Common Cause Of Bacterial Meningitis Research Articles

Pattern of bacterial meningitis in Sudanese children, Omdurman, Sudan

Bacterial meningitis is very serious condition among children less than 5 years, since it might affect the central nervous system (deafness, epilepsy and hemiplegia). We found in this study about half of the cases (48.5%) were due to Meningiococcal meningitis, followed by Hemophilus influenza, which account for one-third of the cases (30.3%). Streptococcal pneumoniae is the least common cause of bacterial meningitis in Sudan, which account for only one-fifth of the cases (21.2%). Most of the presentations were fever, convulsion and sign of meningial irritation. Case fatality rate 5 (5.15%), neurological complications account for 12 (12.37%) cases. Vaccination against meningococcal, haemophilus and Streptococcal infection should be considered, because all of the studied cases were unvaccinated, in addition to facilities for investigations should be readily available. Key words: Haemophilus influenza, bacterial meningitis, meningiococcal, streptococcal pneumonia.

Signs, symptoms and management of bacterial meningitis

This article describes the common causes of bacterial meningitis, signs and symptoms, and management. It summarises the 2010 guideline on bacterial meningitis and meningococcal septicaemia produced by the National Institute for Health and Clinical Excellence.

Meningitis part 2: Prevention and protection

This is the second of three articles about meningitis. It provides information about the vaccinations currently available to prevent meningitis and the procedures which are followed when a case occurs in a school setting. Vaccines have been extremely effective in reducing the numbers of cases caused by Haemophilus influenzae type b and Neisseria meningitidis (meningococcus) group C bacteria. Cases of pneumococcal meningitis have also reduced since the introduction of the pneumococcal conjugate vaccine. However, there is no vaccine currently available to protect against Neisseria meningitidis group B, the most common cause of bacterial meningitis in the UK. As vaccines cannot prevent all types of meningitis, cases in school settings will continue to occur. The procedures undertaken by the Health Protection Unit will reduce the chance of a second case occurring. The school nurse can play an important role in giving accurate information and helping to reassure staff, pupils and parents.

Group B Streptococcus Meningitis in a Child with Cochlear Implant

Group B Streptococcus Meningitis in a Child with Cochlear Implant

TRANSLATIONAL IMPACT

The pathogenic Gram-positive bacterium Listeria monocytogenes causes severe acute infection in immunocompromised people including the very young and the very old. L. monocytogenes is the third most common cause of bacterial meningitis in neonates and causes abortion and stillbirth. Outbreaks of listeriosis continue to occur sporadically, recently claiming 20 lives in Canada. Whereas acute listeriosis is well-modeled in animals, chronic infection is more difficult to study and is consequently poorly understood. Bone marrow has been shown to harbor L. monocytogenes, suggesting that bone might be an important chronic reservoir from which the pathogen can infect the central nervous system. However, this infection is difficult to study because it involves only a few bacteria and the extent of infection cannot be assessed until after the animal is sacrificed.Here, the authors use live animal imaging to examine bone marrow infection by L. monocytogenes. As in previous imaging studies of this pathogen in the gallbladder, they found that bone marrow is another site of chronic infection. In vivo bioluminescence demonstrated that bone marrow infection by this bacterium is focal, and that the foci appear after both oral and intravenous infection. Furthermore, although L. monocytogenes is hypothesized to be an obligate intracellular pathogen, highly attenuated mutants that are defective in intracellular replication can colonize the bone marrow, focally, for many weeks. Persistence of L. monocytogenes in this compartment supports the idea that the bone marrow is a niche for this, and perhaps other, pathogens.Listeriosis can be very difficult to treat, sometimes requiring intravenous antibiotics for weeks. Studies of persistent bacterial infection should consider the bone marrow as a possible site of residual infection during, and after, treatment. In addition, this study demonstrates that the growth mechanism of attenuated L. monocytogenes is unclear; this is significant because attenuated strains are now in clinical trials to induce immune responses and eradicate established tumors without causing disease. The presence of L. monocytogenes in bone marrow might facilitate the induction of such immunity or, conversely, such persistence may indicate a lack of immune response and the induction of tolerance. Thus, in order to maximize efficacy and to ensure the safety of this treatment, future experiments should address immune stimulation in the bone marrow because this substantially sized niche might be beneficial, or detrimental, to anti-cancer therapy and other efforts.

Meningitis

* Young infants who have meningitis may present with nonspecific clinical manifestations. * S. pneumoniae and N. meningitidis remain the most common causes of bacterial meningitis in the infant and child, and GBS continues to be the most common neonatal pathogen. * Empiric therapy for suspected bacterial meningitis in a non-neonate includes a combination of parenteral vancomycin and either cefotaxime or ceftriaxone. * Children whose GCS scores are less than 8, show signs of shock or respiratory compromise, and have focal neurologic findings or clinical signs of elevated intracranial pressure should be admitted to a pediatric intensive care unit. * Sensorineural hearing loss occurs in 30% of children who have pneumococcal and 10% of those who have meningococcal meningitis.

Immunogenicity of the Tetravalent Protein-Conjugated Meningococcal Vaccine in Recipients of Related and Unrelated Allogeneic Hematopoietic Cell Transplants (HCT)

Following the successful introduction of the highly immunogenic protein-conjugated Haemophilus influenza and pneumococcal vaccines, Neisseria meningitidis has become the most common cause of bacterial meningitis in the US. Each year, invasive disease (meningitis, sepsis, pneumonia) due to this organism occurs in approximately 500, 000 persons world-wide, including 1400–2800 in the US. Despite rapid institution of appropriate antibiotics, 10%–14% of affected patients die and significant morbidity occurs in up to 20% of survivors. In 2005, the quadrivalent (A, C, Y, W-135) protein conjugated polysaccharide vaccine (MCV4) was approved in the US and recommended for children 11–12 years of age, previously unimmunized adolescents entering college, military recruits, patients with acquired or functional asplenia, and all travelers to hyperendemic or epidemic areas such as sub-Sahara Africa. Improved disease-free survival following HCT has resulted in an increasing number of survivors entering college and traveling abroad. Due to the lack of information on the immunogenicity of this vaccine in transplant survivors, we assessed the responses of 41 patients immunized with MCV4 following an HLA matched related (n=16), mis-matched related (n=2) or unrelated (n=23) HCT. The median age at HCT and at vaccination was 14 years and 18 years, respectively. Patients were transplanted for acute or chronic leukemia (n=28), immunodeficiency disease (n=4), hemoglobinopathy (n=4), HLH (n=1), NHL (n=1), MDS or aplastic anemia (n=3). Fifty percent of patients received an unmodified HCT and four patients were splenectomized prior to vaccination. MCV4 was administered at a median (range) of 3.2 (0.7–12.5) years following transplant. Ninety percent of patients had undetectable titers to all 4 serotypes prior to immunization. Antibody responses were measured by ELISA. Positive response was defined as > 4 ug/ml (serotype A), >5 ug/ml (serotype C), >4 ug/ml (serotype Y), and >3 ug/ml for serotype W-135. Sixty-one percent of patients developed an antibody response to 31 vaccine serotypes, although only 13 developed positive titers to all 4 serotypes. Response to serotypes A, C, Y, and W-135 was observed in 20, 13, 18, and 13 patients, respectively. Responses were significantly poorer in recipients of an unrelated HCT. Of the 7 non-responders who received a second MCV4, 3 of 4 evaluated patients developed titers to all 4 serotypes. This data suggests that although HCT recipients respond to MCV4, the response is sub-optimal, that pre and post vaccine titers should be assessed to ensure adequate protection, and that a booster immunization should be explored in this patient population.

Children with Bacterial Meningitis Presenting to the Emergency Department during the Pneumococcal Conjugate Vaccine Era

The epidemiology of bacterial meningitis in children in the era of widespread heptavalent conjugate pneumococcal vaccination (PCV7) is unknown. The objective was to describe the epidemiology of bacterial meningitis in children presenting to the emergency department (ED) during the era of widespread PCV7 vaccination. The authors retrospectively reviewed the medical records of all children aged 1 month to 19 years with bacterial meningitis who presented to the EDs of 20 U.S. pediatric centers (2001-2004). Bacterial meningitis was defined by a positive cerebrospinal fluid (CSF) culture for a bacterial pathogen or CSF pleocytosis (CSF white blood cell [WBC] count >or=10 cells/mm(3)) in association with either a positive blood culture or a CSF latex agglutination study. A total of 231 children with bacterial meningitis were identified. The median age was 0.6 years (interquartile range [IQR] = 0.2-4.2). Eight patients (3% of all patients) died. The following bacterial pathogens were identified: Streptococcus pneumoniae (n = 77; 33.3%), Neisseria meningitidis (67; 29.0%), Group B Streptococcus (42; 18.2%), Escherichia coli (17; 7.4%), nontypeable Haemophilus influenzae (10; 4.3%), other Gram-negative bacilli (7; 3.0%), Listeria monocytogenes (5; 2.2%), Group A Streptococcus (5; 2.2%), and Moraxella catarrhalis (1; 0.4%). S. pneumoniae serotypes were determined in 37 of 77 patients; of these, 62% were due to nonvaccine serotypes (including 19A). Although now a rare infectious disease in United States, bacterial meningitis still causes substantial morbidity in affected children. Despite the introduction of PCV7, S. pneumoniae remains the most common cause of bacterial meningitis in U.S. children, with approximately half of cases due to nonvaccine serotypes.

Streptococcus pneumoniae meningoencephalitis with unusual and widespread white matter lesions

Streptococcus pneumoniae is a common cause of bacterial meningitis, frequently leading to death or severe neurological impairment. We report an exceptional case of a 7-month-old child with meningoencephalitis caused by S. pneumoniae. Peculiar, widespread and unique signal abnormalities were found on magnetic resonance imaging (MRI) with extensive central nervous white matter injury as well as evidence of thrombosis of the lateral transverse sinus. These changes were observed very early in the course of the illness, presumably reflecting widespread cytotoxic edema, vasculitis and acute demyelination. These lesions occurred despite appropriate antibiotic and anti-inflammatory (glucocorticoid) therapy started very early in the course of the disease. Such diffuse white matter lesions in the early course of (pediatric) cases of S. pneumoniae meningoencephalitis have not been reported previously.

Meningitis registry of hospitalized cases in children: epidemiological patterns of acute bacterial meningitis throughout a 32-year period.

BackgroundBacterial meningitis remains a source of substantial morbidity and mortality in childhood. During the last decades gradual changes have been observed in the epidemiology of bacterial meningitis, related to the introduction of new polysaccharide and conjugate vaccines. The study presents an overview of the epidemiological patterns of acute bacterial meningitis in a tertiary children 's hospital during a 32-year period, using information from a disease registry. Moreover, it discusses the contribution of communicable disease registries in the study of acute infectious diseases.MethodsIn the early 1970s a Meningitis Registry (MR) was created for patients admitted with meningitis in Aghia Sofia Children's Hospital in Athens. The MR includes demographic, clinical and laboratory data as well as treatment, complications and outcome of the patients. In 2000 a database was created and the collected data were entered, analyzed and presented in three chronological periods: A (1974–1984), B (1985–1994) and C (1995–2005).ResultsOf the 2,477 cases of bacterial meningitis registered in total, 1,146 cases (46.3%) were classified as "probable" and 1,331 (53.7%) as "confirmed" bacterial meningitis. The estimated mean annual Incidence Rate (IR) was 16.9/100,000 for bacterial meningitis, 8.9/100,000 for Neisseria meningitidis, 1.3/100,000 for Streptococcus pneumoniae, 2.5/100,000 for Haemophilus influenzae type b (Hib) before vaccination and 0.4/100,000 for Hib after vaccination. Neisseria meningitis constituted the leading cause of childhood bacterial meningitis for all periods and in all age groups. Hib was the second most common cause of bacterial meningitis before the introduction of Hib conjugate vaccine, in periods A and B. The incidence of bacterial meningitis due to Streptococcus pneumoniae was stable. The long-term epidemiological pattern of Neisseria meningitidis appears in cycles of approximately 10 years, confirmed by a significant rise of IR in period C. The Case Fatality Rate (CFR) from all causes was 3.8%, while higher CFR were estimated for Streptococcus pneumoniae (7.5%, RR=2.1, 95% CI 1.2–3.7) and Neisseria meningitidis (4.8%, RR=1.7, 95% CI 1.1–2.5) compared to other pathogens. Moreover, overall CFR varied significantly among the three time periods (p = 0.0015), and was estimated to be higher in period C.ConclusionBy using the MR we were able to delineate long-term changes in the epidemiology of bacterial meningitis. Thus the MR proved to be a useful tool in the study and the prevention of communicable diseases in correlation with prevention strategies, such as vaccinations.

Listeria monocytogenes encephalitis mimicking Herpes Simplex virus encephalitis: The differential diagnostic importance of cerebrospinal fluid lactic acid levels

Listeria monocytogenes is a common cause of bacterial meningitis in elderly patients and in those with impaired cellular immunity. The most common central nervous system infection caused by L. monocytogenes is acute bacterial meningitis; meningoencephalitis is uncommon and encephalitis is rare. Early diagnosis of L. monocytogenes meningitis is difficult because only 50% of cerebrospinal fluid (CSF) Gram stains are negative. L. monocytogenes is one of the few central nervous system pathogens associated with red blood cells in the CSF. When L. monocytogenes presents as encephalitis with red blood cells in the CSF, the clinical presentation mimics most closely herpes simplex virus (HSV)-1 encephalitis. Because the therapies for L. monocytogenes and HSV-1 are different, early diagnostic differentiation is clinically important. The CSF lactic acid is the best way to rapidly differentiate between these two entities; the CSF lactic acid level is elevated in L. monocytogenes but is not elevated in HSV-1 encephalitis. The case presented is an elderly man with chronic lymphocytic leukemia who presented with encephalitis. Advanced age and chronic lymphocytic leukemia predispose him to a wide variety of pathogens, but the rapidity and severity of his clinical presentation made L. monocytogenes and HSV-1 encephalitis the most likely diagnostic possibilities. The CSF Gram stain was negative, but the elevated CSF lactic acid levels with encephalitis and red blood cells in the CSF indicated L. monocytogenes as the most likely pathogen. We present a case of L. monocytogenes encephalitis mimicking HSV-1 encephalitis. While receiving ampicillin therapy, the patient remained unresponsive for more than 1 week and then suddenly regained consciousness and recovered without neurologic sequelae.

Invasive Disease and Toxic Shock due to Zoonotic Streptococcus suis: An Emerging Infection in the East?

Streptococcus suis ( S. suis) is widely recognised in the veterinary world as a cause of rapidly progressive and fatal sepsis in infant pigs, associated with meningitis, polyarthritis, and, occasionally, pneumonia. A more fulminant bacteraemic infection is seen in neonatal pigs [ 1, 2]. For reasons that are unknown, adult pigs do not succumb to this infection, although they demonstrate asymptomatic nasopharyngeal carriage ( Figure 1), and infant piglets become infected after early contact with colonised adult females. In many respects, S. suis infection is the porcine version of human group B strep disease. Zoonotic disease due to S. suis does occur sporadically in Western countries, but is encountered more commonly in countries such as Thailand, China, and Hong Kong. It affects predominantly individuals with occupational exposure to pigs. In humans, meningitis is the most common presentation (about 80% of all cases), though S. suis disease can be associated with other suppurative complications such as pneumonia and arthritis. Mortalities of 5%–10% of cases are reported [ 2], and S. suis is the third most common cause of bacterial meningitis in Hong Kong [ 3]. Figure 1 Scanning Electron Microscopy of S. suis Diplococci in a Sheet of Mucus on the Surface of the Nasopharyngeal Epithelium from a Pig

Meningoencephalitis caused by Streptococcus pneumoniae: a diagnostic and therapeutic challenge

Streptococcus pneumoniae is a common cause of bacterial meningitis but only rarely causes other infections such as brain abscess, encephalitis, encephalomyelitis or meningoencephalitis. We report on three adult patients with meningoencephalitis caused by S. pneumoniae. In all three, CT and MRI revealed widespread brain lesions, suggesting extensive parenchymal injury. Diffusion-weighted MRI showed lesions with restricted diffusion, reflecting local areas of ischaemia with cytotoxic oedema secondary to an immunologically mediated necrotising vasculitis and thrombosis. High levels of markers of neuronal, glial and myelin damage were found in the cerebrospinal fluid. According to the literature, brain parenchyma lesions in adults with pneumococcal meningoencephalitis are often associated with death or severe neurological deficit. Our patients were treated with pulse doses of glucocorticoids: this resulted in dramatic clinical improvement and an excellent final neurological recovery.

Bacterial meningitis in Hong Kong: 10-years’ experience

Objective: We studied the etiology, clinical features and outcome of patients with bacterial meningitis from an urban Chinese city over a 10-years period. Methods: We reviewed the files of all persons aged 15-years old or above diagnosed with community-acquired bacterial meningitis from a regional hospital. The clinical findings, relevant laboratory and imaging results as well as outcome were recorded in cases with microbiological evidence of meningitis. Neurosurgical and pediatric patients were excluded. Results: Sixty-five patients between the ages of 15 and 86 years of age (mean 52 years) were identified of whom 18 (28%) died. The four most common causes were Mycobacteria tuberculosis (46%), Streptococcus pneumoniae (11%), Streptococcus suis (9%) and Klebsiella pneumoniae (8%). Neisseria meningitidis and Haemophilus influenzae were rare pathogens. The annual incidence of community-acquired bacterial meningitis was 1.27/100,000 adults. Delay in treatment was associated with a poorer prognosis ( p < 0.001, OR = 38.84, CI = 7.33–205.80). Conclusion: The causative organisms found in this region of China differ from that reported from Europe and the US; tuberculous meningitis is the most common cause of bacterial meningitis.

Bacterial inhibition of phosphatidylcholine synthesis triggers apoptosis in the brain.

Streptococcus pneumoniae is the most common cause of bacterial meningitis of high mortality and morbidity. Neurological sequelae include paralysis, mental retardation, and learning disorders. In humans, neurons of the hippocampus undergo apoptosis as a result of meningitis. Phosphatidylcholine (PtdCho) is an essential component of mammalian cell membranes and PtdCho deficiency, either due to chemicals or altered nutrition, leads to apoptosis, especially in hippocampal neurons. We show that apoptosis of a variety of brain cells after pneumococcal infection arises from inhibition of PtdCho biosynthesis, the first such activity described for a bacterium. Apoptosis inhibitors did not prevent the bacterial-dependent inhibition of PtdCho biosynthesis. Supplementation with exogenous lyso-phosphatidylcholine prevents cell death and treatment of mice with cytidine diphosphocholine attenuates hippocampal damage during meningitis, even after the onset of infection. We conclude that bacterial inhibition of PtdCho biosynthesis activates an apoptotic cascade that is a causative event in pathogenesis and amenable to therapeutic intervention.

Surveillance of invasive infection in children and adults admitted to QECH, Blantyre, 1996-2002.

This is a report of blood CSF isolates from the adults medical and paediatric of wards QECH, Blantyre, cultured and identified at the Welcome Trust Research Laboratories during 1996-2002. The commonest causes of adults and children bacteraemia were non-typhoidal Salmonella (35% of all blood isolates for adults and children) and Streptococcus pneumoniae (14% and 13% respectively). Cryptococcus neoformans was the commonest isolates from CSF of adults with meningitis(67%) but was very rare in children. S.pneumoniae was the commonest cause of bacterial meningitis in children and adults (38% and 28% of all CSF isolates respectively). Haemophilus influenzae type b was also a common cause of meningitis in children (27%). Data of in vitro antibiotic sensitivity are also reported. A major concern is the recent marked rise of chloramphenicol resistance among Salmonella enteritidis and Salmonella typhimurium to over 80% resistance.

Clinical study of 44 cases of Staphylococcus aureus meningitis.

In order to describe the clinical features and outcome of Staphylococcus aureus meningitis, the charts of 44 cases seen at one teaching hospital during a 20-year period were retrospectively reviewed. Staphylococcus aureus was the fifth most common cause of bacterial meningitis (10.2% of cases). There were 28 (63%) cases of postoperative meningitis and 16 (37%) of spontaneous meningitis. Patients with postoperative meningitis were younger than patients with spontaneous meningitis (mean age, 40.3 vs. 59.3 years; P=0.04) and had a lower frequency of community-acquired infection (32.1% vs. 93.8%; P<0.01), severe underlying diseases (28% vs. 87%; P<0.01) and associated staphylococcal infection (35% vs. 75%; P=0.01). The clinical presentation was similar in both groups, but patients with postoperative meningitis had a lower frequency of altered mental status (39% vs. 75%; P=0.02), meningeal signs (28% vs. 62%; P=0.02), petechial rash (0% vs. 18%; P=0.04), bacteremia (7% vs. 75%; P<0.01), and septic shock (0% vs. 44%; P<0.01). Most patients were treated with cloxacillin or vancomycin, with or without rifampicin, for a mean period of 22.5 days (range, 1-100 days). Overall mortality was 27%, and the mortality rate was higher for cases of spontaneous than postoperative meningitis (50% vs. 14%; P=0.01). Mortality correlated significantly with advanced age, spontaneous meningitis, altered mental status, and the presence of severe underlying diseases, bacteremia, and septic shock.

Giant retinal tear and meningococcus endogenous endophthalmitis

Giant retinal tear is seen in association with Stickler's syndrome, Marfan syndrome, homocystinurea and after ocular trauma. Although bacterial meningitis1 is not common since the advent of various antibiotics, meningococcus is the second most common cause of bacterial meningitis. Endogenous endophthalmitis2 remains a challenge to clinicians despite the success of antibiotics in reducing its frequency and severity. The association of giant retinal tear and meningococcal endogenous endophthalmitis is not yet reported in the literature. We report here on a 14-year-old girl who developed a giant retinal tear after meningococcal meningitis and endogenous endophthalmitis, and we discuss the possible factors of its cause. (J AAPOS 2002;6:259-60)

Pattern of Meningitis in Al-Ain Medical District, United Arab Emirates—a Decadal Experience (1990–99)

Haemophilus influenzae vaccine was introduced in the United Arab Emirates in 1999. Our objective was to describe the pattern of meningitis in a health district in the decade before the introduction of the vaccine and compare it with the data from elsewhere. For this retrospective study we included 128 meningitis cases reported from 1990 to 1999. Information on the cases was abstracted from the case notification forms and clinical and laboratory data from the hospital case notes. H. influenzae was the most common cause of bacterial meningitis (n=59, 46.1%) followed by Streptococcus pneumoniae (n=20, 15.6%). Meningitis was a disease primarily of infants and children and the median age was 15 months. One fifth of the patients (n=27) had neurological sequelae of which 33.3% had seizures and 25.9% developed deafness. 18.9% (10 out of 53) of H. influenzae isolates were resistant to ampicillin compared with 5.9% (3 out of 51) to chloramphenicol. 78.9% (15 out of 19) of S. pneumoniae isolates were susceptible to penicillin. The epidemiology of meningitis in our health district is similar to the epidemiology of meningitis during the pre-vaccine era in other countries.

The burden of pneumococcal infections in children

Streptococcus pneumoniae, the most common cause of bacterial meningitis in children, is also a leading cause of pneumonia, bacteremia and otitis media. The risk of invasive disease due to pneumococcus is greatest in children between six months and two years of age. Although 90 serotypes exist, only seven account for over 80% of serious disease in young children. These factors create an attractive opportunity for a vaccine program in infants – an effective vaccine could very quickly make an appreciable difference in morbidity and mortality. The current epidemiology of pneumococcal disease in Canadian children is described.