Spotlight on Gram-negative bacillary meningitis

Gram-negative bacilli are common organisms in nosocomial meningitis in adults. Escherichia coli containing the K1 capsule is the leading cause of gram-negative meningitis in neonates. Nosocomial gram-negative bacterial meningitis is a complication in a variety of surgical procedures, such as craniotomy, placement of internal or external ventricular catheters, lumbar puncture, intrathecal infusions, or spinal anesthesia; it can also occur with head injury or secondary to metastatic infection in patients with hospital-acquired bacteremia. The mortality and morbidity associated with gram-negative meningitis have remained significant despite advances in antimicrobial chemotherapy. Some patients lack many of the classic features of bacillary meningitis, especially the elderly, and pose a diagnostic challenge. The exact pathogenesis of gram-negative meningitis is not completely understood. A meta-analysis suggests that prophylactic antibiotics administered before craniotomy reduce rates of postoperative meningitis by one half. Some older antibiotics like polymyxins have been found useful for the treatment of several intensive care unit-acquired infections including meningitis. Combination antibiotic treatment with intraventricular gentamicin was found an effective and safe alternative. Currently, the emergence of multidrug-resistant gram-negative bacilli is a major concern, especially in patients with nosocomial bacterial meningitis. In this updated summary, Dr R K Garg reviews the latest information on the clinical features, etiology, pathogenesis, treatment, and outcome of gram-negative bacillary meningitis.

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MedLink Neurology authors are always at work to bring you broad and up-to-date coverage of neurology topics. We are pleased to highlight clinical summaries that have been recently added or updated and to introduce the authors who write these authoritative articles. We hope you enjoy these overviews and appreciate the contributions of our more than 450 authors who keep MedLink Neurology the premier information resource for neurologists.

Spotlight on CNS listeriosis

Meningitis is the most common CNS infection caused by Listeria monocytogenes, but it can also cause rhombencephalitis, cerebritis, or abscess formation. In this updated clinical summary, Dr. Ratchford of Johns Hopkins Hospital discusses the epidemiology, diagnosis, and treatment of CNS listeriosis. This update includes a review of the major Listeria epidemics and a discussion of recent data indicating that the rate of Listeria infection appears to be decreasing. High-risk foods are highlighted along with recommendations on the prevention of this infection in at-risk groups, such as neonates, the elderly, pregnant women, and immunocompromised patients.

To view the complete clinical summary, click here.

MedLink Neurology authors are always at work to bring you broad and up-to-date coverage of neurology topics. We are pleased to highlight clinical summaries that have been recently added or updated and to introduce the authors who write these authoritative articles. We hope you enjoy these overviews and appreciate the contributions of our more than 450 authors who keep MedLink Neurology the premier information resource for neurologists.

Spotlight on Recurrent meningitis

The term “recurrent meningitis” encompasses a variety of conditions, some of which are life-threatening, some spontaneously remitting, and some representing exacerbations of chronic infections. Recurrent meningitis may, thus, represent repeated episodes of bacterial meningitis, recurrent episodes of viral meningitis, chemical meningitis due to rupture of dermoid or parasitic cysts, or meningitis in response to nonsteroidal or other agents. In some instances, as in protracted cases of meningitis due to Cryptococcus neoformans, what appears to be recurrent meningitis may actually represent periodic exacerbations of a chronic, ongoing infectious process.

In this clinical summary, Dr. John Greenlee, Professor of Neurology at University of Utah School of Medicine and staff neurologist at the George E Wahlen Veterans Affairs Medical Center in Salt Lake City, Utah, reviews the pathogenesis, clinical features, diagnosis, and treatment of this group of disorders.

To view the complete clinical summary, click here.

MedLink Neurology authors are always at work to bring you broad and up-to-date coverage of neurology topics. We are pleased to highlight clinical summaries that have been recently added or updated and to introduce the authors who write these authoritative articles. We hope you enjoy these overviews and appreciate the contributions of our more than 450 authors who keep MedLink Neurology the premier information resource for neurologists.