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Pneumococcal meningitis: clinical-pathological correlations (MeninGene-Path)

Joo-Yeon Engelen-Lee1, Matthijs C Brouwer1, Eleonora Aronica2,3

  • 1Department of Neurology, Academic Medical Center, University of Amsterdam, Center of Infection and Immunity Amsterdam (CINIMA), PO Box 22660, 1100DD, Amsterdam, The Netherlands.

Acta Neuropathologica Communications
|March 23, 2016
PubMed

Insights

Pneumococcal meningitis causes severe brain damage primarily through vascular inflammation and damage. This study highlights vascular damage as a key factor in the pathology of pneumococcal meningitis.

Area of Science:

  • Neurology
  • Pathology
  • Infectious Diseases

Background:

  • Pneumococcal meningitis is a serious infection with high mortality and morbidity.
  • Understanding the detailed brain pathology is crucial for developing effective treatments.

Purpose of the Study:

  • To systematically assess brain histopathology in patients who died from pneumococcal meningitis.
  • To investigate the role of vascular damage and inflammation in the observed neuropathology.
  • To explore the impact of adjunctive dexamethasone therapy on histopathological findings.

Main Methods:

  • Systematic histopathological examination of 31 brains from patients deceased from pneumococcal meningitis.
  • Utilized a standardized pathology score evaluating inflammation and vascular damage.
  • Compared histopathological findings, including hippocampal apoptosis and total pathology scores, between patients treated with and without dexamethasone.

Main Results:

  • Widespread inflammation of medium-large arteries (97%), cerebral hemorrhage (77%), cerebritis (77%), thrombosis (68%), infarction (61%), and ventriculitis (68%) were observed.
  • Inflammation of medium-large arteries led to vascular lumen obstruction in 45% of cases and was associated with infarction and thrombosis.
  • While hippocampal apoptosis was similar, dexamethasone-treated patients showed a higher total pathology score (p=0.003).

Conclusions:

  • Vascular damage, particularly inflammation of medium-large arteries, is a critical component of brain damage in pneumococcal meningitis.
  • The findings underscore the significant role of cerebrovascular pathology in pneumococcal meningitis.
  • The study data will be made open-access for further translational research in pneumococcal meningitis.
Keywords:
ApoptosisHistopathologyPneumococcal meningitisVascular inflammation

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