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Childhood bacterial meningitis in Mbarara Hospital, Uganda: antimicrobial susceptibility and outcome of treatment
Julius P Kiwanuka, Juliet Mwanga
African Health Sciences , 2001,
Abstract: Background : The recommended antibiotic treatment of bacterial meningitis has come under scrutiny following frequent reports of in-vitro resistance by the common causative organisms to penicillin and chloramphenicol. Objective : The study recorded the causative organisms, antibiotic sensitivity patterns and outcome of treatment of bacterial meningitis in children and examined the impact of various factors on the recorded outcome. Design : This was a retrospective review of all case records of patients treated for bacterial meningitis over a one-year period. Setting : The study was set in the paediatric wards of Mbarara University Teaching Hospital, in south western Uganda. Results : A total of 77 patients were treated. Among 56 patients with available CSF results the frequency of bacterial causes was as follows: H. influenzae 13(23.2%), coliforms 7(12.5%), uncultured Gram-negative bacilli 7(12.5%), S. pneumoniae 5(8.9%) and N. meningitidis 3(5.4%). Most isolates tested were resistant to both penicillin and chloramphenicol, but all were sensitive to ciprofloxacin and perfloxacin. Twenty eight(36.8%) patients died, 22(28.9%) survived with sequelae and 15(19.7%) improved without sequelae. 14/18 who received perfloxacin and/or ciprofloxacin survived compared with 23/47 who did not: p=0.04). Conclusions : The high case-fatality rates and the high frequency of resistance to penicillin and chloramphenicol make a case for a review of the currently recommended antibiotic treatment of bacterial meningitis in this region. Fluoroquinolones need further evaluation as potential alternatives to chloramphenicol in the treatment of bacterial meningitis. African Health Sciences 2001: 1(1): 9-11.
Causes and outcome of bacterial meningitis in Malawian children
EM Molyneux, AL Walsh, H Forsyth, M Tembo, J Mwenechanya, K Kayira, L Bwanaisa, A Njobvu, G Malenga
Malawi Medical Journal , 2003,
Abstract: 598 children with bacterial meningitis were admitted to the paediatric wards of the Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi from July 1997 – March 2001. Patients were followed up at 1 and 6 months after hospital discharge when physical, neurological, developmental and hearing assessments were made. The most common causes of pyogenic meningitis were Streptococcus pneumoniae (40%), Haemophilus influenzae type b (28%), Neisseria meningitidis (11%), Salmonella species (5%). There was no growth on culture in 13% of cases. The overall mortality was 31% and 38% were left with significant sequelae. Indicators for a poor prognosis were younger age, lower coma score on admission, bacterial cause, nutritional status and HIV positivity. [Malawi Med J, Vol.15(2) 2003: 43-46]
Clinical outcome of neonatal bacterial meningitis according to birth weight
Krebs, Vera Lúcia Jornada;Costa, Gleise Aparecida Moraes;
Arquivos de Neuro-Psiquiatria , 2007, DOI: 10.1590/S0004-282X2007000700011
Abstract: objective: to describe the clinical outcome and the complications of bacterial meningitis according to birth weight of out born neonates admitted in intensive care unit during an 11 year-period. method: eighty-seven newborns were studied. thirty-four infants were low birth weight newborn and 53 presented birth weight > " 2500 g. the clinical data were obtained through the analysis of patients? files. fisher?s exact test, the c2 and the mann-whitney test were applied. results: neurological symptoms were more common in infants weighed > " 2500 g (p<0.05). complications affected half of the cases in both groups. complications affected half of the cases in both groups, with an overall mortality rate of 11.5%. conclusion: the rate of complications was high in both groups, regardless of the birth weight. no association was observed between the occurrence of death and birth weight. infants with positive csf culture had a poorer prognosis.
Presentation and outcome of eclampsia at a Nigerian University Hospital
AO Olatunji, AO Sule-Odu
Nigerian Journal of Clinical Practice , 2007,
Abstract: Objective: To review the presentation of eclampsia and its outcome on the mother and babies in our environment with a view to suggesting strategies for improvement. Methods: A retrospective study at 93 cases of eclampsia treated at Olabisi Onabanjo University Teaching Hospital Sagamu was undertaken. Data was collected by scrutinizing the case files collected from the medical records library after collecting their numbers from the labour ward register. Results: There were 93 cases of eclampsia out of a total delivery of 5423 giving an incidence of 1.7 percent. Almost all the patients (96.8%) were unbooked. Antepartum eclampsia constituted 93.5 percent of cases. Nulliparous teenagers were the most commonly affected with a relative risk of 25 when compared with multips. Caesarean delivery was more common than vaginal delivery in the ratio 6:4. There were 19 maternal deaths, a case fatality rate of 20.0 percent and this was not related to the mode of delivery. (RR 1- 1.1).The perinatal mortality was significantly less with caesarean delivery (RR 1:0.38). Conclusion: Eclampsia, occurring mainly in unbooked patients is still one of the major causes of maternal mortality and good antenatal care will significantly reduce the incidence and improve the outcome especially in teenage nullipara who are mostly susceptible .
Presentation and Outcome of Tuberculous Meningitis in a High HIV Prevalence Setting  [PDF]
Suzaan Marais,Dominique J. Pepper,Charlotte Schutz,Robert J. Wilkinson,Graeme Meintjes
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0020077
Abstract: Mycobacterium tuberculosis is a common, devastating cause of meningitis in HIV-infected persons. Due to international rollout programs, access to antiretroviral therapy (ART) is increasing globally. Starting patients with HIV-associated tuberculous meningitis (TBM) on ART during tuberculosis (TB) treatment may increase survival in these patients. We undertook this study to describe causes of meningitis at a secondary-level hospital in a high HIV/TB co-infection setting and to determine predictors of mortality in patients with TBM.
Validation of a Dutch Risk Score Predicting Poor Outcome in Adults with Bacterial Meningitis in Vietnam and Malawi  [PDF]
Ewout S. Schut, Matthijs C. Brouwer, Matthew Scarborough, Nguyen Thi Hoang Mai, Guy E. Thwaites, Jeremy J. Farrar, Johannes B. Reitsma, Diederik van de Beek
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0034311
Abstract: We have previously developed and validated a prognostic model to predict the risk for unfavorable outcome in Dutch adults with bacterial meningitis. The aim of the current study was to validate this model in adults with bacterial meningitis from two developing countries, Vietnam and Malawi. Demographic and clinical characteristics of Vietnamese (n = 426), Malawian patients (n = 465) differed substantially from those of Dutch patients (n = 696). The Dutch model underestimated the risk of poor outcome in both Malawi and Vietnam. The discrimination of the original model (c-statistic [c] 0.84; 95% confidence interval 0.81 to 0.86) fell considerably when re-estimated in the Vietnam cohort (c = 0.70) or in the Malawian cohort (c = 0.68). Our validation study shows that new prognostic models have to be developed for these countries in a sufficiently large series of unselected patients.
Intracerebral Hemorrhages in Adults with Community Associated Bacterial Meningitis in Adults: Should We Reconsider Anticoagulant Therapy?  [PDF]
Barry B. Mook-Kanamori, Daan Fritz, Matthijs C. Brouwer, Arie van der Ende, Diederik van de Beek
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0045271
Abstract: Objective To study the incidence, clinical presentation and outcome of intracranial hemorrhagic complications in adult patients with community associated bacterial meningitis. Methods Nationwide prospective cohort study from all hospitals in the Netherlands, from 1 March 2006, through 31 December 2010. Results Of the 860 episodes of bacterial meningitis that were included, 24 were diagnosed with intracranial hemorrhagic complications: 8 upon presentation and 16 during clinical course. Clinical presentation between patients with or without intracranial hemorrhage was similar. Causative bacteria were Streptococcus pneumoniae in 16 patients (67%), Staphylococcus aureus in 5 (21%), Pseudomonas aeruginosa and Listeria monocytogenes both in 1 patient (4%). Occurrence of intracranial hemorrhage was associated with death (63% vs. 15%, P<0.001) and unfavorable outcome (94% vs. 34%, P<0.001). The use of anticoagulants on admission was associated with a higher incidence of intracranial hemorrhages (odds ratio 5.84, 95% confidence interval 2.17–15.76). Conclusion Intracranial hemorrhage is a rare but devastating complication in patients with community-associated bacterial meningitis. Since anticoagulant therapy use is associated with increased risk for intracranial hemorrhage, physicians may consider reversing or temporarily discontinuing anticoagulation in patients with bacterial meningitis.
Neonatal Bacterial Meningitis And Dexamethasone Adjunctive Usage In Nigeria
KI Airede, O Adeyemi, T Ibrahim
Nigerian Journal of Clinical Practice , 2008,
Abstract: Objective: Neonatal bacterial meningitis is devastating, with attendant high mortality and neurological sequelae. We, therefore, aimed to delineate its current incidence, etiologic, clinical, laboratory spectra, and the effect of steroid therapy on the outcome. Methodology: Babies admitted from1992 to 1995 in the Special Care Baby Unit of the University of Maiduguri Teaching Hospital, Maduguri, Nigeria, with bacterial meningitis were studied prospectively. Neonatal bacterial meningitis was confirmed if the cerebrospinal fluid (CSF) microbiological, chemical, immunological and clinical criteria were satisfied. Detailed neurological follow-up was made. Result: Sixty-nine cases of neonatal bacterial meningitis were encountered, (25 were early-onset, and 44 late-onset); the incidence was 6.5/1000 live births. 22 Positive CSF cultures were grown in early-onset meningitis, and 28 in late-onset disease. Low birth weight showed higher risk of bacterial meningitis and it was significantly more likely in the preterm. X2=24.19, p = 0.000001). Gram-negative pathogens were more isolated (28/50, 56%); Escherichia coli (11) being the commonest, while of the Gram-positive pathogens Staphylococcus aureus was most predominant overall (13/50). Concomitant blood culture was positive in 39/50 (78%), inclusive of all 22 “definite” early-onset disease. The CSF WBC was minimally raised (25-30 x 106/L) in 11 (22%) of “definite” neonatal bacterial meningitis. Detection of unusual pathogens was noteworthy: N. meningitidis (2) and H.influenzae (2), contributing 0.6 and 2.2 per 1000 live births and admissions, respectively. Overall mortality was 24.6%. Of the forty survivors, 9(22.5%) had neurological sequelae: sensorineural hearing deficit (3), hydrocephalus (2), subdural effusion (2), hemiparesis (1), afebrile (recurrent) seizure (1), and there was reduced developmental quotients at 24 months follow-up in 33. Dexamethasone therapy decreased mortality significantly; p = 0.0004. Conclusion: The new information highlighted by this research includes the lack of Group B Streptococcus isolation, the finding of S. pneumoniae, N.meningitidis, H.influenzae and S. aureus as significant pathogens, usefulness of blood cultures in the detection of neonatal bacterial meningitis, increasing resistance of Gram-positive neonatal pathogens to cloxacillin, low CSF WBC, and the finding that the adjunctive use of dexamethasone significantly decreases case fatality and neurological sequelae. Nigerian Journal of Clinical Practice Vol. 11 (3) 2008: pp. 235-243
Arterial cerebrovascular complications in 94 adults with acute bacterial meningitis
Matthias Klein, Uwe Koedel, Thomas Pfefferkorn, Grete Zeller, Bianca Woehrl, Hans-Walter Pfister
Critical Care , 2011, DOI: 10.1186/cc10565
Abstract: We retrospectively studied patients with acute bacterial meningitis who were treated in our university hospital from 2000 to 2009. Data were analyzed with the main focus on the incidence of an increase of CBFv on TCD, defined as peak systolic values above 150 cm/s, and the development of stroke.In total, 114 patients with acute bacterial meningitis were treated, 94 of them received routine TCD studies during their hospital stay. 41/94 patients had elevated CBFv values. This increase was associated with an increased risk of stroke (odds ratio (95% confidence intervall) = 9.15 (1.96-42.67); p < 0.001) and unfavorable outcome (Glasgow Outcome Score < 4; odds ratio (95% confidence intervall) = 2.93 (1.23-6.98); p = 0.018). 11/32 (34.4%) patients with an increase of CBFv who received nimodipine and 2/9 (22.2%) patients with an increase of CBFv who did not receive nimodipine developed stroke (p = 0.69).In summary, TCD was found to be a valuable bedside test to detect arterial alterations in patients with bacterial meningitis. These patients have an increased risk of stroke.The development of cerebrovascular alterations is an important intracranial complication in acute bacterial meningitis and is associated with poor outcome [1]. Arterial cerebrovascular complications are reported to occur in approximately one-fifth of patients [2]. Using digital subtraction angiography (DSA), arterial narrowing is the predominant finding in patients with arterial complications, involving all vessel sizes [1]. The underlying reason for narrowing of the cerebral arteries during bacterial meningitis is still a matter of debate. Autopsy and animal model studies indicate severe inflammation of the vessel walls (vasculitis) as a key etiology [3,4]. Furthermore, patients in whom histopathological correlates in terms of inflammation were not found at the sites of arterial narrowing have been reported [5,6]. This suggests vasospasm as a second important etiology. Also, ischemic stroke can occur a
Aetiology, Clinical Presentation, and Outcome of Meningitis in Patients Coinfected with Human Immunodeficiency Virus and Tuberculosis  [PDF]
Smita Bhagwan,Kogieleum Naidoo
AIDS Research and Treatment , 2011, DOI: 10.1155/2011/180352
Abstract: We conducted a retrospective review of confirmed HIV-TB coinfected patients previously enrolled as part of the SAPiT study in Durban, South Africa. Patients with suspected meningitis were included in this case series. From 642 individuals, 14 episodes of meningitis in 10 patients were identified. For 8 patients, this episode of meningitis was the AIDS defining illness, with cryptococcus (9/14 episodes) and tuberculosis (3/14 episodes) as the commonest aetiological agents. The combination of headache and neck stiffness (78.6%) was the most frequent clinical presentation. Relapsing cryptococcal meningitis occurred in 3/7 patients. Mortality was 70% (7/10), with 4 deaths directly due to meningitis. In an HIV TB endemic region we identified cryptococcus followed by tuberculosis as the leading causes of meningitis. We highlight the occurrence of tuberculous meningitis in patients already receiving antituberculous therapy. The development of meningitis heralded poor outcomes, high mortality, and relapsing meningitis despite ART. 1. Introduction Tuberculosis (TB) is the most common opportunistic infection in patients with Human Immunodeficiency Virus (HIV). The estimated relative risk of HIV-infected individuals developing TB is 20.6 compared to HIV uninfected, in populations with a generalized HIV epidemic [1]. HIV contributes significantly to the overall incidence, prevalence and poorer outcomes of meningitis. There is a predominance of chronic opportunistic meningitides in HIV-infected individuals with a higher risk of mortality and impaired cognition [2–6]. It is assumed that positive TB status would account for a greater proportion of tuberculous meningitis among HIV-TB coinfected patients as opposed to cryptococcal meningitis. However, in patients with advanced HIV infection, cryptococcus is the most common aetiology [2]. With increasing numbers of HIV-TB coinfected patients presenting to health facilities and high mortality related to meningitis, we aim to describe the aetiology, clinical presentation, and outcomes of meningitis in HIV-TB coinfected individuals. 2. Methods We retrospectively reviewed HIV-TB coinfected patients with suspected meningitis. Patients 18 years and older, with confirmed pulmonary TB and HIV, enrolled into the SAPiT study, presenting with suspected meningitis were included in this study. The SAPiT study was a prospective randomized control trial conducted in Durban, South Africa (June 2005–July 2008), investigating the optimal timing of antiretroviral therapy (ART) initiation in patients on antituberculous therapy. All patients
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