Combined Bacterial Meningitis and Infective Endocarditis: When Should We Search for the Other When Either One is Diagnosed?

Abstract

Introduction:We aimed to describe patients with coexisting infective endocarditis (IE) and bacterial meningitis (BM). Methods: We merged two large prospective cohorts, an IE cohort and a BM cohort, with only cases of definite IE and community-acquired meningitis. We compared patients who had IE and BM concurrently to patients with IE only and BM only. Results: Among the 1030 included patients, we identified 42 patients with IE-BM (4.1%). Baseline characteristics of patients with IE-BM were mostly similar to those of patients with IE, but meningitis was the predominant presentation at admission (39/42, 92.3%). Causative pathogens were predominantly Streptococcus pneumoniae (18/42, 42.9%) and Staphylococcus aureus (14/42, 33.3%). All pneumococcal IE were associated with BM (18/18). BM due to oral and group D streptococci, Streptococcus agalactiae, and S. aureus were frequently associated with IE Bruno Hoen and Xavier Duval contributed equally.The members of the AEPEI and the COMBAT study groups are listed in the Acknowledgements section.G. Be ´raud (&)

Infective Endocarditis in High-Income Countries

“…These may be large, mobile, located on the mitral valve [ 26 , 27 ], and dependent on the infectious foci of the S. aureus infection [ 26 , 27 , 28 , 29 , 30 , 31 ] that have been linked with a notable augmentation of risk of symptomatic embolic events. A reliable diagnosis is offered by systematic magnetic resonance imaging of the brain that may highlight cerebral abnormalities in up to 80% of patients, including embolic events that occur asymptomatically in 50% of cases [ 32 , 33 , 34 ]. As for the events related to mycotic aneurysms, their development results from a septic arterial embolism which affects the intraluminal space or vasa vasorum.…”

A Rare Case of Streptococcus agalactiae Ventriculitis and Endocarditis

“…Perhaps most importantly, the presence of endocarditis typically extends antibiotic treatment for meningitis from two weeks to six weeks [10]. Recommendations to screen for endocarditis in patients with Staphylococcus aureus meningitis, group D Streptococcus meningitis, and enterococcal meningitis have already been published [12]. Given the increase in morbidity and mortality in GBS meningitis with concomitant endocarditis, as well as divergent treatment requirements when endocarditis is present, we agree that all patients with GBS meningitis should be screened for endocarditis.…”

Streptococcus pneumoniae Serotype 23B Causing Asymptomatic Sinusitis Complicated by Endocarditis and Meningitis: Sequela of a Non-vaccine Serotype

“…While S. pneumoniae is the most common cause of bacterial meningitis in younger patients such as ours, nearly 50% of endocarditis cases due to this pathogen in a cohort study also presented with meningitis [ 4 , 15 ]. Moreover, the occurrence of meningitis is limited to approximately 4% of individuals with endocarditis, and S. pneumoniae is responsible for about 42.9% of cases where meningitis and endocarditis coexist [ 16 , 17 ]. These data indicate that a presentation of pneumococcal meningitis can also have a primary cardiac source and necessitates evaluation for it, as the initial physical examination findings may be non-specific in determining underlying cardiac involvement.…”