Pneumococcal meningitis: Clinical-pathological correlations (meningene-path)

Engelen-Lee, Joo-Yeon; Brouwer, Matthijs C.; Aronica, Eleonora; Beek, Diederik van de

doi:10.1186/s40478-016-0297-4

Cited by 57 publications

(52 citation statements)

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“…Está descrito que la meningitis neumocócica puede engrosar las meninges y originar por excepción una hidrocefalia 4,6 . Sin embargo, el engrosamiento meníngeo asociado a hidrocéfalo en la RNM cerebral y un fondo de ojo normal en esta paciente, nos planteó el diagnóstico diferencial con figura 2.…”

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“…El ingreso del neumococo al SNC genera una respuesta inflamatoria en las meninges y en la pared vascular de medianas arterias y venas. El 97% de los pacientes con meningitis neumocócica, que tienen estudio neuropatológico, muestran arteritis o flebitis de los vasos cerebrales 4 . Estas arteriopatías pueden expresarse como infartos imagenológicos en 6% de los pacientes, quienes concomitantemente pueden desarrollar hemorragias o trombosis venosas 3,4 .…”

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“…El 97% de los pacientes con meningitis neumocócica, que tienen estudio neuropatológico, muestran arteritis o flebitis de los vasos cerebrales 4 . Estas arteriopatías pueden expresarse como infartos imagenológicos en 6% de los pacientes, quienes concomitantemente pueden desarrollar hemorragias o trombosis venosas 3,4 . También es muy frecuente la inflamación parenquimatosa difusa, como la cerebritis y más eventuales, las reacciones de estructuras ependimarias o ventriculares 4 .…”

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“…Estas arteriopatías pueden expresarse como infartos imagenológicos en 6% de los pacientes, quienes concomitantemente pueden desarrollar hemorragias o trombosis venosas 3,4 . También es muy frecuente la inflamación parenquimatosa difusa, como la cerebritis y más eventuales, las reacciones de estructuras ependimarias o ventriculares 4 . Esta amplia actividad inflamatoria que produce el neumococo dentro del SNC corresponde a respuestas ampliadas del sistema inmune en las infecciones neumocócicas, condición que podría generar una reactividad inmunológica tardía, capaz de inducir el desarrollo de vasculitis crónicas en las etapas postagudas de la infección [5][6][7] .…”

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Meningitis crónica autoinmune secundaria a meningitis aguda por neumococo. Caso clínico

et al. 2019

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Autoimmune chronic meningitis secondary to pneumococcal meningitis. Report of one case Pneumococcal meningitis produces several inflammatory disorders in susceptible subjects. A worsening of meningitis can occur on the fourth day of evolution in relation with the withdrawal of steroids. Other complications include the development of inflammatory signs in the post-acute stage of infection associated with disseminated vasculitis of the cerebral blood vessels and, even later, an autoimmune chronic meningitis. All these inflammatory complications are well controlled with the use of steroids. We report a 53-year-old woman with pneumococcal meningitis that had a good response to treatment with antibiotics and steroids. On the four day, after the steroids were discontinued, she complained of headache, became confused, and had an abnormal cerebrospinal fluid (CSF), report CT angiography showed signs of arteritis. She improved when the steroids were re-started. She was discharged in good condition but after slow tapering of the steroids over a four-month period she had a relapse of all her symptoms and had a gait disturbance. On readmission, she had an inflammatory CSF, there were no signs of infection and the cerebral MRI showed meningeal thickening with ventricular space enlargement. She improved again with steroids and she is now well on high-dose steroids but deteriorates each time the steroids are stopped. She experienced both acute and sub-acute inflammatory responses and finally developed a chronic meningitis responsive, and is dependent on steroids. (Rev Med Chile 2019; 147: 803-807)

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Meningitis crónica autoinmune secundaria a meningitis aguda por neumococo. Caso clínico

et al. 2019

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“…S. pneumoniae is the major cause of bacterial meningitis in adults (Engelen‐Lee, Brouwer, Aronica, & van de Beek, ). Pneumococcal meningitis is associated with a high mortality, causing death in 18–30% of patients, and neurological sequalae such as hearing loss and cognitive disabilities occur in ~50% of survivors (Saez‐Llorens & McCracken, ; van de Beek, de Gans, Tunkel, & Wijdicks, ; Weisfelt et al, ).…”

Section: Trafficking Across the Blood–brain Barriermentioning

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Emerging concepts in the pathogenesis of theStreptococcus pneumoniae: From nasopharyngeal colonizer to intracellular pathogen

Subramanian

Henriques‐Normark

Normark

2019

Cellular Microbiology

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Streptococcus pneumoniae (the pneumococcus) is a human respiratory tract pathogen and a major cause of morbidity and mortality globally. Although the pneumococcus is a commensal bacterium that colonizes the nasopharynx, it also causes lethal diseases such as meningitis, sepsis, and pneumonia, especially in immunocompromised patients, in the elderly, and in young children. Due to the acquisition of antibiotic resistance and the emergence of nonvaccine serotypes, the pneumococcus has been classified as one of the priority pathogens for which new antibacterials are urgently required by the World Health Organization, 2017. Understanding molecular mechanisms behind the pathogenesis of pneumococcal infections and bacterial interactions within the host is crucial to developing novel therapeutics. Previously considered to be an extracellular pathogen, it is becoming evident that pneumococci may also occasionally establish intracellular niches within the body to escape immune surveillance and spread within the host. Intracellular survival within host cells also enables pneumococci to resist many antibiotics. Within the host cell, the bacteria exist in unique vacuoles, thereby avoiding degradation by the acidic lysosomes, and modulate the expression of its virulence genes to adapt to the intracellular environment. To invade and survive intracellularly, the pneumococcus utilizes a combination of virulence factors such as pneumolysin (PLY), pneumococcal surface protein A (PspA), pneumococcal adhesion and virulence protein B (PavB), the pilus‐1 adhesin RrgA, pyruvate oxidase (SpxB), and metalloprotease (ZmpB). In this review, we discuss recent findings showing the intracellular persistence of Streptococcus pneumoniae and its underlying mechanisms.

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Stroke in Patients with Bacterial Meningitis: A Cohort Study and Meta‐Analysis

Beuker¹,

Werring²,

Bonberg³

et al. 2023

Annals of Neurology

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Objective: The purpose of this study was to characterize patients with ischemic stroke due to bacterial meningitis. Methods: In a single-center retrospective study, we analyzed 102 patients with bacterial meningitis of which 19 had an ischemic stroke. Clinical characteristics, cerebrospinal fluid (CSF) analyses, and spatiotemporal distribution of infarcts were assessed. In addition, we searched PubMed from database inception to August 2021 for observational studies on ischemic stroke in patients with bacterial meningitis, and performed a meta-analysis to investigate the frequency and timing of stroke as well as its effect on mortality. Results: In our cohort, 15 (78.9%) patients with stroke had an modified Rankin scale (mRS) ≥ 3 at discharge compared to 33 (39.8%) in patients without stroke (p < 0.01). Of 1,692 patients with bacterial meningitis from 15 cohort studies included in our meta-analysis, cerebral infarcts were found in 332 (16%, 95% confidence interval [CI] = 0.13-0.20) patients. The occurrence of stroke was strongly associated with a higher mortality (odds ratio [OR] = 2.38, 95% CI = 1.70-3.34, p < 0.0001). There was no association of any specific causative pathogen with the occurrence of stroke. Infarcts were mainly distributed in territories of arteries located in the vicinity to the infection focus and peaked at 3 to -7 days and at 2 weeks after onset of meningitis. In patients with ischemic stroke, vasculopathy was found in 63.2% and additional intracerebral hemorrhage in 15.8%. Interpretation: This study found that ischemic stroke due to bacterial meningitis is caused by cerebral vasculopathy located in the vicinity of the infection focus, and that the time course of infarctions might enable a therapeutic intervention.

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Pneumococcal meningitis: Clinical-pathological correlations (meningene-path)

Cited by 57 publications

References 43 publications

Meningitis crónica autoinmune secundaria a meningitis aguda por neumococo. Caso clínico

Meningitis crónica autoinmune secundaria a meningitis aguda por neumococo. Caso clínico

Emerging concepts in the pathogenesis of theStreptococcus pneumoniae: From nasopharyngeal colonizer to intracellular pathogen

Stroke in Patients with Bacterial Meningitis: A Cohort Study and Meta‐Analysis

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