Bacterial Meningitis in Adults After Splenectomy and Hyposplenic States
Department of Neurology, Academic Medical Center, Center of Infection and Immunity Amsterdam, the Netherlands. Mayo Clinic Proceedings
(Impact Factor: 6.26).
04/2013; 88(6). DOI: 10.1016/j.mayocp.2013.02.009
To examine the occurrence, disease course, prognosis, and vaccination status of patients with community-acquired bacterial meningitis with a history of splenectomy or functional hyposplenia.
Patients and methods:
Patients with bacterial meningitis proven by cerebrospinal fluid culture were prospectively included in a nationwide cohort study between March 1, 2006, and September 1, 2011. Splenectomy or diseases associated with functional hyposplenia were scored for all patients. Vaccination status, clinical features, and outcome of patients with a history of splenectomy or functional hyposplenia were analyzed and compared with patients with normal spleen function.
Twenty-four of 965 patients (2.5%) had an abnormal splenic function: 16 had a history of splenectomy and 8 had functional hyposplenia. All patients had pneumococcal meningitis. Pre-illness vaccination status could be retrieved for 19 of 21 patients (90%), and only 6 patients (32%) were adequately vaccinated against pneumococci. Pneumococcal serotype was known in 21 patients; 52% of pneumococcal isolates had a serotype included in the 23-valent vaccine. Vaccine failure occurred in 3 patients. Splenectomized patients more often presented with signs of septic shock compared with patients with a normal spleen (63% vs 24%; P=.02). Outcome was unfavorable in 14 patients (58%), and 6 patients died (25%).
Splenectomy or functional hyposplenia is an uncommon risk factor for bacterial meningitis but results in a high rate of mortality and unfavorable outcome. Most patients were not adequately vaccinated against Streptococcus pneumoniae.
Available from: Alejandro Rodriguez
Available from: Nathan C Bahr
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ABSTRACT: Infectious meningitis may be due to bacterial, mycobacterial, fungal or viral agents. Diagnosis of meningitis must take into account numerous items of patient history and symptomatology along with regional epidemiology and basic cerebrospinal fluid testing (protein, etc.) to allow the clinician to stratify the likelihood of etiology possibilities and rationally select additional diagnostic tests. Culture is the mainstay for diagnosis in many cases, but technology is evolving to provide more rapid, reliable diagnosis. The cryptococcal antigen lateral flow assay (Immuno-Mycologics) has revolutionized diagnosis of cryptococcosis and automated nucleic acid amplification assays hold promise for improving diagnosis of bacterial and mycobacterial meningitis. This review will focus on a holistic approach to diagnosis of meningitis as well as recent technological advances.
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ABSTRACT: Acute infectious diseases of the nervous system are potentially life threatening, inherently carrying a high long-term morbidity and mortality. Therefore, the earliest possible diagnosis is absolutely essential. Examination of cerebrospinal fl uid frequently leads the way towards correct diagnosis and allows for focused antimicrobial and adjunctive therapy. This chapter deals with acute infectious diseases of the nervous system, diagnostic procedures being indispensable. Encephalitis, meningitis, poliomyelitis and polyradiculoneuritis are the most important clinical/neurological entities in case of viral infection. It is the acute bacterial meningitis for which the earliest possible diagnosis carries the most important prognostic implication. For this disease, the appropriate examination of the cerebrospinal fl uid (including glucose, cell count, lactate) is of utmost importance. Besides antimicrobial chemotherapy, the best possible adjunctive therapies are essential for acute bacterial meningitis. Fungal, protozoal and helminthic infections of the central nervous system are detailed with respect to diagnostic aspects and therapeutic implications (e.g. eosinophilic meningitis, radiculitis, etc.); for some of these diseases, e.g. cerebral malaria, a normal CSF leads the way to correct diagnosis in a patient with severe impairment of consciousness, high fever and history of exposure to Plasmodium falciparum, thereby easily mistaken for viral encephalitis or acute bacterial meningitis.
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