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Cerebral Infarction in Adults with Bacterial Meningitis

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Abstract

Background

To evaluate clinical features and prognostic factors of cerebral infarctions in adults with community-acquired bacterial meningitis.

Method

An observational cross-sectional study, including 696 patients of whom 174 had cerebral infarction, from a prospective nationwide cohort of community-acquired bacterial meningitis (period, 1998–2002), confirmed by culture of cerebral spinal fluid (CSF) in patients aged over 16 years. Two investigators independently determined the presence of infarction.

Result

Cerebral infarction occurred in 174 episodes (25%), with a high inter-rater agreement for determining the presence of cerebral infarction (kappa 0.95). Cerebral infarctions occurred in 128 of 352 patients (36%) with pneumococcal meningitis, in 22 of 257 (9%) with meningococcal meningitis and in 24 of 87 patients (28%) with meningitis caused by other bacteria. Patients with infarctions were older (P < 0.001) and often presented with predisposing conditions, such as otitis and/or sinusitis (P = 0.001) or an immunocompromised state (P = 0.003) compared to those without infarction. Patients with infarctions presented with lower scores on the Glasgow Coma Scale (P < 0.001), lower CSF white cell counts (P = 0.001), and higher serum erythrocyte sedimentation rate (ESR) (P < 0.001). Unfavorable outcome occurred in 108 (62%) patients with infarctions. In a multivariate analysis, infarction was related with unfavorable outcome (odds ratio 3.37; 95% confidence interval 2.19–5.21; P < 0.001). We identified lower CSF white cell counts and high ESR to be independent risk factors for cerebral infarction.

Conclusion

Cerebral infarction is a common and severe complication in adults with community-acquired bacterial meningitis. Preventing cerebral infarctions will be important in reducing the high morbidity and mortality rate in adults with community-acquired bacterial meningitis.

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References

  1. Brouwer MC, Tunkel AR, van de Beek D. Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis. Clin Microbiol Rev. 2010;23:467–92.

    Article  PubMed  CAS  Google Scholar 

  2. Kastenbauer S, Pfister HW. Pneumococcal meningitis in adults: spectrum of complications and prognostic factors in a series of 87 cases. Brain. 2003;126:1015–25.

    Article  PubMed  Google Scholar 

  3. van de Beek D, de Gans J, Spanjaard L, Weisfelt M, Reitsma JB, Vermeulen M. Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med. 2004;351:1849–59.

    Article  PubMed  Google Scholar 

  4. Durand ML, Calderwood SB, Weber DJ, et al. Acute bacterial meningitis in adults. A review of 493 episodes. N Engl J Med. 1993;328:21–8.

    Article  PubMed  CAS  Google Scholar 

  5. Vergouwen MD, Schut ES, Troost D, van de Beek D. Diffuse cerebral intravascular coagulation and cerebral infarction in pneumococcal meningitis. Neurocrit Care. 2010;13:217–27.

    Article  PubMed  Google Scholar 

  6. Weisfelt M, van de Beek D, Spanjaard L, Reitsma JB, de Gans J. Clinical features, complications, and outcome in adults with pneumococcal meningitis: a prospective case series. Lancet Neurol. 2006;5:123–9.

    Article  PubMed  Google Scholar 

  7. Katchanov J, Heuschmann PU, Endres M, Weber JR. Cerebral infarction in bacterial meningitis: predictive factors and outcome. J Neurol. 2010;257:716–20.

    Article  PubMed  Google Scholar 

  8. Pfister HW, Borasio GD, Dirnagl U, Bauer M, Einhaupl KM. Cerebrovascular complications of bacterial meningitis in adults. Neurology. 1992;42:1497–504.

    Article  PubMed  CAS  Google Scholar 

  9. McMillan DA, Lin CY, Aronin SI, Quagliarello VJ. Community-acquired bacterial meningitis in adults: categorization of causes and timing of death. Clin Infect Dis. 2001;33:969–75.

    Article  PubMed  CAS  Google Scholar 

  10. Grau AJ, Weimar C, Buggle F, et al. Risk factors, outcome, and treatment in subtypes of ischemic stroke. Stroke. 2001;32:2559–66.

    Article  PubMed  CAS  Google Scholar 

  11. Roine I, Peltola H, Fernandez J, et al. Influence of admission findings on death and neurological outcome from childhood bacterial meningitis. Clin Infect Dis. 2008;46:1248–52.

    Article  PubMed  Google Scholar 

  12. Weisfelt M, van de Beek D, Spanjaard L, Reitsma JB, de Gans J. Attenuated cerebrospinal fluid leukocyte count and sepsis in adults with pneumococcal meningitis: a prospective cohort study. BMC Infect Dis. 2006;6:149.

    Article  PubMed  Google Scholar 

  13. Cairns H, Russell DS. Cerebral arteritis and phlebitis in pneumococcal meningitis. J Pathol Bacteriol. 1946;58:649–65.

    Article  PubMed  CAS  Google Scholar 

  14. Buchan GC, Alvord EC Jr. Diffuse necrosis of subcortical white matter associated with bacterial meningitis. Neurology. 1969;19:1–9.

    Article  PubMed  CAS  Google Scholar 

  15. Swartz MN, Dodge PR. Bacterial meningitis—a review of selected aspects. 1. General clinical features, special problems and unusual meningeal reaction mimicking bacterial meningitis. N Engl J Med. 1965;272:842–8.

    Article  PubMed  CAS  Google Scholar 

  16. Weisfelt M, de Gans J, van der Poll T, van de Beek D. Pneumococcal meningitis in adults: new approaches to management and prevention. Lancet Neurol. 2006;5:332–42.

    Article  PubMed  CAS  Google Scholar 

  17. Ries S, Schminke U, Fassbender K, Daffertshofer M, Steinke W, Hennerici M. Cerebrovascular involvement in the acute phase of bacterial meningitis. J Neurol. 1997;244:51–5.

    Article  PubMed  CAS  Google Scholar 

  18. Levi M, van der Poll T, Buller HR. Bidirectional relation between inflammation and coagulation. Circulation. 2004;109:2698–704.

    Article  PubMed  Google Scholar 

  19. Weisfelt M, Determann RM, de Gans J, et al. Procoagulant and fibrinolytic activity in cerebrospinal fluid from adults with bacterial meningitis. J Infect. 2007;54:545–50.

    Article  PubMed  Google Scholar 

  20. Schut ES, Brouwer MC, de Gans J, Florquin S, Troost D, van de Beek D. Delayed cerebral thrombosis after initial good recovery from pneumococcal meningitis. Neurology. 2009;73:1988–95.

    Article  PubMed  CAS  Google Scholar 

  21. Macfarlane JT, Cleland PG, Attai ED, Greenwood BM. Failure of heparin to alter the outcome of pneumococcal meningitis. Br Med J. 1977;2:1522.

    Article  PubMed  CAS  Google Scholar 

  22. Laterre PF. Clinical trials in severe sepsis with drotrecogin alfa (activated). Crit Care. 2007;11(Suppl 5):S5.

    Article  PubMed  Google Scholar 

  23. Vincent JL, Nadel S, Kutsogiannis DJ, et al. Drotrecogin alfa (activated) in patients with severe sepsis presenting with purpura fulminans, meningitis, or meningococcal disease: a retrospective analysis of patients enrolled in recent clinical studies. Crit Care. 2005;9:R331–43.

    Article  PubMed  Google Scholar 

  24. Misra UK, Kalita J, Nair PP. Role of aspirin in tuberculous meningitis: a randomised open-label placebo controlled trial. J Neurol Sc. 2010;293:12–7.

    Article  CAS  Google Scholar 

  25. Brouwer MC, Read RC, van de Beek D. Host genetics and outcome in meningococcal disease: a systematic review and meta-analysis. Lancet Infect Dis. 2010;10:262–74.

    Article  PubMed  CAS  Google Scholar 

  26. Sigurdardottir B, Bjornsson OM, Jonsdottir KE, Erlendsdottir H, Gudmundsson S. Acute bacterial meningitis in adults: a 20-year overview. Arch Intern Med. 1997;157:425–30.

    Article  PubMed  CAS  Google Scholar 

  27. Tunkel AR. Bacterial meningitis. Philadelphia: Lippincott, Williams & Wilkins; 2001.

    Google Scholar 

  28. de Gans J, van de Beek D. Dexamethasone in adults with bacterial meningitis. N Engl J Med. 2002;347:1549–56.

    Article  PubMed  Google Scholar 

  29. Brouwer MC, Heckenberg SG, de Gans J, Spanjaard L, Reitsma JB, van de Beek D. Nationwide implementation of adjunctive dexamethasone therapy for pneumococcal meningitis. Neurology. 2010;75:1533–9.

    Article  PubMed  CAS  Google Scholar 

  30. van de Beek D, de Gans J, McIntyre P, Prasad K. Steroids in adults with acute bacterial meningitis: a systematic review. Lancet Infect Dis. 2004;4:139–43.

    Article  PubMed  Google Scholar 

  31. Thigpen MC, Whitney CG, Messonnier NE, et al. Bacterial meningitis in the United States, 1998–2007. N Engl J Med. 2011;364:2016–25.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

The authors are indebted to many physicians in the Netherlands for their cooperation. This study has been funded by grants from the Netherlands Organization for Health Research and Development (ZonMw; NWO-Veni grant 2006 [916.76.023], NWO-Vidi grant 2010 [016.116.358], both to D.v.d.B.), the Academic Medical Center (AMC Fellowship 2008, D.v.d.B.). M.C.B. is supported by the European Society Clinical of Microbiology and Infectious Diseases and European Federation of Neurologic Societies. Other authors no financial support.

Conflict of interest

None.

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Authors and Affiliations

  1. Department of Neurology, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100, Amsterdam, The Netherlands

    Ewout S. Schut, Marjolein J. Lucas, Matthijs C. Brouwer, Mervyn D. I. Vergouwen & Diederik van de Beek

  2. Department of Medical Microbiology, Center of Infection and Immunity Amsterdam (CINIMA) Academic Medical Center, Amsterdam, The Netherlands

    Arie van der Ende

  3. Netherlands Reference Laboratory for Bacterial Meningitis, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, Amsterdam, The Netherlands

    Arie van der Ende

  4. Experimental Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands

    Mervyn D. I. Vergouwen

Authors
  1. Ewout S. Schut
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  2. Marjolein J. Lucas
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  3. Matthijs C. Brouwer
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  4. Mervyn D. I. Vergouwen
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  5. Arie van der Ende
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  6. Diederik van de Beek
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Corresponding author

Correspondence to Diederik van de Beek.

Additional information

Ewout S. Schut and Marjolein J. Lucas contributed equally in preparing this manuscript.

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Schut, E.S., Lucas, M.J., Brouwer, M.C. et al. Cerebral Infarction in Adults with Bacterial Meningitis. Neurocrit Care 16, 421–427 (2012). https://doi.org/10.1007/s12028-011-9634-4

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