Antibiotic therapy for enterobacter meningitis: a retrospective review of 13 episodes and review of the literature

Enterobacter meningitis is an uncommon form of meningitis whose treatment poses a therapeutic dilemma because of the development of resistance to the third-generation cephalosporins while the patient receives therapy. In recent years, we have been using trimethoprim-sulfamethoxazole (TMP-SMZ) as treatment for this infection. In this report, we reviewed 13 episodes of enterobacter meningitis that were treated with various antibiotic regimens and 33 episodes from the literature. We found that the development of resistance to beta-lactam agents may be much higher than that seen in bacteremias (approximately 30%), that the case-fatality rate is lower among our patients than among those described previously, and that all patients who received TMP-SMZ were cured, compared with about 70% of those receiving beta-lactam agents. TMP-SMZ appears to be an acceptable alternative to the cephalosporins for the treatment of enterobacter meningitis.     

Chronic meningitis

The paper presents the past knowledge of the etiology of chronic meningeal syndrome. The causes are divided into those of infective and those of noninfective etiology. Basic recommendations for general diagnostic approach, laboratory, clinical and radiological follow up of the patients have been given. A wide spectrum of differential-diagnostic possibilities has been pointed out, especially in relation to chronic systemic diseases. Characteristic syndromes of chronic meningitis have been separated and concisely described.     

Trimethoprim-sulphamethoxazole-induced meningitis

Drug-induced meningitis is rarely included in the differential diagnosis of aseptic (usually recurrent) meningitis. A 74-year-old man who suffered from recurrent aseptic meningitis following re-exposures to trimethoprim-sulphamethoxazole (Resprim) is presented. The clinical and laboratory findings resembled those found in bacterial meningitis, excluding normal glycorrachia. Extensive microbiological, serologic and imaging studies did not disclose any relevant findings. All symptoms and signs resolved rapidly following drug withdrawal, and findings on follow-up lumbar puncture were normal.     

Cryptococcal meningitis

Fungal meningitis caused by the yeast Cryptococcus neoformans is most commonly seen in patients with defective T-lymphocyte function. This article focuses on the clinical presentation, diagnosis and management of patients with cryptococcal meningitis, in the setting of AIDS and other immunocompromised hosts, and in 'normal' individuals.     

结核性脑膜炎与化脓性脑膜炎的放射诊断对比分析

目的:探讨结核性脑膜炎与化脓性脑膜炎的放射诊断对比效果.方法:化脓性脑膜炎12例和结核性脑膜炎28例分别都进行CT平扫加增强扫描.结果:化脓性脑膜炎中CT发现异常的为58.3%,结核性脑膜炎发现异常的占64.3%,CT发现异常的病例中均有相应的CT特征表现.结论:结核性脑膜炎与化脓性脑膜炎的放射诊断效果都比较好,结合临床可进一步明确判断疾病的性质,从而指导临床制定更为合理的治疗方案.     

Encephalitis and meningitis

Inflammation of the brain and meninges is a common cause of neurologic dysfunction in dogs and cats. A wide range of infectious agents has been demonstrated to cause encephalitis an meningitis, although there are many inflammatory conditions for which an etiology has not been found. Analysis of cerebrospinal fluid is the most useful diagnostic test to identify central nervous system inflammation. This article discusses the common causes of encephalitis and meningitis in dogs and cats, focusing on clinical presentation, diagnostic findings, treatment modalities, and prognosis.     

Hospital-associated bacterial meningitis

Eighteen of 349 cases (5.2 per cent) of bacterial meningitis seen between 1949 and 1973 were hospital-associated (developed after admission to the hospital). The patients were adults, usually males, and developed symptoms and signs of meningitis from 2 to 23 days (mean, 10.1 days) after hospital admission. The diagnosis of bacterial meningitis was made from less than 1 day to 15 days (mean, 4.8 days) after the onset of symptoms. Fourteen of the 18 patients had received antibiotics during the week prior to developing meningitis. Nine (50 per cent) had a chronic, noninfection, underlying illness. Diagnostic or surgical procedures involving the neuraxis or adjacent structures preceded the development of meningitis in 10 of the 18 patients (56 per cent). Only 6 of the 18 patients survived their infection. Prompt recognition, diagnosis, and therapy of hospital-associated meningitis in high-risk patients may reduce the significant mortality.     

Neisseria lactamica meningitis

Neisseria lactamica was recovered from the blood and cerebrospinal fluid of a 7-month-old girl with acute purulent meningitis. The isolate was identified initially as N meningitidis. However, additional biochemical testing at the Center for Disease Control showed that the organism fermented lactose and produced beta-D-galactosidase, thereby confirming its identity as N lactamica.