Cases reported "Meningitis, Meningococcal"

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1/6. An unusual case of chronic meningitis.

    BACKGROUND: Chronic meningitis is defined as symptoms and signs of meningeal inflammation and persisting cerebrospinal fluid abnormalities such as elevated protein level and pleocytosis for at least one month. CASE PRESENTATION: A 62-year-old woman, of unremarkable past medical history, was admitted to hospital for investigation of a four-week history of vomiting, malaise an associated hyponatraemia. She had a low-grade pyrexia with normal inflammatory markers. A CT brain was unremarkable and a contrast MRI brain revealed sub-acute infarction of the right frontal cortex but with no evidence of meningeal enhancement. Due to increasing confusion and patient clinical deterioration a lumbar puncture was performed at 17 days post admission. This revealed gram-negative coccobacilli in the CSF, which was identified as neisseria meningitidis group B. The patient made a dramatic recovery with high-dose intravenous ceftriaxone antibiotic therapy for meningococcal meningitis. CONCLUSIONS: 1) Chronic bacterial meningitis may present highly atypically, particularly in the older adult. 2) There may be an absent or reduced febrile response, without a rise in inflammatory markers, despite a very unwell patient. 3) Early lumbar puncture is to be encouraged as it is essential to confirm the diagnosis.4) Despite a delayed diagnosis appropriate antibiotic therapy can still lead to a good outcome.
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2/6. Use of universal polymerase chain reaction assay and endonuclease digestion for rapid detection of Neisseria meningitides.

    neisseria meningitidis is a major cause of bacterial meningitis worldwide, especially in children. early diagnosis and empiric antibiotic treatment have led to a reduction in morbidity and mortality. The value of the traditional gold standard diagnostic tests, blood culture and cerebrospinal fluid (CSF) culture, has been adversely affected by preadmission use of parenteral penicillin and fewer lumbar punctures. We report a case of N. meningitidis in a 19-year-old male who was admitted after suffering from progressive severe headache, and intermittent high fever for 2 days. Gram stain and culture of CSF, and culture of throat swab were negative. However, N. meningitidis was detected by polymerase chain reaction (PCR) with a universal primer set and endonuclease digestion. This report indicated that the PCR method may be an alternative method for the rapid diagnosis of meningococcal meningitis.
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3/6. False-positive latex agglutination test for neisseria meningitidis groups A and Y caused by povidone-iodine antiseptic contamination of cerebrospinal fluid.

    The cerebrospinal fluid of a patient yielded a positive latex agglutination test for neisseria meningitidis groups A and Y. The latex agglutination results were not consistent with clinical and other laboratory findings. An investigation determined that the positive agglutination test was caused by contamination of the cerebrospinal fluid with povidone-iodine during the lumbar puncture.
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4/6. Meningococcal septicaemia presenting as erythema multiforme.

    A 48-year-old woman presented with a three-week history of recurrent, generalised rash, flitting joint pains, frontal headache and shivering attacks. On admission she was pyrexial and exhibited a symmetrical generalised maculopapular rash with a few target lesions. The rash faded within the first 24 hours, but over the following week it recurred at intervals of 48 hours and was accompanied by fever and headache. She was started on a short course of steroids, which did not alter her symptoms or signs. Eight days after admission, the patient underwent a lumbar puncture, despite the absence of definite signs of meningeal irritation. The cerebrospinal fluid (CSF) was turbid and diagnostic of bacterial meningitis. Cultures of blood and CSF taken on the day of admission both grew neisseria meningitidis. The patient was successfully treated; symptoms were completely resolved.
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5/6. 'Normal' CSF in bacterial meningitis.

    cerebrospinal fluid with a normal cell count, glucose and protein values, and a negative Gram's stain smear is usually assumed to exclude the possibility of meningitis. We describe four patients and review from literature 19 patients with pyogenic meningitis in whom the CSF initially appeared normal. Thus, finding minimal or no initial CSF abnormality is consistent with early or developing bacterial meningitis. Repeated lumbar puncture and CSF examination within 24 hours should be considered in all febrile patients in whom the clinical features remain compatible with meningitis.
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6/6. Hemorrhagic stroke as a complication of bacterial meningitis in adults: report of three cases and review.

    We describe three adults who had hemorrhagic strokes during the acute phase of bacterial meningitis (BM). We also report the results of a literature review and a review of the charts of 296 adults treated at our hospital for acute BM. The diagnosis of hemorrhagic stroke was made based on the results of cerebral computed tomography (CT) for two of 92 patients with BM who had CT performed and by means of lumbar puncture and a postmortem study in one other case. Two patients died of cerebral bleeding. Although the frequency of hemorrhagic stroke was only 2.1% among adults with acute BM, it is a major determinant of prognosis for such patients.
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