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

Fifty years after the advent of antibiotics for clinical use, the rates of morbidity and mortality associated with bacterial meningitis remain high. The unfavourable clinical outcome is often due to intracranial complications including cerebrovascular insults, raised intracranial pressure, hydrocephalus, and brain edema. Reactive oxygen species (ROS) are known effector molecules in the antimicrobial armature of polymorphonuclear and mononuclear phagocytes. However, over the last decade, there has been a substantial body of work implicating a central role of ROS in the development of intracranial complications and brain damage in bacterial meningitis. Recently, it also became evident that reactive nitrogen species (RNS), especially nitric oxide, are important mediators of meningitis-associated pathophysiological changes, at least during the early phase of the disease. There is now substantial evidence that much of the oxidative injury associated by simultaneous production of superoxide and nitric oxide is mediated by the strong oxidant peroxynitrite. ROS and peroxynitrite can be cytotoxic via a number of independent mechanisms. Their cytotoxic effects include initiation of lipid peroxidation and induction of DNA single strand breakage. Damaged DNA activates poly(ADP-ribose) polymerase (PARP). Recent experimental data propose a role of lipid peroxidation and PARP activation in the development of meningitis-associated intracranial complications and brain injury. Agents which interfere with the production of ROS and peroxynitrite, as well as with PARP activation and lipid peroxidation may represent novel, therapeutic strategies to limit meningitis-associated brain damage, and, thus, to improve the outcome of this serious disease.
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PMID:Oxidative stress in bacterial meningitis. 998 52

Our retrospective study concerned 35 cases of surgical complications related to bacterial meningitis in 16 adults and 19 children. The mean age was 28 years for adults (15-56 years), and 6 months for children (1-12 months). Portal of entry for meningitis was found in 12 cases (35%): 8 sinusitis and 4 otitis. Delay to appearance of complications was 4.5 days, and to diagnosis confirmation 9 days with CT scan (17 cases), and transfontanellar ultrasonography (19 cases). The complications were: hydrocephalus, 19 cases (54%), brain empyemas, 7 cases (20%), abscesses, 10 cases (28.5%), ventriculitis, 2 cases (6%). Twenty-two bacteria were isolated from the CSF: Streptococcus pneumoniae (15 cases), Haemophilus influenzae (5 cases), Neisseria meningitidis (1 case), and Escherichia coli (1 case). Fourteen patients underwent neurosurgical treatment based on aspiration in case of suppuration and external drainage in case of hydrocephalus. The associated medical treatment was antibiotics combining third-generation cephalosporins, fluoroquinolone, and metronidazol, with a mean duration of 12 days. Recovery rate was 89%, letality 11%, and after effect rate were 33%. Our results confirm the low frequency of neurosurgical complications related to bacterial meningitis, but it emphasizes the role of an early CT-scan for diagnosis and prognosis.
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PMID:[Neurosurgical complications of purulent meningitis in the tropical zone]. 1056 62

The aim of this retrospective study was to evaluate the clinical efficacy in terms of mortality and long-term morbidity of third generation cephalosporins and amikacin in combination for the treatment of gram-negative bacterial meningitis in a homogeneous group of neonates. A 15-year experience (1983-1997) with 72 term neonates without central nervous system anomalies and with gram-negative organisms grown in their cerebrospinal fluid treated with the above combination of antibiotics is presented. All isolated organisms were sensitive to cefotaxime or ceftazidime and to amikacin but 80% were resistant to ampicillin. The predominant infecting organism was Escherichia coli (68.0%) which was sensitive to both cefotaxime and amikacin in all cases but resistant to ampicillin in 48% of cases. Survival at discharge was 97.2% but ultimate survival was reduced to 94.4%, as 2 patients died a few months following discharge of conditions unrelated to meningitis. Ventriculitis was diagnosed in 10 neonates (13.8%). Among survivors, 1 neonate (1.3%) developed hydrocephalus needing shunting and 1 neonate (1.3%) with Proteus mirabilis developed a brain abscess with relapse of meningitis which was successfully treated with a 6-week course of chloramphenicol. At follow-up at an age greater than 6 months, 91.1% of the surviving infants were normal, while 92.3% of survivors at an age greater than 6 years were normal and attended normal school. These results, despite any reservations due to the nature of the study (retrospective, uncontrolled study), strongly support the use of third generation cephalosporins and amikacin in combination for the treatment of neonatal gram-negative bacterial meningitis.
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PMID:Treatment of gram-negative bacterial meningitis in term neonates with third generation cephalosporins plus amikacin. 1072 16

E. coli meningitis is a disease that occurs in predisposed patients, either as a result of trauma or in neonates after neurosurgery. Recurrent E. coli meningitis in an adult without any apparent predisposition is uncommon, and hydrocephalus complicating bacterial meningitis is even more rare. We report a unique case of a 67-year-old alcoholic man who had had 2 consecutive episodes of E. coli meningitis within 2 months. In both episodes there was a favorable response to ceftriaxone. However, normotensive hydrocephalus appeared a few weeks later, with mental and physical deterioration.
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PMID:[Normotensive hydrocephalus complicating recurrent E. coli meningitis]. 1091 63

Hydrocephalus occasionally causes West syndrome, but the mechanism is unknown. We experienced a case with West syndrome and congenital hydrocephaly, in which the EEG findings improved after the resolution of shunt complications. The course of this case implied the pathogenesis of West syndrome associated with congenital hydrocephaly, as well as the origin of the seizures and that of the EEG findings in West syndrome. A 7-month-old girl had congenital hydrocephaly. A prenatal diagnosis was made by ultrasonography, and ventricle-peritoneal shunting was performed 7 days after birth. During the following 7 months several shunt replacements were done because of recurrent shunt complications. Her first series of infantile spasms began at the age of 6 months, and treatment was started under the diagnosis of West syndrome. One month later, her seizures were controlled by pyridoxal phosphate, while the EEG still showed hypsarrythmia. Her shunt was then removed again, because of bacterial meningitis due to shunt infection. The recovery from shunt complication resulted in marked improvement of the hypsarrhythmia. Our experience and previous literature suggest the involvement of cerebral cortex in the occurrence of West syndrome associated with congenital hydrocephaly.
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PMID:[A case with congenital hydrocephaly and west syndrome who recovered from hypsarrhythmia after the resolution of shunt trouble]. 1091 75

During the period from 1984 to 1997, 85 bacterial meningitis neonates with positive cerebrospinal fluid cultures were treated. The ages of these patients ranged from 1 to 28 days. The male to female ratio was 1.7 to 1. The most common causative agent was group B beta-hemolytic streptococci (GBS, 31.8%), followed by Escherichia coli (20%), Proteus mirabilis (7.1%), Enterobacter cloacae (5.9%), other streptococci excluding Streptococcus pneumoniae (5.9%), Chryseobacterium meningosepticum (5.9%), enterococci (4.7%), and Klebsiella pneumoniae (3.5%). Among the 85 patients treated, 51 (60%) were younger than 7 days old. Among them, dyspnea was the most common clinical manifestation. In contrast, fever and diarrhea were seen more frequently in neonates with late onset of disease (after seven days of age). Ampicillin and cefotaxime were the most commonly used antibiotics. The most frequently encountered complications were hydrocephalus and seizures. Since 1991, GBS has overtaken E. coli as the leading cause of neonatal bacterial meningitis. This was accompanied by a fall in the mortality rate, but a sustained high incidence of complications and sequelae. The results of this study highlight the importance of developing strategies to prevent group B streptococcal infection.
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PMID:Characteristics of neonatal bacterial meningitis in a teaching hospital in Taiwan from 1984-1997. 1091 79

The present study is a review of patients with pyogenic meningitis diagnosed by clinical and laboratory criteria in which CT scan was done to detect acute phase CT abnormalities with respect to post inflammatory hydrocephalus and ventriculomegaly. Fifty-six patients were identified between 1993 and 1996 in the Department of Pediatrics at the All India Institute of Medical Sciences, New Delhi. A CT scan was available in 30. The diagnosis was compatible with a definitive pyogenic meningitis in 17 and probable pyogenic meningitis in 13. The acute stage CT scans performed within the first four weeks of illness revealed ventriculomegaly in 10 out of 30 bacterial meningitis (33%), (41.1% of definitive meningitis compared to only 23% of the probable meningitis group). Follow-up CT scans revealed persistent ventriculomegaly in 2. Both patients with persistent ventriculomegaly had frontal atrophy. None of the patients merited a shunt or any medical measures. Cortical atrophy as an aftermath of acute bacterial meningitis may cause persistent ventriculomegaly. The frontal cortex localization may explain the frequency of seizures and other sequelae observed in pyogenic meningitis. An early recognition may help to prognosticate patient outcome.
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PMID:Retrospective review of clinical and neuroimaging observations in pyomeningitis. 1112 77

Despite the progress, which has been made in diagnosis and therapy of encephalitis and bacterial meningitis, these acute inflammatory diseases of the brain still display a certain amount of morbidity and mortality. History, physical examination, analysis of serum and cerebrospinal fluid and radiological examination are the mainstay for the diagnosis of these diseases. With respect to the acute inflammatory diseases of the brain computed tomography and magnetic resonance imaging fulfill three purposes: 1. They can be used to clarify the diagnosis and to rule out other diseases. 2. They can identify the focus from which a bacterial meningitis can evolve. 3. Complications like edema, cerebral vasculitis, septic sinus thrombosis, hydrocephalus or abscess can be visualized. If the diagnosis is made early, the possible complications are recognized in good time and the appropriate therapy is started immediately, then morbidity and mortality can be kept at a minimum.
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PMID:[Clinico-neurologic aspects of acute inflammatory brain diseases]. 1114 30

The authors report a case of pneumococcal meningitis which recurred 3 times in a Taiwanese boy due to spontaneous cerebrospinal fluid (CSF) fistulas. The first time occurred at the age of 2 years, and the second episode presented as meningoencephalomyelitis at the age of 6 years 10 months. Studies including serum levels of immunoglobulin and complements, brain magnetic resonance imaging, and coronal cranial computed tomography (CT) were negative for a specific etiology. The third episode of meningitis developed 2 months after the second episode. Repeated immunological studies and high-resolution CT of paranasal sinuses and temporal bones were negative. Technetium-99m diethylenetriamine pentaacetic acid (Tc-99m-DTPA) radionuclide cisternography revealed abnormal retention of radioactivity over the right mastoid area. Neurosurgery was undertaken to seal the dural tear and pack the petrosal fissure. Two years after surgery, he has had no further CSF leak age or meningitis. Tracing back the history, there was no head injury, cranial surgery, brain tumor, or hydrocephalus, which might have created CSF fistulas. Primary spontaneous CSF fistulas constitute the most reasonable diagnosis. In cases of recurrent bacterial meningitis, underlying anatomic defects should be carefully evaluated if there is no immune defect.
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PMID:Recurrence of pneumococcal meningitis due to primary spontaneous cerebrospinal fluid fistulas. 1182 Jun 53

Adult Proteus (P.) mirabilis meningitis is relatively rare and has not been examined individually in the English-language literature. During a period of 15 years (January 1986-December 2000), four adult patients with P. mirabilis meningitis and one adult patient with mixed bacterial meningitis involving P. mirabilis were identified at Chang Gung Memorial Hospital, Kaohsiung. These five patients included one man and four women, aged from 19 to 74 years (mean age=55.4). P. mirabilis infection accounted for 1.7% (4/229) of cases of our culture-proven monomicrobial adult bacterial meningitis and was involved in 7.1% (1/14) of cases of our adult mixed bacterial meningitis during this period. Underlying debilitating conditions including diabetes mellitus and neurosurgical disorders were common in these five cases. Adult P. mirabilis meningitis had an acute clinical course, with fever and consciousness-disturbance occurring as most prominent clinical manifestations in all patients. Other common manifestations included hydrocephalus, seizure, septic shock and wound infection. Hematogenous spread would appear to be the most likely mechanism. Multi-antibiotic resistant strains of P. mirabilis were not found in our patients. All strains were susceptible to third-generation cephalosporins, imipenem, aztreonam and ciprofloxacin. The results of treatment for adult P. mirabilis meningitis were not satisfactory, most of the patients surviving with severe neurological deficit.
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PMID:Frequent association with neurosurgical conditions in adult Proteus mirabilis meningitis: report of five cases. 1193 41


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