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Neuroinfectious Diseases
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Jeremy D. Young, Jesica A. Herrick, Scott Borgetti
The classic signs and symptoms of acute bacterial meningitis are fever, nuchal rigidity, altered mental status, and headache. Fever is present in 95% of patients at the time of presentation. Hypothermia should be a particularly alarming sign. Only 40–50% of patients present with all of the classic signs, but 95% display at least two and almost all have at least one.7
Meningitis
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
The majority of community acquired bacterial meningitis cases are caused by Streptococcus pneumoniae and Neisseria meningitidis. Haemophilus influenzae has become a much less frequent cause since the introduction of the H. influenzae type b conjugate vaccines. The overall efficacy of the 23-valent pneumococcal polysaccharide vaccine against pneumococcal meningitis is about 50%. Streptococcus agalactiae (group B) and Escherichia coli are the main causes of neonatal meningitis. Listeria monocytogenes can be seen in patients aged 50 years or older. Its incidence is decreasing, presumably due to better awareness, increased hygiene and a decrease in food contamination.
Unexplained Fever In Neurological Disorders
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
Partially treated bacterial meningitis might raise a diagnostic problem. In this situation the patient, frequently a child, presents with an undefined febrile illness and is otherwise in good condition. It is a common and probably mistaken practice to treat such children with low doses of antibiotics. When fever persists and the child is finally hospitalized the possibility of partially treated meningitis should be considered. The spinal fluid may be sterile and acellular and thus the diagnosis might be “aseptic meningitis”. However, we do recommend a repeated spinal tap 2 to 12 h (usually 6 h) after discontinuation of antibiotics, at this time if bacterial meningitis is present, the spinal fluid will be diagnostic after such an interval.9 Another difficult diagnostic problem is neonatal meningitis, especially related to enteric Gram-negative bacteria. Meningeal signs in neonates are only rarely present. However, if suspected and CSF is obtained, one must distinguish purulent meningitis from normal neonatal spinal fluid, keeping in mind the fact that in noninfected newborns, up to 32 cells per mm3 may be present, 60% of them polymorphonuclears.10
An Atypical Case of Enterovirus Meningitis Presenting with Unilateral Optic Disc Swelling and Minimal Optical Symptoms
Published in Ocular Immunology and Inflammation, 2023
Efthymios Karmiris, Georgios Vasilakos, Konstantinos Tsiripidis, Evangelia Chalkiadaki
Aseptic meningitis is defined as an acute infectious disease with CSF negative for bacteria and is most frequently due to a viral infection. Viruses are often overlooked as their sequelae are not as severe as bacterial meningitis or viral encephalitis, with the most common clinical symptoms for aseptic meningitis patients being fever, vomiting, headache and nausea. Viruses may reach the meninges from the bloodstream or be reactivated from a dormant state within the nervous system.7 Herpes-, arbo- and enteroviruses are the major etiologic agents of central nervous system infections, however their causative role among adult cases of aseptic meningitis is unclear.8 They preferentially cause harm in the very young9 and children are the primary victims of central nervous system infections due to enteroviruses. Therefore, little is known about the natural history of enterovirus meningitis in adults.6
Recurrent benign lymphocytic (Mollaret’s) meningitis due to herpes simplex virus type 2
Published in Baylor University Medical Center Proceedings, 2022
Michael Grinney, Michael M. Mohseni
Recurrent meningitis is a rare clinical entity that requires prompt investigation to determine the underlying etiology. In cases of recurrent bacterial meningitis, the outcomes can be life threatening,1,2 while in recurrent viral or aseptic meningitis the clinical course is generally self-limited.3 Recent retrospective reviews have implicated herpes simplex virus type 2 (HSV-2) and varicella-zoster virus as the predominant viral causes of meningitis in adults.4,5 HSV-1 and Epstein-Barr viruses have also been reported in a minority of cases.6 Recurrent benign lymphocytic meningitis (RBLM) is a rare form of recurrent aseptic meningitis typically associated with HSV-2; this entity was first described in the mid-20th century by Dr. Pierre Mollaret.7 At the time of its first description, RBLM patients were noted to have mononuclear cells in the cerebrospinal fluid (CSF) that were later termed “Mollaret cells.”8 “Mollaret’s meningitis” has been used interchangeably with RBLM but the relationship with HSV-2 was not effectively established until the 20th century with widespread use of polymerase chain reaction (PCR) to isolate the implicated DNA.6,9 RBLM is characterized by at least three but up to 10 episodes of recurrent meningitis lasting from 2 to 5 days and subsequently followed by rapid recovery.10 We present a case of HSV-2 meningitis in a young woman with seven similar prior episodes.
Outcome of uncorrected CSF leak and consequent recurrent meningitis in a patient: a case presentation and literature review
Published in British Journal of Neurosurgery, 2020
Bacterial meningitis is a severe and life-threatening infection with recurrence occurring in approximately 1–4.8% of all cases.7 Recurrent bacterial meningitis can be defined as the occurrence of two or more episodes of meningitis caused by different organisms, or as multiple episodes caused by the same pathogen after appropriate treatment. It is a rare entity, suggesting the existence of predisposing causes, among which traumatic causes appear to be the most frequent. In a survey conducted in 2 US trauma centres between 1992 and 1999, 0.56% of patients after different head injuries (blunt trauma–75%, penetrating trauma–15%) developed neuroinfection. This data complies with the general statistics estimating the risk of post-traumatic meningitis development as 0.38–2.03%.8