Rapid sterilisation of cerebrospinal fluid in meningococcal meningitis: Implications for treatment duration

Current methods for microbiological diagnosis of acute central nervous system infections

The incidence of infections affecting the central nervous system has increased in recent years, making neuroinfections a current global health problem. The central nervous system is quite well protected from the external and internal environments, although it is susceptible to infection by a wide variety of pathogens. The etiological diversity further complicates the management of such infections because it is important to identify correctly the specific cause in order to choose the most appropriate antimicrobial therapy. Diagnosis is made not only based on clinical and epidemiological data but also on the results of clinical laboratory and microbiological examination of cerebrospinal fluid. This article aims to review current microbiological methods in the diagnosis of acute central nervous system infections and help healthcare providers to recognize their advantages and limitations in order to manage their patients appropriately.

Invasive Streptococcus Agalactiae Causing Meningitis, Ventriculitis, and Endocarditis in a Non-Pregnant Adult

Streptococcus agalactiae is a common bacteria known to cause meningitis and urinary tract infections in neonates and pregnant women, respectively. Recently, S. agalactiae has become an increasingly recognized pathogen in non-pregnant adults, manifesting most commonly as skin and soft tissue infections, urinary tract infections (UTIs), and pneumonia. Meningitis and endocarditis are among the most feared complications of S. agalactiae due to high morbidity and mortality, especially in adults over 65 years of age. Both of these complications are rare. We present a case of simultaneous S. agalactiae meningitis and endocarditis in a 69-year-old woman with a history of uncontrolled Type 2 diabetes mellitus. This case emphasizes the importance of prompt recognition and treatment of a complicated invasive S. agalactiae infection.

[Death within Hours]

Death within Hours Abstract. The clinical picture of invasive meningococcal disease is broad, it mostly manifests as meningitis and/or sepsis. The severity ranges from a simple bacteremia associated with mild, unspecific symptoms to fulminant sepsis with multiorgan failure and death, which happens in 10-15 % of cases. Sometimes purely local infections (e.g. septic arthritis or conjunctivitis) or rarely a chronic course (prolonged, intermittent fever, rash, arthritis and headache) are the only clinical manifestation - which can also lead to a disseminated fulminant disease. Our case illustrates the tragic progression of a fulminant meningococcal sepsis with rapid death.

[Treatment of community acquired bacterial meningitis, after microbiological identification]

INTRODUCTION

Are the 1996 SPILF consensus conference recommendations on bacterial meningitis (BM) still adequate?

OBJECTIVE

The literature published after 1996 was analyzed and the reviewers summarized the available data on antibiotic treatment once BM microbiological diagnosis made or strongly suspected.

METHOD

A review was made using PubMed, 10,015 references were examined. Only articles published after 1997 were analyzed.

RESULTS

No study allowed to recommend other regimens than those previously recommended in 1996, in case of meningococcal or pneumococcal infection: 3rd generation cephalosporin or amoxicillin, combined with vancomycin in case of penicillin-intermediate or resistant pneumococcus. In some cases, alternatives are possible, in case of pneumococcal infection: meropenem or antipneumococcal fluoroquinolone were recommended by US guidelines. New antibiotics available on the market were tested using experimental pneumococcal meningitis models: daptomycin and ertapenem seemed to be useful but linezolid was not. Among the antibiotic combinations tested, ceftriaxone+rifampicine demonstrated a better efficacy than ceftriaxone+vancomycin. There was not contributive published data on the length of treatment for bacterial meningitis.

CONCLUSION

No assessed arguments could be found to modify previous guidelines. In case of problem with penicillin-resistant pneumococci, penem or a combination using ceftriaxone and rifampicin may be used.