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

Human parvovirus B19 infection can cause erythema infectiosum (EI) and several other clinical presentations. Central nervous system (CNS) involvement is rare, and only a few reports of encephalitis and aseptic meningitis have been published. Here, we describe 2 cases of B19 infection in a family presenting different clinical features. A 30 year old female with a 7-day history of headache, malaise, myalgias, joint pains, and rash was seen. Physical examination revealed a maculopapular rash on the patient's body, and arthritis of the hands. She completely recovered in 1 week. Two days before, her 6 year old son had been admitted to a clinic with a 1-day history of fever, headache, abdominal pain and vomiting. On admission, he was alert, and physical examination revealed neck stiffness, Kerning and Brudzinski signs, and a petechial rash on his trunk and extremities. Cerebrospinal fluid analysis was normal. He completely recovered in 5 days. Acute and convalescent sera of both patients were positive for specific IgM antibody to B19. Human parvovirus B19 should be considered in the differential diagnosis of aseptic meningitis, particularly during outbreaks of erythema infectiosum. The disease may mimic meningococcemia and bacterial meningitis.
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PMID:Two family members with a syndrome of headache and rash caused by human parvovirus B19. 1129 Mar 13

Bacterial meningitis remains a highly lethal disease in older adults, with mortality rates averaging >20% despite modern antibiotic therapy. In this population, more variable presentations are seen, with fewer patients manifesting fever, neck stiffness, and headache than among younger adults. In addition, many older adults (aged > or =60 years) may have other underlying diseases causing symptoms that may be confused with those of meningitis. The spectrum of etiologic bacterial organisms is more broad than that for a younger population, in part because of the increased frequency of severe underlying diseases and in part as a result of immunosenescence. Therapy is complicated by both the range of possible causative organisms and the increasing antibiotic resistance manifested by some. These difficulties, contrasted with the success of vaccination in the pediatric population, highlight the need for improved preventive strategies for older adults. This review outlines some key clinical points in the management of bacterial meningitis in the older adult.
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PMID:Bacterial meningitis in aging adults. 1155 Jan 19

Many conditions are associated with neck stiffness. Because of the threatening consequences, bacterial meningitis needs special consideration. The sensitivity of the physical examination is discussed: absence of fever, neck stiffness and altered mental status excludes the diagnosis of bacterial meningitis. Lumbar punction with cerebrospinal fluid examination remains the pivotal diagnostic procedure. A previous CT-scan to exclude increased intracranial pressure is indicated only in special risk situations and delayed antibiotic treatment must be avoided. Ceftriaxon is the standard empiric treatment in immunocompetent adult patients. According to the risk for pneumococcal resistance addition of vancomycin or rifampicin is indicated.
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PMID:[Stiff neck--what to consider]. 1168 Feb 10

The diagnosis of bacterial meningitis is rarely a difficult diagnostic dilemma when a patient presents with fever, headache, neck stiffness, and altered mental status. Unfortunately for the practicing clinician, patients are rarely that straightforward. Patients who are elderly, very young, or immuno-compromised often present with subtle findings, making the correct diagnosis a challenge. In addition, patients being treated with antibiotics may be misleading in their clinical presentation, leading to a missed diagnosis of meningitis. Only when one considers the diagnosis or obtains a sample of cerebrospinal fluid is the correct diagnosis made. Although the clinical scenario may suggest meningitis, it is the cerebrospinal fluid white blood cell count that establishes the definitive diagnosis. Despite the advent of systemic antibiotics over 50 years ago, bacterial meningitis continues to cause considerable morbidity and mortality worldwide. The following case report details a woman diagnosed with Streptococcus pneumoniae meningitis with an extremely high cerebrospinal white blood cell count. Although this is typically thought to be caused by abscesses or malignancy, meningitis alone may cause such an elevation. In addition, a brief review of the current epidemiology and treatment regimens for meningitis is discussed.
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PMID:Marked elevation of cerebrospinal fluid white blood cell count: an unusual case of Streptococcus pneumoniae meningitis, differential diagnosis, and a brief review of current epidemiology and treatment recommendations. 1596 Oct 5

The purpose of this study is to describe the clinical presentation and bacteriology of adult patients admitted to an urban academic medical center with bacterial meningitis over a 10-year period. In this retrospective review, we identified all adult patients discharged from a tertiary care facility between November 1992 and March 2003 with a diagnosis of bacterial meningitis. Data regarding demographics, vital signs, presenting symptoms, seven predisposing factors, body fluid cultures, cerebrospinal fluid (CSF) findings, and mortality were abstracted. Data were analyzed using descriptive methods. We identified 38 cases. Overall mortality rate was 18.4% (95% confidence interval 7.7-34.3%). The most common of the seven predisposing factors was an immunocompromised state (31.6%). Streptococcus pneumoniae (24.3%), other streptococcus species (24.3%), and Gram-negative rods (16.2%) were the most commonly identified organisms. The classic meningitis triad (fever, neck stiffness, mental status change or headache) was present in only 21.1% of cases. CSF analysis demonstrated WBC >or= 100/mm3 in 81.3%, decreased glucose (< 50 mg/dL) in 50%, and elevated protein (> 45 mg/dL) in 91.2%. With increasing numbers of immunocompromised patients, atypical presentations of bacterial meningitis seem to be more common. A higher percentage of bacterial meningitis cases seem to be caused by Gram-negative rods and Streptococcus species other than Streptococcus pneumoniae. The classic meningitis triad occurred in fewer cases than previously described.
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PMID:Ten years of clinical experience with adult meningitis at an urban academic medical center. 1674 Apr 43

We report an episode of bacterial meningitis in a 45 year-old woman, who was treated with infliximab for Wegener's granulomatosis. This patient presented with the classic clinical presentation of acute meningitis: the triad of fever, neck stiffness, and an altered mental state that appeared 6 months after the infliximab initiation. A computed tomographic (CT) scan of the head showed cerebral edema and Streptococcus pneumoniae was isolated from blood and CSF cultures. Prompt diagnosis and early treatment improved the outcome of this patient.
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PMID:Bacterial meningitis associated with infliximab. 1700 22

In order to evaluate characteristics of nosocomial meningitis in adults, we performed a prospective cohort study of 50 episodes of nosocomial bacterial meningitis. These cases were confirmed by culture of cerebrospinal fluid (CSF) in patients aged >16 years. Classic symptoms of bacterial meningitis (headache, neck stiffness and fever) were present in >70% of the episodes, although only a minority (41%) presented with impairment of consciousness. Underlying conditions, such as a history of neurosurgery, recent head injury, CSF leakage or a distant focus of infection, were present in 94% of the episodes. Staphylococcus aureus was the most common pathogen in patients with a history of neurosurgery, causing 10 of 32 episodes (31%). Patients with a distant focus of infection, such as otitis, sinusitis or pneumonia were more likely to have meningitis due to Streptococcus pneumoniae than patients without [six of nine episodes (67%) vs seven of 41 (17%); P=0.01]. Complications occurred in 50% of the episodes and 16% of the patients died. Our study confirms that adults with nosocomial meningitis are a distinct patient group with specific bacterial pathogens, as compared to those with community-acquired bacterial meningitis. Underlying conditions, especially a history of neurosurgery or a distant focus of infection, were present in the large majority of patients, and mortality and morbidity rates were high.
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PMID:Nosocomial bacterial meningitis in adults: a prospective series of 50 cases. 1743 93

A 55-year-old woman was admitted to our hospital complaining of severe headache with fever and apparent neck stiffness. Neutrophilic pleocytosis was demonstrated in cerebrospinal fluid (CSF) and bacterial meningitis was strongly suspected, but bacterial culture of CSF was negative. After the symptoms normalized within a few days, she developed diabetes insipidus and gadolinium (Gd)-enhancement of the enlarged hypophysis and stalk was observed on cranial MRI. A Lymphocytic Hypophysitis (LH) was clinically diagnosed. Follow-up studies demonstrated spontaneous remission of serological, radiological, and CSF findings, and she was discharged on hormonal replacement therapy with desmopressin. Three months later, she returned to our hospital complaining of headache again under adenohypophysial hypofunction and expanding pituitary lesion on MRI. CSF analysis showed meningitis but there was no evidence of infection by microorganisms. Our diagnosis was relapsing LH with aseptic meningitis, and the patient was administered methylprednisolone pulse therapy, which induced rapid improvement in clinical, endocrinological, and radiological findings. This case showed a possible unique clinical presentation of LH characterized as recurrent aseptic meningitis. It is important to recognize this phenotype of LH, and to prescribe corticosteroid therapy after appropriate endocrinological and radiological studies.
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PMID:[A clinically diagnosed lymphocytic hypophysitis presenting as recurrent meningitis]. 1771 Aug 85

Bacterial meningitis is a life-threatening disease with a high mortality if left untreated. School-age children, adolescents and adults often present with typical symptoms such as fever, headache, neck stiffness and altered mental status, whereas infants show rather unspecific symptoms.The important task of the primary physician is to recognize the life-threatening condition in time and to refer the patient immediately to the next hospital.
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PMID:[When should you suspect meningitis?]. 1772 61

After implementation of programmes for active immunization against Haemophilus influenzae b, Streptococcus pneumoniae and Neisseria meningitidis became the most common agents of bacterial meningitis in childhood. Over a 9-year period, children showing clinical and laboratory findings of meningitis on the basis of their positive cultures of blood or cerebro-spinal fluid (CSF) for S. pneumoniae were enrolled. Predisposing conditions, clinical and laboratory findings, and microbiological and imaging studies were considered. Meningitis-related death or neurological sequelae defined an unfavourable outcome. Sixty-four patients met the inclusion criteria. Thirty-one (48%) children had predisposing conditions to pneumococcal meningitis. Fever and neck stiffness were the main symptoms; 14 patients (22%) reported seizures before admission. Twenty-one patients required treatment in the intensive care unit (ICU). Streptococcus pneumoniae strains were penicillin susceptible in 54 cases (84%). Forty-eight children (75%) showed complete recovery. Two patients (3%) died, and 14 (22%) had sequelae. Patients with a low CSF cell count, low neutrophils, early admission to ICU or infection by penicillin-nonsusceptible strains of S. pneumoniae had an unfavourable outcome more frequently. Low blood neutrophils, low CSF cell count, early admission to ICU and infection by penicillin-nonsusceptible strains are the main factors predicting an unfavourable outcome in children with pneumococcal meningitis.
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PMID:Pneumococcal meningitis in childhood: a longitudinal prospective study. 1787 32


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