Acute Bacterial Meningitis in Adults
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Acute bacterial meningitis in adults remains a significant disease burden with a high mortality rate of up to 30%. It is a medical emergency requiring rapid diagnosis via cerebrospinal fluid analysis. Common causes include Streptococcus pneumoniae, Neisseria meningitidis, and various bacteria that affect immunocompromised individuals. Early diagnosis and treatment are essential to improve prognosis, as sequelae such as hearing loss are otherwise common.
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All the causes of this type of TN seen in our clinic in the last 6 years.
When we clasifiy TN by etiology we have three different groups: Classical TN includes patients that have a neurovascular contact on MRI. Secondary TN groups patients with neuropathy caused or associated to another disease and Idiopathic TN includes the patients that do not have an apparent cause for the disease.
In 2016 The AAN published in it’s journal a new classification for trigeminal neuralgia. This new classification resolved some of the confusión that could appear when trying to group patients with the disesae. The big change in this classification is the differentiation of 2 categories, the first one is clinical presentaion; patients with TN can present with sudden episodes of pain that happen scattered during the day and are usually triggered by certain activies or sensations or they can present with a more severe form of continuos persistent pain on top of the paroxismal pain attacks.
On the other hand we can also talk about 3 main types of TN based on it’s etiology. The first and most common group representing about 70% of the patients is Classical TN which includes those patients that have a neurovascular contact affecting the 5th CN and that is demonstrated through an MRI. Secondary TN includes all the patients with the disease that have pain in the distribution of the 5th CN caused by another disease. And Idiopathic TN represents the smallest group in which there is no apparent cause that explains the presence of trigeminal pain.
The European Academy of Neurology recently published a new guideline in 2020 which endorses this classification and furthermore Groups Classical TN and Idiopathic TN into a category named Primary TN when the disease process is intrinsic to the Trigeminal Nerve and Secondary when the disease starts somewhere else.
Bendtsen, L., Zakrzewska, J.M., Abbott, J., Braschinsky, M., Di Stefano, G., Donnet, A., ... & Cruccu, G. (2019). European Academy of Neurology guideline on trigeminal neuralgia. European Journal of Neurology, 26(6), 831-49.
Cruccu, G., Finnerup, N.B., Jensen, T.S., Scholz, J., Sindou, M., Svensson, P., ... & Nurmikko, T. (2016). Trigeminal neuralgia: New classification and diagnostic grading for practice and research. Neurology, 87(2), 220-8.
Carranza-Renteria O, Segura-Lozano M. Evaluation of the New Classification of Trigeminal Neuralgia with a Retrospective Analysis. J Neurol Surg B Skull Base 2019; 80(S 01): S1-S244 DOI: 10.1055/s-0039-1679829
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5. ECG in Medical Practice by ABM Abdullah, 4th edition
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- 1. ACUTE BACTERIAL MENINGITIS IN ADULTS ADE WIJAYA, MD – OKTOBER 2020
- 2. INTRODUCTION Remains a significant burden of disease in adults, with a mortality of up to 30%. True medical emergency Cerebrospinal fluid is essential for diagnosis McGill F, Heyderman RS, Panagiotou S, Tunkel AR, Solomon T. Acute bacterial meningitis in adults. The Lancet. 2016 Dec 17;388(10063):3036-47.
- 3. ETIOLOGY Streptococcus pneumonia (most common) Neisseria meningitides Haemophilus influenzae type b (Infant and Children) Streptococcus suis (South East Asia) Enterobacteriaceae (immunocompromised) Staphylococcus aureus (immunocompromised) Listeria monocytogenes (immunocompromised) McGill F, Heyderman RS, Panagiotou S, Tunkel AR, Solomon T. Acute bacterial meningitis in adults. The Lancet. 2016 Dec 17;388(10063):3036-47.
- 4. PATHOGENESIS McGill F, Heyderman RS, Panagiotou S, Tunkel AR, Solomon T. Acute bacterial meningitis in adults. The Lancet. 2016 Dec 17;388(10063):3036-47.
- 5. DIAGNOSIS Viallon A, Botelho-Nevers E, Zeni F. Clinical decision rules for acute bacterial meningitis: current insights. Open access emergency medicine: OAEM. 2016;8:7.
- 6. DIAGNOSIS McGill F, Heyderman RS, Panagiotou S, Tunkel AR, Solomon T. Acute bacterial meningitis in adults. The Lancet. 2016 Dec 17;388(10063):3036-47.
- 7. DIAGNOSIS Gram stain and culture of the cerebrospinal fluid PCR Multiplex PCR McGill F, Heyderman RS, Panagiotou S, Tunkel AR, Solomon T. Acute bacterial meningitis in adults. The Lancet. 2016 Dec 17;388(10063):3036-47.
- 8. TREATMENT McGill F, Heyderman RS, Panagiotou S, Tunkel AR, Solomon T. Acute bacterial meningitis in adults. The Lancet. 2016 Dec 17;388(10063):3036-47.
- 9. PROGNOSIS Poor prognosis factors: - Older age - Reduced conscious level - Tachycardia - Cerebrospinal fluid leucocyte count of less than 1000 × 10⁹ cells per mL - Reduced platelet count Prognosis can be improved by instigating both antibiotic and steroid treatment early Okike IO, Ribeiro S, Ramsay M, Heath PT, Sharland M, Ladhani SN. Trends in bacterial, mycobacterial and fungal meningitis in England and Wales 2004–11: an observational study. Lancet Infect Dis van de Beek D, de Gans J, Spanjaard L, Weisfelt M, Reitsma JB, Vermeulen M. Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med 2004; 351: 1849–59.
- 10. COMPLICATION Sequelae are more common in pneumococcal meningitis than meningococcal meningitis Hearing loss is one of the most common problems after meningitis, particularly pneumococcal meningitis Other sequelae include limb loss, especially if meningococcal sepsis occurs Subdural empyema Hydrocephalus Seizures Other less life-threatening sequelae include neurocognitive dysfunction such as sleep disorders McGill F, Heyderman RS, Panagiotou S, Tunkel AR, Solomon T. Acute bacterial meningitis in adults. The Lancet. 2016 Dec 17;388(10063):3036-47.
- 11. SUMMARY True medical emergency Need early diagnosis and treatment Future direction: vaccine
- 12. THANK YOU