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

Two infants, an 11-month-old boy and a 7-month-old girl, presented with subarachnoidal abscess associated with severe bacterial meningitis refractory to intensive managements with antibiotics. Computed tomography (CT) revealed bifrontal extracerebral low-density areas and remarkably enhanced surfaces of the bilateral frontal lobes postcontrast. Surgical exploration disclosed thick pus accumulation in the subarachnoid space which required curettage. The boy developed appropriately for his age, but the girl showed severe psychomotor retardation because of additional complications such as subdural fluid collection and hydrocephalus associated with the subarachnoidal abscess. Appropriate early neurosurgical management of subarachnoidal abscess is essential for satisfactory psychomotor development. Postcontrast CT should be performed to detect the subarachnoidal abscess as early as possible, and extensive craniotomy to remove the subarachnoidal pus accumulation performed to preserve psychomotor development.
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PMID:Subarachnoidal abscess associated with bacterial meningitis in infants--two case reports. 752 53

From 1986 to 1993, 12 cases of enterococcal meningitis were identified at the Veterans General Hospital, Taipei. Most of the cases were caused by Enterococcus faecalis and three cases were mixed bacterial meningitis. There were six adult and six pediatric patients. Among the adult patients, four had undergone neurosurgical procedures before onset of meningitis and the other two had severe chronic underlying diseases. In contrast, all six pediatric patients had underlying central nervous system (CNS) pathology such as meningomyelocele or hydrocephalus. Placement of CNS devices was the most important predisposing factor of enterococcal meningitis in this study series. Direct microbial invasion via CNS devices or neural tube defects was considered the most likely portal of entry in most patients. Only one patient had primary meningitis, and one other had an enterococcal infection outside the CNS. The overall mortality rate was 25%. None of the pediatric patients died. Underlying conditions were considered the most important factor influencing the prognosis of these patients.
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PMID:Enterococcal meningitis: analysis of twelve cases. 754 62

Morbidity and mortality associated with bacterial meningitis remain high, although antibiotic therapy has improved during recent decades. The major intracranial complications of bacterial meningitis are cerebrovascular arterial and venous involvement, brain edema, and hydrocephalus with a subsequent increase of intracranial pressure. Experiments in animal models and cell culture systems have focused on the pathogenesis and pathophysiology of bacterial meningitis in an attempt to identify the bacterial and/or host factors responsible for brain injury during the course of infection. An international workshop entitled "Bacterial Meningitis: Mechanisms of Brain Injury" was organized by the Department of Neurology at the University of Munich and was held in Eibsee, Germany, in June 1993. This conference provided a forum for the exchange of current information on bacterial meningitis, including data on the clinical spectrum of complications, the associated morphological alterations, the role of soluble inflammatory mediators (in particular cytokines) and of leukocyte-endothelial cell interactions in tissue injury, and the molecular mechanisms of neuronal injury, with potential mediators such as reactive oxygen species, reactive nitrogen species, and excitatory amino acids. It is hoped that a better understanding of the pathophysiological events that take place during bacterial meningitis will lead to the development of new therapeutic regimens.
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PMID:Mechanisms of brain injury in bacterial meningitis: workshop summary. 781 66

Hydrocephalus is most commonly diagnosed in the first few months of life, though cases also arise in later life. Cerebrospinal fluid shunts used to control the condition are prone to colonization particularly by Staphylococcus epidermidis. The incidence is very much higher in infancy than in older age groups, and this is probably due to prolonged hospital stay as a result of the underlying pathology, combined with the propensity for a high skin bacterial density with more adherent strains, rather than to any immune immaturity. Diagnosis of shunt colonization is often very difficult and serological tests have an important role to play even in infancy. There are several pitfalls in diagnosis, particularly in the elderly. Treatment of shunt infections should include removal of the colonized shunt, though regimens to avoid this are currently being investigated. Intraventricular therapy with vancomycin along with intravenous rifampicin offers the best changes of success at the first attempt. Shunted patients who contract purulent bacterial meningitis should not have their shunts removed but should be treated in the same way as those without shunts.
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PMID:Hydrocephalus shunt infections. 784 76

In this case report, we describe two patients with Candida shunt infection and review 22 cases from the previous literature. All of them had ventriculoperitoneal shunts, except one who had an external ventricular drain. The more outstanding predisposing factors were recent bacterial meningitis and/or neurosurgery (different from the shunt placement) and abdominal complications (intestinal perforation in three cases, and gastrostomy and lengthening of the distal catheter in one each). The clinical manifestations were hydrocephalus in 36%, fever in 31%, meningoencephalitis in 21%, and abdominal symptoms in 10%. The mean cerebrospinal fluid count was 78 cells/mm3 (with 77% lymphocytic predominance). Two patients died (9%); one of them was the only case in which the catheter was not removed. The recommended treatment is the replacement of the shunt and antifungal therapy with intravenous amphotericin B; in cases of poor clinical condition, the latter should also be given intraventricularly.
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PMID:Candida cerebrospinal fluid shunt infection. Report of two new cases and review of the literature. 786 96

A 3 1/2-year-old child with acute tuberculous meningitis was misdiagnosed as having "partially treated" meningitis and was treated with ampicillin, chloramphenicol, and dexamethasone. She developed obstructive hydrocephalus and miliary spread of tuberculosis which led to death. It is likely that failure to consider alternative diagnoses promptly and the use of corticosteroids along with ineffective antibiotics contributed to the outcome. Although they may lessen some complications of bacterial meningitis, the indiscriminate use of corticosteroids in misdiagnosed bacterial meningitis may be detrimental.
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PMID:Danger of corticosteroid administration in meningitis due to misdiagnosed agent. 806 65

Enterococci, a significant cause of human infections outside of the CNS, have only rarely been documented to cause meningitis. To add to our understanding of this uncommon infectious process, we report our experience with four patients with enterococcal meningitis and summarize findings associated with 28 additional cases found in the medical literature. The majority of the adult patients with this condition had coexistent chronic underlying illnesses and were frequently exposed to immunosuppressive therapy. In addition, more than one-third of these patients had experienced CNS trauma or surgery, and 31% had an infection with enterococci at a site other than the CNS. Pediatric patients predominantly had underlying CNS pathology primarily consisting of neural tube defects or hydrocephalus. Primary meningitis occurred in 25% of pediatric patients, with most of these episodes occurring in neonates. Most patients presented with expected signs, symptoms, and physical features of acute bacterial meningitis and had typical CSF abnormalities, including leukocytic pleocytosis, elevated protein levels, and hypoglycorrhachia. The overall mortality rate among patients with enterococcal meningitis was 13%. The small number of patients in this review failed to demonstrate a definite difference in mortality among patients treated with cell wall-active agents alone vs. those treated with combination therapy with an aminoglycoside, although studies of patients with other complicated enterococcal infections suggest that combination therapy would be preferable.
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PMID:Enterococcal meningitis: report of four cases and review. 816 32

Children aged 1 month to 14 years admitted to the Royal Alexandria Hospital for Children during a 10 month period with suspected meningitis were studied prospectively. The aims were to determine how often lumbar puncture (LP) was delayed or never done, in relation to the outcome of all children, in order to determine the risks of LP and the risks of not doing LP. Of 218 children with suspected meningitis, LP was performed immediately in 195 (89.4%). Meningitis was diagnosed in 49 of these (bacterial 18, viral 31). No child developed cerebral herniation due to immediate LP. There were 11 traumatic taps and two children required repeated attempts. Lumbar puncture was delayed, but performed at a later time in 17 children, of whom three had proven bacterial meningitis, 1 had presumed bacterial meningitis but no organism was detected and 13 had alternative diagnoses. Six children never had an LP, although ventricular cerebrospinal fluid was obtained from two. Four of these six children had presumptive bacterial meningitis, one had tuberculous meningitis presenting with acute hydrocephalus and diagnosed post-mortem, and one had a very poor neurological outcome and no final diagnosis was reached. Of the 27 children with bacterial meningitis, LP was performed immediately in 18, or two-thirds. There were only minor adverse effects of immediate LP. Delayed LP probably resulted in failure to identify the organism in one child with bacterial meningitis, but did not adversely affect outcome in any child. Of the six children in whom LP was never performed, in only one was no final diagnosis reached.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Lumbar punctures in suspected bacterial meningitis: too many or too few? 819 52

Bacterial meningitis has special clinical features in the newborn infant. Major complications and sequelae result from the infectious involvement of the CNS in the majority of these children. We studied 109 newborn infants with bacterial meningitis accompanied from January 1977 to April 1987. The mortality rate was 34.8%. Perinatal risk factors were not found. The majority (80.5%) were term newborn infants. The main signs at admission were convulsion (53.2%), bulging fontanel (37.6%) and apnea (20.2%), and the main symptoms were neurosensorial depression (64.2%), nursing refuse (64.2%), fever (50.5%) and irritability (35.8%). Complications during hospitalization were ventriculitis (34.9%), inappropriate antidiuretic hormone secretion syndrome (27.5%), subdural collection (8.3%), brain abscess (4.6%) and brain infarction (2.8%). Inappropriate antidiuretic hormone secretion syndrome and ventriculitis were closely associated with high mortality. Seventy one children survived: 44 (62%) had gross abnormalities at the neurologic examination, and 29 (40.8%) developed hydrocephalus. Neurological follow-up of these children is important. Prognostic can change along the course of long time follow-up.
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PMID:[Bacterial meningitis in the neonatal period. Clinical evaluation and complications in 109 cases]. 821 34

A retrospective review over ten years of childhood cases of bacterial meningitis treated in two hospitals in Nottingham revealed 301 cases: 88.4% of these children survived. The audiological and clinical hospital records of the survivors were examined to see if the children had been assessed for hearing impairment following the illness. Results indicate that 202/261 (77.4%) of the survivors remaining in the local area had had a formal hearing assessment. Fifteen of these children (7.4% of those assessed) suffered some degree of sensorineural or mixed hearing loss as a direct consequence of meningitis. The impairments ranged from mild unilateral to profound bilateral and the affected children were aged between 0 (i.e. infection at birth) to 15 years. The data indicate that bacterial meningitis of any type can result in sensorineural hearing impairment of any degree in a child of any age. A significantly increased risk of hearing impairment was found for children aged less than one month or over 5 years, for children with associated hydrocephalus, for children admitted between October and March, for those in hospital longer than 16 days and for those with a cerebro-spinal fluid glucose concentration of < or = 2.2 mmol/l. No differential increased risk was noted for different causative pathogens. Abnormal tympanograms indicative of conductive hearing impairment were measured at the first visit in 45% of children attending for hearing assessment. These conductive losses resolved in 75% of cases. These data suggest that an English health district, with a total population of 250,000, would need to provide annual resources for about 30-40 appointments for children after meningitis. Over a period of 5 years it might provide hearing aids for three children and a cochlear implant for one child. Bacterial meningitis is the single most important cause of acquired sensorineural hearing impairment in children and every attempt should be made to assess the child's hearing as soon after recovery as possible.
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PMID:Hearing impairment in children after bacterial meningitis: incidence and resource implications. 833 60


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