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Enterococcal meningitis: analysis of twelve cases
1Department of Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan ROC.
Abstract:
From 1986 to 1993, 12 cases of enterococcal meningitis were identified at the Veterans General Hospital, Taipei. Most of the cases were caused by Enterococcus faecalis and three cases were mixed bacterial meningitis. There were six adult and six pediatric patients. Among the adult patients, four had undergone neurosurgical procedures before onset of meningitis and the other two had severe chronic underlying diseases. In contrast, all six pediatric patients had underlying central nervous system (CNS) pathology such as meningomyelocele or hydrocephalus. Placement of CNS devices was the most important predisposing factor of enterococcal meningitis in this study series. Direct microbial invasion via CNS devices or neural tube defects was considered the most likely portal of entry in most patients. Only one patient had primary meningitis, and one other had an enterococcal infection outside the CNS. The overall mortality rate was 25%. None of the pediatric patients died. Underlying conditions were considered the most important factor influencing the prognosis of these patients.
Insights
Enterococcal meningitis, often caused by Enterococcus faecalis, frequently arises from central nervous system (CNS) devices or defects. While adult cases often involve neurosurgery, pediatric cases link to congenital CNS issues, with no pediatric mortality observed.
Area of Science:
- Infectious Diseases
- Neurology
- Microbiology
Background:
- Enterococcal meningitis is a rare but serious infection.
- Identifying predisposing factors and outcomes is crucial for patient management.
Purpose of the Study:
- To analyze the clinical characteristics, predisposing factors, and outcomes of enterococcal meningitis.
- To investigate the differences in presentation and prognosis between adult and pediatric patients.
Main Methods:
- Retrospective case series analysis.
- Review of medical records for 12 patients with enterococcal meningitis.
- Data collection on patient demographics, clinical presentation, predisposing factors, treatment, and outcomes.
Main Results:
- Twelve cases of enterococcal meningitis were identified between 1986 and 1993.
- Enterococcus faecalis was the most common pathogen; three cases involved mixed bacterial meningitis.
- Central nervous system (CNS) devices and congenital CNS abnormalities (e.g., meningomyelocele, hydrocephalus) were significant predisposing factors.
- Adult patients often had a history of neurosurgery or severe chronic diseases.
- Pediatric patients predominantly had underlying CNS pathology.
- The overall mortality rate was 25%, with no deaths among pediatric patients.
- Underlying conditions significantly influenced patient prognosis.
Conclusions:
- Placement of CNS devices and congenital CNS defects are critical predisposing factors for enterococcal meningitis.
- Prompt diagnosis and management are essential, especially in high-risk populations.
- Outcomes appear better in pediatric patients compared to adults, possibly due to fewer severe comorbidities.