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

In two investigative phases over a 13.5-year study period (January 1986-June 1999), 202 adult patients with culture-proven bacterial meningitis were enrolled in this study. In order to determine the epidemiologic trend, prognostic factors and therapeutic results for this disease. Klebsiella pneumoniae (K. pneumoniae), Pseudomonas aeruginosa, and Streptococcus pneumoniae were the three most commonly revealed pathogens, accounting for about 48% of the episodes. Although there was a change in relative frequency for the pathogens, K. pneumoniae remained the most prevalent during the two periods studied (January 1986-December 1992 and January 1993-June 1999). Multiantibiotic resistant strains have been in evidence since their appearance in 1994, with most of our patients acquiring their infection nosocomially. The overall mortality rates during the two periods were 40% and 34%, respectively. In stepwise logistic regression analysis, only initial conscious level, appropriate antibiotic therapy and septic shock were independently associated with mortality, after adjustment for other potentially confounding factors. Initial empirical antibiotics with both third-generation cephalosporin and penicillin G, should be considered for the majority of meningitis cases resulting from infection with Gram-negative bacilli and streptococcal species. Besides the evolution of newer pathogens, there has been increasing incidence for nosocomially acquired bacterial meningitis for patients postneurosurgery, with the emergence of resistant strains presenting a therapeutic challenge in recent years. Vancomycin and imipenem/cilastatin should be considered as the initial empirical antibiotics of choice for the treatment of this special group of patients.
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PMID:Adult bacterial meningitis in Southern Taiwan: epidemiologic trend and prognostic factors. 1110 37

10 patients with posttraumatic bacterial meningitis were treated in the Department of Infectious Diseases of the Jagielloniam University--Collegium Medicum during the period of 63 months. Traffic accidents were responsible for 80% of all cases of trauma. The most common place of injury was the base of anterior cranial fossa. Infecting agent was established in 8 cases. Gram-positive aerobic cocci (Streptococcus pneumoniae, Enterococcus faecalis, and Enterococcus spp.) were found in 4 patients, Gram-negative aerobic cocci (Neisseria meningitidis) in 2 patients, and Gram-negative aerobic rods (Acinetobacter baumanii, Pseudomonas aeruginosa, Klebsiella spp, Escherichia coli) in 3 patients. Streptococcus pneumoniae was still highly sensitive to penicillin, ampicillin and cefotaxime. Enterococcus faecalis and Enterococcus spp. were sensitive to vancomycin and teicoplanin. Neisseria meningitidis was sensitive to penicillin, cefotaxime, amoxicillin/clavulonate. Gram negative aerobic rods were sensitive to third-generation cephalosporins, carbapenems and aminoglycosides. Among 10 patients treated for posttraumatic bacterial meningitis 1 patient died and in 1 preserved vegetative state was diagnosed. In 4 patients severe or moderate disabilities developed, however 4 recovered completely. 6 patients after regression of the CNS infection were qualified to neurosurgical intervention. In 3 patients reconstructive operation of the basis of anterior cranial fossa with tissue glue Beriplast P. was done, the recovery was complete. 3 patients didn't agree to surgical operation, and we don't know what has happened with them. They have not come to the control visit.
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PMID:[Post-traumatic bacterial meningitis]. 1139 89

Acute bacterial meningitis is one of the most important causes of morbidity and mortality in developing countries. Though a wide range of antibiotics is available for therapy, judicious and rational use of antimicrobial agents needs to be ascertained. The choice of antimicrobial agents depends mainly on the age of the patient and its CSF penetrability. Neonatal meningitis is commonly caused by Gram Negative organisms such E. coli, Klebsiella and Pseudomans;Group B streptococciand Listeria, though other organisms like Staphylococcus sp. also contribute. The neonatal meningitis is best treated with a combination of amplicillin and a third generation cephalosporin given for 14-21 days. Post-neonatal meningitis usually occurs due to S. pneumoniae, N. meningitidis and H. influenzae and is best treated with third generation cephalosporins used with or without crystalline penicillin or ampicillin depending on the clinical situation. The therapy should be modified, if necessary, on availability of culture sensitivity report. The use of dexamethasone in meningitis due to the organisms other than H. influenzae still remains controversial.
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PMID:Rational antibiotics therapy in bacterial meningitis. 1198 Apr 57

Between January 1986 and December 1999, 109 adult patients with culture-proven community-acquired bacterial meningitis were identified at Kaohsiung Chang Gung Memorial Hospital. To compare changes over time, the appearance of disease among our patients was divided into two equal time periods: an earlier time period (1986-1992) and a later time period (1993-1999). In this study, there was a decreasing proportion of community-acquired bacterial meningitis compared with nosocomial bacterial meningitis in adult patients in recent years. Its proportion declined dramatically from 81% in the earlier 7 years to 37% in the later 7 years. Of the pathogens, Klebsiella (K.) pneumoniae was the most frequently implicated pathogen, followed by Viridans (V.) streptococci, Streptococcus pneumoniae, and Staphylococcus aureus. Other rare organisms including Acinetobacter baumannii, Salmonella Group B and D, Proteus mirabilis, Group B, D, and non-A, non-B and non-D streptococci, and coagulase-negative staphylococci emerged during the second period. There was a decrease in the mortality rate from 44% in the first to 34% in the second time period, but the overall mortality rate remained high. Of the implicated pathogens, patients infected with V. streptococci had a consistently favorable prognosis, while a dramatic decrease in the mortality rate of those infected with K. pneumoniae was seen in recent years. In the multiple logistic regression analysis, only the presence of septic shock and seizures was independently associated with mortality. The timing of appropriate antimicrobial therapy, as defined by consciousness level, was a major determinant of survival and neurological outcomes for patients with community-acquired bacterial meningitis, and the first dose of an appropriate antibiotic should be administrated before a patient's consciousness deteriorates to a Glasgow coma scale score lower than 10.
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PMID:Community-acquired bacterial meningitis in adults: the epidemiology, timing of appropriate antimicrobial therapy, and prognostic factors. 1214 Jan 4

A 47-case-year old male was admitted to our hospital because of high fever and general fatigue. He had no immune deficiency, and had no other disease in his past history. On admission, the white blood cell count and C-reacted protein were severely elevated (18,700/microliter, 27.7 mg/dl, respectively) and abdominal CT revealed multiple low density, From these results, he was diagnosed as liver abscess. Intravenous MINO and SBT/CPZ injection were started. On the fifth hospital day, he suffered from headache and nuchal rigidity. The clinical data revealed the cerebro-spinal fluid (CSF) counting 8,336 cells/mm3 (mononuclear 8,000,) protein at 119 mg/dl, and sugar 42 mg/dl. CSF cultures were negative, but Klebsiella was recognized in the blood culture and drainage fluid in liver abscess. This condition was diagnosed as bacterial meningitis and antibiotics were changed to intravenous CTRX and MEPM. Furthermore we administered oral PSL and intravenous steroid-pulse therapy. After these combination therapies his condition improved gradually. After 40 hospital day, however, he suddenly had double vision, Axial FLAIR (SE6,000/120) image revealed with high signal intensity at 4th ventricle. Intravenous MEPM was administered again. On the 60th hospital day, double vision was gradually improved and abnormal intensity at 4th ventricle was almost disappeared. This case may provide us a considerable suggestion on the treatment of bacterial meningitis.
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PMID:[A case of ventriculitis with bacterial meningitis occurred during the treatment of liver abscess]. 1467 11

To expand upon the limited comprehensive population-based data for childhood bacterial meningitis in Eastern Europe, the present study was conducted in the Iasi and Constanta districts of Romania. From March 2000 through March 2002, children <5 years of age hospitalized for bacterial meningitis were enrolled in a prospective surveillance study. A total of 56 cases of bacterial meningitis were identified, including 37 due to Neisseria meningitidis (22 per 100,000 per year), 13 due to Haemophilus influenzae type b (7.6 per 100,000 per year), and six due to Streptococcus pneumoniae (3.5 per 100,000 per year). Of the 31 meningococcal isolates that were serotyped, 12 were serogroup A, eight were serogroup B, and 11 were serogroup C. Among all cases of bacterial meningitis, 25 occurred in children <1 year of age, including those due to meningococci (n=14), H. influenzae type b (n=7), pneumococci (n=3), and Klebsiella pneumoniae (n=1). In Romania the incidence of H. influenzae type b meningitis is similar to that found in other areas of Southern and Eastern Europe during the pre-vaccination era, and the incidence of meningococcal meningitis is one of the highest yet found in Europe. An unexpectedly high proportion of these meningococcal meningitis cases is due to serogroup A. Disease burden could be substantially reduced through the introduction of H. influenzae type b conjugate vaccine and, when available, meningococcal conjugate vaccine protective against serogroups A, B and C.
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PMID:Incidence and etiological agents of bacterial meningitis among children <5 years of age in two districts of Romania. 1525 44

The epidemiologic landscape of causative pathogens and clinical characteristics of bacterial meningitis varies with several clinical factors including preceding/pre-existent medical and/or surgical conditions, modes of contraction, geographic distributions, status of vaccinations, the study time periods and differences among age groups. In order to delineate the epidemiology of bacterial meningitis in senior adults (ages > or =60 y/o) in southern Taiwan, we analyzed the clinical characteristics and therapeutic outcomes of 64 senior adults (42 men and 22 women, aged 60-80 years) with bacterial meningitis collected over a period of 13 years at our hospital. The prognostic factors between fatal and non-fatal groups of patients were compared. Twenty-seven of the 64 patients belonged to a nosocomial infection group, and the other 37 comprised a community-acquired infection group. Sixty percent (39/64) of the patients had a post-neurosurgical state as the most preceding event prior to infection. Liver disease (13) and diabetes mellitus (6) were the most common underlying conditions of the other 25 patients with spontaneous meningitis. Of these 64 patients, Klebsiella (K.) pneumoniae (18), Acinetobacter baumannii (5), Escherichia coli (5), and Enterobacter species (5) were the most commonly implicated Gram-negative pathogens. Staphylococcus (S.) aureus infection was increasing during the study period. The therapeutic results of this group of patients showed a mortality rate of 38% (24/64). The presence of septic shock was the most significant prognostic factor. In conclusion, for this study group, a post-neurosurgical state was the single most important preceding event for senior adults developing bacterial meningitis. Of the implicated pathogens, K. pneumoniae and S. aureus were the most common gram-negative and gram-positive pathogens, respectively. The therapeutic result of this specific group of patients showed a high mortality rate; however, the small case number and possible bias of case selection have limited the analytical conclusions of this study.
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PMID:Culture-proven bacterial meningitis in elderly patients in southern Taiwan: clinical characteristics and prognostic factors. 1687 94

The frequency of L-Sorbose utilization differs significantly between pathotypes of Escherichia coli and Shigella from 93% to 0%. Among 266 strains tested, this frequency increased in the order Shigella, enterotoxigenic E. coli (ETEC), enteroinvasive E. coli (EIEC), Shiga toxin-producing E. coli (STEC), enteroaggregative E. coli, enteropathogenic E. coli (EPEC), and neonatal bacterial meningitis (NBM) E. coli. This suggests an association of pathomechanism with the capability to degrade L-Sorbose. The use of a selective agar, containing L-Sorbose and antibiotics, facilitated the isolation of L-Sorbose-non-utilizing ETEC from stool specimens of patients. The sor operon, comprising seven genes in the order sorCDFBAME, confers L-Sorbose utilization. Surprisingly, L-Sorbose-non-degrading Shigella harbored all genes of the sor operon indicating L-Sorbose-utilizing E. coli as ancestor. Additionally, strains of several EIEC and STEC serotypes harbored an inactivated sor operon. These L-Sorbose-non-utilizing Shigella, EIEC, and STEC showed significantly reduced amounts of transcripts as examined for sorC and sorD. Common surface antigens, types of intimin gene, and hemolysin gene as well as use of L-Sorbose suggested the relatedness of attaching and effacing O26:H11 and O55:H7 EPEC and STEC, respectively. pepE and yibC genes flank the sor operon of E. coli and Shigella strains. Surprisingly, one O7:K1:H- NBM E. coli harbored an aroE-homologous gene between its sor operon and pepE as in Klebsiella pneumoniae suggesting a horizontal gene transfer. In conclusion, L-Sorbose utilization of virulent E. coli and Shigella is characterized by different adaptation that represents a valuable tool for evolutionary and diagnostic analysis of related patho- and serotypes.
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PMID:L-Sorbose utilization by virulent Escherichia coli and Shigella: different metabolic adaptation of pathotypes. 1738 90

Bacterial meningitis is an important and frequent devastating disease. The present study was carried out to determine the prevalence of pyogenic meningitis in our hospital in children and to find out the sensitivity of Gram stain, CRP and latex agglutination tests for the diagnosis of pyogenic meningitis from CSF sample. Out of 150 CSF samples studied, 40 were diagnosed as pyogenic meningitis. H. influenzae was the commonest organism (22.5%), followed by Streptococcus pneumoniae 15%, Staphylococcus aureus--10%, Acinetobacter species and coagulase negative Stapylococci 7.5% each, E-coli 5%, and a case each of Klebsiella species, Group B streptococci, Proteus, Pseudomonas and Enterococci. The sensitivity of Gram stain and Latex agglutination test was 90% and that of CRP test was 62.5%. As most of the cases included in our study were treated earlier, the culture positivity was only 62.5%. Hence, Gram stain and/or latex agglutination tests, if done properly are most rapid and reliable tests for the diagnosis of pyogenic meningitis.
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PMID:Bacteriological study of pyogenic meningitis with special reference to latex agglutination. 1747 75

This study was conducted at Tribhuvan University Teaching Hospital, a tertiary care hospital in Nepal from January 2001 to March 2002. The prevalence of bacterial meningitis, its causative organisms and their antibiotic sensitivity patterns were studied in cerebrospinal fluid of 448 suspected cases. The prevalence of acute bacterial meningitis was 8.3%. There was no significant association (p > 0.05) of the disease with gender (X2 = 0.0234) and among different age groups (X2 = 6.07875) studied. The causative bacteria were Pseudomonas aeruginosa (24.3%), Klebsiella pneumoniae (16.2%), Staphylococcus aureus (16.2%), coagulase negative staphylococci (10.8%), Escherichia coli (10.8%), Streptococcus pneumoniae (8.2%), Neisseria meningitidis (5.4%), Acinetobacter spp. (5.4%) and Aeromoanas spp. (2.7%). Imipenem was the most effective antibiotic, however, 11.1% of P. aeruginosa, 25.0% of E. coli and 50.0% of Acinetobacter spp. were resistant to the drug.
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PMID:Acute bacterial meningitis in Nepal. 1789 58


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