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2010, Number 1

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Acta Med 2010; 8 (1)

Neurological complications following the discontinuation of steroid therapy in two patients with pneumococcal meningitis

Rojo-Enríquez A, Skromne-Eisenberg E, Irigoyen-Maldonado MC, Videgaray-Ortega F
Full text How to cite this article

Language: Spanish
References: 9
Page: 33-36
PDF size: 131.80 Kb.


Key words:

Pneumococcal meningitis, meningitis and steroids.

ABSTRACT

Pneumococcal meningitis is potentially fatal and can leave sequelae. Streptococcus pneumoniae causes meningitis more often in adults, with a mortality of approximately 25%, outpacing other agents. Bacterial meningitis is characterized by inflammation of the leptomeninges. Its characteristic triad consisting of fever, neck stiffness and altered mental status. Diagnosis is by lumbar puncture with stains, clumps and cerebrospinal fluid culture. Treatment is with bactericidal antibiotics that penetrate into the cerebrospinal fluid and systemic steroids to reduce neurological complications and mortality. We report two cases of pneumococcal meningitis who had a favorable evolution with treatment, but complications after stopping dexamethasone.


REFERENCES

  1. Koedel U, Scheld W, Pfister H. Pathogenesis and pathophysiology of pneumococcal meningitis. Lancet Infect Dis 2002; 2: 721-736.

  2. Scheld WM, Koedel U, Nathan B, Pfister HW. Pathophysiology of bacterial meningitis: mechanism(s) of neuronal injury. J Infect Dis 2002; 186 Suppl 2: S225-33.

  3. Van de Beek D, de Gans J, Tunkel AR, Wijdicks EF. Community-acquired bacterial meningitis in adults. N Engl J Med 2006; 354: 44-53.

  4. Pfister HW, Feiden W, Einhaulp KM. Spectrum of complications during bacterial meningitis in adults. Results of a prospective clinical study. Arch Neurol 1993; 50: 575-581.

  5. Scarborough M, Gordon SB, Whitty CJ, French N, Njalale Y, Chitani A et al. Corticosteroids for bacterial meningitis in adults in Sub-Saharan Africa. N Engl J Med 2007; 357: 2441-2450.

  6. Van de Beek D, de Gans J, Mclntyre P, Prasad K. Corticosteroids in acute bacterial meningitis. Cochrane Data base Syst Rev 2003; 3: CD004405-CD004405.

  7. de Gans J, Van de Beek D. Dexamethasone in adults with bacterial meningitis. N Engl J Med 2002; 347: 1549-556.

  8. Van de Beek D, de Gans J, Mclntyre P, Prasad K. Steroids in adults with acute bacterial meningitis: a systematic review. Lancet Infect Dis 2004; 4: 139-143.

  9. Van de Beek D, de Gans J. Dexamethasone and pneumococcal meningitis. Ann Intern Med 2004; 141: 327.




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Acta Med. 2010;8