Acute bacterial meningitis in adults: analysis of 218 episodes

Comparison of culture and PCR methods in the diagnosis of bacterial meningitis

Our aim in this study is to compare the standard culture method with the multiplex PCR and the Speed-Oligo^® Bacterial Meningitis Test (SO-BMT) – a hybridization-based molecular test method – during the CSF examination of the patients with the pre-diagnosis of acute bacterial meningitis. For the purposes of this study, patients with acute bacterial meningitis treated at the Dicle University Medical Faculty Hospital, Infectious Diseases and Clinical Microbiology Clinic between December 2009 and April 2012 were retrospectively evaluated. The diagnosis of bacterial meningitis was made based on the clinical findings, laboratory test anomalies, CSF analysis results, and the radiological images. Growth was observed in the CSF cultures of 10 out of the 57 patients included in the study (17.5%) and Streptococcus pneumoniae was isolated in all of them. The CSF samples of 34 patients (59.6%) were positive according to the SO-BMT and S. pneumoniae was detected in 33 of the samples (97.05%), while Neisseria meningitidis was found in 1 sample (2.95%). In a total of 10 patients, S. pneumoniae was both isolated in the CSF culture and detected in the SO-BMT. The culture and the SO-BMT were negative in 23 of the CSF samples. There was no sample in which the CSF culture was positive although the SO-BMT was negative. While SO-BMT seems to be a more efficient method than bacterial culturing to determine the pathogens that most commonly cause bacterial meningitis in adults, further studies conducted on larger populations are needed in order to assess its efficiency and uses.

Incidence of meningitis secondary to suppurative otitis media in adults

AIM

Meningitis is the commonest intracranial complication of suppurative otitis media, and carries the risk of death and life-changing morbidity. This study aimed to estimate the risk of an adult in the UK developing otogenic meningitis.

METHODS

Adults hospitalised with meningitis in Bristol from 1997 to 2002 were identified retrospectively. Cases confirmed by positive blood culture or cerebrospinal fluid investigation were studied. A case was classified as otogenic if there was coexistent evidence of ear infection.

RESULTS

Eighty-seven cases of meningitis were analysed. The overall mortality rate was 5.7 per cent. Acute and chronic suppurative otitis media accounted for 13 and three cases, respectively. The adult population of Bristol at the midpoint of the study was 635,976.

CONCLUSION

In this study, the age-adjusted incidence of otogenic meningitis was 0.42 per 100,000 per year.

[Managing adult patients with acute community-acquired meningitis presumed of bacterial origin]

Early clinical data must lead to suspect bacterial meningitis if fever, the most frequent sign, is present and if it is associated with more or less constant neurological and meningeal signs (consciousness impairment, headache, neck stiffness, focal neurological deficit, seizure, etc.). A skin rash is frequent in case of meningococcal meningitis whereas cranial nerve palsy is more in favor of tuberculous or Listeria meningitis. Presence of otitis, sinusitis, pneumonia, or a recent head trauma strongly suggests a pneumococcal involvement. Tuberculous meningitis is generally characterized by a slow evolution of meningeal signs together with aspecific signs. The main prognostic factors are consciousness impairment, circulatory instability, focal neurological signs, and advanced age. Morbidity and mortality are increased in case of pneumococcal compared to meningococcal meningitis. Cranial tomodensitometry gives further information about intracranial complications of meningitis. In some cases, particularly if focal neurological or intracranial hypertension signs are present, it must be performed before a lumbar puncture. The risk factors of meningitis must be investigated and treated if possible according to the bacterium. The management of patient after hospital discharge depends on evolution after treatment. The presence of neurological sequels imposes a specialized ambulatory follow-up. Neuropsychological sequels (cognitive dysfunction, memory impairment) can also persist for years even in absence of other neurological disorders.

Changing epidemiology of adult bacterial meningitis in southern taiwan: a hospital-based study

BACKGROUND

Many factors may influence the epidemiologic trend of adult bacterial meningitis (ABM). The objective of this study was to analyze recent epidemiologic trends of ABM in order to provide a better therapeutic strategy.

MATERIALS AND METHODS

The clinical features, laboratory data, and therapeutic outcomes of 181 ABM cases collected in the last 6.5 years (July 1999-December 2005) were analyzed. The results were compared with those of our previous study (202 cases, January 1986-June 1999).

RESULTS

The 181 cases consisted of 130 men (age range: 18-82 years) and 51 women (age range: 18-78 years). Monomicrobial infection and mixed infection were found in 165 cases and 16 cases, respectively. A preceding postneurosurgical state was noted in 56.9% (103/181) of cases. Despite a decrease in incidence, Klebsiella pneumoniae (25.5%, 42/165) was still the most common pathogen. A marked increase of Acinetobacter meningitis (11.5%, 19/165) was noted, which replaced Pseudomonas meningitis as the second most common Gram-negative pathogen in ABM. A marked increase in staphylococcal infection, accounting for 23% (38/165) of all cases, was also noted, of which 76% (29/38) were methicillin-resistant strains. The therapeutic result showed a mortality rate of 30.3% (55/181). Significant prognostic factors included septic shock and age at infection.

CONCLUSIONS

This study revealed a change in the epidemiologic trend of ABM, with an increase in the number of patients with a postneurosurgical state and a rising incidence of Acinetobacter and staphylococcal infections. Clinicians should pay greater attention to these changes, which may affect their management of ABM.

Pooled analysis of 2,408 cases of acute adult purulent meningitis from Turkey

OBJECTIVES

The aim of this study was to systematically review the Turkish literature of acute adult purulent meningitis.

MATERIALS AND METHODS

The published series of three national databases and two international databases were searched to perform the review. In addition to the databases, abstracts of congresses held between 1994 and 2003 by the Turkish Clinical Microbiology and Infectious Diseases Association, Turkish Microbiology Association, and the Antibiotic and Chemotherapy Association were searched for reports about acute purulent meningitis.

RESULTS

Data for 2,408 patients with a diagnosis of acute purulent meningitis were obtained from 30 reports. In terms of clinical findings, 1,254 of 1,570 (79.8%) had fever (>38 degrees C), 1,408 of 1,595 (88.2%) headache, 1,403 of 1,562 (89.8%) stiffness of the neck, and 649 of 784 (82.7%) leukocytosis (>10,000/mm(3)). Cerebrospinal fluid culture yielded a pathogen in 873 of 2,260 (38.6%) patients. The most common pathogen was Streptococcus pneumoniae, followed by Neisseria meningitidis and Staphylococcus aureus. Overall mortality was 425 of 2,408 (17.6%). Pathogen-specific mortality was 60 of 202 (29.7%) for S. pneumoniae and 6 of 100 (6%) for N. meningitidis.

CONCLUSION

Meningitis is a serious, life-threatening disease. More preventive measures should be sought to further decrease the mortality and morbidity related to acute purulent meningitis.

An unusual case of chronic meningitis

BACKGROUND

Chronic meningitis is defined as symptoms and signs of meningeal inflammation and persisting cerebrospinal fluid abnormalities such as elevated protein level and pleocytosis for at least one month.

CASE PRESENTATION

A 62-year-old woman, of unremarkable past medical history, was admitted to hospital for investigation of a four-week history of vomiting, malaise an associated hyponatraemia. She had a low-grade pyrexia with normal inflammatory markers. A CT brain was unremarkable and a contrast MRI brain revealed sub-acute infarction of the right frontal cortex but with no evidence of meningeal enhancement. Due to increasing confusion and patient clinical deterioration a lumbar puncture was performed at 17 days post admission. This revealed gram-negative coccobacilli in the CSF, which was identified as Neisseria meningitidis group B. The patient made a dramatic recovery with high-dose intravenous ceftriaxone antibiotic therapy for meningococcal meningitis.

CONCLUSIONS

1) Chronic bacterial meningitis may present highly atypically, particularly in the older adult. 2) There may be an absent or reduced febrile response, without a rise in inflammatory markers, despite a very unwell patient. 3) Early lumbar puncture is to be encouraged as it is essential to confirm the diagnosis.4) Despite a delayed diagnosis appropriate antibiotic therapy can still lead to a good outcome.

Presentation, time to antibiotics, and mortality of patients with bacterial meningitis at an urban county medical center

Our objective was to analyze the presentation, time to antibiotics, treatment, and mortality of patients with bacterial meningitis at a large urban county hospital over a 10-year period. A retrospective chart review of all patients with the diagnosis of bacterial meningitis was done. Information concerning presentation, etiologic organisms, treatment (including time to antibiotics), and outcomes were collected and analyzed. There were 165 charts reviewed with 171 total cases of bacterial meningitis. For adults with community-acquired meningitis, the mortality rate was 14%, for children it was 1.6%. Seventy-six percent of patients received antibiotics in the Emergency Department (ED) with a mean time to antibiotics of 1:08 h +/- 13 min. The rest received them as inpatients with a mean time to antibiotics of 6 +/- 9 h. The mortality rate for patients with community-acquired disease who received an Emergency Department antibiotic was 7.9%; for patients who received their antibiotics as inpatients the mortality rate was 29%. Our results indicate that the mortality rates from bacterial meningitis at our institution are lower than previously published results. Furthermore, our study supports the concept that the early administration of antibiotics in the ED may reduce mortality and may be an explanation of the lower mortality rates seen here.

[Details of meningitis in the elderly]

PURPOSE

Elderly patients being more at risk for infections than younger people, this study was aimed at defining the epidemiological and clinical features of meningitis in this population, with the objective of improving diagnosis and management.

METHODS

Over a period of 10 years, all cases admitted to an infectious diseases unit for acute meningitis were reviewed. Patients infected by human immunodeficiency virus (HIV), fungi meningitis, and who were younger than 15 years of age were excluded from the study. According to age, two groups were constituted (group A: < 65 years and group B: > or = 65 years) and compared.

RESULTS

One hundred fifty-two patients were included in the study: 110 (72.4%) in group A (29 with bacterial and 81 with viral meningitis) and 42 (26.7%) in group B (32 with bacterial and ten with viral meningitis); the mean age was, respectively, 32.7 +/- 12.9 years (range: 15-61 years) and 75.9 +/- 7.6 years (range: 65-94 years). Diagnosis was less frequently evoked in the elderly (n = 11; 26%) than in younger patients (n = 78; 71%) (P < 0.001). Streptococcus pneumoniae, Listeria monocytogenes, and herpes simplex virus were the three most common causal agents in group B. Confusion was the most common symptom among the elderly (88 vs. 17%; P < 0.001). The mortality rate was more important in group B than in group A (11.9 vs. 2.7%; P = 0.04).

CONCLUSIONS

Diagnosis of acute meningitis is difficult and must be evoked in the presence of any new neurologic sign. Cranial computerized tomography should not delay lumbar puncture, except in the presence of focal neurologic symptoms. Antimicrobial therapy takes into account the bacterial epidemiology.