Bacterial meningitis is a type of meningitis serious enough to cause death and permanent damages. The bacteria that cause the condition enters the central nervous system and may also spread from the throat, nasal cavity, and middle ear. The bacteria that cause the condition are Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae, and Streptococcus agalactiae. Bacterial meningitis pathogens can be transmitted through oral secretion such as saliva or when coughing. General symptoms for this condition include headache, fever, vomiting, confusion, nausea, sensitive to light, and stiff neck. Below are the types of bacterial meningitis:– The bacteria that causes meningitis affects what part of the body?
Meningococcal Meningitis: This condition is caused by Neisseria meningitidis bacteria and it is a very serious infection. Sometimes, it can be fatal few hours after the symptoms start. Survivors tend to have nerve damages that are irreversible resulting in the loss of hearing, brain damage, or necrosis. The bacteria can move to the blood causing sepsis which leads to organ failure, septic shock, multiple blood clots, and death.– What bacteria causes the disease meningococcal meningitis?
Pneumococcal Meningitis: This type of meningitis is caused by Streptococcus pneumoniae bacteria. The bacteria are normally found at the back of the mouth and does not cause problems, but if a person is susceptible, the bacteria can cross the blood-brain barrier causing meningitis. Sometimes, the bacteria and its toxins cause blood poisoning or septicemia.– The bacteria that causes pneumococcal meningitis can be found normally at which part of the body?
Haemophilus Influenzae Meningitis: This condition is caused by Haemophilus influenzae bacteria. These bacteria can be found in the throat and are the common cause of meningitis in children below 5 years old.– Meningitis that occurs in children below 5 years old are usually caused by what bacteria?
Neonatal Meningitis: This type of meningitis is caused by Streptococcus agalactiae bacteria and occurs in newborns up to 3 months of age. Sometimes, the bacteria can infect people with different age and can be found in the urinary and digestive tracts. Early stage symptoms include unstable temperature, apnea, slow heart rate, low blood pressure, high irritability, and weakness. Late stage symptoms include seizure, protruding fontanel, stiff neck, half-body paralysis, and backward arching of the head.– What bacteria causes the disease neonatal meningitis?
Parker, N., Schneegurt, M., Thi Tu, A.-H., Forster, B. M., & Lister, P. (n.d.). Microbiology. Houston, Texas: OpenStax. Access for free at: https://openstax.org/details/books/microbiology
Predictive value of repeated cerebrospinal fluid parameters in the outcomes of bacterial meningitis in infants <90 days of age
Background: There are variations in recommendations from different guidelines regarding the indications for repeat lumbar puncture (LP) in young infants with the diagnosis of bacterial meningitis.
Objective: To evaluate the frequency of repeat LPs and the characteristics of cerebrospinal fluid (CSF) parameters in repeated sampling and their predictive values for adverse outcomes in a national cohort.
Methods: This cohort study included infants born January 1, 2013 through December 31, 2014, who had proven or suspected bacterial meningitis within the first 90 days of life at seven paediatric tertiary care hospitals across Canada, and who underwent a repeat LP at the discretion of the treating physicians.
Results: Forty-nine of 111 infants (44%) underwent repeat LP at a median of 5 (IQR: 3, 13) days after the LP that led to the diagnosis of bacterial meningitis. Those who had meningitis caused by gram negative bacilli were more likely to have repeat LP than those with gram positive bacteria (77% versus 57%; p = 0.012). White blood cell (WBC) count on the second spinal tap yielded an area under the curve of 0.88 for predicting sequelae of meningitis at discharge from the hospital, with a cut-off value of 366 × 106/L, providing a sensitivity of 91% and specificity of 88%.
Conclusion: In this multi-centre retrospective cohort study, infants with gram negative meningitis were more likely to have repeated LP. A high WBC on the second CSF sample was predictive of adverse outcome at the time of discharge from the hospital.
Successful Vancomycin Dose Adjustment in a Sepsis patient with Bacterial Meningitis Using Cystatin C
Cystatin C-guided vancomycin (VCM) dosing is useful in critically ill patients. Its usefulness in septic patients with bacterial meningitis remains unknown, as there are no published reports. In this study, we sought to clarify its benefit. Cystatin C was used to guide VCM dosing in a septic bacterial meningitis patient with normal kidney function, according to therapeutic drug monitoring (TDM). Using cystatin C, the Bayesian method-based TDM made optimal VCM dosing possible, and decreased the predicted error (4.85 mg/L) compared to serum creatinine (16.83 mg/L). We concluded TDM of VCM using cystatin C can be considered in sepsis patients with bacterial meningitis with normal kidney function.
Keywords: bacterial meningitis; cystatin C; sepsis; therapeutic drug monitoring; vancomycin
Bacterial meningitis after incomplete retrograde obliteration for duodenal varices with encephalopathy: A case report
We report a case of bacterial meningitis in a 72-year-old female with nonalcoholic steatohepatitis who underwent incomplete retrograde obliteration for duodenal varices with encephalopathy. Two months after incomplete retrograde obliteration, she became febrile, drowsy, and was transported to hospital. Her serum ammonia level was normal. Endoscopy revealed that previously embolized coil was partially migrated into the duodenal lumen. Cerebrospinal fluid examination confirmed the diagnosis of bacterial meningitis. She was treated with intravenous antibiotics. As there was a risk of bleeding, trans-ileocolic vein obliteration of duodenal varices was attempted. The patient slowly recovered and was discharged. This case indicated two problems could occur by coil migration after incomplete retrograde obliteration for duodenal varices with encephalopathy. One was bacterial meningitis and the other was risk of bleeding from duodenal varices. We conclude that cerebrospinal fluid examination is recommended for patients with high fever and abnormal mental status after incomplete retrograde obliteration, and immediate complete obliteration should be attempted for a risk of bleeding.
Keywords: Bacterial meningitis; Coil migration; Duodenal varices; Hepatic encephalopathy; Retrograde obliteration.
Poldip2 mediates blood-brain barrier disruption and cerebral edema by inducing AQP4 polarity loss in mouse bacterial meningitis model
Background: Specific highly polarized aquaporin-4 (AQP4) expression is reported to play a crucial role in blood-brain barrier (BBB) integrity and brain water transport balance. The upregulation of polymerase δ-interacting protein 2 (Poldip2) was involved in aggravating BBB disruption following ischemic stroke. This study aimed to investigate whether Poldip2-mediated BBB disruption and cerebral edema formation in mouse bacterial meningitis (BM) model occur via induction of AQP4 polarity loss.
Methods and results: Mouse BM model was induced by injecting mice with group B hemolytic streptococci via posterior cistern. Recombinant human Poldip2 (rh-Poldip2) was administered intranasally at 1 hour after BM induction. Small interfering ribonucleic acid (siRNA) targeting Poldip2 was administered by intracerebroventricular (i.c.v) injection at 48 hours before BM induction. A specific inhibitor of matrix metalloproteinases (MMPs), UK383367, was administered intravenously at 0.5 hour before BM induction. Western blotting, immunofluorescence staining, quantitative real-time PCR, neurobehavioral test, brain water content test, Evans blue (EB) permeability assay, transmission electron microscopy (TEM), and gelatin zymography were carried out. The results showed that Poldip2 was upregulated and AQP4 polarity was lost in mouse BM model. Both Poldip2 siRNA and UK383367 improved neurobehavioral outcomes, alleviated brain edema, preserved the integrity of BBB, and relieved the loss of AQP4 polarity in BM model. Rh-Poldip2 upregulated the expression of MMPs and glial fibrillary acidic protein (GFAP) and downregulated the expression of β-dystroglycan (β-DG), zonula occludens-1 (ZO-1), occludin, and claudin-5; whereas Poldip2 siRNA downregulated the expression of MMPs and GFAP, and upregulated β-DG, ZO-1, occludin, and claudin-5. Similarly, UK383367 downregulated the expression of GFAP and upregulated the expression of β-DG, ZO-1, occludin, and claudin-5.
Conclusion: Poldip2 inhibition alleviated brain edema and preserved the integrity of BBB partially by relieving the loss of AQP4 polarity via MMPs/β-DG pathway.
Keywords: AQP4; MMPs; Poldip2; bacterial meningitis; blood-brain barrier; cerebral edema.
A functional observational battery for evaluation of neurological outcomes in a rat model of acute bacterial meningitis
Background: Acute bacterial meningitis is a disease with a high mortality and a high incidence of neurological sequelae in survivors. There is an acute need to develop new adjuvant therapies. To ensure that new therapies evaluated in animal models are translatable to humans, studies must evaluate clinically relevant and patient-important outcomes, including neurological symptoms and sequelae.
Methods: We developed and tested a functional observational battery to quantify the severity of a variety of relevant neurological and clinical symptoms in a rat model of bacterial meningitis. The functional observational battery included symptoms relating to general clinical signs, gait and posture abnormalities, involuntary motor movements, focal neurological signs, and neuromotor abnormalities which were scored according to severity and summed to obtain a combined clinical and neurological score. To test the functional observational battery, adult Sprague-Dawley rats were infected by intracisternal injection of a clinical isolate of Streptococcus pneumoniae. Rats were evaluated for 6 days following the infection.
Results: Pneumococcal meningitis was not lethal in this model; however, it induced severe neurological symptoms. Most common symptoms were hearing loss (75% of infected vs 0% of control rats; p = 0.0003), involuntary motor movements (75% of infected vs 0% of control rats; p = 0.0003), and gait and posture abnormality (67% of infected vs 0% of control rats; p = 0.0013). Infected rats had a higher combined score when determined by the functional observational battery than control rats at all time points (24 h 12.7 ± 4.0 vs 4.0 ± 2.0; 48 h 17.3 ± 7.1 vs 3.4 ± 1.8; 6 days 17.8 ± 7.4 vs 1.7 ± 2.4; p < 0.0001 for all).
Conclusions: The functional observational battery described here detects clinically relevant neurological sequelae of bacterial meningitis and could be a useful tool when testing new therapeutics in rat models of meningitis.
Keywords: Acute bacterial meningitis; Functional observational battery; Neurological symptoms; Pneumococcal meningitis; Rat model; Streptococcus pneumoniae.
Cerebrospinal fluid fistula in a patient with chronic constipation related to an autonomic dysfunction and revealed by bacterial meningitis – A case report
Background: Cerebrospinal fluid (CSF) fistula represents a rare neurosurgical entity that can be defined as a communication between the subarachnoid space and nasal fossa or less commonly the ear cavity. It can be spontaneous without an evident etiology or secondary following a skull base surgery or trauma. The early diagnosis of spontaneous forms remains a challenge as clinical signs (e.g., unilateral rhinorrhea) can be absent or neglected by patients and can result in meningitis.
Case description: Here, we report the case of a 31-year-old man with chronic constipation complicated by chronic intracranial hypertension, and resulting in rhinorrhea with bacterial meningitis. The etiological assessment of chronic constipation retained an autonomic dysfunction with sympathetic hyperactivity (e.g., pure autonomic failure) as an underlying cause. Beta-2 transferrin testing associated with cerebral magnetic resonance imaging and computed tomography scan confirmed the diagnosis and localization of the fistula at the cribriform plate. The patient underwent an endoscopic endonasal approach with a repair of fistula. He presented with recurrent rhinorrhea 17 months later which required a surgical revision along with CSF diversion with a ventriculoperitoneal shunt.
Conclusion: Although rare, autonomic dysfunction can result in chronic constipation in young patients, with intermittent or permanent intracranial hypertension, leading to CSF leaks. The early identification and treatment of the underlying etiology may prevent severe complications and improve the management and outcome of CSF fistula patients.
Keywords: Cerebrospinal fluid rhinorrhea; Constipation; Meningitis; Pure autonomic failure.