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Relapsing bacterial meningitis in adults
1Department of Neurology, Chang Gung Memorial Hospital and Medical College, Taipei, Taiwan.
Abstract:
Relapsing bacterial meningitis is a rare condition, diagnosed in eight patients between 1981 and 1993 at our institution. These accounted for 3.4% of 234 adult patients with blood and/or cerebrospinal fluid culture-proven bacterial meningitis. A review of the English-language literature from 1966 to the present revealed only five further adult cases of relapsing bacterial meningitis with in-depth case histories. Of these 13 total patients, nine were female and four male, aged 17-61 years. Ten were neurosurgical patients. Gram-negative bacilli, especially Klebsiella species, were the commonest micro-organisms identified for both the initial episode and the relapse of infection. Three patients died in the course of relapse. Four or more weeks of antibiotic therapy may be needed to treat post-surgical patients with Gram-negative bacillary meningitis. Even a normal cerebrospinal fluid study at the end of treatment of bacterial meningitis is not a guarantee of freedom from relapse.
Insights
Relapsing bacterial meningitis is rare, often involving Gram-negative bacilli in neurosurgical patients. Extended antibiotic treatment is crucial, as normal cerebrospinal fluid tests don't prevent relapse.
Area of Science:
- Infectious Diseases
- Neurology
- Microbiology
Background:
- Relapsing bacterial meningitis is an uncommon but serious condition.
- This study investigates its occurrence and characteristics in adult patients.
Observation:
- Eight cases were identified at our institution between 1981-1993, representing 3.4% of adult bacterial meningitis cases.
- A literature review identified five additional adult cases.
- The total cohort comprised 13 patients (9 female, 4 male), aged 17-61, with 10 having neurosurgical histories.
Findings:
- Gram-negative bacilli, particularly Klebsiella species, were the most frequent pathogens in both initial and relapsed infections.
- Three patients succumbed to the infection during relapse.
- Extended antibiotic therapy (≥4 weeks) may be necessary for post-surgical Gram-negative bacillary meningitis.
Implications:
- A normal cerebrospinal fluid result post-treatment does not preclude meningitis relapse.
- This highlights the need for vigilant monitoring and potentially prolonged treatment strategies for specific meningitis cases.