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Delayed cerebral thrombosis in bacterial meningitis: a prospective cohort study
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Delayed cerebral thrombosis in bacterial meningitis: a prospective cohort study
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Journal Article
Delayed cerebral thrombosis in bacterial meningitis: a prospective cohort study
2013
Overview
Purpose
To study the incidence and clinical characteristics of delayed cerebral thrombosis in bacterial meningitis patients.
Methods
We assessed the incidence and clinical characteristics of delayed cerebral thrombosis in adults with cerebrospinal fluid (CSF) culture-proven community-acquired bacterial meningitis included in a prospective nationwide study in The Netherlands performed from 2006 to 2012.
Results
Delayed cerebral thrombosis occurred in 11 of 1,032 episodes (1.1 %). CSF culture yielded
Streptococcus pneumoniae
in ten patients and
Listeria monocytogenes
in one. Adjunctive dexamethasone therapy was administered before or with the first dose of antibiotics in 9 of 11 patients; two patients were initially not treated with dexamethasone. All patients made good initial recovery, followed by sudden deterioration after 7–42 days. Cranial imaging studies showed multiple cerebral infarctions in all patients. The outcome was unfavorable in all but one patient. In an explorative analysis, patients with delayed cerebral thrombosis had eightfold higher complement C5a CSF concentrations on the diagnostic lumbar puncture as compared in those without delayed cerebral thrombosis (
p
= 0.04).
Conclusion
Delayed cerebral thrombosis is a rare but devastating complication of bacterial meningitis. Adjunctive dexamethasone therapy seems to predispose patients with bacterial meningitis to this complication. We found some evidence that this thrombotic complication is associated with activation of the complement system.
Publisher
Springer-Verlag,Springer,Springer Nature B.V
Subject
/ Anti-Bacterial Agents - therapeutic use
/ Bacteria
/ Coma
/ Dexamethasone - therapeutic use
/ Enzyme-Linked Immunosorbent Assay
/ Female
/ Glucocorticoids - therapeutic use
/ Humans
/ Intracranial Thrombosis - epidemiology
/ Intracranial Thrombosis - etiology
/ Listeria
/ Listeria monocytogenes - isolation & purification
/ Listeriosis - cerebrospinal fluid
/ Male
/ Medicine
/ Meningitis, Bacterial - cerebrospinal fluid
/ Meningitis, Bacterial - complications
/ Meningitis, Bacterial - drug therapy
/ Original
/ Patients
/ Pneumology/Respiratory System
/ Steroids
/ Streptococcal Infections - cerebrospinal fluid
/ Streptococcal Infections - complications
/ Streptococcal Infections - drug therapy
/ Streptococcus pneumoniae - isolation & purification
/ Stroke
