scholarly journals An unusual Case of Meningitis

2015 ◽  
Vol 26 (3) ◽  
pp. e62-e64 ◽  
Author(s):  
Eric DR Pond ◽  
Sameh El-Bailey ◽  
Duncan Webster
Keyword(s):  
Cerebrospinal Fluid ◽  
Bacterial Meningitis ◽  
Lumbar Puncture ◽  
Pasteurella Multocida ◽  
Unusual Case ◽  
Definitive Treatment ◽  
Gram Negative ◽  
Level Of Consciousness ◽  
Low Glucose ◽  
Animal Exposure

Pasteurella multocidais a rare cause of bacterial meningitis. A 56-year-old man with several pets developed a profoundly decreased level of consciousness following left tympanomastoidectomy. Lumbar puncture produced cerebrospinal fluid with the typical findings of meningitis (low glucose, high protein, high leukocytes). Cultures from the cerebrospinal fluid and a swab of the left ear revealed Gram-negative coccobacillus identified asP multocida. The organism was sensitive to ceftriaxone, ampicillin and penicillin, and a 14-day course of intravenous penicillin was used as definitive treatment, resulting in full recovery. Although rare,P multocidashould be considered as a potential cause of meningitis in patients with animal exposure, particularly in the setting of recent cranial surgery.

scholarly journals Bacterial Meningitis in the Absence of Cerebrospinal Fluid Pleocytosis: A Case Report and Review of the Literature

2014 ◽  
Vol 25 (5) ◽  
pp. 249-251 ◽  
Author(s):  
Ryota Hase ◽  
Naoto Hosokawa ◽  
Makito Yaegashi ◽  
Kiyoharu Muranaka
Keyword(s):  
Cerebrospinal Fluid ◽  
Bacterial Meningitis ◽  
Lumbar Puncture ◽  
Early Stage ◽  
Review Of The Literature ◽  
Csf Analysis ◽  
Cell Counts ◽  
Csf Pleocytosis ◽  
Cerebrospinal Fluid Pleocytosis ◽  
Rule Out

Elevation of cerebrospinal fluid (CSF) cell count is a key sign in the diagnosis of bacterial meningitis. However, there have been reports of bacterial meningitis with no abnormalities in initial CSF testing. This type of presentation is extremely rare in adult patients. Here, a case involving an 83-year-old woman who was later diagnosed with bacterial meningitis caused byNeisseria meningitidisis described, in whom CSF at initial and second lumbar puncture did not show elevation of cell counts. Twenty-six non-neutropenic adult cases of bacterial meningitis in the absence of CSF pleocytosis were reviewed. The frequent causative organisms wereStreptococcus pneumoniaeandN meningitidis. Nineteen cases had bacteremia and seven died. The authors conclude that normal CSF at lumbar puncture at an early stage cannot rule out bacterial meningitis. Therefore, repeat CSF analysis should be considered, and antimicrobial therapy must be started immediately if there are any signs of sepsis or meningitis.

Factitious Meningitis: A Recurring Problem

1988 ◽  
Vol 9 (11) ◽  
pp. 501-503 ◽  
Author(s):  
Robert L. Penn ◽  
Richard Normand ◽  
Stephen A. Klotz
Keyword(s):  
Cerebrospinal Fluid ◽  
Lumbar Puncture ◽  
Retrospective Review ◽  
False Positive ◽  
Commercial Products ◽  
Gram Negative ◽  
Specimen Tube

AbstractAlthough gram-negative meningitis is rare in our hospital, between July, 1982 and July, 1983 clusters of cerebrospinal fluid (CSF) smears were reported positive for gram-negative bacilli. Fourteen specimens were obtained by diagnostic lumbar punctures, and one was obtained during a myelogram. No CSF cultures were positive, and a diagnosis of factitious meningitis was eventually established for each patient. Nonviable gram-negative bacilli were found in 6.7% of manometers, and 23.3% to 90% of the specimen tubes tested from the same lots of commercial lumbar puncture trays. It was estimated that there were between 44 and 333 organisms per specimen tube. Two lots of the commercial myelogram trays yielded nonviable gram-negative bacilli from 50% of the specimen tubes and 33.3% of the manometers tested. Retrospective review of laboratory records for 1982 and 1983 revealed 23 total CSF smears positive for gram-negative bacilli. No CSF grew gram-negative bacilli, and chart reviews confirmed a diagnosis of factitious meningitis in each case. In addition to the clusters of false-positive smears, this had occurred sporadically in both years. The problem did not recur after separate sterile tubes were provided for CSF collection. Physicians and laboratories should be aware that nonviable contaminants in commercial products may be a source of false-positive CSF gram-stained smears.

scholarly journals Effect of Antibiotic Pretreatment on Cerebrospinal Fluid Profiles of Children with Acute Bacterial Meningitis

2013 ◽  
Vol 2 (2) ◽  
pp. 135-139 ◽  
Author(s):  
S Adhikari ◽  
E Gauchan ◽  
G BK ◽  
KS Rao
Keyword(s):  
Cerebrospinal Fluid ◽  
Bacterial Meningitis ◽  
Antibiotic Therapy ◽  
Lumbar Puncture ◽  
Laboratory Finding ◽  
Clinical Findings ◽  
Acute Bacterial Meningitis ◽  
Antibiotic Administration ◽  
Intravenous Antibiotic ◽  
Considerable Difficulty

Background: Analysis of cerebrospinal fluid is gold standard for diagnosis of meningitis. There is considerable difficulty in interpreting laboratory finding after prior antibiotic therapy. This study was conducted to evaluate the effect of intravenous antibiotic administration before lumbar puncture on cerebrospinal fluid profiles in children with bacterial meningitis. Methods: A hospital based retrospective study carried out using the data retrieved from the medical record department of Manipal Teaching Hospital Pokhara, Nepal; from 1st July 2006 to 31st July 2011. Clinical findings and relevant investigations were entered in a predesigned proforma. Patients were divided in two different groups as bacterial meningitis with and without prior intravenous antibiotic therapy. Various laboratory parameters including CSF were compared between these two groups using the statistical software, SPSS version 18.0. Results: A total of 114 children were included in this study among which 49(43%) children had received intravenous antibiotics before lumbar puncture. Mean CSF WBC count was(267.6± 211 vs. 208.1±125.3.3) and protein level (114.1±65.9 vs. 98.3±37.7mg/dl) in untreated vs. pretreated groups respectively. Neutrophil percentage was decreased (57.1±28.1vs.72.9±18.9) with higher CSF sugar level (43.3±11.8 vs. 51.2±13.2) after prior antibiotics therapy (p<0.001). Conclusion: Antibiotic pretreatment was associated with higher cerebrospinal fluid glucose levels with decreased neutrophils and increased lymphocytes. Pretreatment did not modify total cerebrospinal fluid white blood cell count and cerebrospinal fluid protein levels. Nepal Journal of Medical Sciences | Volume 02 | Number 02 | July-December 2013 | Page 135-139 DOI: http://dx.doi.org/10.3126/njms.v2i2.8963

Lactate production by aerobic bacteria grown in cerebrospinal fluid.

1984 ◽  
Vol 30 (11) ◽  
pp. 1875-1876 ◽  
Author(s):  
F L Kiechle ◽  
M A Kamela ◽  
R W Starnes
Keyword(s):  
Cerebrospinal Fluid ◽  
Bacterial Meningitis ◽  
Lactate Concentration ◽  
Lactate Production ◽  
Aerobic Bacteria ◽  
Gram Negative Bacteria ◽  
High Concentration ◽  
Gram Positive ◽  
Gram Negative ◽  
Gram Positive Bacteria

Abstract The source of the abnormally high concentration of lactate in the cerebrospinal fluid in patients with bacterial meningitis is not known. It may represent a bacterial metabolite. To determine whether cerebrospinal fluid possesses appropriate substrates to support the growth of pathogenic aerobic bacteria, three Gram-positive and nine Gram-negative bacteria were separately inoculated in pooled normal cerebrospinal fluid. After incubation for 24 h, all Gram-positive bacteria increased lactate, eight Gram-negative bacteria decreased lactate, and one Gram-negative bacteria failed to significantly change the lactate concentration. We conclude that lactate produced in cerebrospinal fluid in patients with aerobic bacterial meningitis is not necessarily a bacterial metabolite.

scholarly journals Cerebrospinal fluid procalcitonin predicts Gram-negative bacterial meningitis in patients with empiric antibiotic pretreatment

Critical Care ◽  
2019 ◽  
Vol 23 (1) ◽  
Author(s):  
Wen Li ◽  
Fang Yuan ◽  
Xiaolong Sun ◽  
Zhihan Zhao ◽  
Yaoyao Zhang ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Bacterial Meningitis ◽  
Gram Negative ◽  
Empiric Antibiotic

Evaluation of IL-8 level in cerebrospinal fluid in acute bacterial meningitis in adults

2021 ◽  
Vol 42 (6) ◽  
pp. 634-641
Author(s):  
Zhinous Bayat-Makoo ◽  
Puran Karimi ◽  
Negar Mohtadi
Keyword(s):  
Cerebrospinal Fluid ◽  
Bacterial Meningitis ◽  
Aseptic Meningitis ◽  
High Sensitivity ◽  
Interleukin 8 ◽  
Acute Bacterial Meningitis ◽  
Neck Stiffness ◽  
Significant Difference ◽  
Level Of Consciousness ◽  
Consciousness Disorder

Background: Interleukin 8 increases in various types of meningitis, specifically acute bacterial meningitis inflammation, and it is important in the distinction between types of meningitis. The present paper aims at evaluation of the level of interleukin 8 in cerebrospinal fluid in acute adult bacterial meningitis. Methods: All adult patients’ with diagnosis of suspected meningitis with symptoms of fever, headache, neck stiffness, and consciousness disorder. Lumbar puncture was taken in between the third and fourth vertebra by a specialist physician for all patients suspected with meningitis. To determine the level of consciousness, the GCS of the patients was determined and the cerebrospinal fluid was cultured and sent to the laboratory for the analyses of cell count, diffraction, CSF fluid glucose, CSF fluid protein, LDH, or lactate dehydrogenase, and the level of interleukin 8. Results: The mean of IL-8 protein was 296.17±48.57Pg/ml in patients with aseptic meningitis and 1088.96±526.55Pg/ml in the group of patients with septic meningitis. There was a significant difference between the two groups in terms of the amount of interleukin 8 (p = 0.009). Cutoff was 297.6 Pg/ml for the detection of positive bacterial meningitis with a sensitivity of 92% and the specificity of 83.1% was 297.6 pg/ml. Conclusion: Interleukin 8 has a high sensitivity and specificity in the diagnosis of bacterial meningitis from aseptic meningitis, and along with the measurement of cerebrospinal fluid protein, it can be a good criterion for differentiation of bacterial from aseptic meningitis.

scholarly journals Penetration of Colistin into Cerebrospinal Fluid

2009 ◽  
Vol 53 (11) ◽  
pp. 4907-4910 ◽  
Author(s):  
S. L. Markantonis ◽  
N. Markou ◽  
M. Fousteri ◽  
N. Sakellaridis ◽  
S. Karatzas ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Lumbar Puncture ◽  
Critically Ill ◽  
Adult Patients ◽  
Gram Negative ◽  
Low Level ◽  
Paired Serum ◽  
Colistin Methanesulfonate ◽  
Sampling Times

ABSTRACT Colistin penetration into the cerebrospinal fluid (CSF) was studied in five critically ill adult patients receiving colistin methanesulfonate for infections by multiresistant gram-negative bacilli. Colistin concentrations were determined in paired serum and CSF samples, with the latter taken by lumbar puncture, with the exception of one patient with an external ventriculostomy. CSF-to-serum ratios (0.051 to 0.057) for all study patients coincided at all sampling times. The low level (5%) of penetration suggests inadequate bactericidal colistin concentrations in the CSF.

Central Nervous System Infections

2016 ◽  
Author(s):  
Nicholas J. Johnson ◽  
David F. Gaieski
Keyword(s):  
Central Nervous System ◽  
Cerebrospinal Fluid ◽  
Nervous System ◽  
Bacterial Meningitis ◽  
Lumbar Puncture ◽  
Clinical Manifestations ◽  
Empirical Therapy ◽  
Cns Infection ◽  
Cns Infections ◽  
Associated Conditions

Infections of the central nervous system (CNS) are among the most devastating diseases that present to the emergency department (ED). Because of the great potential for morbidity, as well as the importance of prompt treatment, emergency physicians must remain vigilant of these diseases, which are also fraught with diagnostic challenges. This review covers the pathophysiology, stabilization and assessment, diagnosis and treatment, and disposition and outcomes of CNS infections. Figures show causes of viral meningitis, an algorithm for the initial evaluation and management of patients with a suspected CNS infection, clinical manifestations of community-acquired meningitis in patients 16 years of age and older, assessment of nuchal rigidity, Kernig sign, and Brudzinski sign for meningeal irritation, proper positioning of the patient for lumbar puncture, and a sagittal view of the lumbar puncture needle as it is advanced into the subarachnoid space. Tables list CNS pathogens based on predisposing and associated conditions, cerebrospinal fluid diagnostic studies for meningitis, adult patients who should receive computed tomography prior to lumbar puncture, classic cerebrospinal fluid characteristics in meningitis, empirical therapy for bacterial meningitis based on predisposing and associated conditions, recommended doses for antibiotics commonly used in the treatment of bacterial meningitis, and antimicrobial therapy for selected CNS infections.   This review contains 8 highly rendered figures, 7 tables, and 94 references

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