Community-acquired Staphylococcus aureus meningitis in adults

BACKGROUND

Staphylococcus aureus is an uncommon cause of community-acquired bacterial meningitis. We aimed to describe patients with this disease.

METHODS

We evaluated clinical characteristics and outcome of adults with community-acquired S. aureus meningitis from prospective nationwide cohort studies from Denmark (2015-2020) and the Netherlands (2006-2021). Whole genome sequencing of S. aureus isolates was performed to evaluate the potential association between clonal complex and clinical characteristics.

RESULTS

We evaluated 111 episodes of community-acquired S. aureus meningitis: 65 from Denmark and 46 from the Netherlands. The median age was 66 years (interquartile range [IQR] 50-74) and 43 of 111 patients were female (39%). Concomitant infectious foci were found in 95 of 107 patients (89%), most commonly endocarditis (53 of 109 [49%]) and spondylodiscitis (43 of 109 [39%]). The triad of neck stiffness, altered mental status (Glasgow Coma Scale score <14), and fever was present in only 18 of 108 patients (17%). Surgery was performed in 14 of 33 patients (42%) with spondylodiscitis and 26 of 52 (50%) with endocarditis. A favorable outcome (Glasgow Outcome Scale score 5) occurred in 26 of 111 patients (23%), while 39 (35%) died. The most common bacterial clonal complexes (CC) were CC30 (16 [17%]), CC45 (16 [17%]), CC5 (12 [13%], and CC15 (10 [11%]); no associations between CCs and concomitant foci or outcome were found.

CONCLUSIONS

Community-acquired S. aureus meningitis is a severe disease with a high case fatality rate, occurring mainly in patients with concomitant endocarditis or spondylodiscitis.

[Cannabinoid hyperemesis syndromecan be relieved by hot showers]

This is a case report of a 19-year-old woman with cannabinoid hyperemesis syndrome (CHS), which is characterised by cyclic vomiting and nausea, relieved by hot showers and caused by chronic cannabis usage. Many diagnoses must be ruled out, but the suspicion of cannabis usage must be present. Early suspicion of CHS can prevent overtreatment and unnecessary investigations. Lack of evidence makes treatment difficult and is primarily symptomatic. Attention to cannabis usage is needed when admitting patients with emesis.