Intracerebral Hemorrhages in Adults with Community Associated Bacterial Meningitis in Adults: Should We Reconsider Anticoagulant Therapy?

Mook-Kanamori, Barry B.; Fritz, Daan; Brouwer, Matthijs C.; Ende, Arie van der; Beek, Diederik van de

doi:10.1371/journal.pone.0045271

Cited by 52 publications

(55 citation statements)

References 28 publications

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“…Uncertainty about the use of therapeutic dose of heparin remains especially for the group of patients with a CNS infection because of the small number of patients and because there are data that suggest that these patients have a higher risk of hemorrhage if treated with anticoagulation. 27 The results of our study cannot be extrapolated to pediatric patients with CVT because the ISCVT included only adult patients. A previous study indicates that treatment with therapeutic doses of heparin was not associated with serious hemorrhages in selected pediatric patients with CVT.…”

Section: Discussionmentioning

confidence: 93%

Clinical Outcome of Anticoagulant Treatment in Head or Neck Infection–Associated Cerebral Venous Thrombosis

Zuurbier

Coutinho

Stam

et al. 2016

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Background and Purpose-Local infections of the head or neck are a cause of cerebral venous thrombosis. Treatment of infectious cerebral venous thrombosis with heparin is controversial. We examined whether this treatment was associated with intracranial hemorrhagic complications and poor clinical outcome. Methods-We retrieved data from a prospective cohort study of 624 cerebral venous thrombosis patients. We compared patients with and without an infection of the head or neck and anticoagulated versus not anticoagulated. We examined death or dependency and new intracerebral hemorrhages. Results-Six hundred four of 624 patients were eligible for the study. Fifty-seven patients had an infection of the head or neck (9.4%). Comparing data between infection and noninfection patients, the frequency of therapeutic doses of heparin was similar in both groups (82.5% versus 83.7%). New intracerebral hemorrhages were more common in patients with an infection (12.3% versus 5.3%; P=0.04), but death or dependency did not differ between patients with and without an infection (15.8% versus 13.7%). In patients with an infection of the head or neck, there was no significant difference in the frequency of new intracerebral hemorrhages and poor outcome between patients who did or did not receive therapeutic doses of heparin. Conclusions-New intracerebral hemorrhages were more frequent in patients with an infection. The use of therapeutic doses of heparin did not seem to influence the risk of new intracranial hemorrhages or poor clinical outcome, but the number of patients who did not receive anticoagulation was too small to draw firm conclusions about safety of heparin in adults with cerebral venous thrombosis and an infection of the head or neck.

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Section: Discussionmentioning

confidence: 93%

Clinical Outcome of Anticoagulant Treatment in Head or Neck Infection–Associated Cerebral Venous Thrombosis

Zuurbier

Coutinho

Stam

et al. 2016

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“…Intracranial hemorrhage is a rare but devastating complication in patients with bacterial meningitis, with high rates of mortality and unfavorable outcome (65% and 95%, respectively). 21 A previous study showed a 5-fold increased risk of developing intracranial hemorrhage in patients with bacterial meningitis using anticoagulant therapy. 21 Patients with S aureus meningitis and endocarditis are at even higher risk of intracerebral hemorrhage compared with other bacterial meningitis patients using anticoagulant therapy.…”

Section: Discussionmentioning

confidence: 98%

“…21 Patients with S aureus meningitis and endocarditis are at even higher risk of intracerebral hemorrhage compared with other bacterial meningitis patients using anticoagulant therapy. 15,21 In these patients, discontinuation of anticoagulant therapy should be considered until the patient has recovered from the acute phase of the bacterial meningitis episode.…”

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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“…[8] ICH is also a rare, but devastating complication in patients with community-associated bacterial meningitis, caused by Streptococcus pneumoniae , Staphylococcus aureus , Pseudomonas aeruginosa and Listeria monocytogenes . [9] The underlying pathophysiological mechanisms are microvascular damage, vasculitis and cerebral infarction. The dysregulation of both coagulation and fibrinolytic pathways, after massive clotting in the central nervous system, may hypothetically result in local depletion of coagulation factors.…”

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confidence: 99%

“…The dysregulation of both coagulation and fibrinolytic pathways, after massive clotting in the central nervous system, may hypothetically result in local depletion of coagulation factors. [9] Finally, ICHs have been described also in young people with typhoid fever. Salmonella endotoxin may stimulate the phagocytosis of neutrophils, red blood cells and platelets by the histiocytes in the bone marrow, resulting in pancytopenia.…”

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confidence: 99%