Affiliation:
1. From the Academic Medical Center, Center of Infection and Immunity Amsterdam, Department of Neurology (M.J.L., M.C.B., D.v.d.B.), Department of Medical Microbiology (A.v.d.E.), and the Netherlands Reference Laboratory for Bacterial Meningitis (A.v.d.E.), Amsterdam, The Netherlands.
Abstract
Background—
Endocarditis may precede or complicate bacterial meningitis, but the incidence and impact of endocarditis in bacterial meningitis are unknown.
Methods and Results—
We assessed the incidence and clinical characteristics of patients with meningitis and endocarditis from a nationwide cohort study of adults with community-acquired bacterial meningitis in the Netherlands from 2006 to 2012. Endocarditis was identified in 24 of 1025 episodes (2%) of bacterial meningitis. Cultures yielded
Streptococcus pneumoniae
in 13 patients,
Staphylococcus aureus
in 8 patients, and
Streptococcus agalactiae
,
Streptococcus pyogenes
, and
Streptococcus salivarius
in 1 patient each. Clues leading to the diagnosis of endocarditis were cardiac murmurs, persistent or recurrent fever, a history of heart valve disease, and
S aureus
as the causative pathogen of bacterial meningitis. Treatment consisted of prolonged antibiotic therapy in all patients and surgical valve replacement in 10 patients (42%). Two patients were treated with oral anticoagulants, and both developed life-threatening intracerebral hemorrhage. Systemic (70%) and neurological (54%) complications occurred frequently, leading to a high proportion of patients with unfavorable outcome (63%). Seven of 24 patients (29%) with meningitis and endocarditis died.
Conclusions—
Endocarditis is an uncommon coexisting condition in bacterial meningitis but is associated with a high rate of unfavorable outcome.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Physiology (medical),Cardiology and Cardiovascular Medicine
Cited by
64 articles.
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