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Query: UMLS:C0085437 (bacterial meningitis)
 4,038 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Bacterial meningitis remains a relatively common disease worldwide (40,000 cases per year in the United States) and the mortality rate has not improved in over 30 years. Certain host factors increase the risk of acquiring meningitis and include: age (increased at extremes of life), male sex, low socioeconomic status (crowding), black race, recent nasopharyngeal carriage of a virulent strain, absence of specific bactericidal antibody, maternal factors at birth (neonatal disease), various immunologic defects (neonates, antibody or terminal complement component deficiency, splenectomy, and immunosuppression including the acquired immune deficiency syndrome), and certain chronic diseases (such as alcoholism, cirrhosis, and diabetes mellitus). Bacterial meningitis represents an infection in an area of impaired host resistance. The blood-brain barrier is a major protective mechanism for the central nervous system against circulating bacteria. However, once bacteria gain entry into the subarachnoid space, host defenses are inadequate. Polymorphonuclear leukocytes are at a disadvantage in the fluid medium of the cerebrospinal fluid and surface phagocytosis is inefficient. In addition, antibody and complement concentrations are low (or absent) in purulent cerebrospinal fluid early in the disease course. Functional opsonic and bactericidal activity is lacking; therefore, efficient phagocytosis of encapsulated meningeal pathogens is limited. The result is huge population densities (often 10(7) to 10(8) cfu per milliliter) of bacteria in cerebrospinal fluid. This finding suggests that bactericidal antibiotics with cerebrospinal fluid concentrations much greater than the minimal bacterial concentration of the pathogen are optimal for therapy of meningitis; this principle has been shown in experimental animal models and supported by therapeutic studies in human subjects.
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PMID:Bacterial meningitis in the patient at risk: intrinsic risk factors and host defense mechanisms. 637 70

In AIDS patients, non-typhoid salmonella metastatic abscesses in lung and brain due to bacteremia have been described previously. Here we present a case in which a group B Salmonella, serotype Copenhagen, caused right parietal subdural empyema. The etiologic diagnosis was based on culture of pus obtained from the lesion. The patient was treated for bacterial meningitis and made a good recovery. He is at present reasonably well and is taking ciprofloxacin as prophylaxis against salmonella relapse.
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PMID:Non-typhoid Salmonella subdural empyema in a patient with AIDS. 766 85

The elevation of ADA in CSF is useful as a diagnostic means for detecting tuberculous meningitis, and in other etiologies such as lymphoma, neurosarcoidosis, fulminant bacterial meningitis, cryptococcal meningitis, neurobrucellosis and AIDS. We report an increase of ADA in CSF in association with SHA. In our case the total activity of ADA was the same as that obtained in serum, which can be interpreted among the false positives of the determination.
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PMID:False positive of ADA determination in cerebrospinal fluid. 770

Hemophilus influenza, Streptococcus pneumoniae, and Neisseria meningitidis account for over 75% of all cases of bacterial meningitis. S. pneumoniae is the commonest causative organism in many developing countries, particularly in Africa. In developing countries overall case fatality rates of 33-44% have been reported, rising to over 60% in adult groups. S. pneumoniae accounts for the highest mortality worldwide. Sequela rates of 22-26% of survivors have been found in African studies, mostly of a neurological nature. There have been few reports of AIDS-related bacterial meningitis in the USA, and a recent study from Uganda found no association between HIV infection and meningococcal meningitis. Stronger associations have been found between opportunistic infections, both viral (cytomegalovirus, herpes virus) and non-viral (TB, Toxoplasma gondii, Cryptococcus neoformans). A lumbar puncture and analysis of the cerebrospinal fluid should be performed on suspected cases unless there is suspicion of impending coning (decreasing consciousness or focal neurological signs). The intramuscular administration of chloramphenicol alone is comparable with intravenous use, and can be given as a shorter course of therapy (2 or 3 days) followed by an oral course. The use of adjunct therapy with corticosteroids in children is now commonplace in the USA and Europe. It appears reasonable to use dexamethasone, given early and in high dosage (0.15 mg/kg 6 hourly for 4 days), in those patients who are severely ill. Rifampicin is effective for chemoprophylaxis (10 mg/kg twice daily for 2 days for meningococcal contacts, 20 mg/kg once daily for 4 days for hemophilus contacts, maximum 600 mg per dose). The recent development and introduction of conjugate vaccines for H. influenza (HIB) has led to rapid reductions in the incidence of hemophilus meningitis in many European countries. An important step in improving prognosis is to increase awareness in both health workers and the public, to encourage early hospital referral, and early antibiotic therapy.
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PMID:Bacterial meningitis in developing countries. 868 85

For some microorganisms, virulence may be an inadvertent consequence of mutation and selection in the parasite population, occurring within a host during the course of an infection. This type of virulence is short-sighted, in that it engenders no advantage to the pathogen beyond the afflicted host. Bacterial meningitis, poliomyelitis and AIDS are three candidates for this model of the evolution of virulence.
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PMID:Short-sighted evolution and the virulence of pathogenic microorganisms. 815 75

Cerebrospinal fluid (CSF) neopterin levels were determined by RIA in individuals with central nervous system (CNS) or human immunodeficiency virus (HIV) infections and in healthy controls. The mean CSF neopterin concentrations were 63.0 nmol/L in 15 patients with acute bacterial meningitis, 54.9 nmol/L in 15 patients with Lyme neuroborreliosis, 32.5 nmol/L in 10 patients with viral meningitis, 130.9 nmol/L in 8 patients with viral encephalitis, 13.9 nmol/L in 15 patients with asymptomatic HIV infection, 26.0 nmol/L in 11 patients with AIDS without dementia, 65.4 nmol/L in 4 patients with AIDS dementia, and 4.2 nmol/L in 24 healthy controls. Although patients with viral encephalitis had higher mean neopterin levels than any other patient category studied, the CSF neopterin concentrations cannot be used to discriminate between viral and bacterial infections. Analysis of CSF levels of neopterin may be useful as guidance in following clinical course and effect of treatment and can provide information of value in addition to CSF cell count as a measurement of CNS immune stimulation.
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PMID:Cerebrospinal fluid neopterin concentrations in central nervous system infection. 822 65

Cytomegalovirus (CMV) radiculopathy has been associated with both viral cytopathic inclusions and an increased number of neutrophils in the cerebrospinal fluid (CSF) of patients with AIDS. The significance of these findings is unknown. To evaluate this, the authors reviewed all CSF cytology specimens from patients with a history AIDS or HIV infection over a 9-year period. Of 193 specimens identified, 42 (22%) had neutrophils present. Neutrophils were rare (<6 per slide) in the majority of specimens (57%). Occasional neutrophils (<2/hpf) were observed in three patients; one with suspected CMV myelitis, one with bacterial meningitis, and one with cryptococcal meningitis. All 6 cases (3 patients) with numerous neutrophils (>10/hpf) had positive CMV CSF cultures and symptoms of radiculopathy. Definite viral inclusions were not seen. The prognosis was poor in all cases. The authors conclude that diagnostic CMV inclusions are quite rare. However, the presence of elevated numbers of neutrophils in the CSF of a patient with AIDS without an identified infectious agent is highly suggestive of CMV radiculopathy.
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PMID:Predominance of neutrophils in the cerebrospinal fluid of AIDS patients with cytomegalovirus radiculopathy. 860 19

To evaluate the spectrum of meningitis and its impact on human immunodeficiency virus (HIV) infection, 284 adults hospitalized with meningitis in Soweto, South Africa, were studied. Tuberculosis meningitis (TBM) was the most common cause of meningitis (25.4%), followed by acute bacterial meningitis (ABM; 22.5%), acute viral meningitis (AVM; 14.1%), and cryptococcal meningitis (13%). The in-hospital mortality rate exceeded 40% in TBM, ABM, cryptococcal meningitis, the neurosurgery group, and the parameningeal/parenchymal group. Only 56.2% of patients with ABM had positive blood or cerebrospinal fluid cultures. 37.3% of the 193 patients tested for HIV were seropositive. All patients with cryptococcal meningitis and at least 54% of those with TBM were HIV-infected. Moreover, at least 27% of the study population presented with an acquired immunodeficiency syndrome (AIDS)-defining illness such as cryptococcal meningitis or TBM. The high mortality rates observed among meningitis patients in this series reflect immunosuppression associated with HIV infection or malnutrition, late presentation at a hospital, lack of access to medical care, and failure on the part of some primary care providers to consider a diagnosis of meningitis. Underlying HIV infection in increasing numbers of meningitis patients can be expected to produce a need for more hospital beds and increased medical expenditures in South Africa.
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PMID:The spectrum of meningitis in a population with high prevalence of HIV disease. 875 89

Meningitis is often associated with hyponatremia due to inappropriate secretion of antidiuretic hormone, and diabetes insipidus is associated with bacterial meningitis. This article describes a patient with acquired immunodeficiency syndrome who experienced recurrent episodes of central diabetes insipidus in association with recurrent fungal meningitis. Desmopressin was effective in controlling the polyuria until the episodes of meningitis resolved.
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PMID:Recurrent central diabetes insipidus secondary to cryptococcal meningitis. 958 72

Toxoplasma encephalitis (TE) is the most common manifestation of a recurrent Toxoplasma gondii infection in immunocompromised individuals, especially in AIDS patients. The infection is associated with considerable morbidity and mortality, even with improved diagnostic procedures and adequate treatment. The diagnosis of TE is difficult to establish by the demonstration of the parasite in the central nervous system or in cerebrospinal fluid (CSF). In order to diagnose TE we have developed a TGA-Dot-ELISA for antigen detection using rabbit anti-toxoplasma antiserum. We have applied this test to specimens of cerebrospinal fluid from patients with toxoplasma encephalitis (180 patients), neurocysticercosis (15), or bacterial meningitis (15). The relative sensitivity and specificity obtained for the TGA-Dot-ELISA were 0.930 and 0.730, respectively. TGA-Dot-ELISA is a promising method for the rapid diagnosis and effective prophylaxis of toxoplasma encephalitis.
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PMID:Detection of Toxoplasma gondii Antigen in Cerebrospinal Fluid Samples Using a Dot-Enzyme-Linked Immunosorbent Assay. 1110 34


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