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PubMed1984

Staphylococcus aureus meningitis.

Thirty-eight cases of meningitis caused by Staphylococcus aureus, occurring from 1966 to 1981 at six hospitals associated with the University of Toronto Faculty of medicine, were reviewed. Thirteen patients were children and 25 were adults. Patients were categorised into three groups: Group A (16)--meningitis related to neurosurgery, trauma or cerebrospinal defects; Group B (7)--meningitis occurring with indwelling ventricular shunts; and Group C (15)--spontaneously occurring meningitis. Bacterial endocarditis was associated with one-third of the spontaneously occurring meningitis cases and this group in general ran a more fulminant course. Meningitis related to a ventricular shunt exhibited a more insidious onset with a lower case-fatality rate, similar to the experience with Gram-negative bacillary meningitis. Gram stain of the cerebrospinal fluid was positive in only one-third of cases. Treatment with cloxacillin, administered parenterally, achieved results similar to those with methicillin, while chloramphenicol was associated with a high failure rate.

Adolescent↗
PubMed1984

The ultrasonographic diagnosis of bacterial meningitis and ventriculitis in infancy: six case reports.

Five infants with meningitis and ventriculitis, and a sixth patient with meningitis only are reported. In one hydrocephalic infant, infection of the central nervous system (CNS) was not suspected until cerebral ultrasonography revealed features of ventriculitis. It appears that in non-communicating hydrocephalus managed with a ventriculo-peritoneal (VP) shunt, infection may involve predominantly the "sequestered ventricles" rather than the spinal meninges. In four infants, bacterial meningitis had been proven but ventriculitis was not diagnosed until cerebral ultrasonography was performed. In a sixth neonate, E coli Kl meningitis was diagnosed and treated very early and cerebral ultrasonography showed involvement of the surface of the brain, but not the ventricles. The ultrasonographic features of bacterial ventriculitis and meningitis in infancy are: Increased echogenicity of the ventricular fluid, either in a fine homogeneous pattern, or with strand-like material and coarse particles. Increased echogenicity of the ependymal lining of the ventricles. Loss of definition of the surface of the choroid plexuses. Hydrocephalus, which may be progressive, with or without loculation of fluid. Abnormally wide and prominent cerebral sulci as a sign of meningitis. With treatment, the ventricular fluid became normal in a few days. The other abnormalities resolved more slowly. Hydrocephalus and fluid loculation were slowest to resolve. Ultrasonography has the potential for recognition of other complications such as subdural fluid collections and cerebral abscess.

Bacterial Infections↗
PubMed1981

Meningitis complicating transsphenoidal hypophysectomy.

The case records of 98 patients who underwent a transsphenoidal hypophysectomy between 1969 and 1979 were examined to establish the frequency of postoperative cerebrospinal rhinorrhea and meningitis. There were seven cases of rhinorrhea and six of meningitis following the procedure. Five of the six patients with meningitis had diabetes mellitus and three of the seven with rhinorrhea had meningitis; thus, both diabetes and rhinorrhea were established as significant risk factors (P less than 0.001) in the development of meningitis after this operation. There were two proven cases of meningitis due to anaerobic organisms and a further two suspected cases. The prophylactic use of antibiotics did not prevent the development of meningitis in this series of patients.

Adult↗
PubMed1995

Clinical correlates of secondary meningitis in HIV-infected adults.

BACKGROUND: Neurologic complaints are common in adults infected with the human immunodeficiency virus, but little is known about which clinical features are associated with secondary causes of meningitis. METHODS: A retrospective cross-sectional study of adults infected with the human immunodeficiency virus who received a diagnostic lumbar puncture (LP) in the infectious disease clinic, emergency department, and inpatient wards of the Deaconess Hospital, Boston, Mass, from 1989 through 1992 to determine which clinical features available at the time of LP are correlated with definite or probable secondary meningitis. RESULTS: Of the 491 LPs, 90% were performed in whites, 93% in men, and 11% in injection drug users. Cerebrospinal fluid test results revealed secondary meningitis in 39 (7.9%) of 491 LPs performed on 322 individuals. Cryptococcal meningitis was the predominant type (27 cases); no bacterial or tuberculous meningitis was found. In multivariate analyses, a history of non-Hodgkin's lymphoma (adjusted odds ratio [OR], 4.3; 95% confidence interval [CI], 1.5 to 12.5), a history of herpes simplex virus infection (OR, 2.5; 95% CI, 1.2 to 5.0), nausea and/or vomiting (OR, 2.0; 95% CI, 1.03 to 4.0), headache in a person with the acquired immunodeficiency syndrome (OR, 2.1; 95% CI, 1.03 to 4.4), and cranial nerve abnormalities (OR, 5.1; 95% CI, 1.8 to 14.1) were positive correlates of opportunistic meningitis; current fluconazole use (OR, 0.3; 95% CI, 0.1 to 0.8) conferred a lower risk. CONCLUSION: In similar clinical settings, physicians and their human immunodeficiency virus-infected patients should consider these features when assessing the risk of secondary meningitis and the necessity for immediate LP.

AIDS-Related Opportunistic Infections↗
PubMed1995

A survey of current Israeli practices and approach to partially treated meningitis in children.

Children with partially treated (PT) meningitis present diagnostic and therapeutic dilemmas. Since the approach to these children is not uniform, both in the literature and in daily practice, we conducted a survey among leading Israeli pediatricians from various hospitals to learn about their opinions and practices relating to this problem. Twenty-eight of 30 senior pediatricians responded to a questionnaire encompassing the various aspects of PT meningitis. The results of the survey highlighted the confusion and lack of clear policy regarding the definition, diagnostic approach and treatment of these children. Fifty percent of the pediatricians stated that even one dose of an antimicrobial agent, regardless of the type of drug, is sufficient for the definition of PT meningitis; 43% of the responders did not require any threshold parameter in CSF findings for the definition of probable bacterial meningitis among PT children and 52% did not think that a second lumbar puncture was useful as a diagnostic aid in PT meningitis. Epidemiological circumstances played a role in the diagnostic and therapeutic approach of infectious disease specialists mainly, but less so in the other groups of pediatricians. Finally, more than half the responders did not use throat cultures to identify potential carriers among PT meningitis patients and did not consider the use of prophylactic treatment in close contacts. These data clearly indicate the need for guidelines regarding the various aspects of PT meningitis.

Anti-Bacterial Agents↗
PubMed1995

[Septic meningitis in children in Rwanda from 1983 to 1990. Retrospective study at the Kigali Hospital Center].

To assess septic meningitis in pediatric units in terms of the bacteriologic distribution, mortality, and groups at risk, we conducted a retrospective study in the pediatric department of the Kigali Hospital Center (Rwanda). Based on bacteriologic study of 1215 cerebrospinal fluid samples, there were 321 cases of septic meningitis due to identifiable germs and 68 involving cloudy fluid with no detectable germs, i.e. 1.5% of admissions to the Pediatric Unit of the Kigali Hospital Center. The most common organisms were pneumococcus (36.5%), Haemophilus influenzae (31%), salmonella (13%), and meningococcus (11.5%). Most of the children (75%) presenting septic meningitis were under the age of 5 years. Overall mortality was 38% with rates of 52% and 39% for cases involving pneumococcus and salmonella respectively. The predominant clinical symptoms of pneumococcus meningitis were coma (p:0.000055) and respiratory compromise (p:0.02). In contrast Haemophilus influenzae meningitis was associated with a lower incidence of coma (p:0.05) and malnutrition (p:0.017). Salmonella meningitis was characterized by a higher incidence of fever over 38.9 degrees C (p:0.025) and malnutrition (p:0.01). In patients with meningococcus meningitis, the incidence of convulsions appeared to be higher, at the threshold of statistical significance (p:0.052), whereas coma (p:0062) and respiratory distress (p:0.0024) were uncommon. Independently of etiology, no clinical symptom was associated with a statistically higher risk for death.

Adolescent↗
PubMed1994

[Usefulness of establishing chosen acute phase proteins concentrations in serum and cerebrospinal fluid for differential diagnosis and monitoring of purulent meningitis in adults. II].

40 adult patients were examined: 24 with purulent meningitis and 16 with lymphocytic meningitis. In the course of purulent meningitis concentrations of the following acute phase proteins were measured in the cerebrospinal fluid: C-reactive protein, alpha 1-antitripsin, alpha 1-orosomucoid, alpha 2-ceruloplasmin, alpha 2-macroglobulin and alpha 2-haptoglobin in the 1st, 3rd, 5th, 7th, 14th and 28th day of the disease. In lymphocytic meningitis patients concentrations of the above mentioned acute phase proteins were measured only in the 1st day of the disease. Full usefulness of establishing concentrations of all the above mentioned acute phase proteins within the first five days of the purulent meningitis for differential diagnosis of purulent and lymphatic meningitis was proved. Evaluation of concentration kinetics of acute phase proteins in cerebrospinal fluid for monitoring of the course of purulent meningitis is of a limited value.

Adult↗
PubMed1994

The effect of a recent previous visit to a physician on outcome after childhood bacterial meningitis.

OBJECTIVE: To assess the effect of a recent previous visit to a physician on the outcome of meningitis in children. DESIGN: Evaluation of data from children examined by a physician and sent home, either the previous day or 2 to 4 days before meningitis was diagnosed, and children whose meningitis was diagnosed at once. The patients were examined daily during hospitalization, neurologic examinations were repeated at 2 weeks and 3 and 6 months after discharge, and hearing was assessed 2 or more months after discharge. SETTING: Eighteen pediatric hospitals in Finland from 1984 through 1991. POPULATION: A total of 325 children aged 3 months to 15 years with bacterial meningitis. MAIN OUTCOME MEASURES: Clinical and laboratory findings on admission, recovery during hospitalization, mortality, and neurologic abnormalities at 6 months of follow-up. RESULTS: In 74% of the patients, meningitis was diagnosed at once, 14% had visited a physician on the previous day, and 11% had seen a physician 2 to 4 days before diagnosis. The group seen 2 to 4 days earlier had a better level of consciousness, less frequent seizures, and more respiratory symptoms and otitis media than the other groups. The cerebrospinal fluid leukocyte count, white blood cell count, and erythrocyte sedimentation rate were highest and the cerebrospinal fluid glucose concentration was lowest in the children who had visited a physician 2 to 4 days earlier, although they also had lower cerebrospinal fluid protein and urine sodium and potassium levels. This group had the most rapid return to normal consciousness. There was no difference in the incidence of hearing impairment or neurologic sequelae. Even the mortality was virtually the same in the three groups: 4%, 4%, and 3% in the "same day," "previous day," and "2 to 4 days earlier" groups, respectively. CONCLUSIONS: Children who had visited a physician the previous day or 2 to 4 days before meningitis was diagnosed did not exhibit an increased frequency of hearing impairment, other neurologic abnormalities, or overall adverse outcome compared with children whose meningitis was diagnosed at once.

Adolescent↗
PubMed1993

Cerebrospinal fluid ferritin in patients with meningitis and cerebral infarction or bleeding.

The diagnostic value of cerebrospinal fluid (CSF) ferritin was assessed in 30 patients with meningeal reaction (viral meningitis 10; bacterial meningitis 6; meningism 14) and in 37 patients with cerebrovascular disease (cerebral infarction 29; transient ischaemic attacks 4; cerebral haemorrhage 4). The control group comprised 13 subjects with minor neurological disorders. CSF-ferritin levels were not significantly different in the various subgroups, most patients having values within the normal reference interval (2-7 micrograms/l). A clearly elevated CSF-ferritin was seen in one patient with bacterial meningitis and in one patient with intraventricular bleeding. In patients with meningeal reaction, CSF-ferritin was significantly correlated to CSF-protein. Patients with cerebrovascular disease displayed significant correlations between CSF-albumin and CSF-IgG and between CSF-ferritin, CSF-albumin and CSF-IgG. The present study indicates that measurement of CSF-ferritin is of no practical clinical relevance in the evaluation of patients with meningeal reaction and cerebrovascular disease.

Adolescent↗
PubMed1993

[Role of dexamethasone in the treatment of purulent meningitis in infants and in children].

Accumulating evidence tends to demonstrate that inflammatory processes are responsible for neurological damage and sequelae in bacterial meningitis in children and infants. Massive liberation of bacterial cell wall components (Lipopolysaccharide, acid teichoic polymers) induce a cascade of reactions including the secretion of many cytokines (such as TNF alpha and IL-1 beta) and prostaglandins (such as PAF and PGE2) which in turn leads to the development of cerebral oedema, intracranial hypertension and cerebral blood flow reduction. Dexamethasone (DXM) is effective at the beginning of the inflammatory cascade and its utilisation in the meningitis experimental model in animals has shown significant reduction in the inflammatory response to bacterial meningitis. The first clinical studies using DXM as an adjunctive therapy to antibiotics have demonstrated its beneficial effect in terms of complications and long-term neurological sequelae in Haemophilus influenzae meningitis in children and infants. It seems that a similar effect can be obtained in meningococcal and pneumococcal meningitis. Little information is actually available concerning the use of DXM in penicillin-resistant pneumococcal meningitis. The rare reported cases of ceftriaxone failure with DXM as treatment of penicillin-resistant pneumococcal meningitis had a favorable outcome with the use of vancomycin.

Animals↗
PubMed1993

Effect of antibiotic therapy and etiologic microorganism on the risk of bacterial meningitis in children with occult bacteremia.

OBJECTIVE: To quantify the effect of antibiotic therapy on the probability of subsequent bacterial meningitis in children with fever without source treated as outpatients. DESIGN: Bayesian meta-analyses. REPORTS INCLUDED: All reports of the organism-specific prevalence of occult bacteremia in children with fever without source treated as outpatients, and the organism-specific prevalence of subsequent meningitis in children with occult bacteremia initially treated as outpatients stratified by type of antibiotic therapy. RESULTS: The mean probabilities of subsequent meningitis in children with occult bacteremia were 9.8%, 8.2%, and 0.3% in the no antibiotic, oral antibiotic, and parenteral antibiotic therapy groups, respectively. All cases of bacterial meningitis in children with occult bacteremia treated with oral antibiotics were due to Haemophilus influenzae. There were no cases of culture-positive bacterial meningitis in 139 bacteremic children treated with ceftriaxone (mean probability, 0.3%; 95% confidence interval, 0.0% to 1.5%). The mean probabilities of bacterial meningitis in a child with fever without source treated as an outpatient without antibiotics were: Streptococcus pneumoniae, 0.21%; and H influenzae, 0.06%. CONCLUSIONS: Antibiotic therapy is effective in preventing meningitis in children at risk of occult bacteremia.

Administration, Oral↗
PubMed1996

[Clinical significance of soluble interleukin-2 receptor levels in the cerebrospinal fluid in patients with adult T-cell leukemia complicated with meningeal infiltration].

We measured soluble interleukin-2 receptor (sIL-2R) levels in the cerebrospinal fluid (CSF) of patients with hematological malignancies especially, adult T-cell leukemia (ATL) and non-Hodgkin's lymphoma (NHL) with or without meningeal infiltration. CSF levels of sIL-2R were significantly higher in patients with ATL and NHL with meningeal infiltration than in patients with both diseases without meningeal infiltration. The sIL-2R levels in CSF were elevated in 4/4 ATL patients (100%) and 3/13 NHL patients (23%) with meningeal infiltration. CSF levels of sIL-2R from ATL patients with meningeal infiltration had a tendency to elevate in correlation with numbers of mononuclear cells and lactic dehydrogenase (LDH) in CSF. However, these had no correlation with serum levels of sIL-2R. Therefore, sIL-2 levels in CSF may be useful in the diagnosis of meningeal infiltration in patients with ATL, are probably specific markers for meningeal infiltration of ATL.

Adolescent↗
PubMed1996

[Soluble interleukin-2 receptor and macrophage colony-stimulating factor (M-CSF) in cerebrospinal fluid in patients with hematological malignancies: clinical significance in adult T-cell leukemia with meningeal infiltration].

We measured soluble interleukin-2 receptor (sIL-2R) and macrophage colony-stimulating factor (M-CSF) levels in the cerebrospinal fluid (CSF) of patients with hematological malignancies with or without meningeal infiltration and meningitis. Levels of sIL-2R and M-CSF in the CSF of adult T-cell leukemia (ATL) patients with meningeal infiltration were significantly higher than those of ATL patients without meningeal infiltration and non-ATL patients with meningeal infiltration. There was a significant positive correlation between sIL-2R levels and numbers of mononuclear cells in CSF of ATL patients with meningeal infiltration. However, M-CSF levels did not correlate with numbers of mononuclear cells. There was no correlation between CSF and serum levels of sIL-2R. There was also no correlation between sIL-2R and M-CSF in the CSF. Therefore, sIL-2R and M-CSF levels in the CSF may be useful in the diagnosis of meningeal infiltration in patients with ATL. In particular sIL-2R may be a sensitive marker.

Biomarkers, Tumor↗
PubMed1997

[The role of meropenem in bacterial meningitis].

Meropenem is a new carbapenem antibiotic of with an antibacterian spectrum similar to that of imipenem, but from which it may mainly be differentiated by the possibility of its administration at high doses and it has no demonstrated proconvulsive effect, properties which make it applicable in the treatment of bacterial meningitis. The clinical and experimental experience in the treatment of bacterial meningitis with this antibiotic is herein reviewed. It has been observed that the efficacy and safety of meropenem in meningitis caused by N. meningitidis, H. influenzae and pneumococci sensitive to penicillin may be similar to that of cefotaxime or ceftriaxone in both the pediatric and adult population. There are very few reports on the treatment of meningitis caused by pneumococci resistant to penicillin. However, given that the activity of meropenem on these pneumococci is similar to that of cefotaxime and that the doses administered are much lower, it does not appear to be recommendable in the treatment of this indication, although it should be tested in all meningeal strain to these characteristics isolated. It may currently be considered that the main indication of meropenem in the infections of the central nervous system is in nosocomial meningitis by multiresistant gram negative bacilli such as those of the Klebsiella-Serratia-Enterobacter and Acinetobacter sp. group. Therefore a limited, albeit favorable, report on the clinical experience with meropenem is herein presented. Meropenem may also be useful in the treatment of meningitis by Pseudomonas aeruginosa in which other treatments have failed.

Adult↗
PubMed1998

Association between facial cutaneous coccidioidomycosis and meningitis.

The skin is frequently a site of extrapulmonary dissemination in patients with coccidioidomycosis. Clinical experience in an endemic area suggests an association between facial cutaneous coccidioidomycosis and meningitis. Awareness of this association is important because coccidioidal meningitis is the most ominous site of spread in coccidioidomycosis. In this study, we assess whether cutaneous dissemination involving the face is associated with meningitis to a greater degree than that limited to the body. We retrospectively reviewed the medical records of 201 patients from 1987 to 1996 with disseminated coccidioidomycosis and found 30 patients with cutaneous involvement. Their mean age was 29.5 +/- 11.6 years; 20 patients were male; 14 were African American, 12 were Hispanic, 3 were white, and 1 was Asian. Nineteen patients had facial involvement, and 11 had isolated body involvement. Meningitis developed in 11 patients, 10 with facial involvement and 1 with only body involvement. Patients with facial lesions were more likely to have meningitis (odds ratio, 11.1; 95% confidence interval, 1.1 to 529, P = .023). The identification of a subgroup of patients at significant risk of developing meningitis may allow earlier detection and perhaps improved management of patients with meningeal disease.

Adult↗
PubMed1998

[Chronic Cryptococcal meningitis with CSF oligoclonal IgG band in a patient with Claude syndrome].

We described a 61-year-old man who was diagnosed as having chronic cryptococcal meningitis, while he was hospitalized with Claude syndrome. The patient was admitted because of acute onset of gait disturbance. He had a tendency to fall down to his left side since he awoke in the morning of August 12, 1995. On admission, he was mentally alert, showing a right oculomotor nerve palsy, gaze-evoked horizontal nystagmus in the left eye on the left lateral gaze, and incoordination of the left upper and lower extremities. In addition, he fell to the left side on standing up with feet together and with eyes closed. He had mild wild-based gait with a tendency to fall down to the left on tandem gait. Babinski sign was present on the left side. He did not have fever, nor meningeal signs, nor sensory abnormalities. X-ray films of the chest showed multiple nodular shadows consistent with pneumoconiosis. Cranial X-ray computed tomography and magnetic resonance imaging revealed a small lesion in the paramedian area of the midbrain on the right, consistent with an infarct. Cerebral arteriography revealed a stenosis in the proximal portion of the right posterior cerebral artery. Cerebrospinal fluid (CSF) showed a moderate mononuclear cell predominant pleocytosis, a moderate elevation of total protein, slightly reduced glucose values. Although the culture and India ink preparation of CSF were negative for cryptococcus in repeated studies, its antigen was positive both in the serum and CSF. In addition, the CSF showed an oligoclonal IgG band which was predominantly K type. After the antigen of Cryptococcus neoformans was added to the CSF in vitro, the oligoclonal IgG band was absorbed completely. The patient was treated with fluconazole (FLCZ), which did not cause any improvement of the CSF abnormalities, so that FLCZ was replaced by 5-flucytosine (5-FC). Since the CSF abnormalities moderately improved with 5-FC, he was discharged on December 21, 1995. After the 5-FC was discontinued, the CSF results slowly worsened over several months without any signs and symptoms of meningitis. He was hospitalized again on October 28, 1996 for treatment with both 5-FC and amphotericin B. Although the CSF abnormalities improved markedly, the meningitis was not cured. After he was discharged on February 1, 1997, he was treated with both 5-FC and FLCZ. Although his CSF abnormalities worsened mildly, he remained afebrile without meningeal signs and symptoms and led an ordinary life. In our patient it remained undetermined whether the Claude syndrome was caused by arteriosclerotic infarction, or vasculitis due to cryptococcal meningitis, or both. Asymptomatic chronic cryptococcal meningitis as observed in our patients is unusual. In addition, this is the second case after Porter et al (1977) that the oligoclonal IgG band in CSF proved to be related to cryptococcal infection.

Biomarkers↗
PubMed2006

Dexamethasone and long-term outcome in adults with bacterial meningitis.

OBJECTIVE: This follow-up study of the European Dexamethasone Study was designed to examine the potential harmful effect of adjunctive dexamethasone treatment on long-term neuropsychological outcome in adults with bacterial meningitis. METHODS: Neurological, audiological, and neuropsychological examinations were performed in adults who survived pneumococcal or meningococcal meningitis. RESULTS: Eighty-seven of 99 (88%) eligible patients were included in the follow-up study; 46 (53%) were treated with dexamethasone and 41 (47%) with placebo. Median time between meningitis and testing was 99 months. Neuropsychological evaluation showed no significant differences between patients treated with dexamethasone and placebo. The proportions of patients with persisting neurological sequelae or hearing loss were similar in the dexamethasone and placebo groups. The overall rate of cognitive dysfunction did not differ significantly between patients and control subjects; however, patients after pneumococcal meningitis had a higher rate of cognitive dysfunction (21 vs 6%; p = 0.05) and experienced more impairment of everyday functioning due to physical problems (p = 0.05) than those after meningococcal meningitis. INTERPRETATION: Treatment with adjunctive dexamethasone is not associated with an increased risk for long-term cognitive impairment. Adults who survive pneumococcal meningitis are at significant risk for long-term neuropsychological abnormalities.

Adult↗
PubMed1984

Encephalitis and aseptic meningitis, Olmsted County, Minnesota, 1950-1981: I. Epidemiology.

All cases fulfilling stated criteria for encephalitis and aseptic meningitis in Olmsted County, Minnesota, for the period 1950 through 1981 were identified. This is, to our knowledge, the first such incidence and trend study in a delineated population, providing rates per 100,000 person-years of 7.4 for encephalitis (189 cases) and 10.9 for aseptic meningitis (283 cases). These are about twelve and six times higher, respectively, than the rates reported by the Centers for Disease Control. The rates have been stable over successive 5- or 10-year periods except for a recent increase in aseptic meningitis. Both conditions were more common in the summer months, in childhood, and among males. Viral identification using conventional laboratory tests has improved with time; in the period 1970 through 1981, virus type was specified in about one-fourth of the cases. The most common agents identified were California and mumps viruses in encephalitis, and entero and mumps viruses in aseptic meningitis. Antecedent and/or concurrent infections were noted in 42 and 35% of encephalitis and aseptic meningitis cases, respectively. No case due to mumps, measles, or rubella viruses has occurred since 1972, reflecting the impact of immunizations. Recovery was reported at the end of the acute phase in 95% of patients with aseptic meningitis, and there were no deaths. Seventy-eight percent of encephalitis patients recovered completely; the case fatality rate was 3.8%. Of the encephalitis cases, 2% were diagnosed initially postmortem.

Adolescent↗