Clinical Features and Prognostic Factors in Adults with Bacterial Meningitis

Beek, Diederik van de; Gans, Jan de; Spanjaard, Lodewijk; Weisfelt, Martijn; Reitsma, Johannes B.; Vermeulen, M.

doi:10.1056/nejmoa040845

Cited by 1,374 publications

(1,189 citation statements)

References 35 publications

Supporting

Mentioning

1,022

Contrasting

Unclassified

Order By: Relevance

“…Since only 44% of patients have all characteristics of bacterial meningitis (van de Beek et al., 2010), we may have included patients in the wrong group. To diminish this possibly important methodological shortcoming, we used international CSF diagnostic values which are individual positive predictors in 88%–99% (van de Beek et al., 2010, 2004). In choosing these parameters, we also hoped to bypass the chance of diagnosing aseptic meningitis as bacterial meningitis.…”

Section: Discussionmentioning

confidence: 99%

“…Positive CSF culture, if available, was used as diagnostic gold standard. These conditions have been proven to be 88%–99% accurate individual predictors of bacterial meningitis (van de Beek et al., 2010, 2004). Our bacterial meningitis group consisted of patients with community‐acquired meningitis (CAM) and patients with postneurosurgical intervention meningitis (PNM).…”

Section: Methodsmentioning

confidence: 99%

“…In the acute setting, however, bacterial cultures take too much time to be used in the decision whether or not to start antibacterial treatment. Polynuclear pleocytosis combined with raised CSF protein and lowered CSF glucose indicate bacterial meningitis, but these findings are not sensitive and may not be present in 12% of patients (van de Beek, Drake, & Tunkel, 2010; van de Beek et al., 2004; Durand et al., 1993). These parameters are even more unreliable in patients with an extraventricular drain (EVD) after subarachnoid‐ or intracranial hemorrhage as intrathecal plasma leakage causes raised erythrocytes and leukocytes counts (Schade et al., 2006).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Procalcitonin in cerebrospinal fluid in meningitis: a prospective diagnostic study

Alons¹,

Verheul²,

Kuipers³

et al. 2016

Brain and Behavior

View full text Add to dashboard Cite

ObjectivesBacterial meningitis is a severe but treatable condition. Clinical symptoms may be ambiguous and current diagnostics lack sensitivity and specificity, complicating diagnosis. Procalcitonin (PCT) is a protein that is elevated in serum in bacterial infection. We aimed to assess the value of PCT in cerebrospinal fluid (CSF) in the diagnosis of bacterial meningitis.MethodsWe included patients with bacterial meningitis, both community acquired and post neurosurgery. We included two comparison groups: patients with viral meningitis and patients who underwent lumbar punctures for noninfectious indications. We calculated mean differences and 95% confidence intervals of procalcitonin in CSF and plasma in patients with and without bacterial meningitis.ResultsAverage PCT concentrations in CSF were 0.60 ng mL−1 (95% CI: 0.29–0.92) in the bacterial meningitis group (n = 26), 0.81 (95% CI: 0.33–1.28) in community‐acquired meningitis (n = 16) and 0.28 (95% CI: 0.10–0.45) in postneurosurgical meningitis (n = 10), 0.10 ng mL−1 (95% CI: 0.08–0.12) in the viral meningitis group (n = 14) and 0.08 ng mL−1 (95% CI: 0.06–0.09) in the noninfectious group (n = 14). Mean difference of PCT‐CSF between patients with community‐acquired bacterial meningitis and with viral meningitis was 0.71 ng mL−1 (95% CI: 0.17–1.25) and 0.73 ng mL−1 (95% CI: 0.19–1.27) for community‐acquired bacterial meningitis versus the noninfectious group. The median PCT CSF: plasma ratio was 5.18 in postneurosurgical and 0.18 in community‐acquired meningitis (IQR 4.69 vs. 0.28).ConclusionProcalcitonin in CSF was significantly higher in patients with bacterial meningitis when compared with patients with viral or no meningitis. PCT in CSF may be a valuable marker in diagnosing bacterial meningitis, and could become especially useful in patients after neurosurgery.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Procalcitonin in cerebrospinal fluid in meningitis: a prospective diagnostic study

Alons¹,

Verheul²,

Kuipers³

et al. 2016

Brain and Behavior

View full text Add to dashboard Cite

show abstract

“…Interestingly, testing both for neck stiffness – after careful exclusion of preceding trauma – and the Babinski sign are highly recommended by our experts. This reflects the importance of using highly specific tests (Isaza Jaramillo et al., 2014; Nakao, Jafri, Shah, & Newman, 2014; van de Beek et al., 2004) that recognize conditions requiring prompt initiation of treatment (Auburtin et al., 2006; Möhlenbruch et al., 2014), although mixed results regarding the sensitivity of each sign have been reported (Isaza Jaramillo et al., 2014; Mattle et al., 2011). …”

Section: Discussionmentioning

confidence: 99%

The essential neurological examination of the unconscious patient in the emergency room

2018

View full text Add to dashboard Cite

ObjectiveTo determine whether neurologists with long‐term experience in the emergency room are in general agreement about the essential components of the neurological examination (NE) used on unconscious patients in whom an obvious cause for coma is lacking.MethodsWe surveyed 31 board‐certified practicing neurologists who regularly examine unconscious patients in the emergency room and asked them to list the specific components of the NE that they would normally choose to apply in at least 80% of cases.ResultsTwenty‐seven neurologists rated 24 of 38 items as essential steps of the neurological examination of the unconscious patient, with a high level of agreement amongst survey participants.ConclusionsThere was a high degree of consensus amongst the neurologists surveyed about which steps are essential for the NE of the unconscious patient. These findings provide an important source of validation for teaching this particular NE to medical students, as well as nonneurologists working in an emergency setting.

show abstract

“…Bacterial meningitis is a significant problem in many areas of the world, especially in developing countries [3], while the mortality rate associated with pneumococcal meningitis has reached 30% in some areas, with sequelae such as hearing loss, focal neurological deficit, and cognitive impairment occurs in approximately 50% of survivors [1,4]. …”

Section: Introductionmentioning

confidence: 99%

Competence-induced protein Ccs4 facilitates pneumococcal invasion into brain tissue and virulence in meningitis

et al. 2018

View full text Add to dashboard Cite

Streptococcus pneumoniae is a major pathogen that causes pneumonia, sepsis, and meningitis. The candidate combox site 4 (ccs4) gene has been reported to be a pneumococcal competence-induced gene. Such genes are involved in development of S. pneumoniae competence and virulence, though the functions of ccs4 remain unknown. In the present study, the role of Ccs4 in the pathogenesis of pneumococcal meningitis was examined. We initially constructed a ccs4 deletion mutant and complement strains, then examined their association with and invasion into human brain microvascular endothelial cells. Wild-type and Ccs4-complemented strains exhibited significantly higher rates of association and invasion as compared to the ccs4 mutant strain. Deletion of ccs4 did not change bacterial growth activity or expression of NanA and CbpA, known brain endothelial pneumococcal adhesins. Next, mice were infected either intravenously or intranasally with pneumococcal strains. In the intranasal infection model, survival rates were comparable between wild-type strain-infected and ccs4 mutant strain-infected mice, while the ccs4 mutant strain exhibited a lower level of virulence in the intravenous infection model. In addition, at 24 hours after intravenous infection, the bacterial burden in blood was comparable between the wild-type and ccs4 mutant strain-infected mice, whereas the wild-type strain-infected mice showed a significantly higher bacterial burden in the brain. These results suggest that Ccs4 contributes to pneumococcal invasion of host brain tissues and functions as a virulence factor.

show abstract

Clinical Features and Prognostic Factors in Adults with Bacterial Meningitis

Cited by 1,374 publications

References 35 publications

Procalcitonin in cerebrospinal fluid in meningitis: a prospective diagnostic study

Procalcitonin in cerebrospinal fluid in meningitis: a prospective diagnostic study

The essential neurological examination of the unconscious patient in the emergency room

Competence-induced protein Ccs4 facilitates pneumococcal invasion into brain tissue and virulence in meningitis

Contact Info

Product

Resources

About