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Recurrent pyogenic meningitis--a retrospective study
Abstract:
Records of 17 patients who had two or more attacks of pyogenic meningitis were collected from eight centres in the United Kingdom for retrospective analysis. Thirteen patients had intracranial abnormality; of seven with head injury five produced cerebrospinal fluid rhinorrhoea. The first of the 28 attacks seen in these occurred between a few weeks and 12 years of the head injury. Pneumococci were identified in 25 episodes in cerebrospinal fluid. Of six patients without a history of head injury, one had 'spontaneous cerebrospinal fluid rhinorrhoea' and five had pathological changes of the ear. Various organisms were found in the cerebrospinal fluid during the 12 attacks in these five. Four of the 17 patients had primary complement deficiency (C7, C5, C4 and C3b inhibitor); 10 (possibly 11) of 16 attacks in these cases were due to Neisseria meningitidis. Routine radiological investigations including computerized tomography did not always identify the abnormality; radioactive cisternography can help to establish cerebrospinal fluid leak. All 58 episodes of pyogenic meningitis in these 17 patients with different underlying disease responded to conventional treatment with antibiotics without mortality and without undue morbidity. Surgical procedures in intracranial disease had variable success. Correction of complement deficiency is not practical at present. In some patients prophylaxis with antimicrobial drugs is the only method of preventing future attacks.
Insights
Recurrent pyogenic meningitis in 17 patients was linked to intracranial abnormalities or complement deficiencies. Prompt antibiotic treatment proved effective, but prophylaxis is key for prevention in some cases.
Area of Science:
- Neurology
- Infectious Diseases
- Immunology
Background:
- Recurrent pyogenic meningitis poses significant clinical challenges.
- Identifying underlying causes is crucial for effective management and prevention.
- Previous studies have highlighted various risk factors, including trauma and anatomical defects.
Purpose of the Study:
- To analyze the causes, clinical features, and outcomes of recurrent pyogenic meningitis.
- To evaluate the effectiveness of conventional antibiotic treatment and explore preventive strategies.
- To investigate the role of intracranial abnormalities and complement deficiencies in recurrent meningitis.
Main Methods:
- Retrospective analysis of 17 patients with two or more episodes of pyogenic meningitis from eight UK centers.
- Review of medical records, including history of head injury, cerebrospinal fluid analysis, and radiological investigations.
- Assessment of underlying pathologies such as intracranial abnormalities, cerebrospinal fluid leaks, and primary complement deficiencies.
Main Results:
- Thirteen patients had intracranial abnormalities, with seven experiencing head injuries and five with cerebrospinal fluid rhinorrhoea.
- Pneumococci were the most common pathogen (25 episodes), followed by Neisseria meningitidis in patients with complement deficiencies (10-11 episodes).
- All 58 meningitis episodes responded to antibiotics without mortality, though surgical interventions had variable success.
Conclusions:
- Recurrent pyogenic meningitis is often associated with identifiable intracranial abnormalities or complement deficiencies.
- Conventional antibiotic therapy is highly effective, but antimicrobial prophylaxis may be necessary for prevention in select patients.
- Advanced imaging like radioactive cisternography can aid in diagnosing cerebrospinal fluid leaks, while complement deficiency correction is not currently feasible.