TY - JOUR
T1 - Community-acquired Bacterial Meningitis in Adults With Cerebrospinal Fluid Leakage
AU - ter Horst, Liora
AU - Brouwer, Matthijs C.
AU - van der Ende, Arie
AU - van de Beek, Diederik
N1 - © The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America.
PY - 2020/6/1
Y1 - 2020/6/1
N2 - BACKGROUND: Cerebrospinal fluid (CSF) leakage is a risk factor for developing bacterial meningitis. METHODS: We analyzed episodes of community-acquired bacterial meningitis associated with CSF leakage from a prospective nationwide cohort study. RESULTS: CSF leakage was identified in 65 episodes of 2022 episodes (3%) in 53 patients. The cause of CSF leakage was identified in 49 of 65 episodes (75%), which most commonly consisted of ear-nose-throat surgery (19 of 49 episodes [29%]) and remote head trauma (15 of 49 episodes [23%]). The episode was a recurrent meningitis episode in 38 patients (59%). Of the recurrent episodes, 27 had known CSF leakage (71%) of whom 20 (53%) had previous surgery aiming to close the leak. Nine patients (38%) with known CSF leakage had been vaccinated (23-valent pneumococcal vaccine in 9 patients, meningococcal serogroup C vaccine in 2, meningococcal serogroup A and Haemophilus influenzae type b vaccine each in 1 patient). Streptococcus pneumoniae was cultured in 33 episodes (51%) and H. influenzae in 11 episodes (17%). The most common pneumococcal serotypes were 3 (4 episodes), 35B, 9N, 38, and 15C (each 2 episodes). Haemophilus influenzae was unencapsulated in all 10 episodes with known capsule type. The outcome was unfavorable in 8 episodes (12%) and no patient died. CONCLUSIONS: Bacterial meningitis in patients with CSF leakage has a high recurrence rate, despite surgical repair or vaccination, and outcome is generally favorable. CSF leakage should be suspected in patients with bacterial meningitis presenting with liquorrhea, recurrent meningitis, or with disease caused by H. influenzae.
AB - BACKGROUND: Cerebrospinal fluid (CSF) leakage is a risk factor for developing bacterial meningitis. METHODS: We analyzed episodes of community-acquired bacterial meningitis associated with CSF leakage from a prospective nationwide cohort study. RESULTS: CSF leakage was identified in 65 episodes of 2022 episodes (3%) in 53 patients. The cause of CSF leakage was identified in 49 of 65 episodes (75%), which most commonly consisted of ear-nose-throat surgery (19 of 49 episodes [29%]) and remote head trauma (15 of 49 episodes [23%]). The episode was a recurrent meningitis episode in 38 patients (59%). Of the recurrent episodes, 27 had known CSF leakage (71%) of whom 20 (53%) had previous surgery aiming to close the leak. Nine patients (38%) with known CSF leakage had been vaccinated (23-valent pneumococcal vaccine in 9 patients, meningococcal serogroup C vaccine in 2, meningococcal serogroup A and Haemophilus influenzae type b vaccine each in 1 patient). Streptococcus pneumoniae was cultured in 33 episodes (51%) and H. influenzae in 11 episodes (17%). The most common pneumococcal serotypes were 3 (4 episodes), 35B, 9N, 38, and 15C (each 2 episodes). Haemophilus influenzae was unencapsulated in all 10 episodes with known capsule type. The outcome was unfavorable in 8 episodes (12%) and no patient died. CONCLUSIONS: Bacterial meningitis in patients with CSF leakage has a high recurrence rate, despite surgical repair or vaccination, and outcome is generally favorable. CSF leakage should be suspected in patients with bacterial meningitis presenting with liquorrhea, recurrent meningitis, or with disease caused by H. influenzae.
KW - Bacterial meningitis
KW - Cerebrospinal fluid leakage
KW - Risk factor
UR - http://www.scopus.com/inward/record.url?scp=85085534874&partnerID=8YFLogxK
U2 - https://doi.org/10.1093/cid/ciz649
DO - https://doi.org/10.1093/cid/ciz649
M3 - Article
C2 - 31300817
SN - 1058-4838
VL - 70
SP - 2256
EP - 2261
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 11
ER -