Meningitis In Association Research Articles

Epidemiology of septic meningitis associated with neuraxial anesthesia: a historical review and meta-analysis.

Neuraxial anesthesia in the form of spinal and epidural are two of the most frequent forms of regional anesthesia. We aimed to describe and compare the relevant epidemiological, clinical and microbiological characteristics of all reported cases of septic meningitis associated with the use of spinal and epidural anesthetics. We performed a systematic review of septic meningitis associated with neuraxial anesthesia. We included all relevant case-reports and observational studies in which authors described septic meningitis in association with spinal, epidural or combined neuraxial anesthesia using local anesthetics. A total of 234 cases of septic meningitis were reported following review of 71 case-report articles and 22 epidemiological studies. In total, there have been 199, 25 and 10 reported cases of septic meningitis associated to spinal, epidural and combined neuraxial anesthesia, respectively. The lack of use of surgical masks was the most common risk factor (41, 16.7%). Streptococcus salivarius was the most common bacteria (17.0%) related to spinal anesthesia and Staphylococcus aureus (26.7%) was the most common one related to epidural. The time to symptom onset was significantly reduced in spinal (median time, 24 hours IQR [8-72] vs. 96 hours IQR [84-240]; P=0.003) compared to epidural anesthesia. The overall mortality rate is 15.3% and 13.3% for reported cases related to spinal and epidural anesthesia, respectively. While the true incidence remains speculative, this review suggests that given increasing indications for spinals and epidurals, septic meningitis remains an important associated with neuraxial anesthesia.

A Rare Coexistence: Drug Induced Hepatitis and Meningitis in Association With Ibuprofen

Ibuprofen, a commonly used NSAID is reported to be associated with drug induced liver injury. Ibuprofen is also known to be associated with drug-induced meningitis especially in patients with connective tissue disorders. However presentation of hepatitis and meningitis in association with Ibuprofen use in the same individual has never been reported. We present a case of young woman who developed abnormal liver chemistries and neurological symptoms while on Ibuprofen. Her liver biopsy findings were suggestive of drug induced liver injury and cerebrospinal fluid analysis was suggestive of aseptic meningitis. Clinical and biochemical improvement was noted on cessation of Ibuprofen.

Recurrent aseptic meningitis in association with Kikuchi-Fujimoto disease: case report and literature review

BackgroundKikuchi Fujimoto disease (KFD), or histiocytic necrotising lymphadenitis, is a benign and self-limiting condition characterised by primarily affecting the cervical lymph nodes. Recurrent aseptic meningitis in association with KFD is extremely rare and remains a diagnostic challenge.Case presentationWe report a 28-year-old man who presented 7 episodes of aseptic meningitis associated with KFD over the course of 7 years. Histopathological findings of enlarged lymph nodes led to the diagnosis of KFD. The patient’s headache and lymphadenopathy spontaneously resolved without any sequelae.ConclusionsA diagnosis of KFD should be considered when enlarged cervical lymph nodes are observed in patients with recurrent aseptic meningitis. A long-term prognosis remains uncertain, and careful follow-up is preferred.

Enteroviral meningitis without pleocytosis in children

ObjectivesThis study aims to describe the clinical characteristics of enteroviral meningitis in association with the absence of cerebrospinal fluid (CSF) pleocytosis.DesignThis was a retrospective analysis of databases of patients diagnosed...

Recurrent meningitis due to epidermoid

Aseptic meningitis is characterized by noninfective serous inflammation of the meninges. It can occur in a recurrent fashion when associated with dermoid and epidermoid cysts due to rupture of cyst contents into subarachnoid space resulting in aseptic chemical meningitis. Bacterial meningitis in association with these tumors is commonly related to a coexisting dermal sinus tract and the most common organism is Staphylococcus aureus.

A 47-year-old man with neuro-Sweet syndrome in association with Crohn's disease: a case report

IntroductionSweet's syndrome is a multi-system inflammatory disorder characterised by painful skin lesions and aseptic neutrophilic infiltration of various organs. We describe a case of Sweet's syndrome with aseptic meningitis in association with Crohn's disease (neuro-Sweet syndrome). This association has never been previously reported.Case presentationA 47-year-old Caucasian male with known Crohn's disease presented with headache, fever and skin lesions resembling erythema nodosum. The cerebrospinal fluid revealed leukocyte pleocytosis and dominant neutrophils, but cultures were negative. A skin biopsy revealed neutrophilic dermatosis compatible with Sweet's disease. The patient made a prompt recovery without the use of corticosteroids.ConclusionBecause of its multisystem nature, Sweet's syndrome may present diagnostic difficulty to specialists. Correct diagnosis by skin biopsy will prompt appropriate treatment.

Investigation of the rate of meningitis in association with urinary tract infection in infants 90 days of age or younger

To test the hypothesis that urinary tract infections (UTI) in young infants are rarely associated with meningitis. We undertook a review of the laboratory results from 322 infants, 90 days of age or younger, with an admission or discharge diagnosis of UTI or meningitis. The study was conducted in a tertiary paediatric hospital. The primary outcome measure was the incidence of coexisting urinary tract and cerebrospinal fluid sepsis. In total, 161 of the 322 (50%) infants with an admission or discharge diagnosis of UTI or meningitis were subsequently shown to have a culture-proven UTI. Of the children with a culture-proven UTI, 75 (47%) had cerebrospinal fluid obtained. We detected one case of probable bacterial meningitis in association with UTI. UTI is rarely associated with meningitis in infants 90 days of age or younger.

STAPHYLOCOCCAL SCALDED SKIN SYNDROME: A RARE COMPLICATION OF A COMMON PATHOGEN.

Introduction Staphylococcal scalded skin syndrome (SSSS) is caused by an exfoliative toxin-producing strain of Staphylococcus aureus (SA). It is a disorder that is commonly seen in children but rarely found in adults. In recent years, there appears to be an increasing awareness of the diagnostic criteria, and as a result, there are now over 50 documented adult cases reported in the literature. However, only two adult cases have been documented from methicillin-resistant SA (MRSA). This is the first reported case involving communtiy-acquired MRSA meningitis in association with SSSS. Case Report A 45-year-old female with type 2 diabetes mellitus presented to an outside hospital with subjective fevers and progressive lower back pain radiating down her legs, inhibiting ambulation. Lumbar puncture studies were initially consistent with viral meningitis. Multiple blood and CSF cultures returned with MRSA. She received a 21-day course of vancomycin, rifampin, and claforan for MRSA meningitis. One week after discharge, the patient presented to our emergency department with a severe desquamating rash with underlying normal skin from the occiput to knees bilaterally, body aches, and dehydration. The rash began on her right upper extremity and spread globally, only sparing the mucous membranes, soles of the feet, and palms of the hands. Nikolsky9s sign was present. Laboratory upon admission revealed an elevated leukocyte count and BUN/Cr of 136/2.3. Skin biopsy revealed subcorneal splitting along the granular layer without dermal infiltration or organisms. MRSA was found in multiple blood cultures. She was treated with a 21-day course of vancomycin, maxipime, and rifampin; in addition, she was treated with aggressive wound care and intravenous hydration. During her hospital course, the patient9s skin rash resolved without scarring. Antibodies to TSST-1 and staphylococcal enterotoxin B were positive. Exfoliative toxins A and B were negative. MRSA was positive for Panton-Valentine leukocidin. Discussion SSSS occurs secondary to a systemic SA infection that produces bullous lesions that spare the mucous membranes. Nikolsky9s sign is typically positive. Exfoliative toxin A or B frequently causes the syndrome, but in the three reported cases involving MRSA, TSST-1 and circulating enterotoxin likely contribute to SSSS. Diagnostic criteria include SA-positive blood cultures, presence of SA toxins, skin biopsy, and clinical findings. Skin biopsy typically reveals subcorneal splitting along the granular layer without dermal infiltration. Treatment for SSSS includes anti-SA antibiotics, meticulous wound care, and aggressive fluid resuscitation. Despite aggressive therapy, the prognosis in adult cases is poor.

Primary Nocardia meningitis in a patient without a predisposingcondition: Case report and review of the literature

A case of primary Nocardia meningitis in a patient without a predisposing condition is presented and 4 other reported cases are reviewed. The presenting features were fever, headache, altered consciousness, and neck stiffness. Cerebrospinal fluid examination (CSF) revealed hypoglycorrhachia (<40 mg/dl), elevated protein (>100 mg/dl), and pleocytosis with predominant neutrophils in all patients. Culture of CSF was positive for Nocardia in 4 of the 5 patients. Mortality was 50%. Diagnosis was frequently delayed and this probably contributed to the high mortality. Compared with Nocardia meningitis in association with a predisposing condition, primary Nocardia meningitis without a predisposing condition has similar clinical features and outcome.

Herpes zoster and aseptic meningitis in a previously healthy child

We describe an 8-year-old boy with aseptic meningitis in association with herpes zoster, a rare complication in immunocompetent children. This previously healthy boy, who had a history of chickenpox at the age of 6 months, presented with grouped, painful vesicular lesions of the right thoracic dermatomes 7–9. A clinical diagnosis of herpes zoster was made and symptomatic local treatment was initiated. Five days later the child had an acute onset of intense headache. On physical examination, the boy was in a moderately well condition and subfebrile with an axillary body temperature of 37.8C; all other vital signs were normal. Herpes zoster of the right thoracic wall was still present, however, no vesicles could be found on the face, ear or mouth. Neurological examination revealed a stiffness of the neck with positive Kernig sign and constant bilateral fasciculation of the periorbicular muscles, albeit more pronounced on the right side. Peripheral facial muscle weakness was not present. Lumbar puncture revealed 47 leukocytes/ll with 87% lymphocytes and 13% polynuclear granulocytes. CSF glucose and protein levels were within the respective normal ranges. A differential diagnosis of aseptic meningitis caused by reactivated varicella zoster virus (VZV) or herpes encephalitis was made and treatment with acyclovir i.v. (1500 mg/m 2 /d in three divided doses) was started empirically. Periorbicular fasciculations stopped 6 h after the first dose of acyclovir. Bacterial culture of CSF yielded no growth. VZV DNA was recovered from CSF by polymerase chain reaction (PCR) whereas herpes simplex virus DNA was not detected. VZV antibodies in CSF were not analysed. However, the presence of VZV DNA in CSF was strong presumptive evidence of VZV infection of the central nervous system, and acyclovir treatment was continued for 7 days. The boy’s general condition normalised gradually over the next few days. During 12 months of follow-up, no neurological or cutaneous complications have occurred. Children who contract varicella in the 1st year of life are at increased risk for zoster during childhood, but it is

Concurrent carboplatin and iodine-125 brachytherapy for recurrent glioblastoma multiforme

Toxicity and safety study of concurrent carboplatin chemotherapy and iodine-125 (I-125) brachytherapy. I-125 brachy therapy has an established albeit limited role in surgically accessible recurrent gliomas. Carboplatin has anti-tumoral; activity against gliomas and demonstrated sensitization of tumor to radiotherapy. In 15 patients (age range 30-77 years; median 53) with recurrent glioblastoma multiforme, stereotactically placed catheters were afterloaded with I-125 sources. A median 50 Gy minimum treatment volume dose was delivered during a 100 h period in conjunction with continuous infusion carboplatin (100 mg/m(2)/20 h x 5). Tumor volumes ranged from 13 to 63 cm(3) (median, 32 cm(3)). Early complications included: headache (n=7), transient exacerbations of pre existing neurologic deficits (n=5), seizures (n=2), nausea/vomiting (n=2), myelosuppression (n=2) and a catheter site wound CSF leak (n=1). Late complications included: steroid dependency (n=10), carcinomatous meningitis in association with hydrocephalus (n=1) and radiation-induced necrosis requiring reoperation (n=6). All patients were evaluable with a median survival of 10 months. In 12 patients, best clinical and neuroradiographic response was stable disease all of whom died of recurrent tumor (local recurrence in 11; CSF dissemination in 1). In 3 patients best response was either complete (n=2) or partial (n=1) all of whom are alive with a median follow-up of 31 months. I-125 brachytherapy with concurrent carboplatin chemotherapy is associated with an acceptable level of toxicity, has anti-tumoral activity and warrants further investigation in carefully selected patients with recurrent gliomas.

Mollaret's meningitis in association with delivery in a Bedouin woman; a case report

A young Beduin woman suffered two clusters of recurrent benign aseptic (Mollaret's) meningitis in association with two of her deliveries. This is the first case of Mollaret's syndrome related to delivery, and also the first presentation in a Bedouin.

Tuberculous meningitis in pregnancy

Four women with tuberculous meningitis in association with pregnancy are described to illustrate both the serious nature and varied presentation of this condition. Mortality or neurological morbidity may occur more frequently during pregnancy, but in general correlate closely with delay in diagnosis and initiation of appropriate therapy. Treatment often needs to be started empirically, and neurosurgical intervention may prove life saving.

Tuberculous meningitis in pregnancy.

Four women with tuberculous meningitis in association with pregnancy are described to illustrate both the serious nature and varied presentation of this condition. Mortality or neurological morbidity may occur more frequently during pregnancy, but in general correlate closely with delay in diagnosis and initiation of appropriate therapy. Treatment often needs to be started empirically, and neurosurgical intervention may prove life saving.

Meningococcal meningitis in association with complement factor P (properdin) deficiency

Meningococcal meningitis in association with complement factor P (properdin) deficiency

Bacterial meningitis in childhood in an African city. Factors influencing aetiology and outcome.

In a retrospective study of 120 children aged 1 month and above with bacterial meningitis confirmed by positive CSF culture, 88.4% were found to be due to three common organisms: H. influenzae, Str. pneumoniae and N. meinigitidis. Gram-negative enteric organisms accounted for 10% of the infections. Despite intensive antibiotic and ancillary therapy, there has been no significant change in case fatality and sequelae over the past decade in this institution. The present study confirms that factors related to the organism and the host are important in determining the outcome of therapy. H. influenzae and Str. pneumoniae infections are associated with statistically significant rise in case fatality rate and neurologic sequelae at the end of therapy. The presence of neurological abnormality at the time of diagnosis significantly increases case fatality rate while delay in diagnosis appears to primarily influence the frequency of neurological sequelae. Protein-energy malnutrition increases the frequency of neurological sequelae and death from bacterial meningitis without significantly influencing the pattern of bacterial aetiology. The finding of enteric Gram-negative meningitis in association with diarrhoeal disease in the present study adds a new dimension to one of the most prevalent health problems in developing countries and needs to be confirmed.

"Cerebral calcification following Pseudomonas meningitis in an infant".

SummaryIntracranial calcification in a young infant, following meningitis in association with Pseudo‐monas septicaemia, is reported. This calcification, most likely in the cerebral cortex, developed in 3 weeks and later largely resolved over a period of 9 months.

Aseptic meningitis in association with herpes progenitalis.

MOST isolates of herpes-simplex virus (HSV) can be segregated into two groups, designated HSV-1 and HSV-2, on the basis of neutralization tests and plaque morphology. HSV-1 strains have usually bee...

AN OUTBREAK OF ASEPTIC MENINGITIS ASSOCIATED WITH COXSACKIE B5 AND A9 VIRUSES IN NORTHERN JAPAN, 1961. VIROLOGICAL AND SEROLOGICAL STUDIES.

Virological and serological studies on an outbreak of aseptic meningitis in association with Coxsackie B5 virus, and Coxsackie A9 virus to a lesser extent, are reported. Coxsackie B5 virus was isolated from spinal fluids of 60 patients and Coxsackie A 9 virus from one spinal fluid. Fifty Coxsackie B 5 and 13 Coxsackie A 9 viruses were recovered from patients' faeces. The evidence that the epidemic was caused by these viruses was confirmed by determination of neutralizing antibody in paired sera.The plaque variants of Coxsackie B5 virus isolated from the faecal specimens and the poor antibody response in Coxsackie A 9 infection were reported as points of virological and serological interest.

Studies of an epidemic of aseptic meningitis in association with Coxsackie and ECHO viruses. II. Serological and clinical observations.

An epidemic of aseptic meningitis has been studied from a serological and clinical point of view. Neutralizing antibodies against ECHO virus type 6 were found in 81 per cent of the cases of aseptic meningitis, and a significant rise in antibody titer in 75 per cent. The occurrence of CF antibodies against ECHO virus type 6 as well as rises in CF antibody titer were found to be of little diagnostic importance. A high frequency of significant rises in CF antibody titers against ECHO-6 antigen appeared among Coxsackie B virus patients.