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Staphylococcus aureus meningitis
Abstract:
Thirty-eight cases of meningitis caused by Staphylococcus aureus, occurring from 1966 to 1981 at six hospitals associated with the University of Toronto Faculty of medicine, were reviewed. Thirteen patients were children and 25 were adults. Patients were categorised into three groups: Group A (16)--meningitis related to neurosurgery, trauma or cerebrospinal defects; Group B (7)--meningitis occurring with indwelling ventricular shunts; and Group C (15)--spontaneously occurring meningitis. Bacterial endocarditis was associated with one-third of the spontaneously occurring meningitis cases and this group in general ran a more fulminant course. Meningitis related to a ventricular shunt exhibited a more insidious onset with a lower case-fatality rate, similar to the experience with Gram-negative bacillary meningitis. Gram stain of the cerebrospinal fluid was positive in only one-third of cases. Treatment with cloxacillin, administered parenterally, achieved results similar to those with methicillin, while chloramphenicol was associated with a high failure rate.
Insights
Staphylococcus aureus meningitis can arise from surgery, shunts, or spontaneously. Spontaneous cases were more severe, while shunt-related meningitis had a slower onset and lower fatality rate.
Area of Science:
- Infectious Diseases
- Neurology
- Clinical Medicine
Background:
- Meningitis caused by Staphylococcus aureus presents diagnostic and therapeutic challenges.
- Understanding the different clinical presentations and outcomes is crucial for effective management.
Purpose of the Study:
- To review cases of Staphylococcus aureus meningitis to identify distinct clinical patterns and treatment outcomes.
- To compare the characteristics and prognoses of meningitis related to neurosurgery/trauma, ventricular shunts, and spontaneous occurrence.
Main Methods:
- Retrospective review of 38 cases of Staphylococcus aureus meningitis from 1966 to 1981.
- Categorization of patients into three groups: neurosurgery/trauma/defect-related, ventricular shunt-related, and spontaneous.
- Analysis of clinical presentation, associated conditions, and treatment outcomes.
Main Results:
- Spontaneous meningitis (Group C) was associated with bacterial endocarditis in one-third of cases and had a more fulminant course.
- Ventricular shunt-related meningitis (Group B) showed an insidious onset and a lower case-fatality rate, similar to Gram-negative meningitis.
- Gram stain of cerebrospinal fluid was positive in only one-third of cases. Parenteral cloxacillin yielded results comparable to methicillin, while chloramphenicol had a high failure rate.
Conclusions:
- Staphylococcus aureus meningitis exhibits varied clinical courses depending on the etiology.
- Prompt and appropriate antibiotic selection is critical, with cloxacillin showing efficacy comparable to methicillin.