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PubMed1997

Risk factors for meningitis after transsphenoidal surgery.

To evaluate possible risk factors for meningitis, we retrospectively reviewed 228 transsphenoidal operations (in which a standard regimen of amoxicillin prophylaxis was used) for sellar pathology. The incidence of meningitis was 3.1% (seven of 228 cases). Cultures of preoperative specimens from the anterior nasal vestibule in three of seven patients yielded Staphylococcus aureus, but none of these patients developed S. aureus meningitis. Two of three patients with significant preoperative paranasal sinus abnormalities developed meningitis compared with only five of 225 patients without significant paranasal sinus abnormalities (P < .005). Three of 22 patients with intraoperative cerebrospinal fluid (CSF) leakage developed meningitis compared with four of 206 patients without intraoperative CSF leakage (P < .05). Six of seven patients with postoperative CSF rhinorrhea and only one of 221 patients without postoperative CSF rhinorrhea developed meningitis (P < .00001). In conclusion, postoperative CSF leakage is an important risk factor for meningitis after transsphenoidal surgery. Cultures of preoperative specimens from the anterior nasal vestibule did not have any predictive value in our study.

Amoxicillin↗
PubMed2003

Pneumococcal meningitis in adults: spectrum of complications and prognostic factors in a series of 87 cases.

Studies on the incidence and spectrum of complications and prognostic factors in adults with pneumococcal meningitis are scarce. Therefore, we analysed 87 consecutive cases who were treated in our department between 1984 and 2002. Meningitis-associated intracranial complications developed in 74.7% and systemic complications in 37.9% of cases. Diffuse brain oedema (28.7%) and hydrocephalus (16.1%) developed more frequently than previously reported. The incidences of arterial (21.8%) and venous (9.2%) cerebrovascular complications were also very high. Furthermore, 9.2% of cases developed spontaneous intracranial haemorrhages (two patients with subarachnoid and two with subarachnoid and intracerebral bleedings, all in association with vasculitis; one subject with intracerebral haemorrhage due to sinus thrombosis; and three cases with intracerebral bleedings of unknown aetiology). Other new findings were the incidence of acute spinal cord dysfunction due to myelitis (2.3%) and that of hearing loss (19.5% of all patients and 25.8% of survivors). The in-hospital mortality was 24.1%. Only 48.3% of the patients had a good outcome at discharge [Glasgow Outcome Scale Score (GOS) = 5]. Outcome did not change during the study period, as mortality and GOS were similar for patients treated between 1984 and 1992 and for those treated between 1993 and 2002. Factors associated with a bad outcome (GOS </= 4) were chronic debilitating diseases, low Glasgow Coma Scale Score and focal neurological deficits on admission, low CSF leucocyte counts, pneumonia, bacteraemia and meningitis-associated intracranial and systemic complications. Low CSF leucocyte counts were also associated with the development of meningitis-associated intracranial complications. Age > or =60 years was associated with a higher mortality (36.7 versus 17.5%), but the GOS of the survivors was comparable to that of the surviving younger patients. The causes of death were mostly systemic complications in the elderly and cerebral complications in the younger patients. A haematogenous pathogenesis seemed likely in asplenic patients, while contiguous spread from sinusitis or otitis was the major cause of meningitis in non-asplenic individuals. Furthermore, asplenic patients had a raised incidence of meningitis-associated intracranial complications, but their outcome was similar to that of non-asplenic subjects. The morbidity and mortality of pneumococcal meningitis in adults are still devastating. We report higher incidences (diffuse brain swelling, hydrocephalus, cerebrovascular complications) or new incidences (myelitis, hearing loss, subarachnoid bleeding) of intracranial complications. Our detailed analysis of prognostic factors may help clinicians to identify patients at risk and may also be helpful in the design of clinical trials.

Acute Kidney Injury↗
PubMedDate not supplied

Staphylococcus aureus meningitis: review of 28 cases.

Staphylococcus aureus is a relatively uncommon cause of meningitis associated with high mortality in neonates and neurosurgical patients. The infrequency of this infection has made its study difficult and has complicated the issues of treatment and prognosis. We reviewed 28 cases of S. aureus meningitis occurring over a 10-year period at three hospitals. Eight cases in children and 20 in adults were identified. Seventy-five percent of the children and 35% of the adults had central nervous system trauma or surgery; 45% of adults had comorbid disease that might have predisposed them to infection. Clinical presentation did not distinguish this form of meningitis from other bacterial meningitides. Findings in cerebrospinal fluid were characteristic of acute bacterial meningitis. Blood cultures were positive in 65% of cases. Overall mortality was 37%; 50% of adults but no children died of meningitis. No patients with S. aureus meningitis complicating cerebrospinal fluid shunts died; however, nine of 11 patients with identifiable foci of infection outside the central nervous system died. Only one patient receiving initial treatment with a penicillinase-resistant penicillin died of meningitis, whereas six of 12 patients not so treated died.

Adolescent↗
PubMedDate not supplied

Postpartum maternal group B streptococcal meningitis.

Maternal group B streptococcal (GBS) meningitis is rare, with only four cases previously reported in the literature. In this review a fifth case of postpartum GBS meningitis is presented. The five cases are compared with 34 cases of GBS meningitis in nonparturient adults. All cases of maternal GBS meningitis followed a vaginal delivery. The mean age of patients who had GBS meningitis outside the perinatal setting was 55 years, and most of these individuals had associated illnesses or frank immunosuppression; the mortality rate in this group was 23%. In contrast, all five patients with maternal GBS meningitis recovered. The case presented herein, like the four previous cases, illustrates the point that when patients with maternal GBS meningitis are treated immediately and have been healthy before the infection, the prognosis is good.

Adult↗
PubMed1993

Meningitis due to Aeromonas species: case report and review.

In recent years, Aeromonas species has been reported to cause extraintestinal infections with a growing frequency. Meningitis due to Aeromonas species is, however, a rare entity. We report a case of aeromonas meningitis in a 54-year-old man with a history of chronic alcoholic liver disease who, after an episode of gastroenteritis, developed an acute clinical picture characteristic of meningitis with septic shock and ecthyma gangrenosum. Aeromonas veronii (biogroup sobria) was isolated from cultures of blood as well as from cultures of stool, peritoneal fluid, skin lesion, and CSF specimens (obtained by lumbar puncture). Our review of seven additional cases of aeromonas meningitis in the world literature revealed that this condition is generally secondary to metastatic dissemination from primary bacteremia. Aeromonas meningitis, which may or may not be preceded by gastroenteritis, presents clinically as bacterial meningitis, although the presence of skin lesions may increase suspicion of the diagnosis. Third-generation cephalosporins are probably the therapy of choice for patients with aeromonas meningitis.

Aeromonas↗
PubMed2002

The risk of aseptic meningitis associated with the Leningrad-Zagreb mumps vaccine strain following mass vaccination with measles-mumps-rubella vaccine, Rio Grande do Sul, Brazil, 1997.

BACKGROUND: Few data are available on the risk of aseptic meningitis following vaccination with the Leningrad-Zagreb (L-Z) strain of mumps vaccine. In 1997 the mumps vaccine was introduced into the state of Rio Grande do Sul in Brazil through mass vaccination with mumps-measles-rubella (MMR), targeting children aged 1-11 years. Five municipalities used exclusively MMR vaccine containing the L-Z strain of mumps. An outbreak of aseptic meningitis was observed shortly after the mass campaign. METHODS: To estimate the risk of aseptic meningitis associated with this strain, we analysed vaccination and meningitis case surveillance data from the selected municipalities. A case of vaccine-associated aseptic meningitis was defined as one with a pleocytosis of 10-1,500 leukocytes/ml and occurring within 15-35 days after vaccine receipt. RESULTS: We estimated a risk of 2.9 cases per 10,000 doses of L-Z administered, equivalent to 1 case per 3,390 doses administered. The overall risk of aseptic meningitis following the campaign was increased 12.2-fold (95% CI: 6.0-24.7) compared with the same period in 1995-1996. Following the mass campaign, the incidence of mumps declined 93% during 1998-2000. CONCLUSIONS: Vaccination with the L-Z strain of mumps vaccine as part of a mass campaign was associated with a significantly increased risk of aseptic meningitis. Decisions about type of mumps vaccine and mumps vaccination strategies must consider vaccine safety issues in addition to other criteria.

Brazil↗
PubMed1990

Cerebrospinal fluid C-reactive protein measurement--a bedside test in the rapid diagnosis of bacterial meningitis.

C-reactive protein (C-RP) determinations were performed by the Latex agglutination method on the cerebrospinal fluid (CSF) samples of 212 patients with clinical features suggestive of meningitis. Patients were grouped as follows Group I: bacterial meningitis and partially treated bacterial meningitis (n = 22). Group II: viral encephalitis (n = 11). Group III: tuberculous meningitis (n = 18). Group IV: (i) febrile convulsions (n = 87); (ii) epileptic seizures (n = 70); (iii) intracranial haemorrhage (n = 4). C-RP was a better indicator of bacterial meningitis (sensitivity 91 per cent) than the Gram's stain (sensitivity 46 per cent). C-RP was positive in 91 per cent of patients in Group I, none in Groups II and III and 0.6 per cent in Group IV. C-RP determination in CSF proved to be a useful indicator of bacterial meningitis and served to distinguish it from viral encephalitis, tuberculous meningitis, febrile convulsions and other central nervous system disorders.

Bacterial Infections↗
PubMed1996

Pediatric meningitis in the Western Cape Province of South Africa.

During the 9 years 1985-1993 a prospective survey of all cases of meningitis in children < 13 years of age presenting to our hospital in the Western Cape Province of South Africa was carried out. Two-thousand-nine-hundred-and-twenty cases of meningitis were identified. The commonest form of bacterial meningitis was tuberculous meningitis (TBM) diagnosed in 282 children (mean age 2.94 years). N. meningitidis identified in 220 children (mean age 2.87 years), Haemophilus influenzae in 156 children (mean age 1.15 years) and S. pneumoniae in 106 children (mean age 2.14) were the next commonest causes of bacterial meningitis diagnosed. One-hundred-and-eighteen cases of bacterial meningitis were confirmed in infants < 1 month of age and the commonest bacteria identified were group B beta-haemolytic Streptococcus in 27, E. coli in 21, Klebsiella species in 11, and Candida species in 15 neonates. The emergence of TBM as the predominant cause of bacterial meningitis in childhood at our hospital is probably a reflection of the worsening tuberculosis situation in the Western Cape Province of South Africa.

Adolescent↗
PubMed1994

Effect of needle puncture on morphine and lidocaine flux through the spinal meninges of the monkey in vitro. Implications for combined spinal-epidural anesthesia.

BACKGROUND: Combined spinal-epidural anesthesia is a technique growing in popularity. However, there have been no attempts to investigate the risk of epidural drug reaching the subarachnoid space in high concentration by passing through the meningeal hole left by the spinal needle. This study begins to address this question by quantitating the flux of morphine and lidocaine through the spinal meninges of the monkey in vitro after puncture with three different-sized needles. METHODS: Spinal meningeal tissue from anesthetized monkeys was mounted in a diffusion cell and drug flux was measured through intact tissue and through tissue punctured with a 27-G Whitacre, a 24-G Sprotte, and an 18-G Tuohy needle. RESULTS: The flux of morphine through the meningeal tissue was significantly increased by puncture with each of the study needles. The flux of lidocaine was significantly increased only by puncture with the 24-G Sprotte and 18-G Tuohy needles. The flux of morphine through intact tissue was less than the flux of lidocaine through intact tissue. In contrast, the flux of morphine and lidocaine were the same through tissue punctured with the study needles. The magnitude of the drug flux through the needle puncture was a function of the diameter of the study needle. CONCLUSIONS: Epidural anesthesia after accidental or intentional puncture of the spinal meninges has occasionally resulted in high spinal blocks and total spinal anesthesia. This study suggests that drug movement through the meningeal hole is responsible for this complication and that the risk may be decreased by using the smallest possible needle to puncture the meninges.

Anesthesia, Epidural↗
PubMed1997

Risk of hospitalization because of aseptic meningitis after measles-mumps-rubella vaccination in one- to two-year-old children: an analysis of the Vaccine Safety Datalink (VSD) Project.

OBJECTIVE: To assess the level of increased risk, if any, of hospitalizations for aseptic meningitis after Jeryl-Lynn mumps strain measles-mumps-rubella (MMR) vaccine in the Vaccine Safety Datalink population. STUDY DESIGN: A possible increased risk of aseptic meningitis 8 to 14 days after receipt of MMR was observed in a preliminary screening analysis of automated data from the Vaccine Safety Datalink (VSD) project Year 2 analysis. To further evaluate this association a retrospective 10-year matched case-control study was undertaken in the four health maintenance organizations (HMOs) in the VSD project. Cases ascertained from a broad scan of the automated data were validated against a standard case definition. Two controls matched on age, sex, HMO and HMO membership were assigned per case. RESULTS: The VSD project involves the cooperative collection of automated vaccination and medical outcome data from four large HMOs that currently have 500,000 children younger than 7 years of age under surveillance. Review of automated screening results from the first 2 years of data revealed a possible increased risk of aseptic meningitis 0 to 14 days after MMR with a relative risk of 3.61 (95% confidence interval, 1.0 to 13.1) although the total number of cases was small. Although the automated data had suggested a possible association of aseptic meningitis with MMR containing the Jeryl-Lynn strain of mumps, review of validated hospitalized cases during the observation period did not reveal evidence of an increased risk of aseptic meningitis after MMR containing the Jeryl-Lynn strain of mumps (odds ratio < 1.0 for all analyses). CONCLUSION: Although it is recognized that hospitalized cases represent a minority of the total cases of aseptic meningitis, it is reassuring that in this evaluation no increased risk of aseptic meningitis after MMR vaccine was found.

Case-Control Studies↗
PubMed2000

Epidemiology of Haemophilus influenzae type b meningitis in Manila, Philippines, 1994 to 1996.

BACKGROUND: Effective vaccines against Haemophilus influenzae type b (Hib) have shown impressive results in decreasing Hib meningitis in developed countries. In the Philippines Hib vaccines are not part of the routine immunization given to children. Before a decision can be made to include Hib vaccines in immunization program, epidemiology of Hib meningitis in Manila, Philippines, should first be described. METHODOLOGY: A cohort of 41,592 children <5 years of age in Central Manila was the study population. Confirmed cases between January, 1994, and December, 1996, were obtained from all hospitals in the region. Confirmation of cases was based on positive culture isolated from blood or cerebrospinal fluid (CSF) or Hib antigen identified in CSF with a clinical diagnosis of Hib meningitis. The progress of children with Hib meningitis postinfection was evaluated from hospital records. RESULTS: There were 118 episodes of Hib meningitis identified in the population in the study period. Sequelae occurred in 15% of the total cases, and the case fatality rate was 11%. The annual incidence of Hib meningitis in Manila for children <5 years old was 95 per 100,000. CONCLUSIONS: Hib meningitis in Central Manila is common. The incidence is particularly high in children <6 months old. Adverse neurologic outcomes and a high case fatality rate in children younger than 1 year suggest that a vaccination program would be useful.

Age Distribution↗
PubMed2002

A season of aseptic meningitis in Germany: epidemiologic, clinical and diagnostic aspects.

OBJECTIVE: We assessed epidemiologic, clinical and laboratory features of aseptic meningitis during one season of multiserotype enteroviral meningitis in East Germany in 70 consecutive patients with aseptic meningitis admitted to the Children's University Hospital Leipzig. RESULTS: Patients, age 1 to 16 years, typically presented with headache, emesis and fever, whereas signs of meningeal irritation were only moderately expressed in one-half of the patients. The median number of leukocytes in the CSF was 151 cells/mm(3) (range, 2 to 1,820) with a high percentage of polymorphonuclear cells (PMNs). Initial blood counts showed mild leukocytosis and pronounced PMN predominance (78.9 +/- 1.3%). The percentage of PMNs in the peripheral blood decreased in favor of mononuclear cells after 3 days to a pattern more compatible with viral infection as opposed to that suggestive for bacteria in the beginning. Mean cerebrospinal fluid values of protein, glucose and lactate and the C-reactive protein were mildly elevated or normal. Nonpolio enteroviruses were detected in 30 of 70 patients. Subsequent serotyping revealed echovirus type 13 (13 patients), type 6 (2), type 30 (1) and coxsackie B virus type 5 (2). There were no differences in demographic or clinical data between enterovirus positive and negative patients. CONCLUSIONS: Even though individual laboratory values do not solely allow discrimination between viral and bacterial meningitis, the combined epidemiologic, clinical and laboratory data facilitate the diagnosis of aseptic meningitis in most cases. Viral diagnostics, identifying echovirus type 13 that thus far has not been associated with epidemics of meningitis, adds important epidemiologic information.

Adolescent↗
PubMed1981

Lumbar puncture and the diagnosis of meningitis.

Because the symptomatology of meningitis in infancy frequently is nonspecific, interns and residents staffing a busy pediatric hospital emergency room are encouraged to perform lumbar punctures at the slightest suspicion of meningitis. The effects of this policy were investigated with regard to the number of lumbar punctures done, number of meningitis cases diagnosed, number of meningitis cases missed, and whether the degree of pyrexia and peripheral leukocytosis were helpful diagnostic clues. The results indicate that particularly when inexperienced interns and residents are evaluating young infants in whom the possibility of meningitis is raised, the only definitive diagnostic procedure is lumbar puncture. Hyperpyrexia and/or elevated peripheral white blood cell counts for not helpful in establishing the diagnosis of meningitis. Black infants of low socioeconomic status are a high-risk group for meningitis.

Child↗
PubMed2001

The use of liver grafts from donors with bacterial meningitis.

BACKGROUND: The shortage of suitable donors for transplantation is a worldwide problem. The use of cadaveric donors with bacterial meningitis may be associated with an increased risk of sepsis. We report the results of orthotopic liver transplantation (OLT) from 33 such donors between 1989 and 1999. METHODS: The hospital records of recipients from cadaveric donors with meningitis (study group) were retrospectively reviewed and compared with matched recipients from cadaveric donors dying from causes other than meningitis (recipient-matched control group). RESULTS: A total of 34 recipients underwent 21 whole, 10 reduced, and 3 split liver transplants from 33 cadaveric donor livers with bacterial meningitis. The donor meningitis pathogens were Neisseria meningitidis (n=14), Streptococcus pneumoniae (n=4), Haemophilus influenzae (n=1), Streptococcus species (n=2), and unknown (n=12). Twenty-seven patients had an elective OLT and seven patients had an emergency OLT. Adequate antimicrobial therapy before organ procurement and after transplant was administrated. The mean posttransplant follow-up was 37 months (range: 1 day-106 months). There was no difference in recipient and graft survival rates between the study and the recipient-matched groups. In the study group, there were no infectious complications caused by the meningeal pathogens. Overall patient survival rates were 79%, 76%, 72%, and 72% at 1, 6, 12, and 60 months, respectively. Graft survival was 77%, 70%, 65%, and 65% at 1, 6, 12, and 60 months, respectively. The survival rate in elective cases was significantly better than emergency cases (P<0.05). CONCLUSION: Liver transplantation from donors with bacterial meningitis is a safe procedure provided both donors and recipients receive adequate antimicrobial therapy.

Adolescent↗
PubMed2006

The epidemiology of Haemophilus influenzae type b meningitis in Burkina Faso.

BACKGROUND: Haemophilus influenzae type b (Hib) disease burden studies are important to conduct in African countries that plan to introduce vaccine so that vaccine impact can be documented. METHODS: We implemented population-based meningitis surveillance in 3 districts of Burkina Faso for 12 months each during 2002-2003 and 2004-2005 using polymerase chain reaction, culture and antigen detection. RESULTS: Lumbar puncture was performed on 1686 patients and 112 had Hib identified. Persons <1, <5, 5-14 and 15+ years of age had annual Hib meningitis incidences of 97, 34, 2.1 and 0.55 per 100,000, respectively; overall case fatality proportion was 25%. During the historic meningitis epidemic season months of December through April, the proportion of purulent cerebrospinal fluid among children aged <5 years that yielded Hib was 27% compared with 30% during other months. Twenty-five of 98 persons with information available were treated with only one or 2 doses of oily chloramphenicol. Among children age <5 years with Hib meningitis, 28% were pretreated with antimalarials and antimalarial pretreatment was associated with delay in hospitalization. CONCLUSIONS: In Burkina Faso, Hib meningitis incidence and case fatality proportion are high and thus vaccine could have a substantial impact. While awaiting well-implemented routine infant Hib vaccination, empiric case management for pediatric meningitis in sub-Saharan Africa must recognize that Hib is likely even during the epidemic season. In malaria-endemic areas, pediatric Hib meningitis case management may be adversely affected by the similar presentation of these 2 diseases.

Burkina Faso↗
PubMed2003

A silkworm larvae plasma test for detecting peptidoglycan in cerebrospinal fluid is useful for the diagnosis of bacterial meningitis.

The silkworm larvae plasma (SLP) test has been established based on a cascade reaction triggered by either peptidoglycan or (1, 3)-beta-D-glucan to produce melanin. We applied this test to the diagnosis of bacterial meningitis. Cerebrospinal fluid (CSF) obtained from patients with bacterial meningitis due to gram-positive bacteria, gram-negative bacteria, or fungi, showed positive reactions to the test. In contrast, CSF from patients with viral meningitis or noninfectious illnesses gave negative reactions. Therefore, this test seems to be useful for diagnosis of bacterial and fungal meningitis. When this test was used together with two types of limulus tests, an endotoxin-specific test, and a conventional test, meningitis was further characterized as gram-positive, gram-negative or fungal meningitis. The SLP test requires a computerized instrument for quantitative colorimetric measurement. A qualitative alternative of this test also can be accomplished by visually observing the darkening color. Thus, this method can be applied for simple and rapid diagnosis of meningitis.

Adolescent↗
PubMed1994

Elevated levels of soluble factors in the cerebrospinal fluid in patients with adult T-cell leukaemia complicated with meningeal infiltration.

We measured some soluble factors in the cerebrospinal fluid (CSF) of patients with adult T-cell leukaemia (ATL) complicated with meningeal infiltration. Interleukin-4 (IL-4) was not detectable in the CSF of all cases with meningeal infiltration. Interleukin-6 (IL-6) was detected in a few patients with ATL. Measurement of IL-4 and IL-6 in CSF had no diagnostic value for meningeal infiltration of ATL cells. Soluble CD4 (sCD4) was highly elevated in all ATL patients with meningeal infiltration. Soluble interleukin-2 receptor (sIL-2R; sCD25) in CSF was markedly elevated in 13/18 ATL patients (72.2%) with meningeal infiltration. Levels of sCD4 and sCD25 in the CSF of ATL patients with central nervous system (CNS) symptoms were significantly higher than those of non-ATL patients with CNS symptoms. These observations indicate that sCD4 and sCD25 in the CSF are probably associated with meningeal infiltration of leukaemia cells that expressed CD4 and CD25 on the surface membrane and new markers for the meningeal infiltration of ATL cells.

CD4 Antigens↗
PubMed1991

Meningitis as a late complication of surgically and medically treated pituitary adenoma.

OBJECTIVE: To report meningitis occurring as a late complication of both medical and surgical treatment of pituitary tumour. DESIGN: Two case reports. PATIENTS: One patient developed meningitis 9 years after she underwent transsphenoidal hypophysectomy for Nelson's syndrome. The second patient developed rhinorrhoea while on treatment with bromocriptine for a prolactin-secreting pituitary adenoma and subsequently developed meningitis. MEASUREMENTS: In Patient 1, CT scanning identified a small defect in the floor of the sella turcica. In Patient 2, CT scan examinations performed with a 3-year interval demonstrated marked shrinkage of a pituitary tumour which had invaded the sphenoid sinus so that the tumour no longer plugged the erosion. RESULTS: Both patients experienced rhinorrhoea for over a year prior to the onset of meningitis. Both patients dismissed the occurrence of rhinorrhoea as insignificant and did not bring it to medical attention. In Patient 1, rhinorrhoea and presumably the entry site for pneumococaal infection was through a defect in the floor of the sella turcica consistent with transsphenoidal hypophysectomy performed 9 years previously. In Patient 2, rhinorrhoea and presumably entry of infection was facilitated by unplugging of a defect in the wall of the sphenoid sinus by bromocriptine-induced shrinkage of the pituitary adenoma. CONCLUSIONS: Meningitis can occur as a late complication of surgical or medical treatment of pituitary tumours. This may be preceded by rhinorrhoea which should be regularly enquired for as the symptom may not prompt patients to disclose its presence spontaneously. These reports document only the third occurrence of meningitis as a late complication of transsphenoidal hypophysectomy and the first occurrence of meningitis as a consequence of treatment of a pituitary tumour with bromocriptine.

Adenoma↗