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Klein M, Abdel-Hadi C, Bühler R, Grabein B, Linn J, Nau R, Salzberger B, Schlüter D, Schwager K, Tumani H, Weber J, Pfister HW. German guidelines on community-acquired acute bacterial meningitis in adults. Neurol Res Pract 2023; 5:44. [PMID: 37649122 PMCID: PMC10470134 DOI: 10.1186/s42466-023-00264-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 09/01/2023] Open
Abstract
INTRODUCTION The incidence of community-acquired acute bacterial meningitis has decreased during the last decades. However, outcome remains poor with a significant proportion of patients not surviving and up to 50% of survivors suffering from long-term sequelae. These guidelines were developed by the Deutsche Gesellschaft für Neurologie (DGN) under guidance of the Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) to guide physicians through diagnostics and treatment of adult patients with acute bacterial meningitis. RECOMMENDATIONS The most important recommendations are: (i) In patients with suspected acute bacterial meningitis, we recommend that lumbar cerebrospinal fluid (with simultaneous collection of serum to determine the cerebrospinal fluid-serum glucose index and blood cultures) is obtained immediately after the clinical examination (in the absence of severely impaired consciousness, focal neurological deficits, and/or new epileptic seizures). (ii) Next, we recommend application of dexamethasone and empiric antibiotics intravenously. (iii) The recommended initial empiric antibiotic regimen consists of ampicillin and a group 3a cephalosporin (e.g., ceftriaxone). (iv) In patients with severely impaired consciousness, new onset focal neurological deficits (e.g. hemiparesis) and/or patients with newly occurring epileptic seizures, we recommend that dexamethasone and antibiotics are started immediately after the collection of blood; we further recommend that -if the imaging findings do not indicate otherwise -a lumbar CSF sample is taken directly after imaging. (v) Due to the frequent occurrence of intracranial and systemic complications, we suggest that patients with acute bacterial meningitis are treated at an intensive care unit in the initial phase of the disease. In the case of impaired consciousness, we suggest that this is done at an intensive care unit with experience in the treatment of patients with severe CNS diseases. CONCLUSIONS The German S2k-guidelines give up to date recommendations for workup, diagnostics and treatment in adult patients with acute bacterial meningitis.
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Affiliation(s)
- Matthias Klein
- Department of Neurology, LMU Klinikum, Ludwig-Maximilians-University, Munich, Germany
- Emergency Department, LMU Klinikum, Ludwig-Maximilians-University, Munich, Germany
| | | | - Robert Bühler
- Department of Neurology, Bürgerspital, Solothurn, Switzerland
| | - Beatrice Grabein
- Klinische Mikrobiologie und Krankenhaushygiene, LMU Klinikum, Ludwig-Maximilians-University, Munich, Germany
| | - Jennifer Linn
- Department of Diagnostic and Interventional Neuroradiology, Faculty of Medicine and University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Roland Nau
- Department of Neuropathology, Evangelisches Krankenhaus Göttingen-Weende, Georg-August-University, Göttingen, Göttingen, Germany
| | - Bernd Salzberger
- Klinik und Poliklinik für Innere Medizin, University of Regensburg, Regensburg, Germany
| | - Dirk Schlüter
- Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Medizinische Hochschule, Hannover, Germany
| | - Konrad Schwager
- Klinik für Hals-Nasen-Ohrenkrankheiten, Kopf- Hals- und plastische Gesichtschirurgie, Kommunikationsstörungen, Fulda, Germany
| | - Hayrettin Tumani
- Labor für Liquordiagnostik, Neurologische Universitätsklinik Ulm, University of Ulm, Ulm, Germany
| | - Jörg Weber
- Department of Neurology, Klinikum Klagenfurt, Klagenfurt, Austria
| | - Hans-Walter Pfister
- Department of Neurology, LMU Klinikum, Ludwig-Maximilians-University, Munich, Germany
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Esposito SB, Miller AHF, Rajan R, Villalobos T, Yaeger SK. Complication of otitis media leads to opisthotonos in a toddler. Am J Emerg Med 2020; 38:1296.e5-1296.e7. [PMID: 31987742 DOI: 10.1016/j.ajem.2020.01.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 01/14/2020] [Accepted: 01/16/2020] [Indexed: 10/25/2022] Open
Abstract
Opisthotonos, extreme involuntary neck and back extension, is rarely seen in modern emergency departments. Vaccines have prevented the most common causes of this clinical presentation. Alternatively, otitis media is one of the most common pediatric infections and is characteristically non-invasive and harmless. In exceedingly rare cases, otitis media can develop complications and progress to invasive pneumococcal diseases including mastoiditis and meningitis. Streptococcus pneumoniae accounts for the majority of otitis media infections, however, since the introduction of the 7-valent pneumococcal conjugate vaccine (PCV7) and 13-valent pneumococcal conjugate vaccine (PCV13) otitis media and its complications have decreased significantly. The present case reports of a previously healthy and immunized child presenting to a pediatric emergency department (PED) with opisthotonos, and was found to have pneumococcal meningitis, bacteremia and mastoiditis arising from otitis media.
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Affiliation(s)
- Samantha B Esposito
- Lehigh Valley Health Network, Department of Emergency and Hospital Medicine/USF, Morsani College of Medicine, Cedar Crest Boulevard & I-78, Allentown, PA 18103, USA.
| | - Andrew H F Miller
- Lehigh Valley Health Network, Department of Emergency and Hospital Medicine/USF, Morsani College of Medicine, Cedar Crest Boulevard & I-78, Allentown, PA 18103, USA
| | - Roy Rajan
- Lehigh Valley Health Network, Department of Surgery (ENT and Otolaryngology)/USF, Morsani College of Medicine, Cedar Crest Boulevard & I-78, Allentown, PA 18103, USA
| | - Tibisay Villalobos
- Lehigh Valley Health Network, Department of Pediatrics, Section of Infectious Disease/USF, Morsani College of Medicine, Cedar Crest Boulevard & I-78, Allentown, PA 18103, USA
| | - Susan K Yaeger
- Lehigh Valley Health Network, Department of Emergency and Hospital Medicine/USF, Morsani College of Medicine, Cedar Crest Boulevard & I-78, Allentown, PA 18103, USA
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Jit M. The risk of sequelae due to pneumococcal meningitis in high-income countries: a systematic review and meta-analysis. J Infect 2010; 61:114-24. [PMID: 20433866 DOI: 10.1016/j.jinf.2010.04.008] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Revised: 04/21/2010] [Accepted: 04/21/2010] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To determine the risk of various kinds of sequelae in survivors of meningitis due to Streptococcus pneumoniae, as well as the influence of co-factors such as study design, study population and treatment on this risk. METHODS MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from 1 September 1991 to 18 June 2009 for original articles on pneumococcal meningitis sequelae. Prevalence of sequelae was pooled using random effects meta-analysis. Studies were appraised for the influence of referral bias, external validity of study populations, testing procedure and publication bias. RESULTS Data were extracted from 63 studies involving 3408 pneumococcal meningitis survivors. The pooled prevalence of any reported sequelae from 48 studies was 31.7% (95% confidence interval 27.2-36.3%) using a random effects model (Cochran-Q = 277, p < 0.01). Differences in studies due to design, study population and treatment were not significant. The pooled prevalence of hearing loss, seizures, hydrocephalus, spasticity/paresis, cranial nerve palsies and visual impairment was 20.9% (17.1-24.7%), 6.5% (3.3-9.7%), 6.8% (3.3-10.2%), 8.7% (6.4-11.0%), 12.2% (5.3-19.1%) and 2.4% (0-5.7%) respectively. CONCLUSIONS The burden of sequelae due to pneumococcal meningitis remains high in the reviewed studies.
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Affiliation(s)
- Mark Jit
- Modelling and Economics Unit, Health Protection Agency Centre for Infections, London, UK.
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Klein M, Pfister HW, Leib SL, Koedel U. Therapy of community-acquired acute bacterial meningitis: the clock is running. Expert Opin Pharmacother 2009; 10:2609-23. [DOI: 10.1517/14656560903277210] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Dzupova O, Rozsypal H, Prochazka B, Benes J. Acute bacterial meningitis in adults: Predictors of outcome. ACTA ACUST UNITED AC 2009; 41:348-54. [DOI: 10.1080/00365540902849391] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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