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

This report emphasizes new clinical information about bacterial meningitis in infants and children. Important elements of diagnosis include examination for the presence of shock and increased intracranial pressure. In such cases, initial treatment should focus on appropriate fluid therapy, administration of oxygen, reduction of intracranial pressure and use of corticosteroids. Currently, antibiotics of choice include ampicillin plus either cefotaxime or ceftriaxone in young infants, and one of these cephalosporins in older patients (beyond 3 months of age). Shorter durations of therapy (5 to 7 days for meningococcus, 7 days for haemophilus and 7-10 days for pneumococcus) are now commonly employed. In many centers, dexamethasone is started before the first dose of antibiotic and continued for 4 days to reduce neurologic and audiologic sequelae. Future trends will include studies of endotoxin neutralizers and non-steroidal anti-inflammatory drugs to reduce further tissue injury in meningitis. Prevention of meningitis is the ultimate goal. Since Haemophilus influenzae vaccination can now begin at 2 months, this approach may bring important results soon.
Clin Pediatr (Phila) 1991 Dec
PMID:Bacterial meningitis--an update. 176 75

Clinical studies of predisposing factors in the development of hearing loss secondary to bacterial meningitis have produced conflicting results. An animal model of meningogenic labyrinthitis was developed for more precise study of these parameters. Rabbits were inoculated intrathecally with 10(5) pneumococci to induce meningitis. Hearing thresholds were measured using auditory-evoked responses to 1 kHz, 10 kHz, and click stimuli before infection and every 12 hours thereafter. Profound deafness occurred in all subjects at an average of 48 hours following infection. The incidence and severity of hearing loss was strongly correlated with the duration of meningitis. Temporal bone histology revealed acute inflammation of all perilymphatic spaces including the cochlear aqueduct. This model demonstrated that the risk and severity of hearing loss increase with the duration of meningitis and suggested that the cochlear aqueduct is an anatomic pathway for the extension of infection from the cerebrospinal fluid to the cochlea. The implications for therapy in humans is discussed.
Laryngoscope 1991 Dec
PMID:Hearing loss and pneumococcal meningitis: an animal model. 176 98

A previously healthy 25 year old sportsman is reported who developed Corynebacterium xerosis meningitis with coma and seizures after spinal anaesthesia. The adequate therapy (dexamethason, penicillin, ampicillin, mannitol, intensive care, hyperventillation) resulted in a complete recovery. To the authors' knowledge this is the first case of Corynebacterium xerosis meningitis and the first bacterial meningitis reported after spinal anaesthesia in Hungary.
Orv Hetil 1991 Dec 30
PMID:[Purulent meningitis, caused by Corynebacterium xerosis, after spinal anesthesia]. 176 61

Quantitative C-reactive protein (CRP) was determined sequentially by nephelometry and photometry from a finger prick serum sample in 67 children with bacterial meningitis (BM) and 16 children with aseptic meningitis (AM). The initial mean CRP value of 180 mg/liter in children with BM differed significantly from the 12 mg/liter found in those with AM (P less than 0.001). In BM a slow descent instead of rapid normalization or a secondary increase in sequential CRP values were early indicators of complications during recovery, such as resistance to the antibiotic. A significant difference in the mean CRP values between uneventful and complicated courses of BM was observed from the fourth day on (P less than 0.001). The measurements obtained with nephelometry correlated reliably with the more widely available photometry (r = 0.99). Easily performed rapid CRP determinations can considerably improve the quality of care in meningitis patients, especially in those situations where facilities for performing bacterial cultures or antibiotic susceptibility testing are not available.
Pediatr Infect Dis J 1991 Dec
PMID:Serum C-reactive protein in childhood meningitis in countries with limited laboratory resources: a Chilean experience. 176 8

Bacterial meningitis is one of complications in the elderly with neurosurgical procedures. In an attempt to find the clinical features of this complication we analyzed 10 cases, which were found in 30 cases of the bacterial meningitis in Tokyo Metropolitan Geriatric Hospital from 1972 to 1989. The patients were 4 males and 6 females, 52-86 years old (the mean, 69). While 2 Enterococcus species were isolated after craniotomy, Staphylococci were common pathogens (4 S. aureus, 4 S. epidermidis and 1 P. aeruginosa) in patients with shunt infection. Most of these patients lacked typical manifestations of meningitis except the fever. Symptoms occurred long after surgery with little abnormality in the data of serum and cerebrospinal fluid. However, blood cultures were positive in 75% of the cases. Removal of the infected catheter was effective in the cases of shunt infection.
Kansenshogaku Zasshi 1991 Dec
PMID:[Bacterial meningitis in the elderly with neurosurgical procedures]. 178 5

Bacterial meningitis is a serious infectious disease, the course of which depends on the correct use of antibiotics and an intensive symptomatic and support therapy. The presence of microbes and their fractions in the CNS determines inflammatory phenomena that lead, through complex mechanisms, to the supportive treatment has the purpose of curbing the inflammatory phenomena, reducing cerebral oedema and avoiding ischaemia. This therapy makes use of cortisone and mannitol. The effectiveness of cortisone in reducing cerebral damage and, consequently, the neurological sequelae of the disease has been documented in experimental models and in man. After analysing the pathogenetic events of cerebral damage and the rationale of the treatment, reference is made to a personal therapeutic protocol that includes an aetiological treatment (Ceftriaxone 100 mg/kg/die), a support therapy (dexamethasone 0.2-0.3 mg/kg/die, mannitol, water restriction) and a symptomatic therapy (for convulsions, high temperature and shock). Both the antibiotic and cortisone are also introduced into the spine on the occasion of lumbar injection. 122 children suffering from non-tubercular bacterial meningitis, admitted to the Emergency Department of the Regina Margherita Infant Hospital of Turin in the period 1984-89, were treated. A further 7 patients, admitted for the same pathology, died within a few hours. In 88% of cases, aetiological agents were found by bacterioscopic and/or cultural and/or co-agglutinin on liquor examination (Neisseria meningitidis 47.5%, Haemophilus influenzae 20.5%, Streptococcus pneumoniae 15.6%, others 4.1%). The patients were treated with support therapy for as long as clinical conditions required it and with Ceftriaxone until clinical cure, end of fever and normalisation of PRC. In the reported series, 90% of patients were treated for from 3 to 6 days. This duration of antibiotic therapy is shorter than that reported and recommended in the literature. Therapeutic results were very good with 95% cure without neurological sequelae even at 6 month/1 year follow-up. Only 6 patients reported sequelae (2 irritative anomalies at EEG, 3 hypoacusis, 12 psychomotor retardation). The results were also better than those reported in the Italian and foreign literature. The Authors are convinced that, in the hands of experienced physicians, timely antibiotic, anti-inflammatory, cerebral anti-oedema and symptomatic treatment will improve the prognosis for bacterial meningitis in infancy.
Minerva Pediatr 1991 Dec
PMID:[Rational bases of current etiopathogenetic therapy of bacterial meningitis. Review of the literature and personal experience in 122 pediatric cases]. 179 1

The pathological basis of hearing loss in bacterial meningitis was investigated using an animal model of Streptococcus suis meningitis. Forty guinea-pigs were infected after their hearing had been assessed by brain stem auditory evoked potentials. In 17 animals, it was possible to repeat the procedure at the onset of meningitis; this included one animal with subclinical disease. Fifteen animals showed evidence of hearing loss, which on subsequent histological examination was found to be associated invariably with suppurative labyrinthitis. The remaining two animals without hearing loss had normal cochleas. It is suggested that cochlear sepsis rather than eighth cranial nerve involvement by meningeal sepsis is primarily responsible for hearing loss in bacterial meningitis, and that bacteria enter the cochlea via the cochlear aqueduct and not the internal auditory canal. The tissue within the lumen of the cochlear aqueduct may act as a barrier against invasion by micro-organisms, and haemolytic streptococci could cause lysis of this barrier by the exotoxins they produce.
Neuropathol Appl Neurobiol 1991 Dec
PMID:The site of the lesion causing hearing loss in bacterial meningitis: a study of experimental streptococcal meningitis in guinea-pigs. 180 Sep 12

Although intensive care medicine and chemotherapy of bacterial infections have made great progress during the last 30 years, therapeutic efficacy in bacterial meningitis in adult patients could not be improved. Retrospective analysis of 391 cases of adult bacterial meningitis between 1950 and 1985 shows no significant changes in etiology and only slight reduction in mortality. The course of the disease depends mostly on age, state of consciousness and CSF cell count. Cases of meningitis in HIV patients and cerebral tuberculosis have not been evaluated in this study.
Med Klin (Munich) 1990 Dec 15
PMID:[Fatality of purulent meningitis in adults 1950 to 1985. Retrospective study of the case histories of 391 patients of the Cologne Neurologic University Clinic]. 208 9

Patients infected with HIV demonstrate increased susceptibility to serious infections with non-typhoidal salmonellae. However, no cases of salmonella meningitis have been reported in this population. We now report three cases of salmonella meningitis which occurred in a population of 1800 patients with AIDS or AIDS-related complex at our hospitals. The incidence of meningitis complicating salmonella infection in our HIV-infected population appears to be much higher than that reported in non-AIDS patients (7.5 versus 0.15%). All had cerebrospinal fluid parameters consistent with bacterial meningitis, and two of three revealed organisms on cerebrospinal fluid Gram stain. Two presented with a fulminant illness and died despite therapy; the third developed a brain abscess associated with a relapse of meningitis. Salmonella meningitis should be considered as a cause of acute neurological deterioration in patients at risk for HIV-related disease. Relapses may occur, and mortality is high.
AIDS 1990 Dec
PMID:Salmonella meningitis and infection with HIV. 208 4

Bacterial meningitis is frequently diagnosed in children below the age of five years. Recently our understanding of the pathophysiology of meningitis has been enhanced by several innovative studies. In addition the development and future application of conjugate vaccines against H. influenzae, N. meningitidis, and S. pneumoniae will result in a substantial reduction of morbidity and mortality in patients with meningitis caused by these microorganisms. This review will discuss the current status on the epidemiology, pathophysiology, prevention and treatment of meningitis.
Tijdschr Kindergeneeskd 1990 Dec
PMID:[Bacterial meningitis in young children. Current viewpoints in pathogenesis, treatment and prevention]. 208 31


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