Acute Community-Acquired Bacterial Meningitis

Figueiredo, Ana Helena A.; Brouwer, Matthijs C.; Beek, Diederik van de

doi:10.1016/j.ncl.2018.06.007

Cited by 23 publications

(24 citation statements)

References 71 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In our study, we were able to demonstrate only one etiological association between the presence of hemorrhagic rash and N. meningitidis. Previous studies also concluded that rashes occur more often in patients with N. meningitidis meningitis [31,32]. Other researchers have also described that hyposplenism, chronic kidney or liver disease and alcoholism were more associated with S. pneumoniae meningitis and H. influenzae meningitis [21,27]; acquired immunodeficiency (diabetes mellitus, cancer, the use of immunosuppressive therapy) was more associated with L. monocytogenes meningitis; and underlying conditions such as otitis, sinusitis or endocarditis were more associated with H. influenzae meningitis and S. aureus meningitis [33].…”

Section: Discussionmentioning

confidence: 93%

“…The strongest risk factors in our study for an unfavorable outcome were an older age, coexisting pneumonia and a low platelet count at presentation. According to other studies, impaired consciousness, low white-cell count, a delay in antibiotic therapy initiation and other comorbidities may also lead to a more severe course of meningitis [21,22,31,43].…”

Section: Discussionmentioning

confidence: 96%

“…The clinical presentation of CABM varies and depends on the patient’s age, coexisting conditions and comorbidities [ 15 , 27 – 31 ]. Our study revealed the most common signs of CABM – headache, fever ≥38 °C and nausea.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

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

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 96%

See 1 more Smart Citation

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

View full text Add to dashboard Cite

show abstract

“…Initiating antibiotic treatment as early as possible is important to optimize clinical outcome of bacterial meningitis [1,2]. However, the diagnosis and treatment of bacterial meningitis continues to present challenges, as causative pathogens may not be detected in all patients in a timely manner and results of routine cerebrospinal fluid (CSF) parameters such as leukocyte count are often insufficiently sensitive and specific, for instance in patients with comorbidities or atypical pathogens as causative agents [3].…”

Section: Introductionmentioning

confidence: 99%

Phosphatidylcholine PC ae C44:6 in cerebrospinal fluid is a sensitive biomarker for bacterial meningitis

et al. 2020

View full text Add to dashboard Cite

Background: The timely diagnosis of bacterial meningitis is of utmost importance due to the need to institute antibiotic treatment as early as possible. Moreover, the differentiation from other causes of meningitis/encephalitis is critical because of differences in management such as the need for antiviral or immunosuppressive treatments. Considering our previously reported association between free membrane phospholipids in cerebrospinal fluid (CSF) and CNS involvement in neuroinfections we evaluated phosphatidylcholine PC ae C44:6, an integral constituent of cell membranes, as diagnostic biomarker for bacterial meningitis. Methods:We used tandem mass spectrometry to measure concentrations of PC ae C44:6 in cell-free CSF samples (n = 221) from patients with acute bacterial meningitis, neuroborreliosis, viral meningitis/encephalitis (herpes simplex virus, varicella zoster virus, enteroviruses), autoimmune neuroinflammation (anti-NMDA-receptor autoimmune encephalitis, multiple sclerosis), facial nerve and segmental herpes zoster (shingles), and noninflammatory CNS disorders (Bell's palsy, Tourette syndrome, normal pressure hydrocephalus).Results: PC ae C44:6 concentrations were significantly higher in bacterial meningitis than in all other diagnostic groups, and were higher in patients with a classic bacterial meningitis pathogen (e.g. Streptococcus pneumoniae, Neisseria meningitidis, Staphylococcus aureus) than in those with less virulent or opportunistic pathogens as causative agents (P = 0.026). PC ae C44:6 concentrations were only moderately associated with CSF cell count (Spearman's ρ = 0.45; P = 0.009), indicating that they do not merely reflect neuroinflammation. In receiver operating characteristic curve analysis, PC ae C44:6 equaled CSF cell count in the ability to distinguish bacterial meningitis from viral meningitis/encephalitis and autoimmune CNS disorders (AUC 0.93 both), but had higher sensitivity (91% vs. 41%) and negative predictive value (98% vs. 89%). A diagnostic algorithm comprising cell count, lactate and PC ae C44:6 had a sensitivity of 97% (specificity 87%) and negative predictive value of 99% (positive predictive value 61%) and correctly diagnosed three of four bacterial meningitis samples that were misclassified by cell count and lactate due to low values not suggestive of bacterial meningitis. © The Author(s) 2020. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article' s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article'

show abstract

“…• Non-communicating obstructive hydrocephalus. 21 • Cerebral mass lesion causing brain shift. 22 • Spinal cord compression 23 • Skin infection near the site of the lumbar puncture (e.g., Suspected spinal epidural abscess).…”

Section: Contraindications For Lumbar Puncturementioning

confidence: 99%

Lumbar Puncture: Indications, Challenges and Recent advances

Mishra

Vishnu

2020

Preprint

View full text Add to dashboard Cite

Introduction The methodological, diagnostic and therapeutic aspects of lumbar puncture (LP) and CSF study have undergone many radical changes, since it was first done in 1890 by Quincke. Objectives To explore the current trends in LP practice and to suggest a safety checklist to avoid the common complications and pitfalls. To study recent advances in diagnostic and therapeutic aspects of LP and safety and efficacy of outpatient LP. We also intended to explore the common practices that are being followed peri-LP procedure, whether these are real diligences or myth only. Methods With the key words of

show abstract

Acute Community-Acquired Bacterial Meningitis

Cited by 23 publications

References 71 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

Phosphatidylcholine PC ae C44:6 in cerebrospinal fluid is a sensitive biomarker for bacterial meningitis

Lumbar Puncture: Indications, Challenges and Recent advances

Contact Info

Product

Resources

About