Bacterial meningitis and COVID-19: a complex patient journey

Hurn, Eliot; Dickinson, Lauren; Abraham, Jijie Annie

doi:10.1136/bcr-2020-239533

Cited by 7 publications

(7 citation statements)

References 11 publications

(10 reference statements)

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“…Prior to the pandemic, we admitted an average of two patients per year to our ICU for bacterial meningitis; by contrast, we did not admit any patients for this condition during the pandemic, which explains why two cases in a single week caught our attention. Although several reports have described otitis media [5,6] and meningitis [7][8][9][10] in patients with COVID-19, to our knowledge, no cases of bacterial meningitis secondary to otitis media in these patients have been described to date. We believe that the development of two such cases in such a short time span is highly unlikely to be coincidental, especially given that involvement of the omicron variant of SARS-CoV-2 is biologically plausible in both of these cases.…”

Section: Discussionmentioning

confidence: 68%

Pneumococcal meningitis secondary to otitis media in two patients with COVID-19 omicron variant

et al. 2022

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Background The SARS-CoV-2 omicron variant produces more symptoms in the upper respiratory tract than in the lower respiratory tract. This form of “common cold” can cause inflammation of the oropharynx and the Eustachian tube, leading to the multiplication of bacteria such as Streptococcus pneumoniae in the oropharynx. Eustachian tube dysfunction facilitates migration of these bacteria to the middle ear, causing inflammation and infection (otitis media), which in turn could lead to further complications such as acute mastoiditis and meningitis. Case presentation In January 2022, during the rapid spread of the omicron variant of the SARS-CoV-2 virus, two patients presented to the emergency room at our hospital complaining of headache and a low level of consciousness. A few days prior to admission, the patients had been diagnosed with COVID-19 based on clinical manifestations of a cold virus, without respiratory failure. Cranial computed tomography revealed signs of bilateral invasion of the middle ear in both cases. Lumbar puncture was compatible with acute bacterial meningitis, and S. pneumoniae was isolated in cerebrospinal fluid in both patients. RT-PCR tests for SARS-CoV-2 were repeated, confirming the presence of the omicron variant in one of the patients. We were unable to confirm the variant in the second patient due to the low viral load in the nasopharyngeal sample obtained at admission. However, the time of diagnosis (i.e., during the peak spread of the omicron variant), strongly suggest the presence of the omicron variant. Both patients were admitted to the intensive care unit and both showed rapid clinical improvement after initiation of antibiotic treatment. Conclusions The omicron variant of the SARS-CoV-2 virus can promote the development of otitis media and secondary acute bacterial meningitis. S. pneumoniae is one of the main bacteria involved in this process.

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Section: Discussionmentioning

confidence: 68%

Pneumococcal meningitis secondary to otitis media in two patients with COVID-19 omicron variant

et al. 2022

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“…Multiple case reports in the literature have reported that lumbar puncture is contraindicated, and therefore CSF could not be obtained for SARS-CoV-2 testing [ 51 , 52 ]. In addition, there were many cases where lumbar puncture was performed but CSF was not tested for SARS-CoV-2 without providing justifications for not testing [ 53 , 54 , 55 , 56 ]. Other case studies reported that CSF samples were not tested for COVID-19 because there is no Food and Drug Administration (FDA) approved PCR kit or a commercially available kit for SARS-CoV-2 diagnosis in CSF [ 57 , 58 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical Implications of COVID-19 Presence in CSF: Systematic Review of Case Reports

Elmakaty

Ferih

Karen

et al. 2022

Cells

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This systematic review focused on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients that had detected SARS-CoV-2 virus in cerebrospinal fluid (CSF). A systematic literature search was carried out in PubMed, Embase, Scopus, Web of Science, Medrxiv, and Biorxiv databases from inception to 19 December 2021. Case reports or case series involving patients with proved SARS-CoV-2 presence in CSF by polymerize chain reaction were included. Our search strategy produced 23 articles documenting a total of 23 patients with positive SARS-CoV-2 in the CSF. Fever (55%) was the most common symptom, followed by headaches (41%), cough (32%), and vomiting/nausea (32%). The majority of the cases included was encephalitis (57%), 8 of which were confirmed by magnetic resonance imaging. The second most prevalent presentation was meningitis. The cerebral spinal fluid analysis found disparities in protein levels and normal glucose levels in most cases. This study demonstrates that SARS-CoV-2 can enter the nervous system via various routes and cause CNS infection symptoms. SARS-CoV-2 has been shown to infect the CNS even when no respiratory symptoms are present and nasopharyngeal swabs are negative. As a result, SARS-CoV-2 should be considered as a possible cause of CNS infection and tested for in the CSF.

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“…Однако абсцесс или эмпиема головного мозга у пациентов с COVID-19 -редкие осложнения. Описано лишь несколько подобных случаев [3,4,9].…”

Section: пролиферация соединительнотканных элементов диапедезное проп...unclassified

“…В 8 % случаев COVID-19 может сопровождаться развитием бактериальной или грибковой инфекции [2]. В интернетресурсе PubMed (https://pubmed.ncbi.nlm.nih.gov / ) найдено всего несколько описаний развития бактериального менингита у взрослых пациентов с COVID-19 [3][4][5]. Каких-либо обобщающих исследований в этой области не найдено.…”

Section: Introductionunclassified

Endoscopic lavage of the cerebral ventricular system for ventriculitis treatment in a patient with complicated new coronavirus infection (COVID‑19)

Poshataev

Paskhin

Dorodov

et al. 2022

Nejrohirurgiâ (Mosk.)

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Introduction. The new coronavirus infection (COVID‑19) has a wide spectrum of complications. Frequency of neurological symptoms varies between 17.3 and 36.4 %. In 8 % of cases, COVID‑19 can be accompanied by bacterial or fungal infection. Since few descriptions of bacterial meningitis in adult patients with COVID‑19 and a single description of surgical treatment of purulent meningitis complicated by empyema of the 4th ventricle in a patient with COVID‑19 were found, and there are no meta‑analyses in this area, descriptions of such cases are of high scientific and practical value.Aim. The describe a case of surgical treatment of purulent ventriculitis in an adult (during treatment of the new coronavirus infection COVID‑19).Materials and methods. A man, 69 years old, with previously established diagnosis of the new coronavirus infection COVID‑19 and a comorbid pathology was admitted to the Moscow City Clinical Hospital No. 40 with newly diagnosed seizure disorder. Computed tomography imaging showed ventriculitis confirmed by MRI with obstructive hypertensive triventricular hydrocephalus.Results. The patient underwent treatment: three‑time endoscopic lavage of the ventricular system, removal of newly formed fibrin membranes with interventricular septostomy, removal of obstruction at the level of the Sylvian aqueduct; the surgery was concluded by external draining of the lateral ventricles, administration of an antibiotic intro the ventricular system and intravenously. Cerebrospinal fluid flow was restored, ventriculitis manifestations completely negated.Conclusion. Development of ventriculitis as one of the first signs of bacterial infection accompanying COVID‑19 is a very rare and life‑threatening complication requiring active surgical intervention. In was shown that endoscopic lavage of the ventricular system for ventriculitis treatment is an effective action against infection and cerebrospinal fluid flow disorders. Use of intraventricular endoscopy for ventriculitis treatment has several advantages compared to needle ventriculostomy. Further studies and analysis of treatment of bacterial ventriculitis using endoscopic surgical techniques in patients with and without the new coronavirus infection are needed.

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Bacterial meningitis and COVID-19: a complex patient journey

Cited by 7 publications

References 11 publications

Pneumococcal meningitis secondary to otitis media in two patients with COVID-19 omicron variant

Pneumococcal meningitis secondary to otitis media in two patients with COVID-19 omicron variant

Clinical Implications of COVID-19 Presence in CSF: Systematic Review of Case Reports

Endoscopic lavage of the cerebral ventricular system for ventriculitis treatment in a patient with complicated new coronavirus infection (COVID‑19)

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