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Bacterial Meningitis I: Introduction

Bacterial meningitis is a severe, life-threatening inflammation of the meninges, particularly the pia mater and arachnoid mater, affecting the subarachnoid space, ventricles, and cerebrospinal fluid (CSF). If untreated, it can lead to significant neurological complications or death.Causative AgentsCommon pathogens vary with age and immune status. In adults, major organisms include Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae. Streptococcus agalactiae (group B...
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Diagnosis and Surgical Treatment of Human Brucellar Spondylodiscitis
06:23

Diagnosis and Surgical Treatment of Human Brucellar Spondylodiscitis

Published on: May 23, 2021

Tuberculous meningitis together with systemic brucellosis.

Abdullah Ozkok1, Omer Celal Elcioglu, Timur Selcuk Akpinar

  • 1Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Fatih, 34390 Istanbul, Turkey. abdullahozkok@yahoo.com

Journal of Infection and Chemotherapy : Official Journal of the Japan Society of Chemotherapy
|October 29, 2011
PubMed
Summary

This case highlights a simultaneous meningitis infection caused by tuberculosis and brucellosis. Early diagnosis and combined treatment are crucial for managing complex central nervous system infections in endemic areas.

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Area of Science:

  • Infectious Diseases
  • Neurology
  • Microbiology

Background:

  • Subacute or chronic meningitis presents a diagnostic challenge, particularly in regions endemic for diseases like brucellosis.
  • Distinguishing between various infectious etiologies is critical for effective patient management.

Observation:

  • A 57-year-old woman presented with meningitis, showing cerebrospinal fluid (CSF) pleocytosis and low glucose.
  • Initial tests suggested brucellosis (positive serum Rose Bengal and Wright tests), but CSF analysis was inconclusive for this specific pathogen.
  • Empirical antituberculosis treatment was initiated due to clinical suspicion.

Findings:

  • The patient was treated empirically for both tuberculosis and brucellosis, with doxycycline and ceftriaxone added to antituberculosis therapy.
  • Cerebrospinal fluid (CSF) culture ultimately confirmed the presence of Mycobacterium tuberculosis, validating the dual-treatment approach.
  • Serum brucellosis tests were positive, but CSF tests were negative, complicating the initial diagnosis.

Implications:

  • This case underscores the importance of considering co-infections in meningitis, especially in endemic areas.
  • Clinicians must maintain a high index of suspicion for etiologies like tuberculosis when brucellosis is suspected.
  • Comprehensive diagnostic workup and empirical treatment strategies are vital for managing complex central nervous system infections.