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Plague meningitis--a retrospective analysis of cases reported in the United States, 1970-1979
Abstract:
Meningitis caused by Yersinia pestis developed in 6 (6%) of a total of 105 patients with plague reported to the Centers for Disease Control from 1970 to 1979. Five of the six cases occurred in children aged 10 to 15 years. All six patients received antibiotic therapy before meningitis developed, which appeared between the 9th and 14th days after the onset of acute illness in five of the six patients. There were no neurologic sequelae. The antigenic and biochemical profiles of the Y pestis strains isolated from cerebrospinal fluid in the meningitis cases did not differ from those of the Y pestis strains obtained from blood and bubo aspirates in the other 99 patients, and neither did in vitro studies suggest antibiotic resistance. While plague meningitis is an uncommon complication of acute plague infection, physicians in the western United States should be aware that it may develop as much as 14 days after antibiotic therapy for the acute plague infection has been initiated.
Insights
Plague meningitis, a rare complication of Yersinia pestis infection, occurred in 6% of patients. This meningitis developed late, even after antibiotic treatment, but without lasting neurological damage.
Area of Science:
- Infectious Diseases
- Neurology
- Microbiology
Background:
- Plague, caused by Yersinia pestis, is a serious bacterial infection.
- Meningitis is inflammation of the membranes surrounding the brain and spinal cord.
Observation:
- A study of 105 plague patients reported between 1970-1979 identified 6 cases (6%) of Yersinia pestis meningitis.
- Five of these cases were in children aged 10-15 years.
- Meningitis onset occurred between days 9-14 after acute illness, even after antibiotic therapy initiation.
Findings:
- No significant differences were found in Yersinia pestis strain profiles between meningitis and non-meningitis cases.
- In vitro studies did not indicate antibiotic resistance in the Yersinia pestis strains.
- All patients recovered without neurological sequelae.
Implications:
- Physicians, particularly in the western US, should consider plague meningitis as a potential complication.
- Awareness of late-onset meningitis is crucial, even during antibiotic treatment for plague.
- Early recognition and management are vital for preventing neurological complications, though this study found none.