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meningitis

Meningitis

Meningitis remains one of the most dreaded complications of neurosurgical procedures and is common in patients with preexisting infection.

Etiology

see Viral meningitis.

see Bacterial meningitis

see Tuberculous meningitis

see Postoperative meningitis.

The responsible pathogens of nosocomial meningitis are quite different from community-acquired meningitis with high rates of morbidity and mortality.

Post-neurosurgical meningitis usually occurs in the autumn and winter of the year in Beijing Tian Tan Hospital, Capital Medical University, Beijing, China;. Gram-positive organisms, which are sensitive to compound sulfamethoxazole and vancomycin, are the most common causative pathogens of post-neurosurgical meningitis in the northern mainland of China 1).


see Frontal sinus posterior wall fracture

Epidemiology

Occurs in 25-50% of untreated traumatic cerebrospinal fluid fistula (CSF) and in 10% of patients in the first week after trauma with head injury.

The diagnosis of external ventricular drain EVD-related ventriculo-meningitis in neurosurgical ICU patients can be established in a rapid manner using a multiplex real-time polymerase chain reaction (PCR) assay on cerebrospinal fluid (CSF) samples in combination with intrathecal biomarkers 2).

Diagnosis

Imaging findings are mostly nonspecific with respect to the causative pathogen 3).


Enterovirus detection in cerebrospinal fluid was effective to differentiate bacterial meningitis from viral meningitis. When the test was analyzed together with the Bacterial Meningitis Score, specificity was higher when compared to Bacterial Meningitis Score alone 4).

Treatment

The most important prognostic factor is the appropriate choice of pathogen-specific antibacterial therapy

Case reports

A report describes the first case, of meningitis in an adult patient caused by Caulobacter spp.

A 75 year-old-man was operated for a glioblastoma with no evident signs of primary infection in the wound site. Eight days after surgery the patient developed signs and symptoms of meningitis. Caulobacter was then isolated on three separate occasions in the patient's cerebrospinal fluid (CSF). Thereafter, specific antibiotic therapy began. After two weeks of therapy the patient was discharged with complete resolution of any related symptoms.

Caulobacter species can cause adult meningitis even where there is no evidence of surgical site infection 5).

1)
Tian R, Hao S, Hou Z, Gao Z, Liu B. The characteristics of post-neurosurgical bacterial meningitis in elective neurosurgery in 2012: A single institute study. Clin Neurol Neurosurg. 2015 Sep 5;139:41-45. doi: 10.1016/j.clineuro.2015.09.002. [Epub ahead of print] PubMed PMID: 26364156.
2)
Rath PM, Schoch B, Adamzik M, Steinmann E, Buer J, Steinmann J. Value of multiplex PCR using cerebrospinal fluid for the diagnosis of ventriculostomy-related meningitis in neurosurgery patients. Infection. 2014 Jan 29. [Epub ahead of print] PubMed PMID: 24470322.
3)
Mohan S, Jain KK, Arabi M, Shah GV. Imaging of meningitis and ventriculitis. Neuroimaging Clin N Am. 2012 Nov;22(4):557-83. doi: 10.1016/j.nic.2012.04.003. Epub 2012 Sep 4. Review. PubMed PMID: 23122257.
4)
Pires FR, Franco ACBF, Gilio AE, Troster EJ. Comparison of enterovirus detection in cerebrospinal fluid with Bacterial Meningitis Score in children. Einstein (Sao Paulo). 2017 Apr-Jun;15(2):167-172. doi: 10.1590/S1679-45082017AO3880. English, Portuguese. PubMed PMID: 28767914.
5)
Penner F, Brossa S, Barbui AM, Ducati A, Cavallo R, Zenga F. Caulobacter spp: A rare pathogen responsible for paucisintomatic persisitant meningitis in a glioblastoma patient. World Neurosurg. 2016 Sep 17. pii: S1878-8750(16)30846-4. doi: 10.1016/j.wneu.2016.09.020. [Epub ahead of print] PubMed PMID: 27650802.
meningitis.txt · Last modified: 2017/08/09 13:06 by administrador