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

Nine hundred seventy cases of childhood bacterial meningitis treated at 107 institutions in Japan from 1979 through 1984 were studied using questionnaire. The number of cases that underwent antimicrobial monotherapy remained nearly constant during the study period, but cases of therapies with beta-lactam combined with aminoglycosides (AGs) decreased in number and a gradual increase in the use of beta-lactam combined with non-AGs antibiotics including beta-lactam (Non AGs) was observed. A trend showing decrease in case fatality rate (CFR) was observed except that CFR for Gram-positive bacterial infections treated with beta-lactam + AGs remained at a same level. Cases treated with antibiotics were classified into 3 groups according to major etiological pathogens. Cases with Staphylococcus aureus gave a poor prognosis, among 27 total cases, CFR was 28.6% (2/7) with monotherapy, 50.0% (6/12) with beta-lactam + AGs and 37.5% (3/8) with beta-lactam + Non AGs (P less than 0.1). Among 100 cases of group B Streptococcus (GBS), CFR was 20.0% as a whole, 17.3% (9/52) for monotherapy and 34.5% (10/29) for beta-lactam + AGs (P less than 0.1). Among 198 cases of Streptococcus pneumoniae, CFR was 12.1% as a whole, and was 12.3% (18/146) with monotherapy. CFR for the cases treated with beta-lactam + AGs was 20.8% (5/24) and with beta-lactam + Non AGs was 3.6% (1/28) (P less than 0.1). CFR for 292 cases of Haemophilus influenzae meningitis was fairly low, and was 6.1% (9/148) with monotherapy, 7.4% (5/68) with beta-lactam + AGs and 3.9% (3/76) with beta-lactam + Non AGs, thus very slight differences were observed among the 3 groups of treatment. Among 111 cases of Escherichia coli, monotherapy and beta-lactam + Non AGs gave 6.5% (2/31) CFR, and 5.6% (1/18) CFR, respectively, whereas beta-lactam + AGs showed CFR of 19.4% (12/62), demonstrating a significant difference tendency (P less than 0.1). Similar tendencies were observed in the cases of Listeria monocytogenes, Proteus mirabilis, Pseudomonas aeruginosa and Enterococcus faecalis. Contrary to the high CFR observed with the beta-lactam + AGs treatment, significantly low CFR was frequently obtained in cases treated with a combination of penicillins with cephalosporins including latamoxef or beta-lactam with chloramphenicol. Infections with GBS, E. coli, and P. mirabilis occurred largely in the age between 0 to 6 months and CFR was especially high in the very young.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Recent trend of childhood bacterial meningitis in Japan (1979-1984). Part 4. A classification of prognosis and antibiotic treatment based on causative agents]. 361 93

Three species of bacteria (Haemophilus influenzae type b, Neisseria meningitidis, and Streptococcus pneumoniae) cause approximately three-quarters of all cases of acute bacterial meningitis in industrialized and developing countries. Infections due to N. meningitidis, S. pneumoniae, and H. influenzae type b are endemic in most countries; major epidemics of meningococcal disease still occur regularly, especially in sub- Saharan Africa. Such epidemics may be large, involving many thousands of patients, with a mortality that can exceed 10%. Both chemoprophylaxis and immunization are used to prevent meningococcal, pneumococcal, and H. influenzae type b meningitis. Chemoprophylaxis may involve the use of expensive antibiotics, and it can encourage the emergence of drug resistance. Mass immunization with meningococcal polysaccharide vaccine can effectively halt an epidemic of group A or group C meningococcal disease, and immunization protects close contacts. However, polysaccharide vaccines are ineffective in infants, who are very susceptible to bacterial meningitis. New protein-polysaccharide conjugated vaccines may be more effective in this young population.
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PMID:Selective primary health care: strategies for control of disease in the developing world. XIII. Acute bacterial meningitis. 642 12

Elderly persons are prone to more frequent or greater morbidity and higher mortality from selected infectious diseases than the average population. Factors that may affect this increased predilection or poorer prognosis include environmental exposure, normal physiological changes of aging, coexistence of chronic diseases and alteration of host defense mechanisms. Infections to which the aged are particularly vulnerable are pneumonia, influenza, tuberculosis, urinary tract infection, Gram-negative bacteremia, intra-abdominal sepsis, soft tissue infection, infective endocarditis, bacterial meningitis, bacterial arthritis and herpes zoster infection.
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PMID:Important infections in elderly persons. 703 32

As a result of hypoxia following right-to-left shunts, cerebral bacterial spreading and an altered blood-brain-barrier permeability, brain abscesses (BA) are typical complications in patients with cyanotic congenital heart disease. In 483 prospectively followed patients the incidence of BA was 0.45%/year. It was higher (0.57%/year) for patients with tetralogy of Fallot where the cumulative risk within the first two decades of life was 12.1 +/- 1.7%. The risk of BA complicating cyanotic heart disease is inconstant and continuously increasing up to approximately age 12 (instantaneous risk at that time: 1.75 +/- 0.12%), decreasing thereafter. With respect to etiology, infectious endocarditis, infections per continuitatem, bacterial meningitis, bacterial lung diseases with intrapulmonary shunts, and thromboembolic complications of systemic infections have to be differentiated. The stepwise diagnosis includes CCT to demonstrate the typical contrast enhancement and a lumbar puncture which shows granulocytic pleocytosis. If the cerebral spinal fluid fails to demonstrate the typical findings, cerebral angiography may be necessary to exclude a malignant vascularized neoplasma. In cases of doubt, stereotactic cerebral biopsy should be performed. Optimal antibiotic therapy after determining the minimal bactericidal concentration and combination of antibiotics is of utmost prognostic significance. Cranial computed tomography should be repeated after 6, 14, and 24 days. Infections resistant to antibiotics may necessitate local instillation of antibiotics.
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PMID:[Brain abscess in patients with cyanotic heart defects]. 751 30

Meropenem and comparator antibiotics, including ceftriaxone, ceftazidime, benzyl penicillin and a combination of ampicillin plus gentamicin, were evaluated in a model of bacterial meningitis in the guinea-pig. The model is an acute infection in which challenge with each organism, if untreated, causes an increase in numbers of white blood cells, elevation of protein concentrations and 6-8 log10 cfu/mL of bacteria in the CSF. Infections caused by Haemophilus influenzae, Neisseria meningitidis, three strains of Streptococcus pneumoniae (two penicillin-resistant), Escherichia coli, Pseudomonas aeruginosa and Listeria monocytogenes all responded to meropenem, which was as active as the comparator agents in all studies, and was more active in most. Of particular note were the results seen against S. pneumoniae (penicillin-resistant) infections, in which meropenem was significantly more effective than ceftriaxone. Also notable were results from the P. aeruginosa infection where meropenem, at low doses, was more effective than ceftazidime. Activity against L. monocytogenes was equivalent to that produced by treatment with the combination of ampicillin plus gentamicin, even when treatment was delayed. These results show that, in an animal model, meropenem penetrates into CSF in concentrations sufficient to produce significant reductions in the numbers of common and less common pathogens.
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PMID:Efficacy of meropenem in experimental meningitis. 854 1

Certain arthropod-borne infections are common in tropical regions because of favorable climatic conditions. Water-borne infections like leptospirosis are common due to contamination of water especially during the monsoon floods. Infections like malaria, leptospirosis, dengue fever and typhus sometimes cause life threatening organ dysfunction and have several overlapping features. Most patients present with classicial clinical syndromes: fever and thrombocytopenia are common in dengue, malaria and leptospirosis; coagulopathy is frequent in leptospirosis and viral hepatitis. Hepatorenal syndrome is seen in leptospirosis, falciparum malaria and scrub typhus. The pulmonary renal syndrome is caused by falciparium malaria, leptospirosis, Hantavirus infection and scrub typhus. Fever with altered mental status is produced by bacterial meningitis, Japanese B encephalitis, cerebral malarial, typhoid encephalopathy and fulminant hepatic failure due to viral hepatitis. Subtle differences in features of the organ failure exist among these infections. The diagnosis in some of these diseases is made by demonstration of antibodies in serum, and these may be negative in the first week of the illness. Hence empiric therapy for more than one disorder may be justified in a small proportion of cases. In addition to specific anti-infective therapy, management of organ dysfunction includes use of mechanical ventilation, vasopressor drugs, continuous renal replacement therapy and blood products. Timely transfer of these patients to well-equipped ICUs with experience in managing these cases can considerably decrease mortality and morbidity.
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PMID:Tropical infections in the ICU. 1694 13

Infections of the major vessels can result in the formation of mycotic aneurysms, which can ultimately rupture and can be associated with a high mortality rate. Mycotic aneurysms can pose a diagnostic dilemma for the clinicians and successful treatment of this condition often requires a very high index of suspicion. We report an unusual case of a 65-year-old black female who initially presented with bacterial meningitis due to Streptococcus pneumoniae and 1 week later died from a ruptured undetected mycotic aneurysm. A similar case, in which a mycotic aneurysm initially presented with bacterial meningitis, could not be found in the literature.
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PMID:Ruptured mycotic aneurysm presenting initially with bacterial meningitis. 1827 35

Infections in the central nervous system (CNS) are caused by a wide range of microorganisms resulting in distinct clinical syndromes including meningitis, encephalitis, and pyogenic infections, such as empyema and brain abscess. Bacterial and viral infections in the CNS can be rapidly fatal and can result in severe disability in survivors. Appropriate identification and acute management of these infections often occurs in a critical care setting and is vital to improving outcomes in this group of patients. This review of diagnosis and management of acute bacterial and viral infections in the CNS provides a general approach to patients with a suspected CNS infection and also provides a more detailed review of the diagnosis and management of patients with suspected bacterial meningitis, viral encephalitis, brain abscess, and subdural empyema.
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PMID:Neuro-intensive care of patients with acute CNS infections. 2210 80

Infections that cause significant nervous system morbidity globally include viral (for example, HIV, rabies, Japanese encephalitis virus, herpes simplex virus, varicella zoster virus, cytomegalovirus, dengue virus and chikungunya virus), bacterial (for example, tuberculosis, syphilis, bacterial meningitis and sepsis), fungal (for example, cryptococcal meningitis) and parasitic (for example, malaria, neurocysticercosis, neuroschistosomiasis and soil-transmitted helminths) infections. The neurological, cognitive, behavioural or mental health problems caused by the infections probably affect millions of children and adults in low- and middle-income countries. However, precise estimates of morbidity are lacking for most infections, and there is limited information on the pathogenesis of nervous system injury in these infections. Key research priorities for infection-related nervous system morbidity include accurate estimates of disease burden; point-of-care assays for infection diagnosis; improved tools for the assessment of neurological, cognitive and mental health impairment; vaccines and other interventions for preventing infections; improved understanding of the pathogenesis of nervous system disease in these infections; more effective methods to treat and prevent nervous system sequelae; operations research to implement known effective interventions; and improved methods of rehabilitation. Research in these areas, accompanied by efforts to implement promising technologies and therapies, could substantially decrease the morbidity and mortality of infections affecting the nervous system in low- and middle-income countries.
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PMID:Global research priorities for infections that affect the nervous system. 2658 Mar 25

There is little published information on the epidemiology of neurological disorders in rural Central Africa, although the burden is considered to be substantial. This study aimed to investigate the pattern, etiology, and outcome of neurological disorders in children > 5 years and adults admitted to the rural hospital of Mosango, province of Kwilu, Democratic Republic of Congo, with a focus on severe and treatable infections of the central nervous system (CNS). From September 2012 to January 2015, 351 consecutive patients hospitalized for recent and/or ongoing neurological disorder were prospectively evaluated by a neurologist, subjected to a set of reference diagnostic tests in blood or cerebrospinal fluid, and followed-up for 3-6 months after discharge. No neuroimaging was available. Severe headache (199, 56.7%), gait/walking disorders (97, 27.6%), epileptic seizure (87, 24.8%), and focal neurological deficit (86, 24.5%) were the predominant presentations, often in combination. Infections of the CNS were documented in 63 (17.9%) patients and mainly included bacterial meningitis and unspecified meningoencephalitis (33, 9.4%), second-stage human African trypanosomiasis (10, 2.8%), and human immunodeficiency virus (HIV)-related neurological disorders (10, 2.8%). Other focal/systemic infections with neurological manifestations were diagnosed in an additional 60 (17.1%) cases. The leading noncommunicable conditions were epilepsy (61, 17.3%), psychiatric disorders (56, 16.0%), and cerebrovascular accident (23, 6.6%). Overall fatality rate was 8.2% (29/351), but up to 23.8% for CNS infections. Sequelae were observed in 76 (21.6%) patients. Clinical presentations and etiologies of neurological disorders were very diverse in this rural Central African setting and caused considerable mortality and morbidity.
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PMID:Clinical Spectrum, Etiology, and Outcome of Neurological Disorders in the Rural Hospital of Mosango, the Democratic Republic of Congo. 2882 Jul 8


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