Bacterial meningitis natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]

Overview

Bacterial meningitis is a medical emergency and need urgent medical treatment. If left untreated, the bacterial meningitis may be associated with significant morbidity and mortality. Common complications which may result from bacterial meningitis may include seizures, focal neurological deficit, sensorineual hearing loss, vision loss, cranial nerve palsies and intellectual impairment.[1][1][2][3][4][5][6]

Natural history

If left untreated, the bacterial meningitis may cause severe neurological complications such as altered mental status, cranial nerve palsy, increased intracranial pressure, seizures, brain abscess, herniation of cerebellar tonsil and death. [1]

Complications

Common complications of bacterial meningitis may be divided into common and uncommon complications:[1][2][3][7][8][9][10][11][12][13][14][15][16]

Common complications

Uncommon complications

Life threatening complications

Prognosis

Bacterial meningitis is a medical emergency and require urgent treatment. Prognosis of this disease largely depends on the duration between acquisation of disease and onset of treatment. Case fatality rate of bacterial meningitis in USA in children more than one month is estimated to be 0 to 15 percent. The mortality rates of bacterial meningitis are significantly high in the infants and old patients. However, there is a decline in mortality in midlife. Despite effective medical treatment, the rate of neurological complications is as high as 30 percent in patients who survive bacterial meningitis. Poor prognositc factors associated with bacterial meningitis which may lead to significant morbidity and mortality may include the following:[4][5][6][17][18][3][19]

  • Decreased level of consciousness at the time of admission
  • Immunosuppression
  • Presence of complications such as seizures, focal neurological deficit
  • Presence of other medical conditions such as diabetes mellitus, CHD
  • Low CSF glucose concentration
  • Infants and old age
  • Poor nutritional status
  • Infective organism such as Pneumococcal and meningococcal meningitis

References

  1. ↑ 1.0 1.1 1.2 1.3 Durand ML, Calderwood SB, Weber DJ, Miller SI, Southwick FS, Caviness VS; et al. (1993). "Acute bacterial meningitis in adults. A review of 493 episodes". N Engl J Med. 328 (1): 21–8. doi:10.1056/NEJM199301073280104. PMID 8416268.
  2. ↑ 2.0 2.1 de Gans J, van de Beek D, European Dexamethasone in Adulthood Bacterial Meningitis Study Investigators (2002). "Dexamethasone in adults with bacterial meningitis". N Engl J Med. 347 (20): 1549–56. doi:10.1056/NEJMoa021334. PMID 12432041. Review in: ACP J Club. 2003 May-Jun;138(3):60
  3. ↑ 3.0 3.1 3.2 Aronin SI, Peduzzi P, Quagliarello VJ (1998). "Community-acquired bacterial meningitis: risk stratification for adverse clinical outcome and effect of antibiotic timing". Ann Intern Med. 129 (11): 862–9. PMID 9867727.
  4. ↑ 4.0 4.1 Kaaresen PI, Flaegstad T (1995). "Prognostic factors in childhood bacterial meningitis". Acta Paediatr. 84 (8): 873–8. PMID 7488809.
  5. ↑ 5.0 5.1 Takayanagi M, Yamamoto K, Nakagawa H, Iinuma K (1997). "[Factors associated with the prognosis of bacterial meningitis in children]". No To Hattatsu. 29 (4): 291–7. PMID 9248288.
  6. ↑ 6.0 6.1 Roine I, Peltola H, Fernández J, Zavala I, González Mata A, González Ayala S; et al. (2008). "Influence of admission findings on death and neurological outcome from childhood bacterial meningitis". Clin Infect Dis. 46 (8): 1248–52. doi:10.1086/533448. PMID 18444863.
  7. ↑ Pfister HW, Feiden W, Einhäupl KM (1993). "Spectrum of complications during bacterial meningitis in adults. Results of a prospective clinical study". Arch Neurol. 50 (6): 575–81. PMID 8503793.
  8. ↑ Zoons E, Weisfelt M, de Gans J, Spanjaard L, Koelman JH, Reitsma JB; et al. (2008). "Seizures in adults with bacterial meningitis". Neurology. 70 (22 Pt 2): 2109–15. doi:10.1212/01.wnl.0000288178.91614.5d. PMID 18305232.
  9. ↑ Kaplan SL, Woods CR (1992). "Neurologic complications of bacterial meningitis in children". Curr Clin Top Infect Dis. 12: 37–55. PMID 1353677.
  10. ↑ Kasanmoentalib ES, Brouwer MC, van der Ende A, van de Beek D (2010). "Hydrocephalus in adults with community-acquired bacterial meningitis". Neurology. 75 (10): 918–23. doi:10.1212/WNL.0b013e3181f11e10. PMID 20820003.
  11. ↑ Wang KW, Chang WN, Chang HW, Wang HC, Lu CH (2005). "Clinical relevance of hydrocephalus in bacterial meningitis in adults". Surg Neurol. 64 (1): 61–5, discussion 66. doi:10.1016/j.surneu.2004.10.009. PMID 15993186.
  12. ↑ Bodilsen J, Schønheyder HC, Nielsen H (2013). "Hydrocephalus is a rare outcome in community-acquired bacterial meningitis in adults: a retrospective analysis". BMC Infect Dis. 13: 321. doi:10.1186/1471-2334-13-321. PMC 3717123. PMID 23855442.
  13. ↑ Hughes DC, Raghavan A, Mordekar SR, Griffiths PD, Connolly DJ (2010). "Role of imaging in the diagnosis of acute bacterial meningitis and its complications". Postgrad Med J. 86 (1018): 478–85. doi:10.1136/pgmj.2010.097022. PMID 20709770.
  14. ↑ Ramos-Estebanez C, Yavagal D (2014). "Meningitis complicated by mycotic aneurysms". Oxf Med Case Reports. 2014 (3): 40–2. doi:10.1093/omcr/omu017. PMC 4369998. PMID 25988022.
  15. ↑ Pfister HW, Borasio GD, Dirnagl U, Bauer M, Einhäupl KM (1992). "Cerebrovascular complications of bacterial meningitis in adults". Neurology. 42 (8): 1497–504. PMID 1641143.
  16. ↑ Rabbani MA, Khan AA, Ali SS, Ahmad B, Baig SM, Khan MA; et al. (2003). "Spectrum of complications and mortality of bacterial meningitis: an experience from a developing country". J Pak Med Assoc. 53 (12): 580–3. PMID 14765936.
  17. ↑ Kornelisse RF, Westerbeek CM, Spoor AB, van der Heijde B, Spanjaard L, Neijens HJ; et al. (1995). "Pneumococcal meningitis in children: prognostic indicators and outcome". Clin Infect Dis. 21 (6): 1390–7. PMID 8749621.
  18. ↑ Arditi M, Mason EO, Bradley JS, Tan TQ, Barson WJ, Schutze GE; et al. (1998). "Three-year multicenter surveillance of pneumococcal meningitis in children: clinical characteristics, and outcome related to penicillin susceptibility and dexamethasone use". Pediatrics. 102 (5): 1087–97. PMID 9794939.
  19. ↑ Rosenthal RE (1984). "Emergency department evaluation of musculoskeletal injuries". Emerg Med Clin North Am. 2 (2): 219–44. PMID 6394301.


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