Recurrent Bacterial Meningitis Research Articles

Epidemiology, Etiology, Pathogenesis, and Diagnosis of Recurrent Bacterial Meningitis

Recurrent bacterial meningitis is a rare phenomenon and generally poses a considerable diagnostic challenge to the clinician. Ultimately, a structured approach and early diagnosis of any underlying pathology are crucial to prevent further episodes and improve the overall outcome for the affected individual. In this article, we are reviewing the existing literature on this topic over the last two decades, encompassing 363 cases of recurrent bacterial meningitis described in 144 publications. Of these cases, 214 (59%) were related to anatomical problems, 132 (36%) were related to immunodeficiencies, and 17 (5%) were related to parameningeal infections. The review includes a detailed discussion of the underlying pathologies and microbiological aspects as well as recommendations for appropriate diagnostic pathways for investigating this unusual entity.

Posterior Fossa Dermoid Cyst With Sinus Tract and Meningitis in a Toddler

Intracranial dermoid cysts are rare, but can cause recurrent bacterial or aseptic meningitis, abscesses or mass effect. We describe a toddler who manifested an occipital "lump" for 6 months without further evaluation. He presented with lethargy and meningitis. A posterior fossa dermoid cyst with a sinus tract was detected by imaging studies. He underwent prompt surgical excision of the cyst and the sinus, and received a prolonged course of antibiotics, because anaerobes were isolated from the contents of the cyst and blood. His postoperative course was complicated, and required the placement of a lumboperitoneal shunt. A high index of suspicion for the detection of dermoid cysts is required when a congenital midline skin lesion such as a dimple or a scalp swelling is reported. Prophylactic excision is indicated to prevent serious sequelae.

Fatal recurrent bacterial meningitis—A complication of chronic Strongyloides infection

Fatal recurrent bacterial meningitis—A complication of chronic Strongyloides infection

Recurrent meningitis caused by cervico-medullary abscess, a rare presentation

Recurrent bacterial meningitis is usually a complication of cranial anatomical defect or the result of impaired humoral immunity, notably, defects of the complement system and agammaglobulinemia. It could present a diverse range of symptoms. Meningitis as a presentation of intramedullary abscess is not common. Here we present a 7-year-old boy with recurrent meningitis as the first manifestation of an underlying upper cervical cord abscess.

RecurrentStreptococcus PneumoniaeMeningoencephalitis in a Patient With a Transethmoidal eningoencephalocele

We report a case of recurrent Streptococcus Pneumoniae meningoencephalitis with a transethmoidal meningoencephalocele (TEME) but without cerebrospinal fluid (CSF) leakage.A 35-year-old man was admitted with S. pneumoniae meningitis. He had suffered from four episodes of recurrent pneumococcal meningitis during the previous 4 years. A computed tomography scan of the paranasal sinus showed the TEME protruding through a bony defect of the right frontal base. However, the patient did not have symptoms that could be attributable to CSF leakage, and radioisotope cisternography did not identify a leak. Brain magnetic resonance imaging revealed cortical lesions overlying the TEME, and electroencephalography revealed epileptiform discharges in frontal regions. Appropriate antibiotics therapy without steroids was given to improve his condition.The presented case suggests that even in the absence of clinically demonstrable CSF leakage, an occult skullbase defect and its associated meningoencephalocele should be considered in patients with recurrent bacterial meningitis.

Community-Acquired Recurrent Bacterial Meningitis in Adults

Community-acquired recurrent bacterial meningitis in adults is a relatively rare disease. All previous data were derived from small retrospective case series. We prospectively evaluated episodes of recurrent bacterial meningitis in a nationwide cohort study in The Netherlands. Thirty-four episodes of recurrent bacterial meningitis were identified among 31 patients; 3 patients experienced 2 episodes during the study period. The mean age was 43 years, and 25 (74%) of 34 episodes occurred in men. Predisposing conditions were involved in 26 (77%) of 34 episodes; the most common predisposing conditions were remote head injury (17 [53%] of 32 episodes) and cerebrospinal fluid (CSF) leakage (9 [32%] of 28 episodes). Lumbar puncture revealed an individual CSF indicator of bacterial meningitis for almost all episodes (88%). The outcome was death for 5 (15%) of 34 episodes; 1 additional patient had a suboptimal score on the Glasgow Outcome Scale. We conclude that most patients with recurrent meningitis are male and have predisposing conditions, which, in most cases, are remote head injury or CSF leakage.

Recurrent Streptococcus pneumoniae meningitis in a child with traumatic anterior cranial base defect

Acute bacterial meningitis is a potentially life-threatening infection of the cranial and spinal leptomeninges. Recurrent episodes of meningitis are rarely seen, but when they occur, an extensive investigation has to be made to find out responsible factors. A single episode of acute meningitis may result from bacteriemia, but when followed by recurrent meningitis in pediatric patients, other possible routes of the bacteria invasion to the cerebrospinal fluid (CSF) should be considered. Patients with head injury have the highest risk of acquiring recurrent bacterial meningitis, followed by patients with a congenital anatomic lesion of the skull or duramater, such as meningomyelocele. The underlying cause is a transdural communication between the meningeal space and paranasal sinuses or skin. The first attack of meningitis may occur several weeks to 12 years after the head injury. In addition, recurrent bacterial meningitis may be due to disorders of the immune system, such as complement deficiency. We report a 14-year-old boy, who suffered from recurrent Streptococcus pneumoniae meningitis due to a well-defined defect at the ethmoid roof after a head trauma.

Congenital spinal dermal sinuses

Neurosurgeons from Children's Memorial Hospital in Chicago present the case reports of 9 children who represent the spectrum of pathologic and clinical findings collectively referred to as congenital spinal “dermal sinuses.” The article could be reprinted in its entirety as a contemporary tutorial. This group of embryonic malformations is common, and their presentations and importance are core knowledge requirements for every pediatrician. The embryologic defect occurs early in fetal life when the ectoblast is differentiated into cutaneous and neural ectoderm. As the neural groove closes to form the medullary tube, cutaneous ectodermal cells may also be invaginated, subsequently developing into intraspinal dermoid or epidermoid growths. If mesodermal defect also occurs, spinal dysraphism results, and a tract may connect the skin directly with the spinal canal. Clinically, defects are recognized in 1 of 3 ways: (1) the finding on routine physical examination of a sinus tract on or near the midline from the tip of the spine to the base of the nose; (2) because of the occurrence of bacterial meningitis or recurrent bacterial meningitis, especially caused by unusual organisms; or (3) when compression or traction on the spinal cord occurs and causes motor weakness, nerve root irritation, or autonomic changes and sphincter dysfunction. The finding of pigmentation, hypertrichosis, hemangioma, lipoma, or intermittent sebaceous discharge also can be the external clue to an almost imperceptible sinus tract. The authors provide astute clinical observations, revealing cases, and excellent discussion of anatomy and embryology—all worth the re-reading. Neurosurgeons from Children's Memorial Hospital in Chicago present the case reports of 9 children who represent the spectrum of pathologic and clinical findings collectively referred to as congenital spinal “dermal sinuses.” The article could be reprinted in its entirety as a contemporary tutorial. This group of embryonic malformations is common, and their presentations and importance are core knowledge requirements for every pediatrician. The embryologic defect occurs early in fetal life when the ectoblast is differentiated into cutaneous and neural ectoderm. As the neural groove closes to form the medullary tube, cutaneous ectodermal cells may also be invaginated, subsequently developing into intraspinal dermoid or epidermoid growths. If mesodermal defect also occurs, spinal dysraphism results, and a tract may connect the skin directly with the spinal canal. Clinically, defects are recognized in 1 of 3 ways: (1) the finding on routine physical examination of a sinus tract on or near the midline from the tip of the spine to the base of the nose; (2) because of the occurrence of bacterial meningitis or recurrent bacterial meningitis, especially caused by unusual organisms; or (3) when compression or traction on the spinal cord occurs and causes motor weakness, nerve root irritation, or autonomic changes and sphincter dysfunction. The finding of pigmentation, hypertrichosis, hemangioma, lipoma, or intermittent sebaceous discharge also can be the external clue to an almost imperceptible sinus tract. The authors provide astute clinical observations, revealing cases, and excellent discussion of anatomy and embryology—all worth the re-reading.

Recurrent Meningitis Associated With a Petrous Apex Cephalocele

We present the case of a 6-year-old girl with recurrent bacterial meningitis and cerebrospinal fluid (CSF) rhinorrhea associated with a petrous apex cephalocele (PAC). We diagnosed her by means of three-dimensional computed tomography (CT) and heavily T2-weighted magnetic resonance imaging (MRI). Petrous apex cephaloceles are usually an asymptomatic incidental finding in adults; however, they should be considered as a possible cause of CSF rhinorrhea, otorrhea, and recurrent meningitis in children.

Spontaneous cerebrospinal fluid otorrhoea via oval window: an obscure cause of recurrent meningitis

Spontaneous cerebrospinal fluid (CSF) leak via the oval window is uncommon and can result in recurrent bacterial meningitis. Current understanding of spontaneous CSF otorrhoea is reviewed and a diagnostic algorithm is presented. A seven-year-old boy presented with bilateral congenital deafness and recurrent meningitis. High-resolution computed tomography (HRCT) of the temporal bone showed a labyrinthine deformity and communication between the internal auditory canal (IAC) and the cochlea. Subtotal petrosectomy with closure of the external acoustic meatus and eustachian tube was performed. Post-operatively, the child had no further episodes of meningitis. This rare and obscure cause of recurrent childhood meningitis requires a high index of suspicion and the use of diagnostic tools, especially HRCT.

Mondini dysplasia and recurrent bacterial meningitis in a girl with relapsing Langerhans cell histiocytosis

We report a case of a girl with Langerhans cell histiocytosis (LCH) of multifocal bone disease, who developed recurrent bacterial meningitis and unilateral sensorineural hearing loss during the relapsing course of the disease. Mondini dysplasia, a congenital inner ear anomaly, was suspected by high resolution computed tomographic scan and the dysplasia with cerebrospinal fluid leakage was confirmed by surgery in the ipsilateral ear showing hearing loss. Although rare, congenital inner ear anomalies such as Mondini dysplasia should be kept in mind in pediatric patients with hearing impairment and/or recurrent bacterial meningitis during chemotherapy for various types of neoplasms including LCH.

Displasia de Mondini: meningitis bacteriana recurrente en la adolescencia

Episodes of recurrent bacterial meningitis can occur in patients due to either congenital or acquired disorders. Congenital deformity of the bony labyrinth can be linked to a fistulous tract communicating it with the intracranial subarachnoid space. Mondini deformity is a frequent malformation in congenitally deaf patients. We report the case of an adolescent with a history of being unable to hear in one ear who, from the age of 10 years, began to suffer repeated bacterial meningoencephalitis with microbiological recovery of Streptococcus pneumoniae on three occasions. The type of germ recovered in the cerebrospinal fluid (CSF) and the history of congenital deafness that was detected when the patient was 3 years old were the diagnostic clues to the possible anomaly of the inner ear with a CSF fistula. The clinically proven CSF rhinorrhea contributed to the diagnosis of an ear anomaly with a fistula. Computerised axial tomography and magnetic resonance studies of the petrous portion of the temporal bone revealed the malformation that was later found and closed during the surgical intervention on the affected ear. The clinical absence of rhinorrhea, a year's progression without new infections after operating on the patient and post-surgery imaging studies were all proof that the fistula had closed. Mondini dysplasia with CSF fistula must be included as a possible diagnosis when faced with a patient with recurrent bacterial meningoencephalitis. Imaging studies, especially magnetic resonance, enable the clinician to check the diagnosis and the CSF fistula can be closed with ear surgery.

Two Cases of Recurrent Bacterial Meningitis Following Traumatic Cerebrospinal Fluid Rinorrhea

Two Cases of Recurrent Bacterial Meningitis Following Traumatic Cerebrospinal Fluid Rinorrhea

Index of Suspicion

Index of Suspicion

Recurrent Bacterial Meningitis Secondary to Cochlear Aplasia, Right and Acquired Cribriform Plate Defect due to Trauma

Recurrent Bacterial Meningitis Secondary to Cochlear Aplasia, Right and Acquired Cribriform Plate Defect due to Trauma

Recurrent bacterial meningitis: a 6-year experience in adult patients

Ten adult patients with recurrent bacterial meningitis (RBM) of 22 episodes were diagnosed and treated at the Dicle University Hospital from January 1990 to December 1995. Apart from 22 episodes of RBM these patients had an additional 25 episodes treated at other hospitals. The RBM attacks developed after closed head trauma in four patients, asplenia and chronic otitis media in one patient, chronic otitis media and oto-mastoiditis in one patient, chronic maxillary sinusitis in one patient, chronic mastoiditis in one patients, and suppurative foci of facial bones caused by shrapnel pieces and no predisposing condition in one patient. In 10 RBM episodes, Streptococcus pneumoniae was isolated from cerebrospinal fluid (CSF) and/or blood culture, and in one episode Proteus vulgaris was isolated from CSF and otitis media suppuration. In the four episodes both cultures were negative, but direct microscopy showed Gram-positive diplococci on Gram-staining. Three of the patients died from meningitis-related complications.

Persistent cerebrospinal fluid otorrhea: a case of Munchausen's syndrome by proxy

A case is presented of a young child who initially presented with recurrent bacterial meningitis 1 year after significant head trauma and was found to have cerebrospinal fluid (CSF) leakage into the middle ear. Surgical procedures were devised to attempt to stop this abnormal flow, but inexplicably clear otorrhea biochemically identical to CSF persisted for weeks. The child's mother was apparently soaking the surgical dressings with CSF obtained through a lumbar drain and confessed to this activity after she was found to have tampered with an intravenous catheter. This activity resulted in a prolonged hospital stay and several presumably unnecessary procedures. Munchausen's syndrome, typified by intentional mimicry of symptoms of serious illness backed by plausible medical history, is well-described. Rarer is the syndrome by proxy, where parents and/or caregivers, by falsifying histories, fabricating laboratory evidence, or deliberately generating bodily lesions, cause unneeded diagnostic and therapeutic procedures to be performed on their young victims. This form of child abuse is hidden by the perpetrator's apparent concern and involvement in the care of the victim. The literature is reviewed, this form of abuse is discussed, and the role of communication of suspicion between the various health care workers is stressed. The medical and social settings in which this disorder is prevalent are covered. Early detection of this entity is essential in rescuing the victim from life-threatening abuse and in obtaining appropriate therapy for the abuser.

Recurrent bacterial meningitis in adults: A case series

Recurrent bacterial meningitis is rare and most commonly associated with an anatomical defect. We report on four adult cases that presented within a 13 month period. Anatomical or immunological abnormalities were found in three of the cases. Thorough investigations for an underlying cause should be carried out before the diagnosis of a chance recurrence is made.

Recurrent pneumococcal meningitis.

Preview Recurrent bacterial meningitis can be caused by acquired or congenital gross anatomic defects, foci of infection, or disorders in immune mechanisms. The diagnosis of occult sinus fracture can be a challenge and, as in the patient described here, requires a high index of suspicion when a child has a remote history of head injury and repeated episodes of meningitis.

Meningococcal Disease in Patients with Late Complement Component Deficiency

The purpose of this study was to examine the occurrence of late complement component deficiency (LCCD) states in the USSR. Thirty deficient individuals were detected: 27 with C8 beta and 3 with C7 deficiency. Among individuals with a first episode of meningococcal infection, about 1% had LCCD, whereas among patients with recurrent bacterial meningitis the prevalence of LCCD rose to approximately 50%. This corresponds to a prevalence for LCCD of approximately 12 per 100,000 in the general population. The individuals with LCCD identified in this study experienced about 77 episodes of meningococcal disease and acute bacterial meningitis. Mathematical analysis of the morbidity from meningococcal disease in individuals with LCCD demonstrated that the probability of disease did not change with the age of the patient and was not affected by prior episodes of infection. This finding suggest that in contrast to the situation in the general population, prior infection fails to protect the deficient individual from recurrent disease. In comparison to complement-sufficient persons, the course of disease in individuals with LCCD is less severe, as shown by a reduction in the number of episodes of endotoxic shock and mortality as well as their more rapid recovery. These findings suggest that exuberant complement activation and concomitant formation of membrane attack complexes during meningococcal infection in complement-sufficient patients plays an important role in the activation and injury of peripheral blood cells and endothelial cells during endotoxic shock.