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Diederik Van De Beek - One of the best experts on this subject based on the ideXlab platform.
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community acquired Bacterial Meningitis
Nature Reviews Disease Primers, 2016Co-Authors: Diederik Van De Beek, Matthijs C Brouwer, Rodrigo Hasbun, Uwe Koedel, Cynthia G Whitney, Eelco F M WijdicksAbstract:Meningitis is an inflammation of the meninges and subarachnoid space that can also involve the brain cortex and parenchyma. It can be acquired spontaneously in the community - community-acquired Bacterial Meningitis - or in the hospital as a complication of invasive procedures or head trauma (nosocomial Bacterial Meningitis). Despite advances in treatment and vaccinations, community-acquired Bacterial Meningitis remains one of the most important infectious diseases worldwide. Streptococcus pneumoniae and Neisseria meningitidis are the most common causative bacteria and are associated with high mortality and morbidity; vaccines targeting these organisms, which have designs similar to the successful vaccine that targets Haemophilus influenzae type b Meningitis, are now being used in many routine vaccination programmes. Experimental and genetic association studies have increased our knowledge about the pathogenesis of Bacterial Meningitis. Early antibiotic treatment improves the outcome, but the growing emergence of drug resistance as well as shifts in the distribution of serotypes and groups are fuelling further development of new vaccines and treatment strategies. Corticosteroids were found to be beneficial in high-income countries depending on the Bacterial species. Further improvements in the outcome are likely to come from dampening the host inflammatory response and implementing preventive measures, especially the development of new vaccines.
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neurological sequelae of Bacterial Meningitis
Journal of Infection, 2016Co-Authors: Marjolein J Lucas, Matthijs C Brouwer, Diederik Van De BeekAbstract:Summary Objectives We reported on occurrence and impact of neurological sequelae after Bacterial Meningitis. Methods We reviewed occurrence of neurological sequelae in children and adults after pneumococcal and meningococcal Meningitis. Results Most frequently reported sequelae are focal neurological deficits, hearing loss, cognitive impairment and epilepsy. Adults with pneumococcal Meningitis have the highest risk of developing focal neurological deficits, which are most commonly caused by cerebral infarction, but can also be due to cerebritis, subdural empyema, cerebral abscess or intracerebral bleeding. Focal deficits may improve during clinical course and even after discharge, but a proportion of patients will have persisting focal neurological deficits that often interfere in patient's daily life. Hearing loss occurs in a high proportion of patients with pneumococcal Meningitis and has been associated with co-existing otitis. Children and adults recovering from Bacterial Meningitis without apparent neurological deficits are at risk for long-term cognitive deficits. Early identification of neurological sequelae is important for children to prevent additional developmental delay, and for adults to achieve successful return in society after the disease. Conclusions Neurological sequelae occur in a substantial amount of patients following Bacterial Meningitis. Most frequently reported sequelae are focal neurological deficits, hearing loss, cognitive impairment and epilepsy.
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corticosteroids for acute Bacterial Meningitis
Cochrane Database of Systematic Reviews, 2015Co-Authors: Matthijs C Brouwer, Peter Mcintyre, Kameshwar Prasad, Diederik Van De BeekAbstract: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 methods We searched CENTRAL (2015, Issue 1), MEDLINE (1966 to January week 4, 2015), EMBASE (1974 to February 2015), Web of Science (2010 to February 2015), CINAHL (2010 to February 2015) and LILACS (2010 to February 2015). 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 We included 25 studies involving 4121 participants (2511 children and 1517 adults; 93 mixed population). Four studies were of high quality with no risk of bias, 14 of medium quality and seven of low quality, indicating a moderate risk of bias for the total analysis. Nine studies were performed in low-income countries and 16 in high-income countries. Corticosteroids were associated with a non-significant reduction in mortality (17.8% versus 19.9%; risk ratio (RR) 0.90, 95% confidence interval (CI) 0.80 to 1.01, P value = 0.07). A similar non-significant reduction in mortality was observed in adults receiving corticosteroids (RR 0.74, 95% CI 0.53 to 1.05, P value = 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 0.74, 95% CI 0.63 to 0.87) and neurological sequelae (RR 0.83, 95% CI 0.69 to 1.00). Subgroup analyses for causative organisms showed that corticosteroids reduced mortality in Streptococcus pneumoniae (S. pneumoniae) Meningitis (RR 0.84, 95% CI 0.72 to 0.98), but not in Haemophilus influenzae (H. influenzae) orNeisseria meningitidis (N. meningitidis) Meningitis. Corticosteroids reduced severe hearing loss in children with H. influenzae Meningitis (RR 0.34, 95% CI 0.20 to 0.59) but not in children with Meningitis due to non-Haemophilus species. 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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endocarditis in adults with Bacterial Meningitis
Circulation, 2013Co-Authors: Marjolein J Lucas, Matthijs C Brouwer, Arie Van Der Ende, Diederik Van De BeekAbstract:Background—Endocarditis may precede or complicate Bacterial Meningitis, but the incidence and impact of endocarditis in Bacterial Meningitis are unknown. Methods and Results—We assessed the incidence and clinical characteristics of patients with Meningitis and endocarditis from a nationwide cohort study of adults with community-acquired Bacterial Meningitis in the Netherlands from 2006 to 2012. Endocarditis was identified in 24 of 1025 episodes (2%) of Bacterial Meningitis. Cultures yielded Streptococcus pneumoniae in 13 patients, Staphylococcus aureus in 8 patients, and Streptococcus agalactiae, Streptococcus pyogenes, and Streptococcus salivarius in 1 patient each. Clues leading to the diagnosis of endocarditis were cardiac murmurs, persistent or recurrent fever, a history of heart valve disease, and S aureus as the causative pathogen of Bacterial Meningitis. Treatment consisted of prolonged antibiotic therapy in all patients and surgical valve replacement in 10 patients (42%). Two patients were treated...
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dexamethasone and long term survival in Bacterial Meningitis
Neurology, 2012Co-Authors: Daan Fritz, Matthijs C Brouwer, Diederik Van De BeekAbstract:ABSTRACT Background: Data on the long-term effect of dexamethasone on survival in Bacterial Meningitis are lacking. Methods: A long-term follow-up study of the European Dexamethasone in Adulthood Bacterial Meningitis Study was performed. In this double-blind, randomized clinical trial, 301 patients were randomly assigned to receive adjunctive dexamethasone (n = 157) or placebo (n = 144) between June 1993 and December 2001. We obtained survival data of patients using the Dutch Municipal Population Register. Results: Death had occurred in 32 of 301 included patients (11%) at the primary outcome measurement 8 weeks after randomization. Follow-up was obtained for 228 of 246 evaluable patients (93%), with median follow-up of 13 years. Overall, 31 of 144 patients (22%) in the dexamethasone group died and 44 of 134 patients (33%) in the placebo group died (log-rank p = 0.029). After the primary end point of the study at 8 weeks, 20 patients in the dexamethasone group died and 23 patients in the placebo group died (log-rank p = 0.27), with age being the sole predictor of death ( p Conclusions: In adults with community-acquired Bacterial Meningitis, the survival benefit from adjunctive dexamethasone therapy is obtained in the acute phase of the disease and remains for years. Classification of Evidence: This study of a population of Dutch patients shows Class III evidence that dexamethasone provides an extended survival benefit in patients treated for Bacterial Meningitis, and this survival benefit extends as long as 20 years.
Matthijs C Brouwer - One of the best experts on this subject based on the ideXlab platform.
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community acquired Bacterial Meningitis
Nature Reviews Disease Primers, 2016Co-Authors: Diederik Van De Beek, Matthijs C Brouwer, Rodrigo Hasbun, Uwe Koedel, Cynthia G Whitney, Eelco F M WijdicksAbstract:Meningitis is an inflammation of the meninges and subarachnoid space that can also involve the brain cortex and parenchyma. It can be acquired spontaneously in the community - community-acquired Bacterial Meningitis - or in the hospital as a complication of invasive procedures or head trauma (nosocomial Bacterial Meningitis). Despite advances in treatment and vaccinations, community-acquired Bacterial Meningitis remains one of the most important infectious diseases worldwide. Streptococcus pneumoniae and Neisseria meningitidis are the most common causative bacteria and are associated with high mortality and morbidity; vaccines targeting these organisms, which have designs similar to the successful vaccine that targets Haemophilus influenzae type b Meningitis, are now being used in many routine vaccination programmes. Experimental and genetic association studies have increased our knowledge about the pathogenesis of Bacterial Meningitis. Early antibiotic treatment improves the outcome, but the growing emergence of drug resistance as well as shifts in the distribution of serotypes and groups are fuelling further development of new vaccines and treatment strategies. Corticosteroids were found to be beneficial in high-income countries depending on the Bacterial species. Further improvements in the outcome are likely to come from dampening the host inflammatory response and implementing preventive measures, especially the development of new vaccines.
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neurological sequelae of Bacterial Meningitis
Journal of Infection, 2016Co-Authors: Marjolein J Lucas, Matthijs C Brouwer, Diederik Van De BeekAbstract:Summary Objectives We reported on occurrence and impact of neurological sequelae after Bacterial Meningitis. Methods We reviewed occurrence of neurological sequelae in children and adults after pneumococcal and meningococcal Meningitis. Results Most frequently reported sequelae are focal neurological deficits, hearing loss, cognitive impairment and epilepsy. Adults with pneumococcal Meningitis have the highest risk of developing focal neurological deficits, which are most commonly caused by cerebral infarction, but can also be due to cerebritis, subdural empyema, cerebral abscess or intracerebral bleeding. Focal deficits may improve during clinical course and even after discharge, but a proportion of patients will have persisting focal neurological deficits that often interfere in patient's daily life. Hearing loss occurs in a high proportion of patients with pneumococcal Meningitis and has been associated with co-existing otitis. Children and adults recovering from Bacterial Meningitis without apparent neurological deficits are at risk for long-term cognitive deficits. Early identification of neurological sequelae is important for children to prevent additional developmental delay, and for adults to achieve successful return in society after the disease. Conclusions Neurological sequelae occur in a substantial amount of patients following Bacterial Meningitis. Most frequently reported sequelae are focal neurological deficits, hearing loss, cognitive impairment and epilepsy.
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corticosteroids for acute Bacterial Meningitis
Cochrane Database of Systematic Reviews, 2015Co-Authors: Matthijs C Brouwer, Peter Mcintyre, Kameshwar Prasad, Diederik Van De BeekAbstract: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 methods We searched CENTRAL (2015, Issue 1), MEDLINE (1966 to January week 4, 2015), EMBASE (1974 to February 2015), Web of Science (2010 to February 2015), CINAHL (2010 to February 2015) and LILACS (2010 to February 2015). 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 We included 25 studies involving 4121 participants (2511 children and 1517 adults; 93 mixed population). Four studies were of high quality with no risk of bias, 14 of medium quality and seven of low quality, indicating a moderate risk of bias for the total analysis. Nine studies were performed in low-income countries and 16 in high-income countries. Corticosteroids were associated with a non-significant reduction in mortality (17.8% versus 19.9%; risk ratio (RR) 0.90, 95% confidence interval (CI) 0.80 to 1.01, P value = 0.07). A similar non-significant reduction in mortality was observed in adults receiving corticosteroids (RR 0.74, 95% CI 0.53 to 1.05, P value = 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 0.74, 95% CI 0.63 to 0.87) and neurological sequelae (RR 0.83, 95% CI 0.69 to 1.00). Subgroup analyses for causative organisms showed that corticosteroids reduced mortality in Streptococcus pneumoniae (S. pneumoniae) Meningitis (RR 0.84, 95% CI 0.72 to 0.98), but not in Haemophilus influenzae (H. influenzae) orNeisseria meningitidis (N. meningitidis) Meningitis. Corticosteroids reduced severe hearing loss in children with H. influenzae Meningitis (RR 0.34, 95% CI 0.20 to 0.59) but not in children with Meningitis due to non-Haemophilus species. 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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endocarditis in adults with Bacterial Meningitis
Circulation, 2013Co-Authors: Marjolein J Lucas, Matthijs C Brouwer, Arie Van Der Ende, Diederik Van De BeekAbstract:Background—Endocarditis may precede or complicate Bacterial Meningitis, but the incidence and impact of endocarditis in Bacterial Meningitis are unknown. Methods and Results—We assessed the incidence and clinical characteristics of patients with Meningitis and endocarditis from a nationwide cohort study of adults with community-acquired Bacterial Meningitis in the Netherlands from 2006 to 2012. Endocarditis was identified in 24 of 1025 episodes (2%) of Bacterial Meningitis. Cultures yielded Streptococcus pneumoniae in 13 patients, Staphylococcus aureus in 8 patients, and Streptococcus agalactiae, Streptococcus pyogenes, and Streptococcus salivarius in 1 patient each. Clues leading to the diagnosis of endocarditis were cardiac murmurs, persistent or recurrent fever, a history of heart valve disease, and S aureus as the causative pathogen of Bacterial Meningitis. Treatment consisted of prolonged antibiotic therapy in all patients and surgical valve replacement in 10 patients (42%). Two patients were treated...
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dexamethasone and long term survival in Bacterial Meningitis
Neurology, 2012Co-Authors: Daan Fritz, Matthijs C Brouwer, Diederik Van De BeekAbstract:ABSTRACT Background: Data on the long-term effect of dexamethasone on survival in Bacterial Meningitis are lacking. Methods: A long-term follow-up study of the European Dexamethasone in Adulthood Bacterial Meningitis Study was performed. In this double-blind, randomized clinical trial, 301 patients were randomly assigned to receive adjunctive dexamethasone (n = 157) or placebo (n = 144) between June 1993 and December 2001. We obtained survival data of patients using the Dutch Municipal Population Register. Results: Death had occurred in 32 of 301 included patients (11%) at the primary outcome measurement 8 weeks after randomization. Follow-up was obtained for 228 of 246 evaluable patients (93%), with median follow-up of 13 years. Overall, 31 of 144 patients (22%) in the dexamethasone group died and 44 of 134 patients (33%) in the placebo group died (log-rank p = 0.029). After the primary end point of the study at 8 weeks, 20 patients in the dexamethasone group died and 23 patients in the placebo group died (log-rank p = 0.27), with age being the sole predictor of death ( p Conclusions: In adults with community-acquired Bacterial Meningitis, the survival benefit from adjunctive dexamethasone therapy is obtained in the acute phase of the disease and remains for years. Classification of Evidence: This study of a population of Dutch patients shows Class III evidence that dexamethasone provides an extended survival benefit in patients treated for Bacterial Meningitis, and this survival benefit extends as long as 20 years.
Bengt Christensson - One of the best experts on this subject based on the ideXlab platform.
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heparin binding protein a diagnostic marker of acute Bacterial Meningitis
Critical Care Medicine, 2011Co-Authors: Adam Linder, Magnus Brink, Marie Studahl, Per Akesson, Lars Björck, Bengt ChristenssonAbstract:BACKGROUND: The early detection of Bacterial Meningitis is crucial for successful outcome. Heparin-binding protein, a potent inducer of increased vascular permeability, is released from activated neutrophils in severe sepsis.OBJECTIVE: In this study we investigated whether heparin-binding protein levels in cerebrospinal fluid could be used as a diagnostic marker for acute Bacterial Meningitis.DESIGN: One prospective and one retrospective patient cohort from two university hospitals in Sweden were analyzed.SETTING AND PATIENTS: Cerebrospinal fluid samples were collected from 174 patients with suspected central nervous system infection. Thirty-seven patients with acute community-acquired Bacterial Meningitis, four patients with neurosurgical Bacterial Meningitis, 29 patients with viral Meningitis or encephalitis, seven patients with neuroborreliosis, and 97 control patients were included.INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: Cerebrospinal fluid samples were analyzed for the concentrations of heparin-binding protein, lactate, protein, glucose, neutrophils, and mononuclear cells. Heparin-binding protein levels were significantly higher (p < .01) in patients with acute Bacterial Meningitis (median 376 ng/mL, range 12-858 ng/mL) than in patients with viral central nervous system infection (median 4.7 ng/mL, range 3.0-41 ng/mL) or neuroborreliosis (median 3.6 ng/mL, range 3.2-10 ng/mL) or in control patients with a normal cerebrospinal fluid cell count (median 3.5 ng/mL, range 2.4-8.7 ng/mL). In the prospectively studied group, a heparin-binding protein concentration exceeding 20 ng/mL gave a sensitivity of 100%, a specificity of 99.2%, and positive and negative predictive values of 96.2% and 100%, respectively, in diagnosing acute Bacterial Meningitis. The area under the receiver-operating characteristic curve for heparin-binding protein was 0.994, which was higher than for the other investigated parameters.CONCLUSION: Elevated cerebrospinal fluid levels of heparin-binding protein distinguish between patients with acute Bacterial Meningitis and patients with other central nervous system infections. (Less)
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heparin binding protein a diagnostic marker of acute Bacterial Meningitis
Critical Care Medicine, 2011Co-Authors: Adam Linder, Magnus Brink, Marie Studahl, Per Akesson, Lars Björck, Bengt ChristenssonAbstract:BACKGROUND: The early detection of Bacterial Meningitis is crucial for successful outcome. Heparin-binding protein, a potent inducer of increased vascular permeability, is released from activated neutrophils in severe sepsis.OBJECTIVE: In this study we investigated whether heparin-binding protein levels in cerebrospinal fluid could be used as a diagnostic marker for acute Bacterial Meningitis.DESIGN: One prospective and one retrospective patient cohort from two university hospitals in Sweden were analyzed.SETTING AND PATIENTS: Cerebrospinal fluid samples were collected from 174 patients with suspected central nervous system infection. Thirty-seven patients with acute community-acquired Bacterial Meningitis, four patients with neurosurgical Bacterial Meningitis, 29 patients with viral Meningitis or encephalitis, seven patients with neuroborreliosis, and 97 control patients were included.INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: Cerebrospinal fluid samples were analyzed for the concentrations of heparin-binding protein, lactate, protein, glucose, neutrophils, and mononuclear cells. Heparin-binding protein levels were significantly higher (p < .01) in patients with acute Bacterial Meningitis (median 376 ng/mL, range 12-858 ng/mL) than in patients with viral central nervous system infection (median 4.7 ng/mL, range 3.0-41 ng/mL) or neuroborreliosis (median 3.6 ng/mL, range 3.2-10 ng/mL) or in control patients with a normal cerebrospinal fluid cell count (median 3.5 ng/mL, range 2.4-8.7 ng/mL). In the prospectively studied group, a heparin-binding protein concentration exceeding 20 ng/mL gave a sensitivity of 100%, a specificity of 99.2%, and positive and negative predictive values of 96.2% and 100%, respectively, in diagnosing acute Bacterial Meningitis. The area under the receiver-operating characteristic curve for heparin-binding protein was 0.994, which was higher than for the other investigated parameters.CONCLUSION: Elevated cerebrospinal fluid levels of heparin-binding protein distinguish between patients with acute Bacterial Meningitis and patients with other central nervous system infections. (Less)
Allan R Tunkel - One of the best experts on this subject based on the ideXlab platform.
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acute Bacterial Meningitis in adults
The Lancet, 2016Co-Authors: Fiona Mcgill, Allan R Tunkel, Robert S Heyderman, Stavros Panagiotou, Tom SolomonAbstract:Over the past several decades, the incidence of Bacterial Meningitis in children has decreased but there remains a significant burden of disease in adults, with a mortality of up to 30%. Although the pathogenesis of Bacterial Meningitis is not completely understood, knowledge of Bacterial invasion and entry into the CNS is improving. Clinical features alone cannot determine whether Meningitis is present and analysis of cerebrospinal fluid is essential for diagnosis. Newer technologies, such as multiplex PCR, and novel diagnostic platforms that incorporate proteomics and genetic sequencing, might help provide a quicker and more accurate diagnosis. Even with appropriate antimicrobial therapy, mortality is high and so attention has focused on adjunctive therapies; adjunctive corticosteroids are beneficial in certain circumstances. Any further improvements in outcome are likely to come from either modulation of the host response or novel approaches to therapy, rather than new antibiotics. Ultimately, the best hope to reduce the disease burden is with broadly protective vaccines.
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Acute Therapy of Bacterial Meningitis
2016Co-Authors: Allan R Tunkel, Michael V. ScheldAbstract:Antimicrobial therapy for Bacterial Meningitis has mark-edly reduced mortality rates from this disorder. The efficacy of an antibiotic in Meningitis depends on many factors, including its penetration into cerebrospinal fluid (CSF), the bactericidal efficacy of the antibiotic within purulent CSF, and the need for bactericidal activity in CSF because Bacterial Meningitis represents an infection in an area of impaired host defense. Penicillin G and ampicillin are equally efficacious for Meningitis caused by Streptococcus pneirmoniae or Neissena tneningi-Zidis This recommendation may change, however, with the emergence of strains of pneumococci or meningo-cocci that are relatively or highly resistant to penicillin; a third-generation cephalosporin (cefotaxime or ceftri-axone) should be used for Meningitis due to relativel
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dilemmas in the diagnosis of acute community acquired Bacterial Meningitis
The Lancet, 2012Co-Authors: Matthijs C Brouwer, Allan R Tunkel, Guy Thwaites, Diederik Van De BeekAbstract:Summary Rapid diagnosis and treatment of acute community-acquired Bacterial Meningitis reduces mortality and neurological sequelae, but can be delayed by atypical presentation, assessment of lumbar puncture safety, and poor sensitivity of standard diagnostic microbiology. Thus, diagnostic dilemmas are common in patients with suspected acute community-acquired Bacterial Meningitis. History and physical examination alone are sometimes not sufficient to confirm or exclude the diagnosis. Lumbar puncture is an essential investigation, but can be delayed by brain imaging. Results of cerebrospinal fluid (CSF) examination should be interpreted carefully, because CSF abnormalities vary according to the cause, patient's age and immune status, and previous treatment. Diagnostic prediction models that use a combination of clinical findings, with or without test results, can help to distinguish acute Bacterial Meningitis from other causes, but these models are not infallible. We review the dilemmas in the diagnosis of acute community-acquired Bacterial Meningitis, and focus on the roles of clinical assessment and CSF examination.
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Advances in treatment of Bacterial Meningitis
The Lancet, 2012Co-Authors: Diederik Van De Beek, Matthijs C Brouwer, Guy E. Thwaites, Allan R TunkelAbstract:Bacterial Meningitis kills or maims about a fi fth of people with the disease. Early antibiotic treatment improves outcomes, but the eff ectiveness of widely available antibiotics is threatened by global emergence of multidrug-resistant bacteria. New antibiotics, such as fl uoroquinolones, could have a role in these circumstances, but clinical data to support this notion are scarce. Additionally, whether or not adjunctive anti-infl ammatory therapies (eg, dexamethasone) improve outcomes in patients with Bacterial Meningitis remains controversial; in resource-poor regions, where the disease burden is highest, dexamethasone is ineff ective. Other adjunctive therapeutic strategies, such as glycerol, paracetamol, and induction of hypothermia, are being tested further. Therefore, Bacterial Meningitis is a substantial and evolving therapeutic challenge. We review this challenge, with a focus on strategies to optimise antibiotic effi cacy in view of increasingly drug-resistant bacteria, and discuss the role of current and future adjunctive therapies.
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nosocomial Bacterial Meningitis
The New England Journal of Medicine, 2010Co-Authors: Diederik Van De Beek, James M Drake, Allan R TunkelAbstract:Nosocomial Bacterial Meningitis is most often related to either complicated head trauma or invasive procedures, such as craniotomy, placement of ventricular catheters, intrathecal infusion of medications, or spinal anesthesia. In addition, metastatic infection from hospital-acquired bacteremia occasionally leads to Meningitis. The conditions are associated with different pathogenetic mechanisms and a different spectrum of microorganisms, and therefore the choice of empirical antimicrobial therapy will vary according to the condition.
Jan De Gans - One of the best experts on this subject based on the ideXlab platform.
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seizures in adults with Bacterial Meningitis
Neurology, 2008Co-Authors: E Zoons, Martijn Weisfelt, Jan De Gans, Lodewijk Spanjaard, J H T M Koelman, Johannes B Reitsma, D Van De BeekAbstract:Objective: To evaluate the occurrence and prognostic relevance of seizures in adults with community-acquired Bacterial Meningitis. Methods: An observational cross-sectional study, in which patients with seizures are selected from a prospective nationwide cohort of 696 episodes of community-acquired Bacterial Meningitis, confirmed by culture of CSF in patients aged >16 years. We retrospectively collected data on EEGs. Results: Seizures occurred in 121 of 696 episodes (17%). Death occurred in 41% of patients with seizures compared to 16% of patients without seizures ( p 3 (36% vs 25%; p = 0.01), had higher median CSF protein levels (4.8 g/L [IQR 3.4 to 7.6] vs 4.1 g/L [IQR 2.1 to 6.8]), and higher median erythrocyte sedimentation rate (46 mm/hour [IQR 31 to 72] vs 36 mm/hour [IQR 18 to 69]; p = 0.02) than patients without in-hospital seizures. Focal cerebral abnormalities developed more often in patients with in-hospital seizures than in those without (41% vs 14%; p Streptococcus pneumoniae , and focal cerebral abnormalities. Neuroimaging was performed on admission in 70% of episodes with prehospital seizures, with CT revealing a focal lesion in 32% of those episodes. Antiepileptic drugs were administered in 82% of patients with seizures and EEG was performed in 31% of episodes; a status epilepticus was recorded in five patients. Conclusions: Seizures occur frequently in adults with community-acquired Bacterial Meningitis. Seizures are associated with severe CNS and systemic inflammation, structural CNS lesions, pneumococcal Meningitis, and predisposing conditions. The high associated mortality rate warrants a low threshold for starting anticonvulsant therapy in those with clinical suspicion of a seizure.
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cognitive outcome in adults after Bacterial Meningitis
Journal of Neurology Neurosurgery and Psychiatry, 2007Co-Authors: Martine Hoogman, Diederik Van De Beek, Martijn Weisfelt, Jan De Gans, Ben SchmandAbstract:Objective: To evaluate cognitive outcome in adult survivors of Bacterial Meningitis. Methods: Data from three prospective multicentre studies were pooled and reanalysed, involving 155 adults surviving Bacterial Meningitis (79 after pneumococcal and 76 after meningococcal Meningitis) and 72 healthy controls. Results: Cognitive impairment was found in 32% of patients and this proportion was similar for survivors of pneumococcal and meningococcal Meningitis. Survivors of pneumococcal Meningitis performed worse on memory tasks (p Conclusions: Adult survivors of Bacterial Meningitis are at risk of cognitive impairment, which consists mainly of cognitive slowness. The loss of cognitive speed is stable over time after Bacterial Meningitis; however, there is a significant improvement in subjective physical impairment in the years after Bacterial Meningitis. The use of dexamethasone was not associated with cognitive impairment.
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community acquired Bacterial Meningitis in adults
The New England Journal of Medicine, 2006Co-Authors: Diederik Van De Beek, Allan R Tunkel, Jan De Gans, Eelco F M WijdicksAbstract:This review summarizes recent changes in the treatment of adults with community-acquired Bacterial Meningitis. It explains the initial assessment and management, the use of adjunctive corticosteroids, and intensive care monitoring. The authors detail the approach to complications such as transtentorial herniation, hydrocephalus, and focal seizures.
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clinical features and prognostic factors in adults with Bacterial Meningitis
The New England Journal of Medicine, 2004Co-Authors: Diederik Van De Beek, Martijn Weisfelt, Jan De Gans, Lodewijk Spanjaard, Johannes B Reitsma, M VermeulenAbstract:Background We conducted a nationwide study in the Netherlands to determine clinical features and prognostic factors in adults with community-acquired acute Bacterial Meningitis. Methods From October 1998 to April 2002, all Dutch patients with community-acquired acute Bacterial Meningitis, confirmed by cerebrospinal fluid cultures, were prospectively evaluated. All patients underwent a neurologic examination on admission and at discharge, and outcomes were classified as unfavorable (defined by a Glasgow Outcome Scale score of 1 to 4 points at discharge) or favorable (a score of 5). Predictors of an unfavorable outcome were identified through logistic-regression analysis. Results We evaluated 696 episodes of community-acquired acute Bacterial Meningitis. The most common pathogens were Streptococcus pneumoniae (51 percent of episodes) and Neisseria meningitidis (37 percent). The classic triad of fever, neck stiffness, and a change in mental status was present in only 44 percent of episodes; however, 95 percent had at least two of the four symptoms of headache, fever, neck stiffness, and altered mental status. On admission, 14 percent of patients were comatose and 33 percent had focal neurologic abnormalities. The overall mortality rate was 21 percent. The mortality rate was higher among patients with pneumococcal Meningitis than among those with meningococcal Meningitis (30 percent vs. 7 percent, P Conclusions In adults presenting with community-acquired acute Bacterial Meningitis, the sensitivity of the classic triad of fever, neck stiffness, and altered mental status is low, but almost all present with at least two of the four symptoms of headache, fever, neck stiffness, and altered mental status. The mortality associated with Bacterial Meningitis remains high, and the strongest risk factors for an unfavorable outcome are those that are indicative of systemic compromise, a low level of consciousness, and infection with S. pneumoniae.
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steroids in adults with acute Bacterial Meningitis a systematic review
Lancet Infectious Diseases, 2004Co-Authors: Diederik Van De Beek, Jan De Gans, Peter Mcintyre, Kameshwar PrasadAbstract:Summary Bacterial Meningitis is uncommon but causes significant mortality and morbidity, despite optimum antibiotic therapy. A clinical trial in 301 patients showed a beneficial effect of adjunctive steroid treatment in adults with acute community-acquired pneumococcal Meningitis, but data on other organisms or adverse events are sparse. This led us to do a quantitative systematic review of adjunctive steroid therapy in adults with acute Bacterial Meningitis. Five trials involving 623 patients were included (pneumococcal Meningitis=234, meningococcal Meningitis=232, others=127, unknown=30). Overall, treatment with steroids was associated with a significant reduction in mortality (relative risk 0·6, 95% Cl 0·4–0·8, p=0·002) and in neurological sequelae (0·6, 0·4–1, p=0·05), and with a reduction of case-fatality in pneumococcal Meningitis of 21% (0·5, 0·3–0·8, p=0·001). In meningococcal Meningitis, mortality (0·9, 0·3–2·1) and neurological sequelae (0·5, 0·1–1·7) were both reduced, but not significantly. Adverse events, recorded in 391 cases, were equally divided between the treatment and placebo groups (1, 0·5–2), with gastrointestinal bleeding in 1% of steroid-treated and 4% of other patients. Since treatment with steroids reduces both mortality and neurological sequelae in adults with Bacterial Meningitis, without detectable adverse effects, routine steroid therapy with the first dose of antibiotics is justified in most adult patients in whom acute community-acquired Bacterial Meningitis is suspected.