less than 1 year in Niamey (Niger)].

A bacteriological and epidemiological study of bacterial meningitis occurring in infants under one year of age was performed from September 1981 to June 1997 in Niamey, a city of 575,000 residents, located within the African meningitis belt. Cases of meningitis were defined either by culture of the cerebrospinal fluid (CSF), specific antigen agglutination, staining or cell counts of the CSF. Over the 16 years involving both epidemic and non epidemic periods, 1,481 infant's CSF were analysed, representing 20% out of the total CSF samples. The average of annual incidence rates was 511.4 cases per 100,000 infants under one year. Haemophilus influenzae b represented 35.1% of the cases, Streptococcus pneumoniae 26.3% and Neisseria meningitidis 17.6%. The other bacteria represented 5.5% and, for 15.5% out of the analysed CSF, the causative agent was not identified. The average annual mortality rate was 146.9 deaths for 100,000 infants under one year. The specific case fatality rates were 43% for H. influenzae b, 58.9% for S. pneumoniae and 17.8% for N. meningitidis. This study showed that in Niamey, as in the rest of the meningitis belt, S. pneumoniae and H. influenzae b were the main causes of bacterial meningitis occurring in infants under one year. However, the specific incidence of N1 meningitidis was identical for every age group between 0 and 20 years, and varied from 45 per 100,000 during non epidemic year to 550 per 100,000 during epidemic year. Immunisation with conjugate vaccines, particularly anti-Haemophilus vaccine appears to be the best preventive measure. The systematic use of ceftriaxone in infants, during meningococcal meningitis either epidemics or not, is highly recommended.

Humans↗
PubMed2003

[Agents of community acquired purulent meningitis in the child: epidemiologic trends in Abidjan, Côte d'Ivoire, from the year 1995 to 2000].

OBJECTIVE: To assess prevalence and trends of community acquired bacterial meningitis in childhood in a tertiary-care hospital before introduction of the HIB conjugate vaccine. STUDY DESIGN: Laboratory based data were recorded from January 1995 to December 2000 on two hundred and eighty seven children with bacterial meningitis. Identification of bacterial agents was performed with conventional methods. Information including age, gender, bacterial aetiology of meningitis, month and annual prevalence of agents was examined. RESULTS: The age of infected children ranges from 1 to 10 years with an average and median age of 34.2 months and 12 months respectively. Fifty five percent of children were male. The overall prevalence of agents were respectively 47.8% for Streptococcus pneumoniae followed by Haemophilus influenzae 39% and Neisseria meningitidis 13.2% with predominance of serogroup C. Stratification by age group shows that Haemophilus influenzae was the most common agent among children < 1 year of age following by S. pneumoniae and N. meningitidis. After 5 years, the number of cases of S. pneumoniae and N. meningitidis was prevalent. After 10 years, N. meningitidis was the first aetiology of bacterial meningitis. The six years data recorded highlighted the high and stable prevalence of H. influenzae B and S. pneumoniae and the low prevalence of N. meningitidis and high incidence of invasive meningococcal, pneumococcal and Haemophilus influenzae during the six years between September and February. CONCLUSION: Conjugated HIB vaccine is needed in our country to lower incidence of H. influenzae meningitis as already seen in developed countries. Continuous surveillance is necessary to monitor the disease trends, serotype distribution and antimicrobial susceptibility in order to implement appropriate public health interventions against community acquired bacterial meningitis.

Child↗
PubMed1992

[Meningitis in pediatrics. Clinical and epidemiological study of 173 cases].

BACKGROUND: To know the incidence, clinical presentation, differential diagnosis and resistance level to antibiotics in pediatric meningitis. METHODS: 173 cases of meningitis (bacterial: 69, viral: 104) have been prospectively followed during 1988 according to a previously established clinical and laboratory protocol. RESULTS: Meningitis attack rate was 60 cases/100,000 children younger than 15 years per year (meningococcal: 25/100,000, Haemophilus: 2/100,000). Mortality was 1.4%. 40% of bacterial meningitis received previous antibiotic treatment. Sensitivity of culture, Gram stain, and direct antigen detection by latex and EIA was 79%, 61.7%, 20.5% and 34%, respectively. Bacterial and viral differential diagnosis, by the application of Boyer's score was 95% sensitive and 98% specific. Four out of six cases of Haemophilus meningitis were ampicillin and chloramphenicol resistant; 39% of meningococcus had their penicillin susceptibility decreased between 2 and 8 times, although no therapeutic failures were seen. CONCLUSIONS: Laboratory parameters might not separate bacterial and viral meningitis at early stages of illness. Gram stain is an excellent and sensitive method of bacterial detection in CSF. Moderate resistance to penicillin in meningococcus is very frequent but clinical failures are not yet present.

Adolescent↗
PubMedDate not supplied

Bacterial meningitis in Navojo Indians.

An analysis of 219 confirmed cases of bacterial meningitis among Navajo Indians during a 5-year period, July 1, 1968, through June 30, 1973, revealed that 56 percent were caused by Haemophilus influenzae, 26 percent by Neisseria meningitidis, 6 percent by Mycobacterium tuberculosis, and 6 percent by other organisms. The annual incidence of H. influenzae meningitis (17.7 per 100,000 persons) and that of pneumococcal meningitis (8.0 per 100,000) were much higher than the rates for these diseases reported from other population groups. The annual incidence of meningococcal meningitis (2.0 per 100,000) was similar to that found elsewhere. There was an ususual concentration of cases during the first year of life; 78 percent of H. influenzae, 64 percent of pneumococcal, and 50 percent of meningococcal meningitis occurred during this time. However, bacterial meningitis during the first month of life was not frequent (0.29 per 1,000 live births). Case fatality rates were similar to those reported for other population groups.

Adolescent↗
PubMed1981

Lumbar puncture-induced meningitis.

A retrospective study was done to evaluate the risk of lumbar puncture-induced meningitis. Fourteen percent (23/165) of patients with bacteremia caused by Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitis, and groups A and B streptococci had spontaneous meningitis (without a preceding lumbar puncture). In contrast, only 0.8% (7/924) of patients with blood culture containing other organisms had spontaneous meningitis and 2.1% (3/140) of these patients had clinical courses consistent with lumbar puncture-induced meningitis. However, the 2.1% incidence in the latter group is not significantly different from 0.8%, the expected incidence of spontaneous meningitis. It is suggested that if lumbar puncture-induced meningitis does occur, it is rare enough to be clinically insignificant.

Adult↗
PubMed1999

Immunocytochemical characterization of reactive optic nerve astrocytes and meningeal cells.

Regeneration in the adult central nervous system (CNS) is thought to be hampered by the lesion-induced activation of astrocytes and meningeal cells and the consecutive formation of a glial scar. The substrate properties of reactive astrocytes differ significantly from their neonatal counterparts, which promote axon growth, but in spite of intensive studies the underlying molecular changes are still not fully understood. We have used two cell culture systems to compare the expression of certain surface molecules on neonatal astrocytes, reactive astrocytes and meningeal cells in vitro. Both, neonatal and reactive adult astrocytes exhibited a very similar expression of growth promoting molecules (NCAM, L1, laminin, fibronectin, DSD-1 proteoglycan) and potential inhibitors (tenascinC, chondroitin sulfate, and NG2-proteoglycan), whereas we could not detect the inhibitory keratan sulfate on either astrocyte population. In contrast, meningeal cells expressed considerable levels of keratan sulfate, but only minimal amounts of NCAM. In addition, the much higher expression of extracellular fibronectin around meningeal cells implies an excess formation of extracellular matrix (ECM). In coculture experiments, embryonic retinal ganglion cell (RGC) axons clearly avoided meningeal cells and instead preferred even reactive adult astrocytes. Our results suggest that the expression of inhibitory keratan sulfate proteoglycans together with a lack of NCAM and an excess production of ECM may be responsible for the non-permissiveness of meningeal cells. Compared to reactive astrocytes, meningeal cells are even worse a substrate for growing axons. None of the molecules investigated, however, seems to account for the different substrate properties of neonatal and reactive adult astrocytes.

Animals↗
PubMed2006

Antibiotic prophylaxis for preventing meningitis in patients with basilar skull fractures.

BACKGROUND: Basilar skull fractures (BSF) predispose patients to meningitis because of the possible direct contact of bacteria in the paranasal sinuses, nasopharynx or middle ear with the central nervous system (CNS). Cerebrospinal fluid (CSF) leakage has been associated with a greater risk of contracting meningitis. Antibiotics are often given prophylactically, although their role for preventing bacterial meningitis is not established. OBJECTIVES: To evaluate the effectiveness of prophylactic antibiotics for preventing meningitis in patients with BSF. SEARCH STRATEGY: We searched the Cochrane Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 3, 2005), MEDLINE (1966 to September 2005), EMBASE (1974 to June 2005), and LILACS (1982 to September 2005). We also performed an electronic search of meeting proceedings from the American Association of Neurological Surgeons (1997 to September 2005) and handsearched the abstracts of meeting proceedings of the European Association of Neurosurgical Societies (1995, 1999 and 2003). SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing any antibiotic versus placebo or no intervention. We also identified non-RCTs to perform a separate meta-analysis to compare results. DATA COLLECTION AND ANALYSIS: At least two authors independently appraised the quality and extracted the data of each trial. MAIN RESULTS: Five RCTs and 17 non-RCTs comparing different types of antibiotic prophylaxis with placebo or no intervention in patients with BSF were identified. Most trials presented insufficient methodological detail. All studies included meningitis in their primary outcome. Overall, we evaluated 208 participants from the four RCTs that were considered suitable for inclusion in the meta-analysis. There were no significant differences between antibiotic prophylaxis groups and control groups in terms of reduction of the frequency of meningitis, all-cause mortality, meningitis-related mortality, and need for surgical correction in patients with CSF leakage. We performed a subgroup analysis to evaluate the primary outcome in patients with and without CSF leakage. We also completed a meta-analysis of all the identified controlled non-RCTs (enrolling a total of 2168 patients), producing results consistent with the randomised data. AUTHORS' CONCLUSIONS: Currently available evidence from RCTs does not support prophylactic antibiotic use in patients with BSF, whether there is evidence of CSF leakage or not. Until more research is completed, the effectiveness of antibiotics in patients with BSF cannot be determined because studies published to date are flawed by biases. Large, appropriately designed RCTs are needed.

Antibiotic Prophylaxis↗
PubMed2005

Proton MR CSF analysis and a new software as predictors for the differentiation of meningitis in children.

This article describes proton MR spectroscopic analysis of cerebrospinal fluid of 167 children suffering from meningitis and 24 control cases. Quantification of 12 well-separated and commonly observed cerebrospinal fluid metabolites viz., beta-hydroxybutyrate, lactate, alanine, acetate, acetone, acetoacetate, pyruvate, glutamine, citrate, creatine/creatinine, glucose (total) and urea was carried out using Bruker's NMRQUANT software with respect to a known concentration of sodium-3-(trimethylsilyl)-2,2,3,3-d4-propionate (TSP), serving as an external reference. The assignment of urea in CSF is reported for the first time by NMR. The presence of cyclopropane, observed for the first time in tuberculous meningitis overall in 85.1% of cases, acts as a finger-print marker for the differential diagnosis. Multivariate discriminant function analysis was carried out for the proton MR-detected metabolite information and the clinical symptoms data of the meningitis and control cases to find the important descriptors for classification, followed by a re-validation of the entire database. It was found that the control could be differentiated from the disease group with a success rate of 96.4%, followed by the differential diagnosis of tuberculous meningitis with a corresponding value of 77.2%. Excluding the presence of cyclopropane, bacterial meningitis could be classified 84.4% correct and viral meningitis with a rate of 83.3%. It is proposed that the NMR spectroscopic information, along with other routine clinical features, may serve as an additional diagnostic tool for the differential diagnosis of meningitis in children.

Algorithms↗
PubMed1995

Migration of oligodendrocyte precursors on astrocytes and meningeal cells.

Oligodendrocytes populate developing white matter and repopulate demyelinated regions of the CNS by migration. Although little is known about their migratory routes, the environment through which these cells migrate, whether during development, disease, or injury, is packed with astrocytes infiltrated with or bounded by meningeal cells. In the present study, the migration of oligodendrocyte precursors from primary cultures and of the precursor cell lines (CG4 and Oli-neu) on astrocytes and meningeal cells was investigated using tissue culture migration assays and time lapse video microscopy. Oligodendrocyte precursors and the cell lines were found to migrate poorly on astrocytes and meningeal cells compared to migration on laminin even though both astrocytes and meningeal cells express cell surface laminin. The migration-inhibitory activity was not detected in conditioned media derived from either astrocytes or meningeal cells, nor was it detected from matrix deposited by these cells. Analyses of the events immediately following cell-cell contacts revealed that oligodendrocyte precursor-astrocyte contacts were typically long-lasting and appeared to be adhesive, whereas precursor-meningeal cell contacts usually resulted in rapid withdrawal of the precursor cell process. No correlation was found, however, between general adhesiveness and the rate of migration. Our results suggest that both astrocytes and meningeal cells retard migration of oligodendrocyte precursors, consistent with the view that they may impede the movement of oligodendrocyte precursors into CNS lesion sites.

Animals↗
PubMed1992

Measurements of CSF biochemical tumor markers in patients with meningeal carcinomatosis and brain tumors.

CSF beta-glucuronidase, polyamines and carcinoembryonic antigen (CEA) were analyzed in 16 patients with meningeal carcinomatosis from solid tumor in systemic organs, 27 with benign brain lesions, 18 with primary brain tumors, 14 with metastatic brain tumors and 5 with leptomeningeal dissemination of other malignant diseases. Beta-glucuronidase levels in all cases of meningeal carcinomatosis, meningeal gliomatosis and meningeal lymphoma were higher than 100 micrograms/dl/hr; on the other hand, levels in all cases of benign brain lesions were below 100 micrograms/dl/hr. Levels of beta-glucuronidase and polyamines were not high in the cases with positive cytology after tumor resection. Polyamine levels were below 0.05 nmol/ml in all cases after resection of the metastatic brain tumor. Cystic fluid of malignant tumors showed high levels of beta-glucuronidase and polyamines. On the other hand, the levels of polyamines in the cystic fluid of benign tumor were low, although the levels of beta-glucuronidase were high. Some cases of meningeal carcinomatosis with high levels of serum CEA did not show high levels of CSF CEA. For metastatic brain tumors, the cases with intraparenchymal tumors, especially with dural attachment showed high levels of beta-glucuronidase and CEA preoperatively, but they returned to normal after surgery. In cases of meningeal carcinomatosis treated by intrathecal chemotherapy with methotrexate (MTX) and cytosine arabinoside (Ara-C), CSF beta-glucuronidase reflected the neurological status better than the cell count decreased rapidly following chemotherapy and beta-glucuronidase was considered as a useful CSF marker in cases of meningeal carcinomatosis to monitor the course of the disease. The same situation was observed in CSF CEA and CEA was also considered as a useful marker when CEA levels in CSF are higher than those in serum.

Antineoplastic Agents↗
PubMed1989

Meningeal cells increase in vitro astrocytic gap junctional communication as measured by fluorescence recovery after laser photobleaching.

The presence of meningeal cells is necessary for the normal development of the glia limitans. Astrocytes comprising the adult glia limitans have several unique features, including many more gap junctions than is typical for astrocytes in the underlying molecular layer. This study examines the possible influence of meningeal cells on the establishment and maintenance of specific characteristics of astrocytes in the glia limitans. Primary cultures of rat astrocytes and meningeal cells were used to examine whether meningeal cells could alter astrocytic gap junctional dye coupling. Astrocytes and meningeal cells were grown on separate glass slides and co-cultured by forming a sandwich with the slides. The sides of the slides containing the cells faced each other and were separated by a 1 mm thick gasket along the edge of the slides. Although the meningeal cells and astrocytes were bathed in the same medium, they were separated by a distance of 1 mm and were not in direct contact during the co-culture period. The cells were co-cultured for 24, 48 or 72 hours, and astrocytic gap junctional dye coupling was examined using the gap-FRAP technique. The mean total recovery of fluorescence for control astrocytes was 14%. Astrocytes co-cultured with meningeal cells for 24 hours did not show a significant difference in the fluorescence recovery when compared to the control values. After 48 hours of co-culture, there was a significant increase in the gap junctional dye coupling. After 72 hours, gap junctional dye coupling continued to increase (total fluorescence recovery = 53%).(ABSTRACT TRUNCATED AT 250 WORDS)

Astrocytes↗
PubMed2004

Characteristics and immediate outcome of childhood meningitis treated in the pediatric intensive care unit.

OBJECTIVE: To describe patient characteristics, use of technology and mortality in children with meningitis admitted to the pediatric intensive care unit (PICU). DESIGN: Retrospective cohort study. SETTING: Fifteen US PICUs. PATIENTS: All admissions with a diagnosis of meningitis between 1995 and 2000 in the Pediatric Intensive Care Unit Evaluations (PICUEs) database. MEASUREMENTS AND RESULTS: Of 559 patients with meningitis, 58% were male. The median age was 19 months and the median length of PICU stay was 2 days. The crude PICU mortality rate was 7%. Three hundred thirty-four (60%) patients had bacterial meningitis. Non-survivors had significantly higher Pediatric Risk of Mortality (PRISM) III scores and also constituted a larger proportion of the patients with bacterial meningitis, coma and shock upon PICU admission. The use of invasive devices was higher among non-survivors, patients with bacterial meningitis or those who were in coma or shock upon PICU admission. There was significant variation in the use of intracranial pressure (ICP) monitors by coma status and by institution. In multivariate analysis, patients had 1.26 higher odds of mortality for each unit increase in PRISM III score (odds ratio 1.26, 95% confidence interval: 1.19-1.34), while adjusting for other variables. CONCLUSION: In a large cohort of children admitted to the PICU with meningitis, severity of illness, particularly the presence of shock or coma, was significantly associated with both the higher use of invasive medical devices and higher mortality. There was significant variation in the use of ICP monitors among the various PICUs without statistical association with survival.

Databases, Factual↗
PubMed1999

Intrathecal 5-fluoro-2'-deoxyuridine (FdUrd) for the treatment of solid tumor neoplastic meningitis: an in vivo study.

To evaluate the possible intrathecal use of 5-fluoro-2'-deoxyuridine (FdUrd) for neoplastic meningitis, its antitumor activity and neurotoxicity in vivo were assessed. FdUrd at doses in the range 5-100 microg/animal was effective against meningeal carcinomatosis using Walker 256 carcinoma cells in rats and MM46 mammary cancer cells in mice and against meningeal gliomatosis using 203 glioma cells in mice. After four intrathecal injections, FdUrd at these doses also showed minimal neurotoxicity in the C57BL/6 mouse brain. To estimate the mechanism of FdUrd efficacy, thymidine phosphorylase (TPase) and thymidine kinase (TK), key enzymes in the metabolism of FdUrd, were measured in rat, mouse and normal human brain tissue, and in human brain tumor tissues and cerebrospinal fluid (CSF) from patients with malignant brain tumors including meningeal carcinomatosis. TPase levels were lower in brain and malignant brain tumors than in other organs and their tumors. Moreover, the activity of TPase in the gray matter of human brain, which faces the cerebrospinal fluid across the cortical surface and into which malignant cells invade in meningeal carcinomatosis, was lower than that in the white matter. TK was undetectable, and TPase was detected (at very low concentrations) in only 4 of 56 patients with brain tumors or meningeal carcinomatosis. These findings indicate that brain tissue and CSF are favorable sites for FdUrd chemotherapy because the rate of conversion of FdUrd to 5-FU would be minimal. In conclusion, FdUrd is potentially useful for intrathecal treatment of neoplastic meningitis from primary brain tumors and systemic cancer.

Animals↗
PubMed2006

Dexamethasone treatment in adults with pneumococcal meningitis: risk factors for death.

In experimental meningitis, adjunctive treatment with steroids reduces cerebrospinal fluid inflammation and thereby improves neurological outcome. On the basis of these findings, several clinical trials have assessed treatment with adjunctive steroids in bacterial meningitis, with conflicting results. Recently, the results of the European Dexamethasone Study showed a beneficial effect of adjunctive dexamethasone in adults with bacterial meningitis. In that study, the effect of dexamethasone on outcome was most striking in patients with pneumococcal meningitis. The aim of the present study was to further evaluate the effect of dexamethasone in adults with pneumococcal meningitis by performing a post hoc analysis of the European Dexamethasone Study. In a multivariate analysis, tachycardia (p=0.02), advanced age (p=0.03), low score on the Glasgow Coma Scale (p=0.03), positive blood culture (p=0.04), and absence of dexamethasone therapy (p=0.05) were independent predictors for death. Patients who were treated with adjunctive dexamethasone were less likely to develop both systemic and neurological complications during hospitalisation, compared with patients who received placebo. In conclusion, independent risk factors for death in pneumococcal meningitis are tachycardia, advanced age, low level of consciousness, bacteraemia, and absence of dexamethasone therapy. Treatment with adjunctive dexamethasone in adults with pneumococcal meningitis reduces both systemic and neurological complications.

Adult↗
PubMed2004

Solitary fibrous tumors of the meninges: report of four cases and literature review.

Central nervous system solitary fibrous tumors are a new pathological entity. To our knowledge, only 60 meningeal solitary fibrous tumors both in the spinal cord and in the brain have been described in the literature. The 56 previously reported cases of meningeal solitary fibrous tumors are critically reviewed. In addition, we report four new cases of solitary fibrous tumors of the meninges. There is a slight male prepoderance. Meningeal solitary fibrous tumors show a tendency to arise in the posterior fossa (26%) and spine (25%). The treatment was mainly total surgical excision. Radiotherapy was given only to four patients with tumors involving the cerebral parenchyma. Sporadic cases of recurrence and distant metastasis have been reported. The prognosis of meningeal solitary fibrous tumors is still unknown because the follow-up of the reported cases is short. It is probable that cases of solitary fibrous tumors of the meninges have been misdiagnosed as other tumors in the past. The best management of these tumors seems to be total surgical excision whenever possible. It is important that every new case of meningeal SFT be reported to throw light on this particular tumor and to affirm its status as a clinicopathological entity.

Adult↗
PubMedDate not supplied

Adult Enterobacter meningitis: a high incidence of coinfection with other pathogens and frequent association with neurosurgical procedures.

BACKGROUND: The clinical characteristics of Enterobacter infection in adult bacterial meningitis were defined. PATIENTS AND METHODS: The clinical manifestations and therapeutic outcomes of ten adult patients with Enterobacter infections in acute bacterial meningitis were analyzed. RESULTS: Enterobacter infection was found in 4.5% (10/223) of our adult patients with culture-proven bacterial meningitis. The ten patients comprised seven men and three women aged between 16-69 years (mean 47 years). Coinfections with other pathogens were found in 50% of the cases, the most common pathogen being Klebsiella pneumoniae. Nine of the ten patients had a history of neurosurgery, and seven patients contracted the infection nosocomially. Multiple antibiotic-resistant strains, including resistance to third-generation cephalosporins, were found in three patients with polymicrobial infections. These three patients received iv imipenem/cilastin therapy. The therapeutic results showed that two of the ten patients died; five of the eight surviving patients had neurological sequelae. CONCLUSION: The predominant coinfection with Enterobacteriaceae in adult Enterobacter meningitis may reflect the fact that most of the cases of polymicrobial Enterobacter infections have a potential gastrointestinal source. A postneurosurgical state was the most important predisposing factor for the development of Enterobacter infection in adult bacterial meningitis in our patients. The strains of the Enterobacter species in adult polymicrobial Enterobacter meningitis were commonly resistant to multiple antibiotics, including third-generation cephalosporins. In light of the high incidence of multiple antibiotic-resistant Enterobacter strains in adult polymicrobial Enterobacter meningitis, the choice of initial empiric antibiotics may include carbapenem (imipenem/cilastin or meropenem). Although the mortality rate was not high in this group of patients, most survivors suffered neurological sequelae.

Acute Disease↗
PubMed2001

Adults with meningitis caused by viridans streptococci.

BACKGROUND: We analyzed the clinical features and therapeutic outcomes of adults with meningitis caused by viridans streptococci. PATIENTS AND METHODS: 12 adult patients with meningitis caused by viridans streptococci were enrolled in this study. Clinical data were collected over a period of 15 years. RESULTS: Of the 12 patients, 11 patients had community-acquired meningitis, while one had nosocomially acquired meningitis. 11 contracted the spontaneous form and one contracted the postneurosurgical form. All isolates were susceptible to penicillin. The portals of entry of infection were determined in all 12 patients; five patients had otopharyngeal infections with or without their being spread hematogenously. The infections in six patients were spread hematogenously, but one of them was spread hematogenously with endocarditis. One patient became infected after a craniotomy. The patients infected by viridans streptococci had a high incidence of focal suppuration and cerebral vasculitis but no deaths occurred. CONCLUSION: Adult bacterial meningitis caused by viridans streptococci is not uncommon and otopharyngeal infection appears to be an important portal of entry. Clinical manifestations varied according to the different underlying conditions. The results of this study also demonstrate the high incidence of intracranial focal suppuration and cerebral vasculitis concomitant with meningitis. Penicillin remains the treatment of choice for patients with meningitis caused by viridans streptococci. Therapeutic outcome is favorable for patients who receive prompt treatment.

Adult↗
PubMed2005

Coagulase-negative staphylococcal meningitis in adults: clinical characteristics and therapeutic outcomes.

BACKGROUND: We wanted to analyze the clinical characteristics and therapeutic outcomes of adult meningitis caused by coagulase-negative staphylococci (CoNS). PATIENTS AND METHODS: Over a period of 5 years (January 1999 to December 2003), 127 cases were identified as having adult culture-proven bacterial meningitis caused by a single pathogen. Of them, 14 cases with CoNS meningitis were enrolled, and their clinical characteristics and therapeutic outcomes were analyzed. RESULTS: The 14 cases (median age 37.5; range 24-77 years old) included nine men and five women. With polynerase chain reaction sequencing of bacterial 16S r-RNA, 10 of the 14 CoNS strains were identified as Staphylococcus epidermidis infection, and the other four belonged to Staphylococcus haemolyticus. All 14 cases were in a postneurosurgical state with insertion of a ventriculoperitoneal shunt, external ventricular device or intrathecal port A as their underlying conditions, and 12 of the 14 patients contracted the infection nosocomially. Fever (86%), leukocytosis (79%), hydrocephalus (50%), consciousness disturbance (36%), and seizure (7%) were the major clinical manifestations. All the involved CoNS strains showed resistance to oxacillin but retained their susceptibility to vancomycin and linezolid. All 14 CoNS strains had positive mecA gene detection. With the removal of neurosurgical devices and intravenous vancomycin therapy, 86% (12/14) of the patients survived. CONCLUSION: CoNS meningitis accounted for 11% (14/127) of our adult bacterial meningitis. All adult CoNS meningitis patients had a disrupted barrier of the central nervous system as the underlying condition. S. epidermidis was the most common CoNS subtype involved. All involved CoNS strains were oxacillin resistant. The therapeutic result showed that adult CoNS meningitis had a mortality rate of 14% (2/14).

Acetamides↗