-
Continuum (Minneapolis, Minn.) Dec 2015Bacterial infections of the central nervous system are neurologic emergencies. Prompt recognition and treatment are essential not only to prevent mortality, but also to... (Review)
Review
PURPOSE OF REVIEW
Bacterial infections of the central nervous system are neurologic emergencies. Prompt recognition and treatment are essential not only to prevent mortality, but also to decrease neurologic sequelae. This article focuses on the two most common central nervous system bacterial infections, bacterial meningitis and spinal epidural abscess.
RECENT FINDINGS
Two outbreaks of serogroup B meningococcal disease have occurred on US college campuses. The meningococcal vaccine given to young adults does not contain serogroup B.
SUMMARY
In bacterial meningitis and in bacterial spinal epidural abscess, the identification of and eradication of the pathogen with antimicrobial therapy is the easy part. It is the recognition of the disorder, the understanding of which diagnostic studies to obtain and their limitations, and the management of the neurologic complications that require the expertise of a neurologist.
Topics: Central Nervous System Bacterial Infections; Epidural Abscess; Humans; Meningitis, Bacterial
PubMed: 26633782
DOI: 10.1212/CON.0000000000000242 -
Indian Pediatrics Oct 2018
Topics: Child; Child, Preschool; History, 17th Century; History, 18th Century; History, 19th Century; History, 20th Century; History, 21st Century; Humans; India; Infant; Infant, Newborn; Meningitis, Bacterial; Vaccination
PubMed: 30426957
DOI: No ID Found -
International Journal of Molecular... Feb 2023Despite advances in supportive care and antimicrobial treatment, bacterial meningitis remains the most serious infection of the central nervous system (CNS) that poses a... (Review)
Review
Despite advances in supportive care and antimicrobial treatment, bacterial meningitis remains the most serious infection of the central nervous system (CNS) that poses a serious risk to life. This clinical dilemma is largely due to our insufficient knowledge of the pathology behind this disease. By controlling the entry of molecules into the CNS microenvironment, the blood-brain barrier (BBB), a highly selective cellular monolayer that is specific to the CNS's microvasculature, regulates communication between the CNS and the rest of the body. A defining feature of the pathogenesis of bacterial meningitis is the increase in BBB permeability. So far, several contributing factors for BBB disruption have been reported, including direct cellular damage brought on by bacterial virulence factors, as well as host-specific proteins or inflammatory pathways being activated. Recent studies have demonstrated that targeting pathological factors contributing to enhanced BBB permeability is an effective therapeutic complement to antimicrobial therapy for treating bacterial meningitis. Hence, understanding how these meningitis-causing pathogens affect the BBB permeability will provide novel perspectives for investigating bacterial meningitis's pathogenesis, prevention, and therapies. Here, we summarized the recent research progress on meningitis-causing pathogens disrupting the barrier function of BBB. This review provides handy information on BBB disruption by meningitis-causing pathogens, and helps design future research as well as develop potential combination therapies.
Topics: Humans; Blood-Brain Barrier; Meningitis, Bacterial; Central Nervous System; Biological Transport; Bacteria
PubMed: 36769171
DOI: 10.3390/ijms24032852 -
BMC Medicine Jun 2021Diagnosing bacterial meningitis is essential to optimise the type and duration of antimicrobial therapy to limit mortality and sequelae. In sub-Saharan Africa, many...
BACKGROUND
Diagnosing bacterial meningitis is essential to optimise the type and duration of antimicrobial therapy to limit mortality and sequelae. In sub-Saharan Africa, many public hospitals lack laboratory capacity, relying on clinical features to empirically treat or not treat meningitis. We investigated whether clinical features of bacterial meningitis identified prior to the introduction of conjugate vaccines still discriminate meningitis in children aged ≥60 days.
METHODS
We conducted a retrospective cohort study to validate seven clinical features identified in 2002 (KCH-2002): bulging fontanel, neck stiffness, cyanosis, seizures outside the febrile convulsion age range, focal seizures, impaired consciousness, or fever without malaria parasitaemia and Integrated Management of Childhood Illness (IMCI) signs: neck stiffness, lethargy, impaired consciousness or seizures, and assessed at admission in discriminating bacterial meningitis after the introduction of conjugate vaccines. Children aged ≥60 days hospitalised between 2012 and 2016 at Kilifi County Hospital were included in this analysis. Meningitis was defined as positive cerebrospinal fluid (CSF) culture, organism observed on CSF microscopy, positive CSF antigen test, leukocytes ≥50/μL, or CSF to blood glucose ratio <0.1.
RESULTS
Among 12,837 admissions, 98 (0.8%) had meningitis. The presence of KCH-2002 signs had a sensitivity of 86% (95% CI 77-92) and specificity of 38% (95% CI 37-38). Exclusion of 'fever without malaria parasitaemia' reduced sensitivity to 58% (95% CI 48-68) and increased specificity to 80% (95% CI 79-80). IMCI signs had a sensitivity of 80% (95% CI 70-87) and specificity of 62% (95% CI 61-63).
CONCLUSIONS
A lower prevalence of bacterial meningitis and less typical signs than in 2002 meant the lower performance of KCH-2002 signs. Clinicians and policymakers should be aware of the number of lumbar punctures (LPs) or empirical treatments needed for each case of meningitis. Establishing basic capacity for CSF analysis is essential to exclude bacterial meningitis in children with potential signs.
Topics: Child; Child, Hospitalized; Humans; Infant; Kenya; Meningitis, Bacterial; Retrospective Studies; Spinal Puncture
PubMed: 34082778
DOI: 10.1186/s12916-021-01998-3 -
European Journal of Pediatrics Feb 1995Bacterial meningitis continues to be a serious infectious disease with a high morbidity and mortality in young children. Early recognition and initiation of adequate... (Review)
Review
Bacterial meningitis continues to be a serious infectious disease with a high morbidity and mortality in young children. Early recognition and initiation of adequate treatment are the major determinants for a good outcome. Recent advances in our understanding of the host inflammatory response by cytokines may result in the use of new therapeutic strategies. Such modulation of the inflammatory response may reduce the incidence of sequelae and death. The use of steroids as adjunctive therapy in children with bacterial meningitis probably has beneficial effects although the available data are still controversial. Additionally, studies in experimental meningitis models indicate that non-steroidal anti-inflammatory drugs and monoclonal antibodies against bacterial products, cytokines and CD18 on leucocytes reduce the extent of the meningeal inflammation. Human studies to evaluate the efficacy of these immune modulators are expected to start soon. However, prevention of bacterial meningitis by conjugate vaccines against Streptococcus pneumoniae and Neisseria meningitidis will be the most promising development in the next decade.
Topics: Humans; Meningitis, Bacterial
PubMed: 7720755
DOI: 10.1007/BF01991906 -
The Brazilian Journal of Infectious... 2019The precise diagnosis of bacterial meningitis is essential. Cytological and biochemical examination of cerebrospinal fluid (CSF) are not specific. Conventional methods...
The precise diagnosis of bacterial meningitis is essential. Cytological and biochemical examination of cerebrospinal fluid (CSF) are not specific. Conventional methods for bacterial meningitis lack sensitivity or take too long for a final result. Therefore, other methods for rapid and accurate diagnosis of central nervous system infections are required. FilmArray meningitis/encephalitis (ME) panel is a PCR multiplex for simultaneous and rapid identification of 14 pathogens, including 6 bacteria, 7 viruses, and Cryptococcus. We evaluated 436 CSF samples submitted to FilmArray ME Panel. Among them, 25 cases were positive for bacteria, being Streptococcus pneumonia the most frequent (48 %). Among positive cases for bacteria, 60 % were positive only with FilmArray. All the bacterial meningitis cases in which the only positive test was FilmArray had CSF findings suggestive of bacterial meningitis, including neutrophilic pleocytosis, increased CSF protein and lactate, and decreased CSF glucose. These findings suggest that FilmArray may increase the diagnostic sensitivity for bacterial meningitis.
Topics: Bacteria; Cerebrospinal Fluid; Humans; Meningitis, Bacterial; Microbial Sensitivity Tests; Multiplex Polymerase Chain Reaction; Sensitivity and Specificity; Viruses
PubMed: 31738885
DOI: 10.1016/j.bjid.2019.10.008 -
PLoS Neglected Tropical Diseases 2015Streptococcus suis is the most common cause of meningitis in pork consuming and pig rearing countries in South-East Asia. We performed a systematic review of studies on... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Streptococcus suis is the most common cause of meningitis in pork consuming and pig rearing countries in South-East Asia. We performed a systematic review of studies on S. suis meningitis to define the clinical characteristics, predisposing factors and outcome.
METHODOLOGY
Studies published between January 1, 1980 and August 1, 2015 were identified from main literature databases and reference lists. Studies were included if they were written in West-European languages and described at least 5 adult patients with S. suis meningitis in whom at least one clinical characteristic was described.
FINDINGS
We identified 913 patients with S. suis meningitis included in 24 studies between 1980 and 2015. The mean age was 49 years and 581 of 711 patients were male (82%). Exposure to pigs or pork was present in 395 of 648 patients (61%) while other predisposing factors were less common. 514 of 528 patients presented with fever (97%), 429 of 451 with headache (95%), 462 of 496 with neck stiffness (93%) and 78 of 384 patients (20%) had a skin injury in the presence of pig/pork contact. The case fatality rate was 2.9% and hearing loss was a common sequel occurring in 259 of 489 patients (53%). Treatment included dexamethasone in 157 of 300 (52%) of patients and was associated with reduced hearing loss in S. suis meningitis patients included in a randomized controlled trial.
CONCLUSION
S. suis meningitis has a clear association with pig and pork contact. Mortality is low, but hearing loss occurs frequently. Dexamethasone was shown to reduce hearing loss.
Topics: Age Distribution; Animals; Anti-Inflammatory Agents; Asia, Southeastern; Dexamethasone; Environmental Exposure; Humans; Meningitis, Bacterial; Mortality; Occupational Exposure; Risk Factors; Sex Distribution; Streptococcal Infections; Streptococcus suis; Swine
PubMed: 26505485
DOI: 10.1371/journal.pntd.0004191 -
Archives of Disease in Childhood Jul 2003This review focuses on recent advances of topical interest regarding the diagnosis and treatment of common causes of bacterial meningitis occurring in children beyond... (Review)
Review
This review focuses on recent advances of topical interest regarding the diagnosis and treatment of common causes of bacterial meningitis occurring in children beyond the neonatal period. Tuberculous meningitis is beyond the scope of this review.
Topics: Anti-Bacterial Agents; Child; Child, Preschool; Dexamethasone; Drug Resistance, Bacterial; Fluid Therapy; Glucocorticoids; Humans; Infant; Intracranial Hypertension; Meningitis, Bacterial; Spinal Puncture
PubMed: 12818910
DOI: 10.1136/adc.88.7.615 -
Medicina 2024Streptococcus suis (S. suis) is a globally prevalent swine pathogen, capable of generating infections in humans who were in contact with the animal or its raw meat....
Streptococcus suis (S. suis) is a globally prevalent swine pathogen, capable of generating infections in humans who were in contact with the animal or its raw meat. Clinical manifestations range from asymptomatic cases to systemic involvement, with low mortality, but with the possibility of leaving definitive sequelae such as ataxia and hearing loss. There are few case reports, due to lack of knowledge of the disease and its atypical presentation. The objective of this article is to report the case of a man with an occupational history of contact with pigs, who was admitted for meningitis and in whom the isolation of S. suis was obtained in cerebrospinal fluid and paired blood cultures; He completed antibiotic treatment adjusted to bacterial sensitivity, and was left with mild hearing loss as a consequence.
Topics: Streptococcus suis; Humans; Male; Meningitis, Bacterial; Streptococcal Infections; Animals; Swine; Anti-Bacterial Agents; Adult; Middle Aged
PubMed: 38683518
DOI: No ID Found -
Epilepsia Aug 2008The high incidence and prevalence of epilepsy in developing countries has partly been attributed to an increased frequency of central nervous system (CNS) infections. Of...
The high incidence and prevalence of epilepsy in developing countries has partly been attributed to an increased frequency of central nervous system (CNS) infections. Of the CNS infections, bacterial meningitis is endemic in many countries and several epidemics have also been reported in these regions. Unprovoked seizures and epilepsy (recurrent unprovoked seizures) can be long-term sequelae of bacterial meningitis. The probability of developing an unprovoked seizure or epilepsy varies according to the etiologic agent responsible for meningitis and this probability appears to be higher for Streptococcus pneumoniae. The risk factors for late unprovoked seizures/epilepsy include early seizures during the acute phase of meningitis and persistent neurological deficits other than sensorineural hearing loss. The majority of unprovoked seizures occur within 5 years of the meningitis episode and tend to be recurrent. The burden of epilepsy associated with bacterial meningitis depends upon the incidence of the latter and hence is to some extent preventable. Implementing vaccination programs against the three most important meningeal pathogens can reduce the incidence of bacterial meningitis. In developed countries, a decline in the incidence of bacterial meningitis has been accomplished with the implementation of vaccination programs.
Topics: Cost of Illness; Developing Countries; Epilepsy; Humans; Incidence; Meningitis, Bacterial; Prevalence; Prognosis; Risk Factors; Severity of Illness Index; Streptococcal Infections
PubMed: 18754955
DOI: 10.1111/j.1528-1167.2008.01750.x