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Gram-negative bacillary meningitis in Egypt.

Osama Mohamed Hammad1, Tamer Mohamed Said Hifnawy, Dalia Abdel Hamid Omran

  • 1aDepartments of Tropical Medicine bPublic Health, Faculty of Medicine, Beni Suef University, Beni Suef, Egypt cDepartment of Tropical Medicine, Faculty of Medicine, Al Azhar University, Damieta dDepartment of Tropical Medicine, Faculty of Medicine, Cairo University eDepartment of Microbiology, Imbaba Fever Hospital, Egypt.

The Journal of the Egyptian Public Health Association
|April 30, 2011
PubMed
Summary

Gram-negative bacillary meningitis (GNBM) has a high mortality rate. Early suspicion and treatment with ceftriaxone are crucial, as it remains an effective option with low resistance.

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Area of Science:

  • Infectious Diseases
  • Neurology
  • Bacteriology

Background:

  • Gram-negative bacillary meningitis (GNBM) is a rare but severe condition with significant mortality.
  • Understanding the clinical differences between primary and secondary GNBM is essential for effective management.

Purpose of the Study:

  • To delineate the clinical presentation and outcomes of primary versus secondary GNBM.
  • To assess the efficacy of ceftriaxone in treating GNBM.

Main Methods:

  • A retrospective analysis of 95 GNBM patients in Egypt (1993-2009).
  • Bacteriological examination of cerebrospinal fluid to identify causative Gram-negative bacilli.
  • Classification of cases into primary (no predisposing cause) and secondary (with predisposing cause) GNBM.

Main Results:

  • Primary GNBM presented abruptly with meningeal signs; Salmonella typhi and Escherichia coli were common pathogens. Secondary GNBM had an insidious onset, often with coma, linked to Proteus mirabilis and Pseudomonas aeruginosa, with otitis media as a frequent predisposing factor.
  • Primary GNBM showed higher cure rates (53%) compared to secondary GNBM (33%), though both had significant mortality and neurological sequelae.
  • Ceftriaxone demonstrated a low overall resistance rate of 4%.

Conclusions:

  • GNBM necessitates emergency management due to its high mortality.
  • Clinical suspicion should be heightened in patients with otitis media, neurosurgical conditions, head trauma, or post-spinal anesthesia presenting with altered consciousness, even without meningeal signs.
  • Ceftriaxone remains an effective treatment for GNBM, exhibiting low resistance in this study population.