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

Brain abscesses are rare in infants and their clinical presentation is specific for this age group. Seven cases of brain abscess in infants aged 2-11 months are reported. The underlying cause was meningitis in four, sepsis in two, and unknown in one. Gram-negative organisms were cultured in 6 patients. The abscess size was 5 cm or more in five cases; in four there were multiple lesions. Two abscesses were aspirated and irrigated; four particularly large lesions were drained and repeatedly aspirated and irrigated. One craniotomy was done. There were two deaths, one in the postoperative period and the other 6 months after discharge. Follow-up information is available for four children, showing a good result in only one of them. Formation of an abscess should be diagnosed early, and close ultrasound monitoring or CT scanning in infants with bacterial meningitis and sepsis is essential. The prognosis in cases in which large/multiple abscesses develop is poor.
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PMID:Brain abscess in infants. 139 67

The incidence of brain abscess was studied on all cases occurring in residents of Olmsted County, Minn., from 1935 through 1981. Thirty-eight cases (9 cases first diagnosed at autopsy) were identified and followed through the Rochester Olmsted County medical record-linkage system at the Mayo Clinic. The incidence rate was 1.3/100,000 person-years (PY), 1.9 in males and 0.6 in females. Incidence decreased from 2.7 in 1935-44 to 0.9 in 1965-81. Rates were higher in children 5-9 years old (2.4) and after age 60 (2.6 PY). An etiologic agent was identified in 29 cases (76%) with streptococci being the most frequently isolated. Case-fatality ratio was 38% (11/29), stable over time. Concurrent bacterial meningitis was the strongest predictor of death. Neurologic sequelae were observed in 8 (44%) of the 18 surviving patients including epilepsy (5 cases), deafness and motor impairment.
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PMID:Incidence and prognosis of brain abscess in a defined population: Olmsted County, Minnesota, 1935-1981. 192 45

Patients infected with HIV demonstrate increased susceptibility to serious infections with non-typhoidal salmonellae. However, no cases of salmonella meningitis have been reported in this population. We now report three cases of salmonella meningitis which occurred in a population of 1800 patients with AIDS or AIDS-related complex at our hospitals. The incidence of meningitis complicating salmonella infection in our HIV-infected population appears to be much higher than that reported in non-AIDS patients (7.5 versus 0.15%). All had cerebrospinal fluid parameters consistent with bacterial meningitis, and two of three revealed organisms on cerebrospinal fluid Gram stain. Two presented with a fulminant illness and died despite therapy; the third developed a brain abscess associated with a relapse of meningitis. Salmonella meningitis should be considered as a cause of acute neurological deterioration in patients at risk for HIV-related disease. Relapses may occur, and mortality is high.
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PMID:Salmonella meningitis and infection with HIV. 208 4

CSF evaluation is the single most important aspect of the laboratory diagnosis of meningitis. Analysis of the CSF abnormalities produced by bacterial, mycobacterial, and fungal infections may greatly facilitate diagnosis and direct initial therapy. Basic studies of CSF that should be performed in all patients with meningitis include measurement of pressure, cell count and white cell differential; determination of glucose and protein levels; Gram's stain; and culture. In bacterial meningitis, Limulus lysate assay and tests to identify bacterial antigens may allow rapid diagnosis. Where there is strong suspicion of tuberculous or fungal meningitis, CSF should also be submitted for acid-fast stain, India ink preparation, and cryptococcal antigen; unless contraindicated by increased intracranial pressure, large volumes (up to 40-50 mL) should be obtained for culture. If a history of residence in the Southwest is elicited, complement-fixing antibodies to Coccidioides immitis should also be ordered. Newer tests based on immunologic methods or gene amplification techniques hold great promise for diagnosis of infections caused by organisms that are difficult to culture or present in small numbers. Despite the great value of lumbar puncture in the diagnosis of meningitis, injudicious use of the procedure may result in death from brain herniation. Lumbar puncture should be avoided if focal neurologic findings suggest concomitant mass lesion, as in brain abscess, and lumbar puncture should be approached with great caution if meningitis is accompanied by evidence of significant intracranial hypertension. Institution of antibiotic therapy for suspected meningitis should not be delayed while neuroradiologic studies are obtained to exclude abscess or while measures are instituted to reduce intracranial pressure.
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PMID:Approach to diagnosis of meningitis. Cerebrospinal fluid evaluation. 227 90

The occurrence of central nervous system (CNS) complications was studied retrospectively in 150 patients with bacteremia caused by Staphylococcus aureus, Streptococcus pneumoniae, beta-hemolytic streptococci or Escherichia coli. The incidence and clinical manifestations of different CNS complications were noted during 1 month after the bacteremia. Special attention was paid to vascular complications (infarction or hemorrhage), infections (meningitis or brain abscess) and mental changes when they were the only signs of CNS origin (lowered level of consciousness, confusion or delirium). The risk of cerebral infarction was elevated in the patients with bacteremia during the first month after the positive blood culture as compared with the overall risk of stroke in the general population. 10/150 patients (7%) developed cerebral infarction during that month. Two of these cases were associated with bacterial meningitis and 1 with endocarditis. Mental changes as a main symptom of CNS origin occurred in 27% of patients with bacteremia. Increasing patient age predisposed to this complication. Mental changes were not associated with any bacterial species studied. Altogether 40% of the patients developed CNS complications, which were a significant risk factor for death during the first month after the bacteremia.
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PMID:Central nervous system complications in patients with bacteremia. 266 96

The movement of drugs from the systemic circulation into the central nervous system is restricted by several factors, including the blood-brain and blood-CSF barriers, an active transport system that affects primarily the beta-lactam antibiotics, and the high degree of serum protein binding of certain agents. The functions of the blood-brain and blood-CSF barriers and of the active transport system are reduced but not abolished by inflammation. For most antimicrobial agents, the major determinant of passage aside from serum protein binding is the degree of lipid-solubility of the drug. The beta-lactam and aminoglycoside antibiotics and vancomycin penetrate the central nervous system relatively poorly, whereas chloramphenicol, metronidazole, the fluoroquinolones and trimethoprim-sulfamethoxazole fare better. Knowledge of the relative capacity of various drugs to penetrate the central nervous system after systemic administration may help the physician to choose an optimum regimen for the treatment of bacterial meningitis and brain abscess.
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PMID:Use of antibacterial agents in infections of the central nervous system. 267 Nov 39

An early treatment and an adequate antimicrobial chemotherapy are major prognostic factors for bacterial meningitis, brain abscesses and related infections. The necessity of an early therapy requires to begin an empiric antibiotic treatment prior to obtain microbiological results. The principles that apply to empiric therapy of other types of infections are equally applicable to the treatment of central nervous system (CNS) infections and include: the capacity of achieving adequate levels of antibiotic in the CNS and for the brain (pharmacokinetic criteria), the knowledge of the most likely etiologic agents for central nervous system infections and their antibiotic susceptibility (bacteriological criteria). The main clinical types of CNS infection are reviewed for their usual etiologic agents, with a definition of an optimal "bacteriological deal" for each situation. Most studies emphasize the striking differences in the clinical features, etiologic agents and prognosis of spontaneously occurring (primary) meningitis, as opposed to post-traumatic or post-surgical, frequently Gram negative bacillary (secondary) meningitis and other CNS infections (brain abscesses and related infections). These studies, as our experience, suggest that the selection of an empiric therapy must be adapted for each clinical situation. Ampicillin still appears to be an ideal agent for empiric therapy for primary meningitis in older children and adults, in whom meningitis are usually caused by N. meningitidis and S. pneumoniae. In younger children (before 6 years), H. influenzae is more often implicated and the occurrence of beta lactamase mediated resistance to ampicillin in as high as 15% of isolates led to use a third generation cephalosporin as an empiric therapy. Neonatal meningitis, meningitis following trauma or surgery, brain abscess, subdural empyema, epidural abscess are caused by various etiologic agents including Streptococcus sp, Staphylococcus sp, Enterobacteriaceae, and for brain infections, anaerobic bacteria. Each situation led to specific recommendations by authors. Finally, miscellaneous aspects of therapy as the usefulness of intrathecal or intraventricular therapy, duration of treatment and place of the neuro-surgery during CNS infections are briefly reviewed.
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PMID:[Bases of antibiotherapy in neuromeningeal infections]. 328 1

Serial cranial ultrasound examinations were performed through the anterior fontanel to detect and follow the complications of bacterial meningitis in 16 neonates. The final results included normal findings in 9 patients, and abnormal in the other 7 cases. Among the latter, 5 patients with hydrocephalus were sequentially found after the second week of the disease and the earlier the onset, the larger the ventricular dilation. One ventriculitis showed polycystic loculi with abnormal septa in the advanced stage. Cystic low attenuation lesion with mass effect at a later stage of meningitis specified one patient with brain abscess. Progressive dilatation of ventricular systems without associated growth of head girth disclosed a process of brain atrophy. They had neither obvious neurological signs nor specific CSF findings clinically, but their sonograms showed the abnormal changes which were finally proved by CT scans. The potential value of cranial ultrasound in the detection of post-meningitic complication besides CT scan is stressed.
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PMID:Cranial ultrasound in the detection of postmeningitic complications in the neonates. 351 20

Central nervous system (CNS) infections in immunocompromised hosts are often accompanied by subtle disorders because immunosuppression usually decreases the inflammatory response. CNS infections in immunocompromised patients are usually caused by organisms different from those found in the general population. The organism causing CNS infection in an immunocompromised host can often be predicted if the type of immune abnormality of the patient is known. The common causes of CNS infection in immunocompromised hosts are reviewed here. Meningitis in patients with neutropenia is usually due to enteric Gram negative bacilli that live in the patient's own digestive tract. Pseudomonas aeruginosa is most common and is followed by E. Coli, Klebsiella, Enterobacter and Proteus. A major risk in patients with abnormal immunoglobulins or splenectomy is infection with encapsulated bacteria, particularly Streptococcus pneumoniae, Haemophilus influenzae and Neisseria meningitidis. Meningitis caused by any of the encapsulated bacteria can be fulminant. Listeria monocytogenes is the most common cause of bacterial meningitis in patients with impaired cellular immunity. Nocardia asteroides is a leading cause of brain abscess in patients with hematologic malignancy. Most patients have evidence of concomitant pulmonary lesions. Fungi are among the most common organisms involving the CNS in immunocompromised hosts. Susceptible patients include those with lymphoma or leukemia and those who receive therapies aimed at suppressing delayed hypersensitivity. Cryptococcus neoformans is a common fungal cause of CNS infection in immunocompromised hosts. The primary site of infection is the lung. Spread to the CNS is via the blood stream. The clinical course is highly variable: meningitis, meningoencephalitis and focal mass lesions. Candida causes meningitis or meningoencephalitis characterized by multiple small abscesses in neutropenic hosts. Organisms reach the CNS via the blood stream usually from the digestive tract or infected intravenous catheters. Aspergillus causes brain abscess, cerebral infarction and focal meningitis in patients with neutropenia. The primary infection is in the lung. The parasites that infest the CNS of immunocompromised patients are usually those that exploit a T-lymphocyte, mononuclear phagocyte host defect. The most common are Toxoplasma gondii and Strongyloides stercoralis. There have been a few cases of amebiasis with dissemination to the brain in patients with hematologic malignancies. Toxoplasma gondii causes major CNS disease in immunocompromised hosts: meningoencephalitis or mass lesions.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Infections of the central nervous system in malignant hemopathies]. 372 88

We identified all diagnosed cases of infections of the central nervous system (CNS), excluding poliomyelitis, in the population of Olmsted County, Minnesota, from 1950 to 1981 and described incidence, time trends, etiologic agents, and mortality for these infections. The adjusted incidence rate for bacterial meningitis was 8.6/100,000 person-years (with a case fatality ratio of 10%) and was highest in children less than five years of age; in this age-group, rates more than doubled from 1950 to 1981. The adjusted incidence rate of brain abscess was 1.1, with a case fatality ratio of 37%. The adjusted incidence rate of aseptic meningitis was 10.9/100,000 person-years. Age-specific rates were highest in children less than one year of age and in men, and increased during the study period. The adjusted incidence rate of viral encephalitis was 7.4, with a case fatality ratio of 3.8%. Rates were highest in children less than 10 years of age and in men. By 10 years of age, 0.9% of the men and 0.7% of the women were affected by a CNS infection. Cumulative incidence (risk) through age 80 was 2.3% for men and 1.5% for women.
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PMID:Epidemiology of central nervous system infections in Olmsted County, Minnesota, 1950-1981. 373 90


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