Bacterial Meningitis in Patients using Immunosuppressive Medication: a Population-based Prospective Nationwide Study

Veen, K.E.B. van; Brouwer, Matthijs C.; Ende, Arie van der; Beek, Diederik van de

doi:10.1007/s11481-016-9705-6

Cited by 25 publications

(23 citation statements)

References 29 publications

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“…Unlike most previously reported outbreaks of invasive meningococcal disease that were associated with serotype B [20], we found that all our cases of meningococcal meningitis were sporadic. According to other studies, L. monocytogenes is the third most common causative agent of CABM and is associated with older age and immunodeficiency [15,[21][22][23][24]. In our study, L. monocytogenes meningitis was the third most common etiological factor and 40% of L. monocytogenes meningitis in our study occurred in adults under the age of 50 without specific risk factors.…”

Section: Discussionsupporting

confidence: 61%

Retrospective analysis of the etiology, clinical characteristics and outcomes of community-acquired bacterial meningitis in the University Infectious Diseases Centre in Lithuania

et al. 2020

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Background The morbidity and mortality in community-acquired bacterial meningitis (CABM) remain substantial, and the etiology, clinical characteristics, treatment outcomes and predictors of poor prognosis must be assessed regularly. The aim of this study was to identify the distribution of etiological agents and their relationship with clinical characteristics, treatment and outcomes in this cohort of patients with CABM. Methods Our retrospective chart review analyzed the causative microorganisms, clinical characteristics, laboratory findings, treatment and outcomes of 159 adults with CABM hospitalized in the Infectious Diseases Centre of Vilnius University Hospital from January 1, 2009 to December 31, 2016. A Glasgow Outcome Scale (GOS) score ≤ 3 was defined as unfavorable outcome. Predictors of an unfavorable outcome were identified through logistic regression analysis. Results The median patient age was 36 (IQR 24–56), and 51.6% were male. Microbiologically confirmed causative agents were identified in 80 (50.3%) patients: N. meningitidis in 55 (34.6%) patients with serotype B accounting for 85% of cases, S. pneumoniae in 15 (9.4%), L. monocytogenes in 5 (3.1%) and other in 5 (3.1%). The clinical triad of fever, neck stiffness and a change in mental status was present in 59.1% of patients. Coexisting conditions and comorbidities were similar in all groups stratified by etiology. Initial antimicrobial treatment consisted of penicillin in 78 patients (49.1%) and ceftriaxone in 72 patients (45.3%). The median time in which antibiotic treatment was started was 40 min (IQR 30.0–90.0). The outcome was unfavorable in 15.7% of episodes and death occurred in 5.7% of cases and did not differ according to the causative agent. Risk factors for an unfavorable outcome were age > 65 years, coexisting pneumonia and a platelet count <150x10e9/l. Conclusions The most common causative agent of CABM was N. meningitidis, with serotype B clearly dominant. Causative agents did not influence the disease outcome. The strongest risk factors for an unfavorable outcome were older age, pneumonia and a low platelet count. Since the introduction of routine vaccination against meningococcus B for infants in Lithuania in 2018, the national vaccination policy may hopefully contribute to a decrease in the incidence of serogroup B meningococcal disease in the Lithuanian population.

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Section: Discussionsupporting

confidence: 61%

Retrospective analysis of the etiology, clinical characteristics and outcomes of community-acquired bacterial meningitis in the University Infectious Diseases Centre in Lithuania

et al. 2020

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“…L. monocytogenes is an intra-cellular pathogen that is transmitted through contaminated food ( 10 ). It primarily affects elderly or immunocompromised patients, such as cancer patients or those using immunosuppressive drugs ( 8 , 11 , 12 ). Diagnosis of L. monocytogenes meningitis can be challenging due to slow onset of symptoms ( 7 ), atypical cerebrospinal fluid (CSF) findings ( 13 ) consistent with a relatively low grade of infection and high percentage of negative CSF culture ( 14 ).…”

Section: Introductionmentioning

confidence: 99%

Histopathology of Listeria Meningitis

Engelen-Lee

Koopmans

Brouwer

et al. 2018

Journal of Neuropathology &Amp; Experimental Neurology

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Listeria monocytogenes meningitis is the third most common cause of bacterial meningitis in adults and has high mortality and morbidity rates. We describe the clinical course and score brain pathology of 5 patients who died of listeria meningitis. All patients were immunocompromised and ages ranged between 48 and 76 years. Three cases were confirmed by cerebrospinal fluid culture; one was confirmed by brain culture; and one diagnosis was based on a positive blood culture and neuropathological findings. Mild inflammation of meningeal arteries was found in 3 of 5 cases (60%). Moderate/severe ventriculitis was seen in 4 of 4 cases (100%), abscesses in 3 of 4 cases (75%), mild vascular inflammation in 4 of 5 cases (80%), mild/moderate hemorrhage in 2 of 4 cases (50%), mild/moderate thrombosis of meningeal artery in 3 of 5 cases (60%), and 1 case (25%) showed a moderate infarct. The inflammatory cells present in the meninges were characterized by a mix of monocytes, macrophages, and neutrophils and removal of apoptotic inflammatory cells by macrophages (efferocytosis). Gram stain showed intra- and extracellular presence of rod-shaped bacteria in 3 cases. Pathological examination was characterized by moderate to severe ventriculitis, abscesses and abundant efferocytosis which has been suggested to be exploited by L. monocytogenes for cell-to-cell spread.

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“…In bacterial meningitis, the CSF leukocyte count may exceed 1,000 mm 3 . 5 Patients who are on immunomodulating therapy 13 or are septic 14 or neutropenic 15 often have lower CSF leukocyte counts, or in the case of neutropenia, may have a normal CSF leukocyte count.…”

Section: Serum Biomarkers May Assist In the Diagnosis Of Bacterialmentioning

confidence: 99%

Bacterial Infections of the Central Nervous System

LaPenna

Roos

2019

Semin Neurol

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Bacterial infections of the central nervous system are a neurological emergency. Prompt recognition and treatment are not only essential to prevent mortality but also to decrease neurological sequelae. This chapter will focus on the two most common central nervous system bacterial infections, bacterial meningitis and spinal epidural abscess. The eradication of the pathogen with antimicrobial therapy is the easy part. It is the recognition of the disorder, the understanding of the diagnostic studies and their limitations, and the management of the neurological complications that requires the expertise of a neurologist. Adult: 12 g/d (q4-6h) Cefepime Infants and children: 150 mg/kg/d (q8h) Adult: 6 g/d (q8h) Cefotaxime Infants and children: 225-300 mg/kg/d (q6-8h) Adult: 8-12 g/d (q4-6h) Ceftriaxone Infants and children: 80-100 mg/kg/d (q12h) Adult: 4 g/d (q12h) Gentamicin Infants and children: 7.5 mg/kg/d (q8h) Adult: 5 mg/kg/d (q8h) Meropenem Infants and children: 120 mg/kg/d (q8h) Adult: 6 g/d (q8h) Metronidazole Infants and children: 30 mg/kg/d (q6h) Adult dose: 2000 mg/day (q6h) Nafcillin Infants and children: 200 mg/kg/d (q6h) Adult: 9-12 g/d (q4h) Penicillin G Infants and children: 0.3 mU/kg/d (q4-6h) Adult: 24 million units/d (q4-6h) Rifampin Infants and children: 10-20 mg/kg/d (q12-24h) Adults: 600-1200 mg/d (q12h) Vancomycin* Infants and children: 60 mg/kg/d (q6h) Adults: 45-60 mg/kg/d (q6-12h) Chemoprophylaxis Neisseria meningitidis Rifampin 600 mg twice daily for two days or Ceftriaxone 250 mg intramuscular or *Intraventricular vancomycin administration: children 10 mg/d, adults 20 mg/d Etiological organism

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Bacterial Meningitis in Patients using Immunosuppressive Medication: a Population-based Prospective Nationwide Study

Cited by 25 publications

References 29 publications

Retrospective analysis of the etiology, clinical characteristics and outcomes of community-acquired bacterial meningitis in the University Infectious Diseases Centre in Lithuania

Retrospective analysis of the etiology, clinical characteristics and outcomes of community-acquired bacterial meningitis in the University Infectious Diseases Centre in Lithuania

Histopathology of Listeria Meningitis

Bacterial Infections of the Central Nervous System

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