A study on the clinical outcomes and management of meningitis at a tertiary care centre

Yerramilli, Aparna; Mangapati, Priya; Prabhakar, Subhashini; Sirimulla, Harish; Vanam, Shravani; Voora, Yashaswini

doi:10.4103/neuroindia.ni_785_15

Cited by 16 publications

(18 citation statements)

References 2 publications

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“…As other previous studies have shown [17,46], the CSF parameters were diagnostic for bacterial meningitis and did not differ between the two groups; therefore, these parameters were still helpful for the diagnosis of meningitis.…”

Section: Discussionsupporting

confidence: 63%

“…Diabetes mellitus is steadily increasing in western societies, and its association with the development of several types of infection is well-known [4,8,11,16,[19][20][21]. On the other hand, common infections in diabetic patients may be caused by unusual pathogens, and the presentation and course may be different from those without DM, which may delay the correct diagnosis and the adequate therapy [9][10][11][12][13][14][15][17][18][19].…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of spontaneous BM in diabetic patients is unknown since most of the previous reports have combined spontaneous and post-neurosurgical meningitis, or diabetes has not been the focus of the study [9,[17][18][19]. A recent study describes communityacquired bacterial meningitis in patients with and without diabetes, but this study focused on community-acquired, culture-proven meningitis [20].…”

Section: Introductionmentioning

confidence: 99%

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Characteristics and outcome of spontaneous bacterial meningitis in patients with diabetes mellitus

et al. 2020

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Background: Studies on bacterial meningitis in diabetics patients versus non-diabetics are scarce. In patients with diabetes, bacterial meningitis may have a different presentation, etiology and course. We analyzed and compared the characteristics and outcome of spontaneous BM in adult patients with and without diabetes mellitus (DM). Methods: We performed a single-center, prospective observational cohort study, conducted between 1982 and 2017, in a tertiary university hospital in Barcelona (Spain). The primary outcome measure was in-hospital mortality. Results: We evaluated 715 episodes of bacterial meningitis; 106 patients (15%) had diabetes mellitus. Patients with diabetes were older (median 67 [IQR 17] vs 49 [IQR 40] years, p < 0.001) and more often had a Charlson comorbidity score of ≥3 (40% vs 15%, p < 0.001). Neck stiffness (56% vs 75%, p < 0.001), headache (41% vs 78%) p < 0.001), nausea and/or vomiting (32% vs 56% p < 0.001), and rash (12% vs 26%, p = 0.007) were less frequent in diabetics, whereas altered mental status was more common. Streptococcus pneumoniae and Listeria meningitis were the most common etiologic agents (24 and 18%, respectively). Listeria was more frequent (18% vs. 10%, p = 0.033), whereas meningococcal meningitis was less frequent (10% vs 32%, p < 0.001). Overall mortality was higher in patients with diabetes (26% vs 16%, p = 0.025) concerning non-diabetics. Conclusions: Patients with bacterial meningitis and diabetes mellitus are older, have more comorbidities, and higher mortality. S. pneumoniae and L. monocytogenes are the predominant pathogens, Listeria being more common, whereas Neisseria meningitidis is significantly less frequent than in non-diabetics.

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Section: Discussionsupporting

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Characteristics and outcome of spontaneous bacterial meningitis in patients with diabetes mellitus

et al. 2020

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“…A very similar study conducted on a 5-year retrospective clinical data in East England during [17] showed that highest prevalence of fever and headache (82% each), and neck rigidity was one of it. The other study done in India also revealed the same finding [25].…”

Section: Fig 1 Organisms Isolated From Csf Cultures Of Patients Of supporting

confidence: 66%

A Five Years Retrospective Study on Etiology and Clinical Analysis of Meningitis in St. Paul’s Hospital Millennium Medical College Pediatric Ward from 2012-2016

Ayele

Bitew

Temesgen

et al. 2019

IJTDH

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Meningitis is the sever CNS pyogenic infections which primarily affects infants and children. Ethiopia is one of the countries where meningitis is endemic and frequent episodes of meningococcal epidemics are very common in the dry season (December to June). The main purpose of this study was to identify determinants and clinical analysis of meningitis in pediatrics ward admitted to St.Paul’s hospital millennium medical college pediatrics wards from 2012-2016. A retrospective study on etiology and clinical analysis of meningitis was conducted at the pediatric unit. The study population was all pediatric patients admitted with meningitis that were presented in ward during the study period. Those fulfilling the mentioned inclusion criteria were included. The data were collected using a structured format in September /2016. From the study population 95 cases fulfilled the inclusion criteria and 64 & 31 of them were males and females, respectively making a male to female ratio of 2:1. The most significant seasonal variation was observed for N. meningitidis having high incidence in the 2nd quarter (April to June). In the dry season 18 cases were diagnosed using the culture results. Culture findings also revealed that S. pneumonia was one of the commonest causes of bacterial meningitis. The most common symptom was fever with high grade fever (>38oC) recorded in 84 (88.4%) of cases. Most (65.5 %). of clients were recovered from meningitis at the end of the treatment where as death was the second outcome with 17(20.2 %) cases ended up with death. Neurological or other complications were seen in 9(10.7 %) cases.

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“…Similarly, Yerramilli et al in 2017 studied 147 cases of suspected meningitis in a tertiary hospital in India and found the incidence of TBM to be around 28%. 11 Out of 100 suspected cases of meningitis, 22 were diagnosed as TBM in our study. Clinical findings on presentation were headache (87%), fever (78%), neck rigidity (69%), seizure (52%) and 74% had altered sensorium.…”

Section: Discussionmentioning

confidence: 79%

A Study on the Utility of GeneXpert in Cerebrospinal Fluid in the Diagnosis of Tuberculous Meningitis

Sundar¹,

Iqbal²,

Mookkappan³

et al. 2020

jebmh

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BACKGROUND One of the most common forms of central nervous tuberculosis is tubercular meningitis and has high morbidity and mortality. The natural course of TBM is subacute in nature; hence, the symptoms may persist for weeks before diagnosis. The diagnosis of tuberculosis is based on clinical presentation and cerebrospinal fluid analysis. GeneXpert is a reliable and rapid diagnostic modality for diagnosing pulmonary tuberculosis. Various studies have shown various sensitivity patterns of GeneXpert in TBM. This study aims to find the utility of GeneXpert in TBM. METHODS All adult patients who presented with signs and symptoms of meningitis were included in the study. Detailed history was recorded and physical examination done. All patients were subjected to routine blood investigations, chest X ray, brain imaging along with lumbar puncture for cerebrospinal fluid (CSF) analysis. Apart from routine CSF analysis for cell type, cell count, and biochemical analysis, 3-5 ml of CSF was sent for GeneXpert to intermediate reference laboratory at Government Hospital for Chest Diseases, Pondicherry. On the basis of clinical history, examination, and investigations, composite gold standard for the diagnosis of TBM was defined. The composite gold standard included definite case of TBM, highly probable case of TBM, probable case of TBM and definitely not TBM. Sensitivity and specificity were calculated for GeneXpert for the composite gold standard. RESULTS 100 patients were included in the study. 64 were males and 36 were females. TBM was detected in 22 cases. Mean age for TBM was 42 ± 19.2 years. Among 22 cases of TBM, only one case was categorized as definite TBM, and the rest 21 were either highly probable TBM (7) or probable TBM cases (14). Common clinical signs and symptoms on presentation were headache (87%), fever (78%), neck rigidity (69%), seizure (52%) and altered sensorium (74%). GeneXpert and CSF culture was positive in only one case with sensitivity of 14% and specificity of 100%. Adenosine deaminase (ADA) was high in 13 cases with sensitivity of 60% and specificity of 100%. CONCLUSIONS The utility of GeneXpert in diagnosing tubercular meningitis is very insignificant. Negative GeneXpert in CSF analysis does not rule out TBM as sensitivity is 14% but positive GeneXpert has 100% specificity. In the absence of reliable diagnostic test, clinician should look for specific signs and symptoms of meningitis along with routine CSF analysis and CSF ADA level.

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A study on the clinical outcomes and management of meningitis at a tertiary care centre

Cited by 16 publications

References 2 publications

Characteristics and outcome of spontaneous bacterial meningitis in patients with diabetes mellitus

Characteristics and outcome of spontaneous bacterial meningitis in patients with diabetes mellitus

A Five Years Retrospective Study on Etiology and Clinical Analysis of Meningitis in St. Paul’s Hospital Millennium Medical College Pediatric Ward from 2012-2016

A Study on the Utility of GeneXpert in Cerebrospinal Fluid in the Diagnosis of Tuberculous Meningitis

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