Cerebral Vasculitis Complicating Pneumococcal Meningitis

Khedher, Ahmed; Sma, Nesrine; Slama, Dorsaf; Fraj, Nesrine; Hachfi, W.; Benzarti, M.

doi:10.12890/2018_000819

Cited by 3 publications

(3 citation statements)

References 5 publications

(11 reference statements)

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“…Prior to the wide spread use of adjunctive steroids in bacterial meningitis 36 , 37 cerebral vascular alterations were devastating but common complications. Reasons may be cerebral vasculitis, septic emboli, intraarterial thrombosis or disseminated intravascular coagulation 35 , 38 – 40 . Thus specific anti-inflammatory regimes are desirable 41 , 42 beyond adjuvant corticosteroid treatment which has been proven beneficial on case fatality rates in adult patients with pneumococcal meningitis but only in high-income countries 37 .…”

Section: Discussionmentioning

confidence: 99%

Neutrophil-to-lymphocyte ratio is associated with increased cerebral blood flow velocity in acute bacterial meningitis

Giede-Jeppe

Atay

Koehn

et al. 2021

Sci Rep

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In community-acquired bacterial meningitis (CABM) intracranial vascular alterations are devastating complications which are triggered by neuroinflammation and result in worse clinical outcome. The Neutrophil-to-Lymphocyte ratio (NLR) represents a reliable parameter of the inflammatory response. In this study we analyzed the association between NLR and elevated cerebral blood flow velocity (CBFv) in CABM-patients. This study included all (CABM)-patients admitted to a German tertiary center between 2006 and 2016. Patients’ demographics, in-hospital measures, neuroradiological data and clinical outcome were retrieved from institutional databases. CBFv was assessed by transcranial doppler (TCD). Patients’, radiological and laboratory characteristics were compared between patients with/without elevated CBFv. Multivariate-analysis investigated parameters independently associated with elevated CBFv. Receiver operating characteristic(ROC-)curve analysis was undertaken to identify the best cut-off for NLR to discriminate between increased CBFv. 108 patients with CABM were identified. 27.8% (30/108) showed elevated CBFv. Patients with elevated CBFv and normal CBFv, respectively had a worse clinical status on admission (Glasgow Coma Scale: 12 [9–14] vs. 14 [11–15]; p = 0.005) and required more often intensive care (30/30 [100.0%] vs. 63/78 [80.8%]; p = 0.01).The causative pathogen was S. pneumoniae in 70%. Patients with elevated CBFv developed more often cerebrovascular complications with delayed cerebral ischemia (DCI) within hospital stay (p = 0.031). A significantly higher admission-NLR was observed in patients with elevated CBFv (median [IQR]: elevated CBFv:24.0 [20.4–30.2] vs. normal CBFv:13.5 [8.4–19.5]; p < 0.001). Multivariate analysis, revealed NLR to be significantly associated with increased CBFv (Odds ratio [95%CI] 1.042 [1.003–1.084]; p = 0.036). ROC-analysis identified a NLR of 20.9 as best cut-off value to discriminate between elevated CBFv (AUC = 0.713, p < 0.0001, Youden's Index = 0.441;elevated CBFv: NLR ≥ 20.9 19/30[63.5%] vs. normal CBFv: NLR > 20.9 15/78[19.2%]; p < 0.001). Intracranial vascular complications are common among CABM-patients and are a risk factor for unfavorable outcome at discharge. Elevated NLR is independently associated with high CBFv and may be useful in predicting patients’ prognosis.

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Section: Discussionmentioning

confidence: 99%

Neutrophil-to-lymphocyte ratio is associated with increased cerebral blood flow velocity in acute bacterial meningitis

Giede-Jeppe

Atay

Koehn

et al. 2021

Sci Rep

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“…The cerebral vascular involvement in pneumococcal meningitis has been modestly reported both in adults and children, with disease features ranging from hearing loss, hydrocephalus, parenchymal infarctions, cerebritis, and hemorrhages [17-21]. Systemic involvement in the form of a diffuse skin rash has been reported once previously by Theonimfi Tavladaki et al They encountered a 2-year-old child with pneumococcal meningitis, followed by immune-mediated vasculitic rashes and cerebral diffusion restriction diffusion-weighted MRI [1].…”

Section: Discussionmentioning

confidence: 99%

Complicated Pneumococcal Meningitis: A Diagnostic and Therapeutic Challenge

et al. 2021

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Meningitis is an uncommon complication of head trauma. Vasculitis in bacterial meningitis is seen in 9–25% of adults while neurological deficits in bacterial meningitis are seen in about one-third of children. We report a 5-year-old boy, previously healthy who was admitted in March 2019 to Latifa Women’s and Children’s Hospital, Dubai, UAE, with pneumococcal meningitis. One day before presentation, he had a history of fall with head trauma while running at school. Initial brain CT scan was normal. Few hours after admission, the child was noticed to be drowsy with cold extremities and mottled skin. He was shifted to PICU and, ultimately, he required intubation and mechanical ventilation. The child continued spiking high-grade fever with deterioration in the neurologic status. His GCS deteriorated to 4/15 with decerebrations posture. He underwent serial brain imaging which revealed multiple chronic infarcts with hydrocephalic changes due to ongoing cerebral vasculitis. The child was started on steroid therapy on 28 April 2019 after which his condition improved at an incredible pace.

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“…Unexpectedly and contrary to published data 30,31 we did not identify dexamethasone administration to be independently associated with increased cerebral blood ow velocity in multivariate analysis. Prior to the wide spread use of adjunctive steroids in bacterial meningitis 32,33 cerebral vascular alterations were devastating but common complications mediated by cerebral vasculitis, septic emboli, intraarterial thrombosis or disseminated intravascular coagulation 31,[34][35][36] . This emphasizes the need for speci c antiin ammatory drugs in bacterial meningitis 37,38 beyond adjuvant corticosteroid treatment which has been proven bene cial on case fatality rates in adult patients with pneumococcal meningitis but only in highincome countries 33 .…”

Section: Discussionmentioning

confidence: 99%

Neutrophil-to-Lymphocyte Ratio is Associated With Increased Cerebral Blood Flow Velocity in Acute Bacterial Meningitis

Giede-Jeppe

Atay

Koehn

et al. 2020

Preprint

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ObjectiveIn community-acquired bacterial meningitis(CABM) intracranial vascular alterations are devastating complications which are triggered by neuroinflammation and result in worse clinical outcome. The neutrophil-to-lymphocyte ratio(NLR) represents a reliable parameter of the inflammatory response. So far, in CABM-patients the association between NLR and elevated cerebral blood flow velocity(CBFv) remains unclear.MethodsThis study included all (CABM)-patients admitted to a German tertiary center between 2006-2016. Patient demographics, in-hospital measures and neuroradiological data were retrieved from institutional databases. CBFv was assessed by transcranial Doppler sonography transcranial doppler(TCD). Patients’, radiological and laboratory characteristics were compared between patients with/without elevated CBFv. Multivariate-analysis investigated parameters independently associated with elevated CBFv. Receiver operating characteristic(ROC-)curve analysis was undertaken to identify the best cut-off for NLR to discriminate between increased CBFv.Results108 patients with CABM were identified. 27.8%(30/108) showed elevated CBFv. These patients had a worse clinical status on admission(Glasgow Coma Scale:12[9-14vs.14[11-15]; p=0.005) and required more often intensive care (30/30[100%]vs.63/78[80.8%];p=0.01).The causative pathogen was S. pneumoniae in 70%. These patients developed more often cerebrovascular complications with delayed cerebral ischemia(DCI) within hospital stay(p=0.031). A significantly higher admission-NLR was observed in patients with elevated CBFv(median[IQR]:elevated CBFv:24.0[20.4-30.2]vs. normal CBFv:13.5[8.4-19.5];p<0.001). After adjusting for significant parameters in univariate testing, NLR on admission was significantly associated with increased CBFv(Odds ratio[95%CI]:1.042[1.003-1.084];p=0.036). ROC-analysis identified a NLR of 20.9 as best cut-off value to discriminate between elevated CBFv(area under the curve=0.713, p<0.0001,Youden's Index=0.441;elevated CBFv:NLR>20.9 19/34[55.9%]vs.NLR<20.9 11/74[14.9%];p<0.001).ConclusionsIntracranial vascular complications are common among CABM-patients and are a risk factor for unfavorable outcome at discharge. NLR is independently associated with elevated CBFv.

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Cerebral Vasculitis Complicating Pneumococcal Meningitis

Cited by 3 publications

References 5 publications

Neutrophil-to-lymphocyte ratio is associated with increased cerebral blood flow velocity in acute bacterial meningitis

Neutrophil-to-lymphocyte ratio is associated with increased cerebral blood flow velocity in acute bacterial meningitis

Complicated Pneumococcal Meningitis: A Diagnostic and Therapeutic Challenge

Neutrophil-to-Lymphocyte Ratio is Associated With Increased Cerebral Blood Flow Velocity in Acute Bacterial Meningitis

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