Acute pneumococcal meningitis. The significance of mechanical factors in influencing moratality

Cerebrospinal fluid outflow resistance in rabbits with experimental meningitis. Alterations with penicillin and methylprednisolone

Acute bacterial meningitis may be associated with increased intracranial pressure, neurological sequelae such as communicating hydrocephalus, and a slow response to antibiotic therapy. Alterations in cerebrospinal hydrodynamics are at least partially responsible for these complications. Constant, low-flow short-duration manometric infusion studies through a hollow-bore pressure monitoring device in direct continuity with the supracortical subarachnoid space were performed in rabbits with experimental meningitis. Maximal resistance to cerebrospinal fluid (CSF) outflow from the subarachnoid to vascular space was markedly increaed in acute pneumococcal meningitis when compared to control, uninfected animals (6.77 +/- 3.52 vs. 0.26 +/- 0.04 mm Hg/microliter per min, P less than 0.001). Similar elevations (8.93 +/- 4.15 mm Hg/microliter per min were found in experimental Escherichia coli meningitis. Despite eradication of viable bacteria from the CSF by penicillin therapy during the acute stage of pneumococcal meningitis, resistance remained elevated (6.07 +/- 4.68 mm Hg/microliter per min) and had not returned to normal up to 15 d later. Administration of methylprednisolone during the early stages of acute pneumococcal meningitis reduced mean peak outflow resistance towards control values (0.59 mm Hg/microliter per min) and no "rebound" effect was apparent 24 h later. These hydrodynamic alterations in experimental meningitis prevent normal CSF absorption and decrease the ability of the bran to compensate for changes in intracranial volume and pressure.

Pyogenic meningitis in Ibadan, Nigeria. A 15-month prospective study

Between January 1976 and March 1977, cerebrospinal fluid samples from 2130 patients at University College Hospital, Ibadan, Nigeria were examined, 130 patients were shown to have pyogenic meningitis. The commonest causative bacteria were Streptococcus pneumoniae (53.8%), Haemophilus influenzae (23%), Neisseria meningitidis (7.7%) and Klebsiella spp. (3%). Most of the infections occurred in very young children: 47% of all patients were under 1 year of age, and 69% were under 5 years old. The overall case fatality rate was 30% (Strep. penumoniae infection 28.6%, H. influenzae and N. meningitidis infection both 20%). All 4 patients with klebsiella infection died. There was a noticeable increase in the incidence of Strep. pneumoniae strains showing resistance to tetracycline, between 1974 and 1976, and this was attributed to the widespread use and abuse of the antibiotic among the general population. Two strains of H. influenzae were found to be resistant to ampicillin; such strains have not previously been reported from Nigeria. The results of the study support the use of a combination of ampicillin and gentamicin in the initial treatment of pyogenic meningitis in Ibadan.

Mortality from pneumococcal meningitis

The records of 207 patients with pneumococcal meningitis admitted to Ahmadu Bello University Hospital, Zaira, northern Nigeria, between February, 1971 and June, 1976 have been reviewed. Mortality was 51%. Death was more likely in patients with a short history, impaired consciousness on admission, and an associated pneumonia. Cerebrospinal fluid levels of protein, lactate, fibrin degradation products, and polysaccharide antigen were higher in patients who died than in survivors.