Pneumococcal Meningitis in Adults: A Prospective Nationwide Cohort Study Over a 20-year Period

Abstract

Background The epidemiology and treatment of pneumococcal meningitis has changed with the implementation of conjugate vaccines and the introduction of adjunctive dexamethasone therapy. Methods We analysed episodes of community-acquired pneumococcal meningitis in adults (≥16 years) in the Netherlands, identified by the National Reference Laboratory for Bacterial Meningitis or treating physician between Oct 1, 1998 and Apr 1, 2002 and between Jan 1, 2006 and July 1, 2018. We studied incidence, pneumococcal serotypes and clinical features. Predictors for unfavourable outcome (Glasgow Outcome Scale score 1-4) were identified in a multivariable logistic regression model. Two physicians independently categorized causes of death as neurological or systemic. Results There were 1816 episodes in 1783 patients. The incidence of 7- and 10-7-valent pneumococcal conjugate vaccine serotypes decreased (0.42 to 0.06, p=0.001 and 0.12 to 0.03 episodes per 100,000 population per year, p=0.014). Incidence of non-vaccine serotypes increased (0.45 to 0.68, p=0.005). The use of adjunctive treatment with dexamethasone increased and was administered in 85% of patients in 2018. In-hospital death occurred in 363 episodes (20%) and unfavourable outcome in 772 episodes (43%). Delayed cerebral thrombosis occurred in 29 patients (2%) of whom 15 patients (52%) died. Adjunctive dexamethasone therapy was associated with favourable outcome (adjusted odds ratio 2.27, p<0.001), individual pneumococcal serotypes were not. Conclusion Implementation of conjugate vaccines and adjunctive dexamethasone therapy have changed the incidence and outcome of pneumococcal meningitis in adults over the last two decades. Despite recent advances pneumococcal meningitis remains associated with a residual high rate of mortality and morbidity.

Severe community-acquired Streptococcus pneumoniae bacterial meningitis: clinical and prognostic picture from the intensive care unit

“…Our study describes a large series of meningitis cases caused by S. pneumoniae in a Spanish population requiring ICU admission over a period of 8 years. Despite the fact that S. pneumoniae CABM carries terrible morbidity and mortality, publications concerning the critically ill patient are scarce and are mostly from the pre-steroid era [1][2][3][13][14][15][16][17]. Remarkably, the mortality in our series is clearly lower than previously published.…”

“…Despite the clinical and social impact of CABM caused by S pneumoniae, there is a deficit of current publications on routine medical practices and the prognosis of patients requiring ICU admission [2,3,[13][14][15][16][17]. Therefore, we designed this retrospective, multicenter study with the aim to examine current epidemiology and management of the disease in Spanish ICUs.…”

Bilateral oculomotor nerve palsy secondary to bacterial meningitis

“…Leonardo Kami [1]  and Bernardo Correa de Almeida Teixeira [1]  A 17-year-old male was referred to a tertiary hospital with a 3-day history of headache, fever, neck stiffness, and progressive loss of consciousness. During hospitalization, he presented with bilateral mydriasis with fixed pupils, palpebral ptosis, and right horizontal gaze palsy.…”

“…Cranial nerve palsies are a relatively uncommon complication of bacterial meningitis, occurring in approximately 4-11% of cases 1 , and are associated with a poor prognosis when presented during hospitalization 2 . The most common pathogen responsible is S. pneumoniae 1 , 3 .…”

“…Cranial nerve palsies are a relatively uncommon complication of bacterial meningitis, occurring in approximately 4-11% of cases 1 , and are associated with a poor prognosis when presented during hospitalization 2 . The most common pathogen responsible is S. pneumoniae 1 , 3 . Furthermore, the most affected cranial nerves are the oculomotor, abducens, facial, and trochlear nerves, and mainly the latter, because of sensitivity to high intracranial pressure.…”