Community-acquired Bacterial Meningitis in Adults With Cerebrospinal Fluid Leakage

Author:

ter Horst Liora1,Brouwer Matthijs C1,van der Ende Arie23,van de Beek Diederik1

Affiliation:

1. Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands

2. Department of Medical Microbiology, Amsterdam Infection and Immunity, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands

3. Netherlands Reference Laboratory for Bacterial Meningitis, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands

Abstract

Abstract 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.

Funder

Netherlands Organization for Health Research and Development

Academic Medical Center

European Research Council

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,Microbiology (medical)

Reference30 articles.

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