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Combined Bacterial Meningitis and Infective Endocarditis: When Should We Search for the Other When Either One is
Guillaume Béraud1, Sarah Tubiana2,3, Marie-Line Erpelding4
1Médecine Interne et Maladies Infectieuses, University Hospital of Poitiers, CHU de Poitiers, 2, rue de la Milétrie, 86021, Poitiers, France. guillaume@beraud.pro.
Introduction:
We aimed to describe patients with coexisting infective endocarditis (IE) and bacterial meningitis (BM).
Methods:
We merged two large prospective cohorts, an IE cohort and a BM cohort, with only cases of definite IE and community-acquired meningitis. We compared patients who had IE and BM concurrently to patients with IE only and BM only.
Results:
Among the 1030 included patients, we identified 42 patients with IE-BM (4.1%). Baseline characteristics of patients with IE-BM were mostly similar to those of patients with IE, but meningitis was the predominant presentation at admission (39/42, 92.3%). Causative pathogens were predominantly Streptococcus pneumoniae (18/42, 42.9%) and Staphylococcus aureus (14/42, 33.3%). All pneumococcal IE were associated with BM (18/18). BM due to oral and group D streptococci, Streptococcus agalactiae, and S. aureus were frequently associated with IE (14/30, 46.7%). Three-month mortality was 28.6% in patients with IE-BM, 20.5% in patients with IE, and 16.6% in patients with BM.
Conclusions:
Patients with pneumococcal IE or altered mental status during IE must be investigated for BM. Patients with S. aureus, oral and group D streptococcal or enterococcal BM, or unfavorable outcome in pneumococcal meningitis would benefit from an echocardiography. Patients with the dual infection have the worst prognosis. Their identification is mandatory to initiate appropriate treatment.
Insights
Co-infection of infective endocarditis (IE) and bacterial meningitis (BM) occurs in 4.1% of cases, with Streptococcus pneumoniae and Staphylococcus aureus being common causes. This dual infection significantly increases mortality risk, necessitating prompt identification and treatment.
Area of Science:
- Infectious Diseases
- Cardiology
- Neurology
Background:
- Coexisting infective endocarditis (IE) and bacterial meningitis (BM) represent a complex clinical challenge.
- Understanding the characteristics and outcomes of this dual infection is crucial for effective management.
Purpose of the Study:
- To describe patients with concurrent IE and BM.
- To compare outcomes of patients with IE-BM to those with IE or BM alone.
Main Methods:
- Merged two prospective cohorts: one for IE and one for BM.
- Included only definite IE and community-acquired meningitis cases.
- Compared concurrent IE-BM cases with IE-only and BM-only cases.
Main Results:
- Identified 42 patients (4.1%) with IE-BM among 1030 patients.
- Meningitis was the primary presentation in 92.3% of IE-BM cases.
- Predominant pathogens included Streptococcus pneumoniae (42.9%) and Staphylococcus aureus (33.3%).
- Three-month mortality was highest in the IE-BM group (28.6%) compared to IE-only (20.5%) and BM-only (16.6%).
Conclusions:
- Investigate for BM in patients with pneumococcal IE or altered mental status during IE.
- Consider echocardiography for patients with specific bacterial meningitis types (S. aureus, streptococci) or poor outcomes in pneumococcal meningitis.
- Dual IE-BM infection carries the worst prognosis and requires urgent, targeted treatment.
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