Bacterial Meningitis in Cirrhotic Patients

Barahona-Garrido, Josué; Hernández-Calleros, Jorge; Téllez-Ávila, Félix Ignacio; Chávez-Tapia, Norberto C.; Troche, José María Remes; Torre, Aldo

doi:10.1097/mcg.0b013e3181d88d53

Cited by 7 publications

(2 citation statements)

References 42 publications

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“…The specific species associations with hepatobiliary disorders vary for SGP (10–83%) and SL (25–60%) followed by SGG (2–35%) and rarely for SII, SGM and S. alactolyticus (Beck et al, 2008 ; Romero et al, 2011 ; Lazarovitch et al, 2013 ; Corredoira et al, 2014 ; Sheng et al, 2014 ; Toepfner et al, 2014 ; Almeida et al, 2016 ). In rare cases, SB was obtained from cerebrospinal fluid and blood culture of patients with liver cirrhosis that developed bacterial meningitis (Barahona-Garrido et al, 2010 ). Urinary tract infections are a further infection caused by SBSEC members, particularly SGP , which are responsible for nearly 10% of cases in Vietnam (Poulsen et al, 2012 ).…”

Section: Clinical Infections and Host-immune Response Due To Sbsec Inmentioning

confidence: 99%

The Road to Infection: Host-Microbe Interactions Defining the Pathogenicity of Streptococcus bovis/Streptococcus equinus Complex Members

Jans¹,

Boleij²

2018

Front. Microbiol.

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The Streptococcus bovis/Streptococcus equinus complex (SBSEC) comprises several species inhabiting the animal and human gastrointestinal tract (GIT). They match the pathobiont description, are potential zoonotic agents and technological organisms in fermented foods. SBSEC members are associated with multiple diseases in humans and animals including ruminal acidosis, infective endocarditis (IE) and colorectal cancer (CRC). Therefore, this review aims to re-evaluate adhesion and colonization abilities of SBSEC members of animal, human and food origin paired with genomic and functional host-microbe interaction data on their road from colonization to infection. SBSEC seem to be a marginal population during GIT symbiosis that can proliferate as opportunistic pathogens. Risk factors for human colonization are considered living in rural areas and animal-feces contact. Niche adaptation plays a pivotal role where Streptococcus gallolyticus subsp. gallolyticus (SGG) retained the ability to proliferate in various environments. Other SBSEC members have undergone genome reduction and niche-specific gene gain to yield important commensal, pathobiont and technological species. Selective colonization of CRC tissue is suggested for SGG, possibly related to increased adhesion to cancerous cell types featuring enhanced collagen IV accessibility. SGG can colonize, proliferate and may shape the tumor microenvironment to their benefit by tumor promotion upon initial neoplasia development. Bacteria cell surface structures including lipotheichoic acids, capsular polysaccharides and pilus loci (pil1, pil2, and pil3) govern adhesion. Only human blood-derived SGG contain complete pilus loci and other disease-associated surface proteins. Rumen or feces-derived SGG and other SBSEC members lack or harbor mutated pili. Pili also contribute to binding to fibrinogen upon invasion and translocation of cells from the GIT into the blood system, subsequent immune evasion, human contact system activation and collagen-I-binding on damaged heart valves. Only SGG carrying complete pilus loci seem to have highest IE potential in humans with significant links between SGG bacteremia/IE and underlying diseases including CRC. Other SBSEC host-microbe combinations might rely on currently unknown mechanisms. Comparative genome data of blood, commensal and food isolates are limited but required to elucidate the role of pili and other virulence factors, understand pathogenicity mechanisms, host specificity and estimate health risks for animals, humans and food alike.

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Section: Clinical Infections and Host-immune Response Due To Sbsec Inmentioning

confidence: 99%

The Road to Infection: Host-Microbe Interactions Defining the Pathogenicity of Streptococcus bovis/Streptococcus equinus Complex Members

Jans¹,

Boleij²

2018

Front. Microbiol.

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“…Few reports have also documented high rates of bacterial meningitis among patients with cirrhosis compared to those without liver disease, including pneumococcal infections[ 31 ]. Increased creatinine serum levels were associated with mortality in cirrhotic patients with meningitis[ 32 ]. The overall incidence of bacteremia, urinary tract infections, pneumonia, meningitis, tuberculosis, and liver abscess appeared increased more than tenfold in LC, and mortality rates of each episode were 3 to 10 times higher than in non-cirrhotic patients[ 33 ].…”

Section: Bacterial Infections In Patients With Liver Cirrhosismentioning

confidence: 99%

Management of bacterial and fungal infections in end stage liver disease and liver transplantation: Current options and future directions

Righi¹

2018

WJG

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Patients with liver cirrhosis are susceptible to infections due to various mechanisms, including abnormalities of humoral and cell-mediated immunity and occurrence of bacterial translocation from the intestine. Bacterial infections are common and represent a reason for progression to liver failure and increased mortality. Fungal infections, mainly caused by Candida spp., are often associated to delayed diagnosis and high mortality rates. High level of suspicion along with prompt diagnosis and treatment of infections are warranted. Bacterial and fungal infections negatively affect the outcomes of liver transplant candidates and recipients, causing disease progression among patients on the waiting list and increasing mortality, especially in the early post-transplant period. Abdominal, biliary tract, and bloodstream infections caused by Gram-negative bacteria [e.g., Enterobacteriaceae and Pseudomonas aeruginosa (P. aeruginosa)] and Staphylococcus spp. are commonly encountered in liver transplant recipients. Due to frequent exposure to broad-spectrum antibiotics, invasive procedures, and prolonged hospitalizations, these patients are especially at risk of developing infections caused by multidrug resistant bacteria. The increase in antimicrobial resistance hampers the choice of an adequate empiric therapy and warrants the knowledge of the local microbial epidemiology and the implementation of infection control measures. The main characteristics and the management of bacterial and fungal infections in patients with liver cirrhosis and liver transplant recipients are presented.

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Streptococcus gallolyticus meningitis in adults: report of five cases and review of the literature

Samkar¹,

Brouwer²,

Pannekoek³

et al. 2015

Clinical Microbiology and Infection

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We describe the incidence and patient characteristics of Streptococcus gallolyticus meningitis. We identified S. gallolyticus meningitis in a nationwide cohort of patients with community-acquired bacterial meningitis, and performed a systematic review and meta-analysis of all reported adult cases in the literature. Five cases were identified (0.3%) in a cohort of 1561 episodes of bacterial meningitis. In one patient, bowel disease (colon polyps) was identified as a predisposing condition for S. gallolyticus infection, whereas no patients were diagnosed with endocarditis. In a combined analysis of our patients and 37 reported in the literature, we found that the median age was 59 years. Predisposing factors were present in 21 of 42 patients (50%), and mainly consisted of immunosuppressive therapy (seven patients), cancer (four patients), and alcoholism (four patients). Colon disease was identified in 15 of 24 patients (63%) and endocarditis in five of 27 patients (18%). Co-infection with Strongyloides stercoralis was identified in 14 of 34 patients (41%), ten of whom were infected with human immunodeficiency virus or human T-lymphotropic virus. Outcomes were described for 37 patients; eight died (22%) and one (3%) had neurological sequelae. S. gallolyticus is an uncommon cause of bacterial meningitis, with specific predisposing conditions. When it is identified, consultation with a cardiologist and gastroenterologist is warranted to rule out underlying endocarditis or colon disease. Stool examinations for Strongyloides stercoralis should be performed in patients who have travelled to or originate from endemic areas.

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Bacterial Meningitis in Cirrhotic Patients

Abstract: BM in cirrhotic patients is associated with a high mortality rate. The clinical and microbiologic features of BM in cirrhotic patients differ from those in the general population. A serum creatinine level ≥1.3 mg/dL on admission is associated with a higher risk of mortality.

Cited by 7 publications

References 42 publications

The Road to Infection: Host-Microbe Interactions Defining the Pathogenicity of Streptococcus bovis/Streptococcus equinus Complex Members

The Road to Infection: Host-Microbe Interactions Defining the Pathogenicity of Streptococcus bovis/Streptococcus equinus Complex Members

Management of bacterial and fungal infections in end stage liver disease and liver transplantation: Current options and future directions

Streptococcus gallolyticus meningitis in adults: report of five cases and review of the literature

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