Cerebral Infarction in Adults with Bacterial Meningitis

Schut, Ewout S.; Lucas, Marjolein J.; Brouwer, Matthijs C.; Vergouwen, Mervyn D.I.; Ende, Arie van der; Beek, Diederik van de

doi:10.1007/s12028-011-9634-4

Cited by 113 publications

(77 citation statements)

References 31 publications

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“…For endocarditis and meningitis, AMI and AIS risk estimates in our study were particularly high but were less than the ≥10% reported in previous studies that included hemorrhagic stroke outcomes. 20,21 Most previous cohort studies on the association between infection and cardiovascular events lacked a comparison group or did not have adequate long-term follow-up. One small cohort study compared 208 patients hospitalized for pneumonia with 395 hospitalized controls and found an 8-fold risk increase for acute coronary syndrome within 15 days, 9 higher than our 2.2-fold increased RR within 30 days.…”

Section: Discussionmentioning

confidence: 99%

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Risk for Myocardial Infarction and Stroke After Community-Acquired Bacteremia

et al. 2014

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E ach year, >1 000 000 Americans experience acute myocardial infarction (AMI) or acute ischemic stroke (AIS). 1 Any role of acute infection in triggering acute cardiovascular events is of major clinical and public health interest. [2][3][4][5] Infections may increase the risk of AMI and AIS 6-14 by inducing demand ischemia, decreasing myocardial contractility, or causing endothelial dysfunction, coagulation disturbance, or direct platelet activation. [2][3][4][15][16][17][18] The magnitude and duration of the increased cardiovascular risk is debatable. Cohort studies have reported short-term risks of AMI and stroke varying from 0.2% to >10% after patients have been hospitalized with pneumonia, sepsis, endocarditis, or meningitis. [7][8][9][10][11][19][20][21] Editorial see p 1375 Clinical Perspective on p 1396Case-only studies suggest a 10-to 50-fold increased risk for AMI or stroke shortly after patients have been hospitalized with infection, 6,9,12 and a 2-to 5-fold increased risk shortly after infection diagnosed by general practitioners. 13,14 Only 1 cohort study of 206 patients with pneumonia included a comparison group, 9 and we are aware of only 3 studies that included microbiological test results. 6,9,10 The lack of laboratory confirmation of infection may have falsely inflated the effect estimates if cardiovascular events were initially misdiagnosed as infections. Community-acquired bacteremia (CAB) is a well-defined clinical entity that embraces a wide range of mechanisms whereby infection may trigger cardiovascular events. We conducted a 20-year population-based cohort study in Denmark to assess the short-and longer-term risks of AMI and AIS among medical patients with CAB in Background-Infections may trigger acute cardiovascular events, but the risk after community-acquired bacteremia is unknown. We assessed the risk for acute myocardial infarction and ischemic stroke within 1 year of community-acquired bacteremia. Methods and Results-Thispopulation-based cohort study was conducted in Northern Denmark. We included 4389 hospitalized medical patients with positive blood cultures obtained on the day of admission. Patients hospitalized with bacteremia were matched with up to 10 general population controls and up to 5 acutely admitted nonbacteremic controls, matched on age, sex, and calendar time. All incident events of myocardial infarction and stroke during the following 365 days were ascertained from population-based healthcare databases. Multivariable regression analyses were used to assess relative risks with 95% confidence intervals (CIs) for myocardial infarction and stroke among bacteremia patients and their controls. The risk for myocardial infarction or stroke was greatly increased within 30 days of community-acquired bacteremia: 3.6% versus 0.2% among population controls (adjusted relative risk, 20.86; 95% CI,) and 1.7% among hospitalized controls (adjusted relative risk, 2.18; 95% CI, 1.80-2.65). The risks for myocardial infarction or stroke remained modestly increased from 31 to 180 days aft...

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Section: Discussionmentioning

confidence: 99%

“…Cohort studies have reported short-term risks of AMI and stroke varying from 0.2% to >10% after patients have been hospitalized with pneumonia, sepsis, endocarditis, or meningitis. [7][8][9][10][11][19][20][21] …”

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Risk for Myocardial Infarction and Stroke After Community-Acquired Bacteremia

et al. 2014

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“…In a previous study, we showed that cerebral infarction was present in 25% of 696 patients with bacterial meningitis. 18 Ischemic stroke is also a major complication in endocarditis patients; in a previous cohort study of 1437 patients, 15.2% developed cerebral infarctions. 19 In patients with both bacterial meningitis and endocarditis, there seems to be an additional risk at developing ischemic stroke; 9 of 24 patients (38%) with both bacterial meningitis and endocarditis developed cerebral infarctions in our study.…”

Section: Discussionmentioning

confidence: 99%

Endocarditis in Adults With Bacterial Meningitis

et al. 2013

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Background— Endocarditis may precede or complicate bacterial meningitis, but the incidence and impact of endocarditis in bacterial meningitis are unknown. Methods and Results— We assessed the incidence and clinical characteristics of patients with meningitis and endocarditis from a nationwide cohort study of adults with community-acquired bacterial meningitis in the Netherlands from 2006 to 2012. Endocarditis was identified in 24 of 1025 episodes (2%) of bacterial meningitis. Cultures yielded Streptococcus pneumoniae in 13 patients, Staphylococcus aureus in 8 patients, and Streptococcus agalactiae , Streptococcus pyogenes , and Streptococcus salivarius in 1 patient each. Clues leading to the diagnosis of endocarditis were cardiac murmurs, persistent or recurrent fever, a history of heart valve disease, and S aureus as the causative pathogen of bacterial meningitis. Treatment consisted of prolonged antibiotic therapy in all patients and surgical valve replacement in 10 patients (42%). Two patients were treated with oral anticoagulants, and both developed life-threatening intracerebral hemorrhage. Systemic (70%) and neurological (54%) complications occurred frequently, leading to a high proportion of patients with unfavorable outcome (63%). Seven of 24 patients (29%) with meningitis and endocarditis died. Conclusions— Endocarditis is an uncommon coexisting condition in bacterial meningitis but is associated with a high rate of unfavorable outcome.

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“…A cerebral infarction is a severe complication of bacterial meningitis, reported as a result of vasculitis, vasospasm, endocarditis, or intra-arterial thrombosis. Only a few cohort studies on cerebral infarctions in bacterial meningitis have been published (5)(6)(7)(8). Cerebrovascular involvement, including cerebral infarction, is particularly common in pneumococcal meningitis (5, 9, 10) and typically occurs only in the acute phase of bacterial meningitis (11).…”

Section: Discussionmentioning

confidence: 99%

A Delayed Cerebral Vasospasm with Infarction Is Secondary to <i>Listeria monocytogenes</i> Meningitis: MRI and MRA Are Diagnostically Useful

et al. 2015

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Among patients with bacterial meningitis, a cerebral vasospasm typically occurs during the acute phase. We experienced a case of delayed cerebral vasospasm with infarction that was secondary to Listeria monocytogenes meningitis. An 82-year-old woman with Listeria monocytogenes meningitis, whose symptoms had been improving after the initiation of antibacterial therapy, fell into a coma on day 15 and developed generalized seizure. Magnetic resonance imaging (MRI) and MR angiography (MRA) indicated a cerebral vasospasm with multiple infarctions. The risk of vascular complications following acute bacterial meningitis requires close follow-up to identify neurological changes and a low threshold for vascular evaluation. In such cases, MRI and MRA have diagnostic utility.

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Cerebral Infarction in Adults with Bacterial Meningitis

Abstract: Cerebral infarction is a common and severe complication in adults with community-acquired bacterial meningitis. Preventing cerebral infarctions will be important in reducing the high morbidity and mortality rate in adults with community-acquired bacterial meningitis.

Cited by 113 publications

References 31 publications

Risk for Myocardial Infarction and Stroke After Community-Acquired Bacteremia

Risk for Myocardial Infarction and Stroke After Community-Acquired Bacteremia

Endocarditis in Adults With Bacterial Meningitis

A Delayed Cerebral Vasospasm with Infarction Is Secondary to <i>Listeria monocytogenes</i> Meningitis: MRI and MRA Are Diagnostically Useful

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