Endocarditis in Adults With Bacterial Meningitis

Abstract

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.

Long-term Outcome of Neurological Complications after Infective Endocarditis

“…These scattered reports and our results both demonstrated that meningitis is a rare neurological complication but is associated with a high probability of an unfavorable outcome 30 . The reason may be destructive neurological dysfunction by diffused brain infection 30 . The result of brain abscess has not been reported previously.…”

“…In the limited reports, the incidence of a brain abscess may range from 2.8% to 30% based on the different diagnostic tools and criteria 29 . Endocarditis is an uncommon condition in bacterial meningitis, identified in 2% 30 of patients and 1.1% 29 complications of patients with IE. Our study revealed 0.7% cases of IE-related abscess and 0.5% cases of meningitis, confirmed by imaging.…”

“…The choice between surgical clip and endovascular technique depends on the lesion itself (numbers, size, and location), approachable parent and distal arteries, patient's conditions, and priority of the medical institute 14,42,43 . A few previous clinical studies discussed the result of IE-related cerebral meningitis 29,30 . These scattered reports and our results both demonstrated that meningitis is a rare neurological complication but is associated with a high probability of an unfavorable outcome 30 .…”

“…A few previous clinical studies discussed the result of IE-related cerebral meningitis 29,30 . These scattered reports and our results both demonstrated that meningitis is a rare neurological complication but is associated with a high probability of an unfavorable outcome 30 . The reason may be destructive neurological dysfunction by diffused brain infection 30 .…”

A complication of meningitis and infective endocarditis due toStreptococcus pyogenes

“…Upper respiratory infection or soft tissue infection precede IE due to S. pyogenes 2. A nationwide cohort study in the Netherlands suggested that they found 24 cases (2%) of IE in 1025 patients with all bacterial meningitis and only one case was due to S. pyogenes although the detail was not described 12. From these epidemiological data, we assumed that IE was the primary cause of her clinical course in the present case, although we could not completely deny another hypothesis; IE might be secondary to bacterial meningitis.…”