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Published on: November 5, 2019
[Predisposing factors of community acquired bacterial meningitis (excluding neonates)]
1Maladies infectieuses et réanimation médicale, hôpital Pontchaillou, CHU de Rennes, 35033 Rennes cedex, France.
Abstract:
Meningeal defects and primitive ENT infections are known to promote pneumococcal meningitis. Other risk factors can be identified in the occurrence of community acquired bacterial meningitis (CABM) and play a key role either in the frequency of this kind of infection, the type of bacteria concerned, the prognosis or the risk of recurrence. Thus, epidural infiltrations are rarely responsible for staphylococcal or streptococcal meningitis. Cochlear implants are also known to increase the risk of pneumococcal meningitis. The occurrence in children of aseptic meningitis or meningitis due to Staphylococcus aureus or Enterobacteriaceae is strongly suggestive of congenital spinal or cerebral anomalies (dermal sinus or spina bifida). MRI must be rapidly performed. In cases of splenectomy or asplenism, pneumococcal meningitis is common and must be prevented. According to the larger series available on this topic, age over 60, diabetes mellitus, alcoholism and immune deficiency are found to promote CABM in about 25% of cases. Streptococcus pneumoniae is the most frequent causative bacteria in elderly patients, in case of alcoholism, as well as Listeria monocytogenes and some Enterobacteriaceae (Escherichia coli, Klebsiella pneumoniae). L. monocytogenes is frequently isolated in immunodepressed patients and patients treated by anti-TNF molecules (infliximab notably). Finally, some genetic polyphormisms promote CABM: complement and properdin deficiencies (meningococcal meningitis), mannose-binding lectin deficiency, Fcgamma receptors alteration or interleukin-1 and IL-1R polymorphisms. Screening for such genetic disorders may be discussed in case of CABM but is mandatory in case of recurrent meningococcal infections.
Insights
Community acquired bacterial meningitis (CABM) risk factors include meningeal defects, ENT infections, and specific patient conditions like age, diabetes, and immune deficiencies. Certain genetic factors also predispose individuals to CABM.
Area of Science:
- Neurology
- Infectious Diseases
- Genetics
Context:
- Meningeal defects and ENT infections are established risk factors for pneumococcal meningitis.
- Community-acquired bacterial meningitis (CABM) is influenced by various factors affecting its incidence, bacterial type, prognosis, and recurrence.
- Specific conditions like cochlear implants, congenital anomalies, and splenectomy increase susceptibility to certain types of meningitis.
Purpose:
- To identify and elucidate the diverse risk factors contributing to community-acquired bacterial meningitis (CABM).
- To highlight the interplay between patient-specific conditions, anatomical abnormalities, and genetic predispositions in the development of meningitis.
- To inform clinical practice regarding diagnosis, prevention, and management strategies for CABM.
Summary:
- Meningeal defects, ENT infections, and cochlear implants are linked to pneumococcal meningitis.
- Congenital anomalies in children may present as aseptic meningitis or meningitis caused by Staphylococcus aureus or Enterobacteriaceae, necessitating prompt MRI.
- Risk factors for CABM in adults over 60 include diabetes, alcoholism, and immune deficiency, with Streptococcus pneumoniae, Listeria monocytogenes, and Enterobacteriaceae being common pathogens.
- Genetic polymorphisms in complement, properdin, mannose-binding lectin, Fcgamma receptors, and interleukin-1 pathways are associated with increased CABM risk, particularly meningococcal meningitis.
Impact:
- Understanding these risk factors aids in targeted prevention strategies, especially for high-risk populations.
- Early identification of congenital anomalies through clinical presentation and imaging can improve patient outcomes.
- Genetic screening may be considered for individuals with recurrent meningitis, guiding personalized medical management.
- This comprehensive overview supports improved diagnostic approaches and therapeutic interventions for bacterial meningitis.
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