Adjunctive corticosteroid therapy for acute bacterial meningitis is one of the most. In experimental studies, the outcome of bacterial meningitis has been related to the severity of inflammation in the subarachnoid space. Acute bacterial meningitis remains a disease with high mortality rate, ranging from 10 to 30 percent, despite advances in critical care. Sep 12, 2015 corticosteroids for acute bacterial meningitis. Death and longterm disabilities are common outcomes of acute bacterial meningitis, especially in developing countries, even when highly effective antibiotic therapy is given. This report describes two cases of oslers triad of pneumonia, meningitis, and endocarditis, as a result of streptococcus pneumoniae infection, also called austrians syndrome. Bacterial meningitis is uncommon but causes significant mortality and morbidity, despite optimum antibiotic therapy. Jan 16, 2019 pediatric bacterial meningitis is a lifethreatening illness that results from bacterial infection of the meninges and leaves some survivors with significant sequelae.
Efns guideline on the management of communityacquired. The use of corticosteroids as adjunctive therapy to antibiotics has been studied in clinical trials and. Acute bacterial meningitis is an infection of the meninges the system of membranes that envelops the brain and spinal cord, which often causes hearing loss. Corticosteroids for managing people with tuberculous meningitis. Communityacquired bacterial meningitis inflammation of the meninges is most commonly caused by streptococcus pneumoniae or neisseria meningitidis. The role of corticosteroids in the immediate management of acute bacterial meningitis is becoming clearer. The mitral valve was affected in a 70 year old woman without underlying. Patients of any age and in any clinical condition, treated with antibacterial agents and randomised to corticosteroid therapy or placebo of any type, could be included. The use of adjuvant therapy in acute bacterial meningitis draws its rationale from the notion of arresting the inflammatory cascade at an early stage of. Bacterial meningitis is a potentially catastrophic infectious disease associated with substantial mortality and a risk of permanent disability in survivors. Background acute bacterial meningitis is an infection of the meninges the system of membranes that envelops the brain and spinal cord, which oken causes hearing loss.
Bacterial meningitis is fatal in 5% to 40% of children and 20% to 50% of adults despite treatment. On the basis of these experimental studies, several clinical trials were. Corticosteroids for managing tuberculous meningitis. Steroids in adults with acute bacterial meningitis. The first study included both children and adults from boston and chicago. Other symptoms include confusion or altered consciousness, vomiting, and an inability to tolerate light or loud noises.
Two recent studies shed new light on potential benefits of adjunctive corticosteroids in developing countries. Corticosteroids may not reduce mortality in children with. Adjunctive dexamethasone treatment in acute bacterial meningitis. Corticosteroids for acute bacterial meningitis in developing. The use of adjuvant therapy in acute bacterial meningitis draws its rationale from the notion of arresting the inflammatory cascade at an early stage. Pediatric bacterial meningitis is a lifethreatening illness that results from bacterial infection of the meninges and leaves some survivors with significant sequelae. Bacterial meningitis treatment algorithm bmj best practice. Adjunctive corticosteroids in adults with bacterial meningitis. Bacterial meningitis in infants is a serious infection of the meninges and subarachnoid space. Patients with symptoms of compensated shock neurological status usually remains normal, but the pulse rate may be persistently elevated, the skin mottled, the extremities cool due to increased systemic vascular resistance, the capillary refilling prolonged, and the urinary output decreased or respiratory distress should. Bacterial meningitis causes substantial neurological morbidity and mortality worldwide. Corticosteroids for acute bacterial meningitis brouwer, mc 2015. Bacterial meningitis is a complex disorder in which neurologic injury is caused, in part, by the causative organism and, in part, by the hosts own inflammatory response. A randomized trial is warranted to explore the possible benefit of adjuvant corticosteroid therapy on both morbidity and mortality in children with bacterial meningitis before such corticosteroid use becomes routine.
Use of corticosteroids in treating infectious diseases. Bacterial meningitis was an almost invariably fatal disease at the start of the 20th century. Acute bacterial meningitis is rapidly progressive bacterial infection of the meninges and subarachnoid space. Bacterial meningitis is life threatening, and must be distinguished from the more common aseptic viral. Do steroids benefit patients with bacterial meningitis.
It is usually caused by bacteria spreading from an ear or throat. Corticosteroids for acute adult bacterial meningitis emconsulte. The picture is even more gloomy for neonatalgramnegativebacillary meningitis, inwhichalmost. Corticosteroids and mortality in children with bacterial. A clinical trial in 301 patients showed a beneficial effect of adjunctive steroid treatment in adults with acute communityacquired pneumococcal meningitis, but data on other organisms or adverse events are sparse. Acute bacterial meningitis abm is a serious lifethreaten. Pdf corticosteroids in bacterial meningitis researchgate. The effectiveness of dexamethasone in the management of acute.
In the past decades the epidemiology and treatment strategies for communityacquired bacterial meningitis have significantly changed. In the first patient, a 51 year old nonalcoholic man, the aortic valve was affected and needed to be replaced in an emergency operation. Opening pressure is generally in the range of 200500 mm h 2 o, although values may be lower in neonates, infants, and children with acute bacterial meningitis. Except in some trials of viral infections, sore throat, and cerebral cysticercosis, all patients also received active antimicrobial agents in addition to placebo or corticosteroids. The inflammatory response induced by bacterial products in the subarachnoid space is responsible for neuronal injury. Although corticosteroids have been used for over half a century, their use for management of many pediatric conditions is controversial. Corticosteroids as adjunctive treatment in austrians. Dec 15, 2010 acute meningitis is a medical emergency with a potential for high morbidity and mortality. Acute bacterial meningitis is associated with high morbidity and mortality despite the availability of effective antibiotics. Nov 01, 2004 the diagnosis of bacterial meningitis rests on csf examination performed after lumbar puncture 1, 7.
Bacterial meningitis is a severe infectious disease of the mem branes lining the. Background acute bacterial meningitis is an inflammation of the meninges, which results from bacterially mediated recruitment and activation of inflammatory cells in the cerebrospinal fluid csf. Acute bacterial meningitis is an infection of the meninges the system of. We selected trials on steroids as adjuvant therapy in adults with acute bacterial meningitis that were published or unpublished. Also, if lumbar puncture is delayed pending neuroimaging results, antibiotic and corticosteroid treatment begins. Most cases of acute meningitis are infectious and result from a potentially wide range of bacterial and viral pathogens. In this study, adjunctive treatment with dexamethasone was given before or with. Mai and colleagues conducted a study of 435 adolescents and adults who presented with acute bacterial meningitis in one vietnamese hospital, where tuberculosis is the most common cause of meningitis. Meningitis is an acute inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges. What is the role of corticosteroids in the treatment of.
Patients with suspected acute bacterial meningitis should be rapidly admitted to hospital and assessed for whether a lumbar puncture lp is clinically safe. Corticosteroids in acute bacterial meningitis request pdf. Findings typically include headache, fever, and nuchal rigidity. Corticosteroids reduce mortality from tuberculous meningitis, at least in the short term corticosteroids may have no effect on the number of people who survive tuberculous meningitis with disabling neurological deficit, but this outcome is less common than death, and the ci for the relative effect includes possible harm. I would like to draw attention to the following printing. Use of corticosteroids and other adjunct therapies for acute. If patients appear ill and findings suggest meningitis, antibiotics see table initial antibiotics for acute bacterial meningitis and corticosteroids are started as soon as blood cultures are drawn and even before lumbar puncture. Infants may present with nonspecific symptoms and signs eg, lethargy, irritability, poor feeding, fever or hypothermia. Corticosteroids for acute bacterial meningitis nejm. Bacterial meningitis is a severe infectious disease of the membranes lining the brain resulting in a high mortality and morbidity throughout the world. It has been estimated that between 5 to 40 percent of all patients can suffer hearing loss. However, adjuvant corticosteroid use in the treatment of bacterial meningitis appears to be increasing. Treatment is with antibiotics and corticosteroids given as soon as possible. Algorithm for the initial management of suspected acute meningitis.
Therefore, meticulous attention must be paid to appropriate treatment and monitoring of patients with this disease. Bacterial meningitis in infants over 3 months of age. Corticosteroid treatment was associated with an increase in recurrent fever rr 1. Corticosteroid dosage for acute bacterial meningitis in. It has been estimated that between 5 to 40 percent of all. Acute bacterial meningitis merck manuals professional edition. Bacterial meningitis is fatal in 5% to 40% of children and 20% to 50% of adults despite treatment with adequate antibiotics. Diagnosis, initial management, and prevention of meningitis. The organized approach to the patient with suspected meningitis enables the prompt administration of antibiotics, possibly corticosteroids, and diagnostic testing with neuroimaging and spinal fluid analysis. Corticosteroids for managing tuberculous meningitis date. Acute bacterial meningitis is an infection of the meninges the system of membranes that envelops the brain and spinal cord. No bacterial disease has undergone a more dramatic change in epidemiology during the past decade than acute bacterial meningitis.
Corticosteroids for acute bacterial meningitis ncbi. Treatment recommended for all patients in selected patient group. Difficult and recurrent meningitis journal of neurology. Acute bacterial meningitis neurologic disorders msd. Eligible published and nonpublished rcts on corticosteroids as adjuvant therapy in acute bacterial meningitis. Acute bacterial meningitis is an infection of the membrane lining the brain that often causes hearing loss and is frequently fatal. Mortality from haemophilus infiuenzae, meningococcal, andpneumococcal meningitis is about 5%, 9%, and 20% respectively. Even with appropriate treatment, morbidity and mortality can be substantial. In studies of experimental bacterial meningitis, adjuvant treatment with corticosteroids, specifically dexamethasone, has beneficial effects. Betamethasone and dexamethasone in adult communityacquired. Corticosteroids for acute adult bacterial meningitis. If it turns out that if its not bacterial meningitis, treatment with steroids could potentially do some harm, says litman. Death and longterm disabilities are common outcomes of acute bacterial meningitis, especially in developing countries, even when.
Bacterial meningitis is a severe, lifethreatening infection of the central nervous system that requires immediate medical attention. Treating meningitis with corticosteroids meningitis center. May 6, 2008 in children with bacterial meningitis, adjuvant treatment with corticosteroids was not associated with a decreased risk for death or shorter hospital stay, according to the results of a retrospective cohort study reported in the may 7 issue of the journal of the american medical association. Eligible patients were adults predefined as 16 years or older with bacterial meningitis, treated with antibiotics and randomised to steroid therapy of any type or placebo. The estimated incidence is 25 per 100 000 people per year in developed countries and may be ten times that in developing countries.
Death rates from bacterial meningitis haveremained largely unchanged despite a bewildering portfolio of potent antibiotics. Bacterial meningitis is fatal in 5% to 40% of children and 20% to 50% of adults despite treatment with. The role of corticosteroids in preventing such outcomes in bacterial meningitis has been widely researched over the last 40 years. Use of corticosteroids in tuberculous meningitis the lancet. Bacterial meningitis, corticosteroids, dexamethasone. For patients with bacterial meningitis, tuberculous meningitis, tuberculous pericarditis, severe typhoid fever, tetanus, or pneumocystis pneumonia with moderate to. First, the introduction of conjugate vaccines in europe resulted in the virtual disappearance of. It is essential for clinicians to recognize the clinical signs and symptoms of meningitis and understand its management and prevention. Acute bacterial meningitis in adults the hospitalist. But if the patient is receiving penicillin four or six hourly and a dose is missed, he or she will have gone without the drug for eight or 12 hours, with potentially serious consequences in the context of pyogenic meningitis. Acute bacterial meningitis is a serious, lifethreatening neurological disease. Practice guidelines for the management of bacterial meningitis. The use of corticosteroids as adjunctive therapy in adults with bacterial meningitis was evaluated in eight studies, performed over 45 years.
1567 605 1272 1535 1449 1180 85 1326 645 1647 963 139 851 264 117 1265 956 1388 1393 759 1326 645 70 1044 536 1080 840 665