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Overall survival of patients with anaplastic oligodendroglial tumors has been improved due to the addition of procarbazine, lomustine and vincristine (PCV) chemotherapy to radiotherapy (RT), especially in 1p/19q-codeleted tumors. With improved survival, quality of survival becomes pivotal. We evaluated cognitive functioning and health-related quality of life (HRQOL) in a cohort of long-term anaplastic oligodendroglioma survivors. Thirty-two out of 37 long-term survivors included in European Organisation for Research and Treatment of Cancer (EORTC) study 26951 in the Netherlands and France participated. Cognition was assessed using neuropsychological tests for 6 domains, and HRQOL with the EORTC Quality of Life Questionnaire (EORTC QLQ-C30) and Brain Cancer Module (EORTC QLQ-BN20). Fatigue and mood were evaluated. Results were compared to healthy controls and to patients' own HRQOL 2.5 years following initial treatment. At the time of assessment, median survival for the patients was 147 months, 27 were still progression-free since initial treatment. Of progression-free patients, 26% were not, and 30% were severely cognitively impaired; 41% were employed and 81% could live independently. Patients' HRQOL was worse compared to controls, but similar to 2.5 years after initial treatment. Initial treatment (RT versus RT + PCV) was not correlated with cognition or HRQOL. In conclusion, cognitive functioning in long-term anaplastic oligodendroglioma survivors is variable. However, most patients function independently. In progression-free patients, HRQOL is relatively stable during the disease course. In this small sample, no effect of the addition of PCV on cognition or HRQOL was identified.
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Astrocitoma/complicaciones , Astrocitoma/psicología , Neoplasias Encefálicas/complicaciones , Neoplasias Encefálicas/psicología , Trastornos del Conocimiento/etiología , Calidad de Vida , Anciano , Astrocitoma/terapia , Neoplasias Encefálicas/terapia , Estudios de Cohortes , Metilasas de Modificación del ADN , Enzimas Reparadoras del ADN , Dacarbazina/análogos & derivados , Dacarbazina/uso terapéutico , Femenino , Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Radioterapia , Estadísticas no Paramétricas , Sobrevivientes/psicología , Temozolomida , Proteínas Supresoras de TumorRESUMEN
INTRODUCTION: Magnetic resonance imaging of the brain in patients with corticobasal degeneration typically shows focal or asymmetric atrophy, usually maximal in the frontoparietal cortex. Many patients who are diagnosed with corticobasal degeneration using current diagnostic criteria do not have classical corticobasal degeneration pathology. Our case is remarkable for the fact that the symptoms and the characteristic magnetic resonance imaging appearance were typical for corticobasal degeneration. However, we were quite convinced that the clinical picture had a vascular etiology. Only a few cases have been reported where the presumed cause for the corticobasal syndrome was multiple brain infarctions bilaterally. CASE PRESENTATION: A 64-year-old Caucasian man visited a neurologist because of profound asymmetric sensory and motor disturbances. A magnetic resonance imaging scan of his brain revealed occlusion of his internal carotid artery on the left side with multiple vascular lesions in his left hemisphere and notable atrophy of mainly the left parietal and frontal cortex. CONCLUSION: We describe a patient with corticobasal syndrome caused by multiple infarctions, probably caused by emboli of the carotid stenosis. This patient illustrates the fact that the word 'syndrome' should be preferred above 'degeneration' in the name of this disease.
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BACKGROUND: In experimental studies, the outcome of bacterial meningitis has been related to the severity of inflammation in the subarachnoid space. Corticosteroids reduce this inflammatory response. OBJECTIVES: To examine the effect of adjuvant corticosteroid therapy versus placebo on mortality, hearing loss and neurological sequelae in people of all ages with acute bacterial meningitis. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, issue 1), MEDLINE (1966 to February 2010), EMBASE (1974 to February 2010) and Current Contents (2001 to February 2010). SELECTION CRITERIA: Randomised controlled trials (RCTs) of corticosteroids for acute bacterial meningitis. DATA COLLECTION AND ANALYSIS: We scored RCTs for methodological quality. We collected outcomes and adverse effects. We performed subgroup analyses for children and adults, causative organisms, low-income versus high-income countries, time of steroid administration and study quality. MAIN RESULTS: Twenty-four studies involving 4041 participants were included. Similar numbers of participants died in the corticosteroid and placebo groups (18.0% versus 20.0%; risk ratio (RR) 0.92, 95% confidence interval (CI) 0.82 to 1.04, P = 0.18). There was a trend towards lower mortality in adults receiving corticosteroids (RR 0.74, 95% CI 0.53 to 1.05, P = 0.09). Corticosteroids were associated with lower rates of severe hearing loss (RR 0.67, 95% CI 0.51 to 0.88), any hearing loss (RR 0.76, 95% CI 0.64 to 0.89) and neurological sequelae (RR 0.83, 95% CI 0.69 to 1.00).Subgroup analyses for causative organisms showed that corticosteroids reduced severe hearing loss in Haemophilus influenzae meningitis (RR 0.34, 95% CI 0.20 to 0.59) and reduced mortality in Streptococcus pneumoniae meningitis (RR 0.84, 95% CI 0.72 to 0.98).In high-income countries, corticosteroids reduced severe hearing loss (RR 0.51, 95% CI 0.35 to 0.73), any hearing loss (RR 0.58, 95% CI 0.45 to 0.73) and short-term neurological sequelae (RR 0.64, 95% CI 0.48 to 0.85). There was no beneficial effect of corticosteroid therapy in low-income countries.Subgroup analysis for study quality showed no effect of corticosteroids on severe hearing loss in high quality studies.Corticosteroid treatment was associated with an increase in recurrent fever (RR 1.27, 95% CI 1.09 to 1.47), but not with other adverse events. AUTHORS' CONCLUSIONS: Corticosteroids significantly reduced hearing loss and neurological sequelae, but did not reduce overall mortality. Data support the use of corticosteroids in patients with bacterial meningitis in high-income countries. We found no beneficial effect in low-income countries.
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Antiinflamatorios/uso terapéutico , Glucocorticoides/uso terapéutico , Meningitis Bacterianas/tratamiento farmacológico , Adolescente , Antiinflamatorios/efectos adversos , Niño , Dexametasona/uso terapéutico , Glucocorticoides/efectos adversos , Pérdida Auditiva/etiología , Pérdida Auditiva/prevención & control , Humanos , Meningitis Bacterianas/complicaciones , Prednisolona/uso terapéutico , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
OBJECTIVE: To examine recovery of psychological functioning nine years after meningitis. METHODS: In a follow-up study, cognitive functioning and quality of life were evaluated in 28 adults 8-10 years after recovery from bacterial meningitis (n=17 due to Streptococcus pneumoniae; n=11 due to Neisseria meningitidis), and 13 controls. Test results were compared with those performed one year after the disease. All patients were well recovered at discharge (defined as a score on the Glasgow Outcome Scale of 5), but some pneumococcal patients still showed cognitive slowness and low quality of life one year after bacterial meningitis. RESULTS: At follow-up, psychological functioning and quality of life of patients and controls were similar. On group level, cognitive functioning had normalized. This was also true for patients after pneumococcal meningitis, although some cognitive slowness persisted on an individual level. CONCLUSION: Psychological functioning continues to improve slowly during the first decade after bacterial meningitis.
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Cognición/fisiología , Meningitis Meningocócica/complicaciones , Meningitis Neumocócica/complicaciones , Calidad de Vida/psicología , Adolescente , Adulto , Anciano , Femenino , Estudios de Seguimiento , Humanos , Masculino , Meningitis Meningocócica/psicología , Meningitis Neumocócica/psicología , Persona de Mediana Edad , Adulto JovenRESUMEN
BACKGROUND: Dexamethasone improves outcome for some patients with bacterial meningitis, but not others. We aimed to identify which patients are most likely to benefit from dexamethasone treatment. METHODS: We did a meta-analysis of individual patient data from the randomised, double-blind, placebo-controlled trials of dexamethasone for bacterial meningitis in patients of all ages for which raw data were available. The pre-determined outcome measures were death at the time of first follow-up, death or severe neurological sequelae at 1 month follow-up, death or any neurological sequelae at first follow-up, and death or severe bilateral hearing loss at first follow-up. Combined odds ratios (ORs) and tests for heterogeneity were calculated using conventional Mantel-Haenszel statistics. We also did exploratory analysis of hearing loss among survivors and other exploratory subgroup analyses by use of logistic regression. FINDINGS: Data from 2029 patients from five trials were included in the analysis (833 [41.0%] aged <15 years). HIV infection was confirmed or likely in 580 (28.6%) patients and bacterial meningitis was confirmed in 1639 (80.8%). Dexamethasone was not associated with a significant reduction in death (270 of 1019 [26.5%] on dexamethasone vs 275 of 1010 [27.2%] on placebo; OR 0.97, 95% CI 0.79-1.19), death or severe neurological sequelae or bilateral severe deafness (42.3%vs 44.3%; 0.92, 0.76-1.11), death or any neurological sequelae or any hearing loss (54.2%vs 57.4%; 0.89, 0.74-1.07), or death or severe bilateral hearing loss (36.4%vs 38.9%; 0.89, 0.73-1.69). However, dexamethasone seemed to reduce hearing loss among survivors (24.1%vs 29.5%; 0.77, 0.60-0.99, p=0.04). Dexamethasone had no effect in any of the prespecified subgroups, including specific causative organisms, pre-dexamethasone antibiotic treatment, HIV status, or age. Pooling of the mortality data with those of all other published trials did not significantly change the results. INTERPRETATION: Adjunctive dexamethasone in the treatment of acute bacterial meningitis does not seem to significantly reduce death or neurological disability. There were no significant treatment effects in any of the prespecified subgroups. The benefit of adjunctive dexamethasone for all or any subgroup of patients with bacterial meningitis thus remains unproven. FUNDING: Wellcome Trust UK.
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Antiinflamatorios/uso terapéutico , Dexametasona/uso terapéutico , Meningitis Bacterianas/tratamiento farmacológico , Adolescente , Adulto , Niño , Preescolar , Quimioterapia Combinada/tendencias , Femenino , Humanos , Lactante , Masculino , Meningitis Bacterianas/epidemiología , Persona de Mediana Edad , Ensayos Clínicos Controlados Aleatorios como Asunto , Adulto JovenRESUMEN
BACKGROUND: Alcoholism is associated with susceptibility to infectious disease, particularly bacterial pneumonia. In the present study we described characteristics in alcoholic patients with bacterial meningitis and delineate the differences with findings in non-alcoholic adults with bacterial meningitis. METHODS/PRINCIPAL FINDINGS: This was a prospective nationwide observational cohort study including patients aged >16 years who had bacterial meningitis confirmed by culture of cerebrospinal fluid (696 episodes of bacterial meningitis occurring in 671 patients). Alcoholism was present in 27 of 686 recorded episodes of bacterial meningitis (4%) and alcoholics were more often male than non-alcoholics (82% vs 48%, P = 0.001). A higher proportion of alcoholics had underlying pneumonia (41% vs 11% P<0.001). Alcoholics were more likely to have meningitis due to infection with Streptococcus pneumoniae (70% vs 50%, P = 0.01) and Listeria monocytogenes (19% vs 4%, P = 0.005), whereas Neisseria meningitidis was more common in non-alcoholic patients (39% vs 4%, P = 0.01). A large proportion of alcoholics developed complications during clinical course (82% vs 62%, as compared with non-alcoholics; P = 0.04), often cardiorespiratory failure (52% vs 28%, as compared with non-alcoholics; P = 0.01). Alcoholic patients were at risk for unfavourable outcome (67% vs 33%, as compared with non-alcoholics; P<0.001). CONCLUSIONS/SIGNIFICANCE: Alcoholic patients are at high risk for complications resulting in high morbidity and mortality. They are especially at risk for cardiorespiratory failure due to underlying pneumonia, and therefore, aggressive supportive care may be crucial in the treatment of these patients.
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Alcohólicos , Alcoholismo/epidemiología , Meningitis Bacterianas/epidemiología , Adulto , Anciano , Alcoholismo/mortalidad , Estudios de Cohortes , Infecciones Comunitarias Adquiridas/epidemiología , Infecciones Comunitarias Adquiridas/microbiología , Comorbilidad , Femenino , Humanos , Listeria monocytogenes/aislamiento & purificación , Masculino , Meningitis Bacterianas/líquido cefalorraquídeo , Persona de Mediana Edad , Neisseria meningitidis/aislamiento & purificación , Países Bajos/epidemiología , Neumonía/epidemiología , Estudios Prospectivos , Tasa de Supervivencia , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: Indonesia has a concentrated but rapidly growing HIV epidemic. We examined the effect of HIV on causative organisms, clinical features and prognosis of adult meningitis. DESIGN: A prospective cohort study. METHODS: All adult patients at a referral hospital who underwent cerebrospinal fluid examination for suspected meningitis were examined for HIV and included in a prospective cohort study. Microbiological testing was done for common bacterial pathogens, mycobacteria and fungi. Patients were followed for at least 6 months, and logistic regression models were used to identify risk factors for mortality. RESULTS: Among 185 patients who mostly presented with subacute meningitis, 60% were male and the median age was 30 years. HIV infection was present in 25% of the patients; almost two-thirds were newly confirmed, and all presented with severe immunosuppression (median CD4 cell count 13/microl, range 2-98). One-third of HIV-infected patients had cryptococcal meningitis whereas two-thirds suffered from tuberculosis. After 1 month, 41% of patients had died. HIV infection was strongly associated with 1-month mortality (adjusted odds ratio 12.15; 95% confidence interval 3.04-15.72) and death during extended follow-up (hazard ratio 2.48; 95% confidence interval 1.97-5.74). CONCLUSION: Although HIV is still uncommon in the general population in Indonesia, its prevalence among adult meningitis cases already seems high. Mycobacterium tuberculosis and Cryptococcus neoformans are the main causes of meningitis in this setting, and mortality is very high, especially in HIV-infected patients. Our data suggest that adult meningitis cases in Indonesia should be screened routinely for HIV infection. Further studies are needed to address the high mortality.
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Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Meningitis Fúngica/epidemiología , Tuberculosis Meníngea/embriología , Infecciones Oportunistas Relacionadas con el SIDA/líquido cefalorraquídeo , Infecciones Oportunistas Relacionadas con el SIDA/microbiología , Adulto , Recuento de Linfocito CD4 , Cryptococcus neoformans , Femenino , Humanos , Indonesia/epidemiología , Masculino , Meningitis Fúngica/microbiología , Prevalencia , Pronóstico , Estudios Prospectivos , Tuberculosis Meníngea/microbiologíaRESUMEN
BACKGROUND: Hyperglycemia has been associated with unfavorable outcome in several disorders, but few data are available in bacterial meningitis. We assessed the incidence and significance of hyperglycemia in adults with bacterial meningitis. METHODS: We collected data prospectively between October 1998 and April 2002, on 696 episodes of community-acquired bacterial meningitis, confirmed by culture of CSF in patients >16 years. Patients were dichotomized according to blood glucose level on admission. A cutoff random non-fasting blood glucose level of 7.8 mmol/L (140 mg/dL) was used to define hyperglycemia, and a cutoff random non-fasting blood glucose level of 11.1 mmol/L (200 mg/dL) was used to define severe hyperglycemia. Unfavorable outcome was defined on the Glasgow outcome scale as a score <5. We also evaluated characteristics of patients with a preadmission diagnosis of diabetes mellitus. RESULTS: 69% of patients were hyperglycemic and 25% severely hyperglycemic on admission. Compared with non-hyperglycemic patients, hyperglycemia was related with advanced age (median, 55 yrs vs. 44 yrs, P < 0.0001), preadmission diagnosis of diabetes (9% vs. 3%, P = 0.005), and distant focus of infection (37% vs. 28%, P = 0.02). They were more often admitted in coma (16% vs. 8%; P = 0.004) and with pneumococcal meningitis (55% vs. 42%, P = 0.007). These differences remained significant after exclusion of patients with known diabetes. Hyperglycemia was related with unfavorable outcome in a univariate analysis but this relation did not remain robust in a multivariate analysis. Factors predictive for neurologic compromise were related with higher blood glucose levels, whereas factors predictive for systemic compromise were related with lower blood glucose levels. Only a minority of severely hyperglycemic patients were known diabetics (19%). The vast majority of these known diabetic patients had meningitis due to Streptococcus pneumoniae (67%) or Listeria monocytogenes (13%) and they were at high risk for unfavorable outcome (52%). CONCLUSION: The majority of patients with bacterial meningitis have hyperglycemic blood glucose levels on admission. Hyperglycemia can be explained by a physical stress reaction, the central nervous system insult leading to disturbed blood-glucose regulation mechanisms, and preponderance of diabetics for pneumococcal meningitis. Patients with diabetes and bacterial meningitis are at high risk for unfavorable outcome.
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Glucemia/análisis , Hiperglucemia/complicaciones , Meningitis Bacterianas/complicaciones , Adulto , Anciano , Infecciones Comunitarias Adquiridas/complicaciones , Diabetes Mellitus/sangre , Escala de Consecuencias de Glasgow , Humanos , Hiperglucemia/diagnóstico , Meningitis Bacterianas/diagnóstico , Persona de Mediana Edad , Análisis Multivariante , Prevalencia , Pronóstico , Estudios Prospectivos , Factores de Riesgo , Adulto JovenRESUMEN
We present 9 patients with community acquired Staphylococcus aureus meningitis. Foci of infection outside the central nervous system were present in 8 (89%) patients, mostly endocarditis and pneumonia. Cardiorespiratory complications occurred frequently and 6 patients died (67%). Identification and treatment of the primary focus of infection should be a priority in these patients.
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Meningitis Bacterianas/diagnóstico , Meningitis Bacterianas/epidemiología , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/epidemiología , Staphylococcus aureus , Adolescente , Adulto , Anciano , Estudios de Cohortes , Infecciones Comunitarias Adquiridas/diagnóstico , Infecciones Comunitarias Adquiridas/epidemiología , Infecciones Comunitarias Adquiridas/microbiología , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/etiología , Endocarditis Bacteriana/microbiología , Femenino , Humanos , Masculino , Meningitis Bacterianas/microbiología , Persona de Mediana Edad , Neumonía Bacteriana/diagnóstico , Neumonía Bacteriana/etiología , Neumonía Bacteriana/microbiología , Factores de Riesgo , Infecciones Estafilocócicas/complicacionesRESUMEN
Streptococcus pneumoniae and Neisseria meningitidis can cause sepsis and meningitis. Several risk factors for pneumococcal and meningococcal disease have been identified, but the cause of basic differences in susceptibility between individuals and populations is unknown. Single-nucleotide polymorphisms are thought to explain interindividual differences in susceptibility. New technologies provide the opportunity to study the genetic basis of susceptibility to these diseases. In recent years, several studies have been published on these polymorphisms in pneumococcal and meningococcal disease, many with apparently conflicting results. Herein we provide a systematic overview of all polymorphisms studied for a relation with susceptibility to pneumococcal and meningococcal disease. We also propose an initiative to pool genetic data on pneumococcal and meningococcal meningitis in one biobank.
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Predisposición Genética a la Enfermedad , Infecciones Meningocócicas/genética , Infecciones Neumocócicas/genética , Humanos , Infecciones Meningocócicas/inmunología , Infecciones Meningocócicas/microbiología , Infecciones Neumocócicas/inmunología , Infecciones Neumocócicas/microbiología , Polimorfismo GenéticoAsunto(s)
Dexametasona/efectos adversos , Dexametasona/uso terapéutico , Meningitis Bacterianas/complicaciones , Meningitis Bacterianas/tratamiento farmacológico , Simplexvirus/crecimiento & desarrollo , Activación Viral , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Humanos , Persona de Mediana EdadRESUMEN
BACKGROUND: The treatment of Herpes-simplex-virus-encephalitis (HSVE) remains a major unsolved problem in Neurology. Current gold standard for therapy is acyclovir, a drug that inhibits viral replication. Despite antiviral treatment, mortality remains up to 15%, less than 20% of patients are able to go back to work, and the majority of patients suffer from severe disability. This is a discouraging, unsatisfactory situation for treating physicians, the disabled patients and their families, and constitutes an enormous burden to the public health services. The information obtained from experimental animal research and from recent retrospective clinical observations, indicates that a substantial benefit in outcome can be expected in patients with HSVE who are treated with adjuvant dexamethasone. But currently there is no available evidence to support the routine use of adjuvant corticosteroid treatment in HSVE. A randomized multicenter trial is the only useful instrument to address this question. DESIGN: GACHE is a multicenter, randomized, double-blind, placebo-controlled, parallel group clinical trial of treatment with acyclovir and adjuvant dexamethasone, as compared with acyclovir and placebo in adults with HSVE. The statistical design will be that of a 3-stage-group sequential trial with potential sample size adaptation in the last stage. CONCLUSION: 372 patients with proven HSVE (positive HSV-DNA-PCR), aged 18 up to 85 years; with focal neurological signs no longer than 5 days prior to admission, and who give informed consent will be recruited from Departments of Neurology of academic medical centers in Germany, Austria and The Netherlands. Sample size will potentially be extended after the second interim analysis up to a maximum of 450 patients. TRIAL REGISTRATION: Current Controlled TrialsISRCTN45122933.
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Aciclovir/uso terapéutico , Antiinflamatorios/uso terapéutico , Antivirales/uso terapéutico , Dexametasona/uso terapéutico , Encefalitis por Herpes Simple/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Quimioterapia Adyuvante , Método Doble Ciego , Quimioterapia Combinada , Glucocorticoides/uso terapéutico , Humanos , Persona de Mediana Edad , Selección de Paciente , Proyectos de Investigación , Resultado del Tratamiento , Adulto JovenRESUMEN
Meningococcal meningitis remains a life-threatening disease. Neisseria meningitidis is the leading cause of meningitis and septicemia in young adults and is a major cause of endemic bacterial meningitis worldwide. The Meningitis Cohort Study was a Dutch nationwide prospective observational cohort study of adults with community-acquired bacterial meningitis, confirmed by culture of cerebrospinal fluid, from October 1998 to April 2002. Patients underwent a neurologic examination at discharge, and outcome was graded with the Glasgow Outcome Scale. Serogrouping, multi-locus sequence typing, and susceptibility testing of meningococcal isolates were performed. The study identified 258 episodes of meningococcal meningitis in 258 patients. The prevalence of the classical triad of fever, neck stiffness, and change in mental status was low (70/258, 27%). When rash was added to the classical triad, 229 of 258 (89%) patients had at least 2 of 4 signs. Systolic hypotension was associated with rash (22/23 vs. 137/222, p = 0.002) and absence of neck stiffness (6/23 vs. 21/220, p = 0.05). Neuroimaging before lumbar puncture was an important cause of delay of therapy: antibiotics were not initiated before computed tomography (CT) scan in 85% of patients who underwent CT scan before lumbar puncture. Unfavorable outcome occurred in 30 of 258 (12%) patients, including a mortality rate of 7%. Neurologic sequelae occurred in 28 of 238 (12%) patients, particularly hearing loss (8%). Factors associated with sepsis and infection with meningococci of clonal complex 11 (cc11) are related with unfavorable outcome.
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Meningitis Meningocócica/fisiopatología , Neisseria meningitidis/genética , Adulto , Antibacterianos/uso terapéutico , Técnicas Bacteriológicas , ADN Bacteriano/genética , Femenino , Genotipo , Escala de Consecuencias de Glasgow , Humanos , Masculino , Meningitis Meningocócica/terapia , Neisseria meningitidis/clasificación , Neisseria meningitidis/aislamiento & purificación , Prevalencia , Estudios Prospectivos , Factores de Riesgo , Análisis de Secuencia de ADN , Resultado del TratamientoRESUMEN
We present four patients with Streptococcus suis meningitis identified during a 3.5-year prospective surveillance study in the Netherlands. All cases were associated with exposure to pigs. Patients presented with classic symptoms and signs of bacterial meningitis. Outcome was characterized by severe hearing loss. Physicians should be aware of occupational exposure with S. suis and risk of meningitis associated with this pathogen.
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Meningitis Bacterianas/etiología , Meningitis Bacterianas/microbiología , Enfermedades Profesionales/epidemiología , Infecciones Estreptocócicas/epidemiología , Streptococcus suis/patogenicidad , Enfermedades de los Trabajadores Agrícolas/epidemiología , Animales , Pérdida Auditiva , Humanos , Países Bajos/epidemiología , Exposición Profesional , Estudios Prospectivos , Infecciones Estreptocócicas/complicaciones , Infecciones Estreptocócicas/diagnóstico , Infecciones Estreptocócicas/microbiología , PorcinosRESUMEN
Despite the availability of effective antibiotics, vaccination programmes and skilled acute-care facilities, there is still a significant mortality and morbidity from bacterial meningitis. Neurologists are often called on to "rule out bacterial meningitis", which can be difficult with the history and physical examination alone. In this review the authors will discuss the epidemiology, diagnosis and treatment of acute community-acquired bacterial meningitis in adults, focussing particularly on the management of patients with neurological complications, and stressing the importance of adjunctive dexamethasone.
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Infecciones Comunitarias Adquiridas , Meningitis Bacterianas , Adulto , Antibacterianos/uso terapéutico , Infecciones Comunitarias Adquiridas/complicaciones , Infecciones Comunitarias Adquiridas/diagnóstico , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Infecciones Comunitarias Adquiridas/epidemiología , Dexametasona/uso terapéutico , Quimioterapia Combinada , Glucocorticoides/uso terapéutico , Pruebas Hematológicas , Humanos , Incidencia , Meningitis Bacterianas/complicaciones , Meningitis Bacterianas/diagnóstico , Meningitis Bacterianas/tratamiento farmacológico , Meningitis Bacterianas/epidemiología , Enfermedades del Sistema Nervioso/etiología , Punción Espinal , Tomografía Computarizada por Rayos X , Inconsciencia/etiologíaRESUMEN
OBJECTIVE: To derive and validate a bedside risk score for adverse outcome in adults with bacterial meningitis. METHODS: We derived a score for the risk for an unfavorable outcome (Glasgow Outcome Scale score 1-4) by performing logistic regression analyses of data from a prospective cohort study (Dutch Meningitis Cohort; N = 696). A key set of independent prognostic variables was selected from 22 potential predictors. A nomogram based on these key variables was constructed to facilitate use in clinical practice. To validate this nomogram, we used data from our randomized controlled trial on adjunctive dexamethasone therapy in adults with bacterial meningitis (European Dexamethasone Study; N = 301). RESULTS: Unfavorable outcome occurred in 237 of 696 episodes (34%) in the Dutch Meningitis Cohort; 143 patients (21%) died. In the analysis, 6 of 22 variables that are routinely available within 1 hour after admission were robust enough for inclusion in the final risk score: age, heart rate, Glasgow Coma Scale score, cranial nerve palsies, a cerebrospinal fluid leukocyte count less than 1,000 cells/mm3, and gram-positive cocci in cerebrospinal fluid Gram's stain. The concordance index for the risk score was 0.84 (95% confidence interval, 0.80-0.87) in the original cohort and 0.81 (95% confidence interval, 0.74-0.87) in the external validation cohort (European Dexamethasone Study). INTERPRETATION: This bedside risk score can be used to identify patients with a high risk for unfavorable outcome in adults with bacterial meningitis within 1 hour after the initial presentation.
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Meningitis Bacterianas/diagnóstico , Índice de Severidad de la Enfermedad , Adulto , Factores de Edad , Anciano , Antibacterianos/uso terapéutico , Arritmias Cardíacas/epidemiología , Líquido Cefalorraquídeo/microbiología , Estudios de Cohortes , Comorbilidad , Enfermedades de los Nervios Craneales/epidemiología , Método Doble Ciego , Diagnóstico Precoz , Femenino , Humanos , Masculino , Meningitis Bacterianas/epidemiología , Meningitis Bacterianas/fisiopatología , Persona de Mediana Edad , Nomogramas , Efecto Placebo , Pronóstico , Estudios Prospectivos , Ensayos Clínicos Controlados Aleatorios como Asunto/estadística & datos numéricos , Análisis de Regresión , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Community-acquired recurrent bacterial meningitis in adults is a relatively rare disease. All previous data were derived from small retrospective case series. METHODS: We prospectively evaluated episodes of recurrent bacterial meningitis in a nationwide cohort study in The Netherlands. RESULTS: 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. CONCLUSION: 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.
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Traumatismos Craneocerebrales/complicaciones , Meningitis Bacterianas/mortalidad , Efusión Subdural/complicaciones , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Causalidad , Infecciones Comunitarias Adquiridas/epidemiología , Femenino , Escala de Coma de Glasgow , Humanos , Incidencia , Masculino , Meningitis Bacterianas/complicaciones , Meningitis Bacterianas/microbiología , Persona de Mediana Edad , Países Bajos/epidemiología , Estudios Prospectivos , Recurrencia , Factores de Riesgo , Factores SexualesAsunto(s)
Hipernatremia/epidemiología , Adulto , Anciano , Infecciones Comunitarias Adquiridas/epidemiología , Femenino , Humanos , Hipernatremia/etiología , Masculino , Meningitis Bacterianas/complicaciones , Meningitis Bacterianas/epidemiología , Persona de Mediana Edad , Países Bajos/epidemiologíaRESUMEN
Acute bacterial meningitis is a serious and life-threatening neurological infectious disease. Despite the availability of effective antibiotics, supportive care facilities and recent advances in adjunctive strategies, for example, adjunctive dexamethasone, mortality and morbidity rates associated with bacterial meningitis remain unacceptably high. The review presents a brief overview of key clinical and epidemiological aspects of the disease and focuses on advances in pharmacotherapeutic strategies in adult patients with bacterial meningitis in the developed world.