Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0085437 (bacterial meningitis)
 4,038 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The clinical and biological characteristics of adult bacterial meningitis are usually unequivocal, but more subtle clinical presentations can be observed. A 24-year-old woman was admitted with fever and abdominal discomfort, which had been developing for 24 hours. There were no meningeal signs, but a transient cutaneous rash was observed on admission. A clear CSF was obtained showing no cytological or biochemical abnormality. Ceftriaxone 2 g was administrated intravenously. In the following hours of admission, a frank meningeal syndrome with purpura appeared, leading to a second lumbar puncture, which revealed purulent CSF. The culture of the first CSF yielded Neisseria meningitidis, while the second CSF remained sterile. This case showed a probable meningococcal rash. This is a reminder that a normal CSF can be obtained early in the course of a proved bacterial meningitis, and that CSF bacterial eradication can occur very rapidly after a single dose of third-generation cephalosporin.
Med Mal Infect
PMID:[Early lumbar puncture and cutaneous rash: a clear CSF is not always a normal CSF]. 1613 58

Few adverse effects have been reported with adjunctive dexamethasone treatment in pneumococcal meningitis. Nevertheless, we report a case of cerebral vasculitis. A 49-year-old man was admitted for fever and altered mental status. Lumbar puncture revealed a high inflammatory response and Streptococcus pneumoniae was identified by culture. Antibacterial therapy and adjunctive dexamethasone treatment were initiated as recommended. The immediate outcome was favorable but due to the onset of focal cerebral abnormalities, a CT scan was performed on the ninth day showing cerebral vasculitis. The patient died on the thirteenth day despite antibacterial therapy and resuscitation. In our case, a secondary neurological worsening appeared when adjunctive dexamethasone treatment was stopped suggesting a rebound effect. Observation of similar cases may lead to modifying adjunctive dexamethasone treatment protocol in bacterial meningitis.
Med Mal Infect 2007 Feb
PMID:[Implication of dexamethasone adjunctive therapy after the onset of cerebral vasculitis in Streptococcus pneumoniae meningitis]. 1726 55

Bacterial meningitis in adults is a severe disease, with high fatality and morbidity rates. Experimental studies showed that the inflammatory response in the subarachnoid space is associated with unfavorable outcome. In these experiments, corticosteroids, and in particular dexamethasone, were able to reduce the inflammatory cascades in the subarachnoid space. The use of corticosteroids as adjunctive therapy in adults with bacterial meningitis was evaluated in eight studies, performed over 45 years. Most studies on adjunctive dexamethasone therapy in adults with bacterial meningitis suffered from methodological flaws. In 2002, a trial with sufficient study-power to show significant differences was published. This study showed that adjunctive dexamethasone therapy reduced the rate of unfavorable outcomes from 25 to 15% in adults with bacterial meningitis. In this study, adjunctive treatment with dexamethasone was given before or with the first dose of antibiotics, without serious adverse effects. A quantitative review showed a consistent beneficial effect of dexamethasone on mortality and a borderline statistical beneficial effect on neurologic sequels. On the basis of available evidence, adjunctive dexamethasone therapy should be initiated before or with the first dose of antibiotics and continued for four days in all adults with suspected or proven community bacterial meningitis in high-income countries, regardless of bacterial etiology. Since prompt use of dexamethasone and appropriate antibiotics improves the prognosis of adults with bacterial meningitis, hospitals will need protocols to include dexamethasone with the initial antibiotic therapy.
Med Mal Infect
PMID:Corticosteroids for acute adult bacterial meningitis. 1938 56

The most frequent bacteria responsible for acute bacterial meningitis, after the neonatal period, are meningoccoci and pneumococci, very rarely Haemophilus influenzae and Listeria monocytogenes. The microbiological diagnosis is based on cell count, Gram stain, and culture of cerebrospinal fluid. Antigen detection and DNA detection are useful to identify the bacteria in cases of negative cultures, because of the fragility of some bacterial species (meningococci), or a prior antibiotic administration, before a lumbar puncture. Some tests for screening antimicrobial resistances are needed, such as those for detection of resistance to betalactam agents in pneumococcal isolates. Blood cultures, serum samples, skin rash biopsies also contribute to the diagnosis.
Med Mal Infect
PMID:[Contribution of microbiological methods to the diagnosis of acute bacterial meningitis]. 1939 76

Bacterial meningitis remains a major cause of death and neurological and hearing sequels. In adults, the death rate ranges from 16 to 37% in meningitis due to Pneumococcus pneumoniae and neurological sequels occur in 30 to 52% of survivors. In childhood, the prognosis is better, with a death rate ranging from 2 to 15%, higher for Pneumococcus pneumoniae. Seventy-five percent of children survive without any sequel, 15% with hearing disorders (up to 30% with Pneumococcus), and rarely (3-4%) present with mental retardation, motor deficit, or epilepsy. In addition to the type of germ, the risk of sequels is six times higher in case of Pneumococcus, several factors of poor prognosis are described on admission: degree of coma, neurological deficit, cranial nerve palsy, high protein level, high erythrocytes count and low leukocytes count in CSF (less than 600 or 1000 leukocytes per microliter). Any neurological complication such as epilepsy, stroke, brain edema, hydrocephalus, or hemodynamic failure will be correlated to a poor outcome. Hearing must be tested within 15 days, followed by audiologic consultation and MRI focused on labyrinths to detect early onset cochlear ossification. One year after meningitis, behavior and cognitive skills must be assessed, including IQ, memory, attention and executive functions, adaptive abilities, to set up specific educative and teaching strategies.
Med Mal Infect
PMID:[Long-term follow-up of bacterial meningitis - sequels in children and adults: incidence, type, and assessment issues]. 1939 75

The use of dexamethasone (DXM) as adjunctive therapy for bacterial meningitis (BM) in infants and children has remained controversial for 20 years. In spite of solid pathophysiological arguments, the limited number of patients, methodological flaws in clinical studies taken individually and pooled into meta-analyses, and the emergence of pneumococcal cephalosporin-resistance did not allow to reach a consensus on the effectiveness of DXM in the prevention of neurological sequelae, in the course of non Haemophilus influenzae b (Hib) BM. A recent meta-analysis conducted with an adequate number of patients (2,750 patients including 2,074 infants and children below 15 years of age) demonstrated that DXM prevented mortality and sequelae in adults with pneumococcal meningitis and suggested that this efficacy could also apply to infants and children. Data from the active surveillance networks of pediatric BM and pneumococcal resistance in France suggested that DXM anti-inflammatory effect on antibiotic CSF penetration would not have a significant impact on the bactericidal efficacy if recommended dosages of cefotaxime (300 mg/kg per day) and vancomycin (60 mg/kg per day) were used. DXM could be considered in the early treatment of pneumococcal BM in infants and children in industrialized countries. But there is no proven efficacy of DXM in meningococcal meningitis in infants and children.
Med Mal Infect
PMID:[Corticosteroids in children with bacterial meningitis: indications and administration]. 1939 73

The epidemiology of acute community-acquired bacterial meningitis in children in industrialized nations was greatly modified because of recommended vaccination against Haemophilus influenzae b, Streptococcus pneumoniae (SP) and in some countries against Neisseria meningitidis (Nm) group C. However, most cases of bacterial meningitis are caused by SP and Nm most frequently group B, which validates the first intention use of cefotaxime or ceftriaxone combined or not with vancomycin according to the probability of pneumococcal resistance.
Med Mal Infect
PMID:[Antibiotic management of pediatric presumptive bacterial meningitis (rational, methods, course, and follow-up)]. 1939 75

This review of pediatric bacterial meningitis was presented in the 17th French Consensus Conference of antimicrobial chemotherapy. It should contribute to the elaboration of guidelines for the treatment of this disease. The incidence of bacterial meningitis rates is 44/100,000 in children under 1 year of age and 6.9/100,000 for children between 1 and 4 years of age (in 2002). Neisseria meningitidis was the most frequently identified bacterium (53.7%) followed by Streptococcus pneumoniae (32.5%), group B streptococci (5.8%), and H. influenzae (3.2%). Group B streptococci predominated in children 28 days to 2 months of age (49.4%) and S. pneumoniae in children 2 to 12 months of age (45.2%). In children older than 1 year of age, N. meningitidis was the most frequently identified bacterium (69.7%). All N. meningitidis strains were susceptible to cefotaxim and ceftriaxone, one-third had decreased susceptibility to penicillin. Ten percent of S. pneumoniae strains were resistant to penicillin G in 2001, but this decreased to 3% in 2005. No strain was resistant to cefotaxim, while 6% had decreased susceptibility to cefotaxim in 2005 and highest MIC was 2 microg/ml. Using new conjugate vaccines and selective pressure on bacterial strains exhibited by antibiotics use have probably changed the epidemiology of pediatric bacterial meningitis in France.
Med Mal Infect
PMID:[Epidemiology of pediatric bacterial meningitis in France]. 1939 74

In 2006, the number of bacterial meningitis cases was estimated at 1375 (2.23/100,000). The leading pathogens involved in adult meningitis were, according to frequency, Streptococcus pneumoniae, Neisseria meningitidis, Listeria monocytogenes, Streptococcus agalactiae, and Haemophilus influenzae. The overall mortality rate averaged 20%, higher among patients with pneumococcal meningitis or in individuals over 65 years of age. Sequels were observed in 30% of cases and more frequent after pneumococcal meningitis. A decrease in susceptibility to antibiotics was reported for N. meningitidis, S. pneumoniae and H. influenzae. Generalized vaccination of children less than two years of age with H. influenzae type b conjugate vaccine has lead to a dramatic decrease in adult H. influenza meningitis. The few cases involved almost exclusively non-typeable strains, presenting in 12% of cases, a modified penicillin binding protein leading to a decreased susceptibility to aminopenicillins. Decreased susceptibility to amoxicillin was observed in 30% of meningococcal isolates, but all strains remained susceptible to parenteral third generation cephalosporins. Resistances to rifampicin or to ciprofloxacin, recommended in meningococcal meningitis prophylaxis, were unusual, but had to be documented. Finally, the proportion of pneumococcal strains with decreased susceptibility to beta-lactams has decreased since 2002. In adult meningitis, pneumococcal isolates with decreased susceptibility to penicillin, amoxicillin, and cefotaxime or ceftriaxone accounted for 37, 18, and 4% of cases respectively. It should be noted that for these isolates, no parenteral third generation cephalosporins MIC was above 2mg/l. Resistance to rifampin was very unusual and all pneumococcal isolates were fully susceptible to glycopeptides.
Med Mal Infect
PMID:[Epidemiology of acute bacterial meningitis in adult patients in France]. 1939 9

Despite breakthroughs in the diagnosis and treatment of infectious diseases, meningitis still remains an important cause of mortality and morbidity. An accurate and rapid diagnosis of acute bacterial meningitis is essential for a good outcome. The gold-standard test for diagnosis is CSF analysis. Gram staining of CSF reveals bacteria in about 50 to 80 % of cases and cultures are positive in at best 80 % of cases. However, the sensitivity of both tests is less than 50 % in patients who are already on antibiotic treatment. CSF leukocyte count and concentration of protein and glucose lack specificity and sensitivity for the diagnosis of meningitis. Other biological tests are available for the diagnosis. Latex agglutination test were adapted for rapid and direct detection of soluble bacterial antigens in CSF of patients suspected with bacterial meningitis. This test is efficient in detecting antigens of most common central nervous system bateria but lacks sensibility. Furthermore, in the early phases of acute bacterial and viral meningitis, signs and symptoms are often non specific and it is not always possible to make a differential diagnosis. Markers like CRP, procalcitonin, or sTREM-1 may be very useful for the diagnosis and to differentiate between viral and bacterial meningitis. Bacterial meningitis diagnosis and management require various biological tests and a multidisciplinary approach.
Med Mal Infect
PMID:[Laboratory diagnosis of bacterial meningitis: usefulness of various tests for the determination of the etiological agent]. 1939 86


1 2 3 Next >>