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

A 42-year-old woman developed headache and epistaxis followed by fever, stiff neck, and loss of vision of the right eye. The diagnosis of simple epistaxis was changed to mucormycosis, then to bacterial meningitis and then to sphenoid sinusitis, before the correct diagnosis of pituitary apoplexy was established by CT scan. Epistaxis is yet another confusing symptom of pituitary apoplexy.
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PMID:Pituitary apoplexy presenting with epistaxis. 623 14

We studied 30 patients with infectious sphenoid sinusitis (15 acute cases and 15 chronic cases) in an effort to characterize the clinical presentation, bacteriology, and associated complications of this frequently misdiagnosed infection. Severe frontal, temporal, or retro-orbital headache that radiated to the occipital regions or pain in the trigeminal (V1 to V3) distribution or both were the most prominent presenting symptoms. In acute cases, purulent exudate was frequently seen in the middle and superior nasal turbinates. Computerized axial tomography or sinus tomography and cannulation of the sphenoid sinus proved to be the most useful diagnostic studies. Organisms detected in acute cases included streptococci other than Streptococcus pneumoniae (41 per cent), Staphylococcus aureus (29 per cent), and Str. pneumoniae (17 per cent). In chronic infections, gram-negative bacilli (43 per cent) and staphylococcal species (24 per cent) were the predominant organisms. In acute disease, early diagnosis and aggressive therapy, including surgical drainage, were important. Delay in treatment was always associated with serious morbidity or mortality. Fatal complications included cavernous sinus thrombosis and bacterial meningitis.
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PMID:Sphenoid sinusitis. A review of 30 cases. 662 61

CT examinations of 42 cases of bacterial meningitis revealed in 38, 1% of the cases relevant inflammatory processes at the base of the skull which were of significant importance for a transmitted infection. Such infections were: Sinusitis frontalis, ethmoidalis, maxillaris and sphenoidalis, mastoiditis or petrositis, suppurating mucocele, impression fracture, and an intracranially penetrated foreign body. Excepting the identification of fine fractures, conventional x-ray films were diagnostically superior. Hence, especially in the acute stages, special projections can be omitted, if CT is effected in the region of the osseous base of the skull. CT performed in inflammatory diseases of the brain must include the base of the skull, since this will yield reliable pointers to an original focus of the inflammation requiring appropriate treatment and elimination.
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PMID:[CT of the base of the skull in bacterial meningitis (author's transl)]. 734 61

Streptococcus pneumoniae continues to be the most common organism causing acute otitis media and sinusitis in infants and children and remains an important bacterial cause of pneumonia, septic arthritis, and bacterial meningitis in the pediatric age group. The definition, incidence, and mechanisms for penicillin resistance in pneumococcus are reviewed here. Physicians caring for children should know and understand these important concepts. At present, for most respiratory infections in children penicillin-resistant pneumococcus does not represent a clinical dilemma as far as regarding alteration of empiric antibiotic therapy. However, as this problem continues to grow, especially for patients with recurrent otitis media or sinusitis, physicians will be facing upper respiratory infections that are more commonly caused by these isolates and the antibiotic management of infections in the respiratory tract caused by penicillin and other antibiotic-resistant pneumococcal isolates will require modification.
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PMID:The emergence of resistant pneumococcus as a pathogen in childhood upper respiratory tract infections. 776 12

Sudden, explosive headache is rather rare. Though dramatic for the patient and the physician, it does not necessarily herald an intracranial catastrophe. Benign and dangerous thunderclap headaches cannot be distinguished from the features of headache itself, but rather on the basis of the situation, the additional symptoms and the findings. This means that every sudden headache should be considered potentially dangerous and be investigated immediately. The dangerous forms comprise intermittent hydrocephalus, acute bacterial meningitis and above all vascular complications. Subarachnoid hemorrhage frequently must be ruled out by computed tomography and lumbar puncture. Intracerebral, especially cerebellar hemorrhage, as well as hypertensive crisis require immediate treatment. Fatal cerebral embolism complicating spontaneous dissection of craniocervical arteries (carotid or vertebral arteries) can be prevented by early anticoagulant therapy. To confirm diagnosis, additional investigations such as CT, lumbar puncture or cerebrovascular ultrasound, and in rare cases MRI, should be performed early as the available time for effective therapy in many situations is short. Many of the benign forms of sudden headache can be diagnosed with a focused interview (cold or drug induced and food dependent headaches, sinusitis, glaucoma). Others, such as neuralgia, cough and coital headache, can be diagnosed as benign only when additional investigations have ruled out symptomatic forms.
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PMID:[Acute headache]. 848 83

We report two cases of pneumococcal meningitis with paranasal sinusitis followed by cerebrovascular disease. Both cases were occupational divers, and had past histories of head trauma and paranasal sinusitis. Despite the combined therapy with antibiotics and dexamethasone, they developed cerebrovascular complications. Case 1 developed cerebral infarction and hemorrhage on day 13, and in case 2 cerebral infarction occurred on day 15. In both cases, serum levels of TNF-alpha and IL-6 were elevated in the early stage of the illness (12 pg/ml and 21.3 pg/ml in case 1, and 50 pg/ml and 7,570 pg/ml in case 2, respectively). In case 2, TNF-alpha, IL-1 beta and IL-6 levels in the cerebrospinal fluid were also elevated on day 4 (25 pg/ml, 320 pg/ml and 6,870 pg/ml, respectively). Thrombocytosis was observed in both cases before the onset of the cerebrovascular complications. These cytokines may play significant roles in thrombocytosis leading to cerebrovascular complications in pneumococcal meningitis. Although the use of steroids as adjunctive therapy for bacterial meningitis has been found to be beneficial, the dosage of dexamethasone administered in our cases may not be enough to suppress the synthesis and release of the cytokines. Therefore, administration of large doses of glucocorticoid should be recommended before the treatment with antibiotics.
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PMID:[Two cases of severe bacterial meningitis with paranasal sinusitis followed by cerebrovascular disease--pathophysiology and treatment of cerebrovascular disease]. 897 33

Ten adult patients with recurrent bacterial meningitis (RBM) of 22 episodes were diagnosed and treated at the Dicle University Hospital from January 1990 to December 1995. Apart from 22 episodes of RBM these patients had an additional 25 episodes treated at other hospitals. The RBM attacks developed after closed head trauma in four patients, asplenia and chronic otitis media in one patient, chronic otitis media and oto-mastoiditis in one patient, chronic maxillary sinusitis in one patient, chronic mastoiditis in one patients, and suppurative foci of facial bones caused by shrapnel pieces and no predisposing condition in one patient. In 10 RBM episodes, Streptococcus pneumoniae was isolated from cerebrospinal fluid (CSF) and/or blood culture, and in one episode Proteus vulgaris was isolated from CSF and otitis media suppuration. In the four episodes both cultures were negative, but direct microscopy showed Gram-positive diplococci on Gram-staining. Three of the patients died from meningitis-related complications.
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PMID:Recurrent bacterial meningitis: a 6-year experience in adult patients. 927 25

Pneumococci are a leading cause of bacterial meningitis and bacteraemia, as well as pneumonia, otitis media and sinusitis in childhood. These organisms recently have shown a dramatic increase in antibiotic resistance. Penicillin-resistant pneumococci are of special concern as they are often resistant to other unrelated antibiotics. This is of particular significance to Aboriginal children who have among the highest rates of pneumococcal infection in the world. Laboratories should now test all invasive pneumococcal isolates for penicillin and third generation cephalosporin resistance. Local treatment guidelines are required for pneumococcal infections, especially for meningitis, taking into account the prevalence of resistant strains within the community. At present, penicillin and amoxycillin remain the drugs of choice for pneumococcal infections, with the exception of meningitis where initial empirical therapy must be with a third generation cephalosporin. Judicious antibiotic use, which avoids over-prescribing and unnecessary use of broad-spectrum agents, improved living standards in underprivileged communities and introduction of an effective conjugate vaccine, able to reduce the rates of pneumococcal infection and hopefully colonization, may limit the spread of resistant strains.
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PMID:Antibiotic management of pneumococcal infections in an era of increased resistance. 932 14

Haemophilus influenzae is an infrequent etiologic agent of bacterial meningitis in adult patients. In the last 12 years, it was the cause in 12 out of 238 cases (5.0%) of acute bacterial meningitis in adults. There were 5 men and 7 women with a mean age (SD) of 45.4 (16) years (range: 18-68 years). Seven patients (60%) had a communication between subarachnoid space and skin surface or mucosal cavities, and five (41.7%) had otitis or sinusitis. Most of the strains (9/12) were serotype b. Only one patient (8.3%) developed severe neurologic and extra-neurologic complications, and was the one who died. One of the survivors (9.1%) had partial deafness. H. influenzae is not a negligible cause of bacterial meningitis in adults. Moreover, its detection has been increasing in the last years. Patients with a cerebrospinal fluid leak, otitis or sinusitis are at high risk. The outcome is usually favorable if an early adequate therapy is given.
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PMID:[Haemophilus influenzae meningitis in adults: analysis of 12 cases]. 981 May 48

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


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