Edit concept Create issue ticket

Staphylococcus Aureus Meningitis

Staphylococcus aureus meningitis is rarely encountered in clinical practice. It is described as a community-acquired ailment that can occur without any major risk factors, but intrahospital infections, mostly associated with neurosurgical interventions, are much more common. Fever is the main symptom, whereas headaches, vomiting, seizures, nuchal rigidity and altered consciousness are reported in a variable number of cases. Examination of the cerebrospinal fluid and subsequent implementation of microbiological studies is pivotal in order to confirm Staphylococcus aureus as the cause of meningitis.


Presentation

Bacterial meningitis is a potentially life-threatening condition caused by a myriad of pathogens. Staphylococcus aureus, a gram-positive bacteria that is responsible for many types of diseases, is rarely described in patients with meningitis. However, it may develop as a community-acquired (CA) infection with a primary source outside of the central nervous system -CNS (skin, soft tissues, heart valves, or bacteremia) [1] [2], or as a nosocomial infection, with head trauma and associated neurosurgical procedures (craniotomy, use of ventricular catheters, intrathecal administration of drugs or infusions, cerebrospinal fluid leakage, etc.) serving as risk factors for the introduction of pathogens in the CNS [1] [3] [4]. In a small number of cases, additional comorbidities, eg. diabetes mellitus, intravenous drug use, and severe alcohol abuse are noticed, possibly contributing to the pathogenesis [1] [3] [5]. Several studies have confirmed that fever is almost universally present in people suffering from Staphylococcus aureus meningitis (SAM), whereas symptoms related to meningeal irritation, such as headaches and nuchal rigidity are not always reported [1] [3] [5]. Furthermore, altered consciousness (ranging from mild alterations in the mental state to coma) and seizures, as well as other focal neurological deficits, vomiting, and a rash are observed in patients who developed SAM [1] [3] [5].

Fever
  • Fever is the main symptom, whereas headaches, vomiting, seizures, nuchal rigidity and altered consciousness are reported in a variable number of cases.[symptoma.com]
  • At admission, more than 75% of the patients had fever, nuchal rigidity and decreased consciousness. In 57% of cases the focus for the S. aureus infection was endocarditis, pneumonia or skin infections.[ncbi.nlm.nih.gov]
  • If patient complains of headache and fever after epidural PCA, physician should perform cerebrospinal fluid study to rule out bacterial meningitis.[e-jnc.org]
  • Most patients had fever (89%), altered mental status (68%), headache (40%), and meningeal signs (29%). The most common CSF findings were pleocytosis (90%), elevated protein level (77%), and hypoglycorrhachia (30%).[ncbi.nlm.nih.gov]
  • […] primary purulent infection, systemic infection symptoms, chills and fever, with persistent and severe headache, neck stiffness is more obvious than general meningitis, except for meningeal In addition to symptoms of inflammation, there are localized[healthfrom.com]
Malaise
  • Patient's mother stated he was doing well until early morning when he complained of malaise, fever and headache. Physical examination was positive for temperature of 40.5 C. Other vital signs were normal.[ijcasereportsandimages.com]
  • Malaise d. Headache (cephalgia) e. Myalgia 2. Increased intracranial pressure, manifestations of which are: a. Headache b. Vomiting c. Eye effects d. Papilledema (late) e.[atsu.edu]
  • […] hospital settings; surface infections include impetigo, folliculitis, abscesses, boils, infected lacerations; deep infections include endocarditis, meningitis, septic arthritis, pneumonia, osteomyelitis; systemic infection may cause fever, headache malaise[msdsonline.com]
  • CLINICAL SYMPTOMS: 1- Infectious manifestations: - Chills - Headache - Fever - Myalgia - Malaise 2- Increased intracranial pressure, manifested as - Headache - lethargy - Vomiting -- Papilledema - Unilateral or bilateral 6th nerve palsy, 3- Meningeal[slideshare.net]
  • Bacteremia may be characterized by one of more of the following symptoms: fever, chills, malaise, abdominal pain, nausea, vomiting, diarrhea, anxiety, shortness of breath, and confusion. Bacteremia is diagnosed by culturing blood for bacteria.[microbewiki.kenyon.edu]
Chills
  • […] primary purulent infection, systemic infection symptoms, chills and fever, with persistent and severe headache, neck stiffness is more obvious than general meningitis, except for meningeal In addition to symptoms of inflammation, there are localized[healthfrom.com]
  • The signature symptoms of meningitis include a severe headache and stiff neck – which, in extreme cases, can cause sufferers to arch backwards – as well as fevers and chills, nausea, sensitivity to light and sound, and sometimes purple or red splotches[giantmicrobes.com]
  • She suffered severe, debilitating pain down her leg, vomiting, headache, fever, chills, lethargy and convulsions but was originally diagnosed with sciatica. She tells her story here.[meningitisnow.org]
  • Chills accompanying fevers are especially suspicious. Many patients with Pneumonia will also cough up sputum produced by the alveoli. Pneumonia is diagnosed through symptoms and a chest examination.[microbewiki.kenyon.edu]
  • Risk factors include: Infections of heart valves Past infection of the brain Past meningitis due to spinal fluid shunts Recent brain surgery Spinal fluid shunt Trauma Symptoms may come on quickly, and include: Fever and chills Mental status changes Nausea[medlineplus.gov]
High Fever
  • You should get medical care right away if you have A sudden high fever A severe headache A stiff neck Nausea or vomiting Early treatment can help prevent serious problems, including death.[icdlist.com]
  • Seek medical care right away if someone has any of these signs or symptoms: Sudden high fever Sudden severe headache Stiff neck that's related to a headache Confusion or seizures Sleepiness or difficulty waking up Sensitivity to light Risk factors Several[columbianeurology.org]
  • fever, vomiting, profuse watery diarrhea, myalgia, hypotension erythematous rash EPIDEMIOLOGY: Occurs worldwide; particularly in areas where personal hygiene is suboptimal; in hospitals by development of antibiotic-resistant strains HOST RANGE: Humans[msdsonline.com]
  • When produced in large quantities, this toxin can enter the blood stream and cause high fever, vomiting, diarrhea, headache, rash, sore throat, and body aches.[microbewiki.kenyon.edu]
Epilepsy
  • […] elsewhere classified Approximate Synonyms Meningitis, staphylococcal ICD-10-CM G00.3 is grouped within Diagnostic Related Group(s) (MS-DRG v 36.0): 023 Craniotomy with major device implant or acute complex cns pdx with mcc or chemotherapy implant or epilepsy[icd10data.com]
  • Experimental models for bloodCNSbarrier observations The best-studied system so far is a human brain microvascular endo-thelial cell line (HBMEC) that has been derived from a brain biopsy of an adult female with epilepsy.[alpfmedical.info]
Vomiting
  • Fever is the main symptom, whereas headaches, vomiting, seizures, nuchal rigidity and altered consciousness are reported in a variable number of cases.[symptoma.com]
  • We report an 11-year-old girl with fever, headache and vomiting, right hemiparesis with left-sided upper motor neuron facial nerve palsy and bladder incontinence.[academic.oup.com]
  • […] localized lesions, sepsis patients may also have other migratory lesions, skin rashes, such as urticaria-like, scarlet fever-like rash or small impetigo, bleeding spots on the skin, but rarely fused, Unlike meningococcal meningitis, such as headache, vomiting[healthfrom.com]
  • She suffered severe, debilitating pain down her leg, vomiting, headache, fever, chills, lethargy and convulsions but was originally diagnosed with sciatica. She tells her story here.[meningitisnow.org]
Nausea
  • The signature symptoms of meningitis include a severe headache and stiff neck – which, in extreme cases, can cause sufferers to arch backwards – as well as fevers and chills, nausea, sensitivity to light and sound, and sometimes purple or red splotches[giantmicrobes.com]
  • You should get medical care right away if you have A sudden high fever A severe headache A stiff neck Nausea or vomiting Early treatment can help prevent serious problems, including death.[icdlist.com]
  • Risk factors include: Infections of heart valves Past infection of the brain Past meningitis due to spinal fluid shunts Recent brain surgery Spinal fluid shunt Trauma Symptoms may come on quickly, and include: Fever and chills Mental status changes Nausea[medlineplus.gov]
  • […] normal flora; produces a variety of syndromes with a range of clinical manifestations; clinically different in general community, newborns, menstruating women, and hospitalized patients; food intoxication is characterized by abrupt/violent onset, severe nausea[msdsonline.com]
Tachycardia
  • Ferri's popular "5 books in 1" format provides quick guidance on vitamin-D deficiency, statin-induced muscle syndrome, postural tachycardia syndrome (POTS), and much more.[books.google.de]
  • Initial physical examination was remarkable for tachycardia of 123 bpm and temperature of 38 C. No meningeal signs or focal deficits were found on the initial presentation. The remaining physical examination was unremarkable.[ijcasereportsandimages.com]
  • […] mycobacterial infection A312Disseminated mycobacterium avium-intracellulare complex (DMAC) A318Other mycobacterial infections A319Mycobacterial infection, unspecified PDX Collection 0083:18 codes A33Tetanus neonatorum P290Neonatal cardiac failure P2911Neonatal tachycardia[cms.gov]
  • Shock: signs of shock include tachycardia and/or hypotension, respiratory distress, altered mental state and poor urine output. Kernig's sign (pain and resistance on passive knee extension with hips fully flexed).[patient.info]
Photophobia
  • […] valves Past infection of the brain Past meningitis due to spinal fluid shunts Recent brain surgery Spinal fluid shunt Trauma Symptoms may come on quickly, and include: Fever and chills Mental status changes Nausea and vomiting Sensitivity to light ( photophobia[medlineplus.gov]
  • Photophobia and a general hyperesthesia to all forms of stimuli are present. Venous congestion of the ocular fundi is common.[atsu.edu]
  • Stiff neck (generally not present in children under the age of one year or in patients with altered mental state), back rigidity, bulging fontanelle (in infants), photophobia, opisthotonus (if severe).[patient.info]
  • Eye affects: - Photophobia - Venous congestion of ocular fundi - Unequal pupils, Pupil dilation - Sluggish reaction to light. 6.[slideshare.net]
Diplopia
  • Diplopia I. Papilledema 6. Mentation a. Delirium b. Drowsiness c. Stupor d. Coma The infant with meningitis may have signs of infection but more commonly is simply fretful and refuses food.[atsu.edu]
Headache
  • Fever is the main symptom, whereas headaches, vomiting, seizures, nuchal rigidity and altered consciousness are reported in a variable number of cases.[symptoma.com]
  • If patient complains of headache and fever after epidural PCA, physician should perform cerebrospinal fluid study to rule out bacterial meningitis.[e-jnc.org]
  • Most patients had fever (89%), altered mental status (68%), headache (40%), and meningeal signs (29%). The most common CSF findings were pleocytosis (90%), elevated protein level (77%), and hypoglycorrhachia (30%).[ncbi.nlm.nih.gov]
  • Volume 1 covers the visual sensory system, the autonomic nervous system, the ocular motor system, the eyelid, facial pain and headache, and nonorganic disease. Volume 2 covers tumors, the phacomatoses, and vascular disease.[books.google.es]
  • […] neck scarlet fever-like skin rash meningitis encephalitis-like changes Onset is not very urgent, often occurs in the first few days or weeks after primary purulent infection, systemic infection symptoms, chills and fever, with persistent and severe headache[healthfrom.com]
Seizure
  • Fever is the main symptom, whereas headaches, vomiting, seizures, nuchal rigidity and altered consciousness are reported in a variable number of cases.[symptoma.com]
  • While in the emergency department, the patient experienced a seizure and was intubated to protect the airway.[academic.oup.com]
  • Seizures: occur more commonly during the acute stage of the disease.[patient.info]
  • There was no history of seizures, head injury, skin or soft-tissue infections, diabetes mellitus, or any immunodeficient state, but he had history of recurrent upper respiratory tract infections.[ijmm.org]
  • If patients have focal neurologic deficits, obtundation, seizures, or papilledema (suggesting increased ICP or an intracranial mass effect), defer lumbar puncture pending results of neuroimaging.[merckmanuals.com]
Irritability
  • Several studies have confirmed that fever is almost universally present in people suffering from Staphylococcus aureus meningitis (SAM), whereas symptoms related to meningeal irritation, such as headaches and nuchal rigidity are not always reported.[symptoma.com]
  • Symptom Staphylococcus aureus meningitis symptoms common symptoms chills meningeal irritation purulent neck neck scarlet fever-like skin rash meningitis encephalitis-like changes Onset is not very urgent, often occurs in the first few days or weeks after[healthfrom.com]
  • Eight hours prior to presentation, the patient developed altered mentation with irritability and restlessness. He had a past history of abdominal trauma related splenectomy ten years ago and had remained asymptomatic thereafter.[jpma.org.pk]
  • Fever and chills Mental status changes Nausea and vomiting Sensitivity to light ( photophobia ) Severe headache Stiff neck Other symptoms that can occur with this disease: Agitation Bulging fontanelles in infants Decreased alertness Poor feeding or irritability[medlineplus.gov]
  • In the critical evaluation of case reports of meningitis one has to recognize that pleocytosis and symptoms of meningeal irritation may exist without actual bacterial infection of the cerebrospinal[jamanetwork.com]
Confusion
  • Trois patients présentaient une confusion. L’analyse du LCR retrouvait moins de 950 éléments avec une hyperprotéinorachie et une hypoglycorachie. Le germe n’a été retrouvé dans le LCR chez deux patients uniquement.[em-consulte.com]
  • MALADIE DE PARKINSON 241 MOUVEMENTS ANORMAUX 249 HÉMIBALLISME 257 TREMBLEMENTS 264 DYSTONIES 267 DÉMENCES 275 PATHOLOGIES INFECTIEUSES 287 SYNDROME MÉNINGÉ FÉBRILE 295 ÉPILEPSIE 81 TRAITEMENT 95 ÉTAT DE MAL ÉPILEPTIQUE 102 ÉPILEPSIE ET GROSSESSE 108 CONFUSION[books.google.ro]
  • Seek medical care right away if someone has any of these signs or symptoms: Sudden high fever Sudden severe headache Stiff neck that's related to a headache Confusion or seizures Sleepiness or difficulty waking up Sensitivity to light Risk factors Several[columbianeurology.org]
  • Seizures, confusion, and an eventual coma are all possibilities if the infection remains untreated. The most reliable way to diagnose meningitis is a lumbar tap, where a sample of spinal fluid is taken from the lower spinal chord.[microbewiki.kenyon.edu]
Focal Neurologic Deficit
  • Furthermore, altered consciousness (ranging from mild alterations in the mental state to coma) and seizures, as well as other focal neurological deficits, vomiting, and a rash are observed in patients who developed SAM.[symptoma.com]
  • Fever is an inconsistent finding, only reported in 25% cases. [3] [5] Altered mental status (AMS) and focal neurologic deficit are inconsistent findings reported in different series with a range for AMS being 18–48% and from 25–65% for focal neurologic[ijcasereportsandimages.com]
  • In our patient, an acute infarct in the left thalamo-capsular region was seen as a complication with residual right lower limb monoparesis seen as a focal neurological deficit.[academic.oup.com]
  • neurologic deficits; death may occur within 24 hours of disease onset; pathologic features include a purulent exudate in the subarachnoid space, and diffuse inflammation of neural and vascular structures.[fpnotebook.com]

Workup

Mortality rates of Staphylococcus aureus meningitis are about 35% according to different case series [1] [5], suggesting that an early diagnosis and proper treatment can be life-saving. For this reason, the role of the physician in obtaining a detailed history and conducting a thorough physical examination is crucial. During collection of anamnestic data, recent trauma to the head and neck area or neurosurgical procedures can point to S. aureus as the underlying etiology. The presumptive diagnosis of meningitis can be made after conducting a proper neurological examination and the evaluation of meningeal signs, but they may be positive in only 29% cases [5], which is why laboratory studies need to be employed. Examination of the cerebrospinal fluid (CSF) is a vital step that aids in discriminating the etiologic factors of CNS diseases [6]. In bacterial meningitis, typical findings are pleocytosis (with a predominance of polymorphonuclear leukocytes), elevated protein levels, and very low concentrations of sugar (hypoglycorrhachia) [6]. Serum inflammatory parameters: C-reactive protein (CRP) and calcitonin are important markers of an ongoing inflammatory process caused by bacteria, but microbiological exams must be used in order to identify the exact pathogen [6]. The culture of CSF, Gram-staining (useful for culture-negative meningitis as it provides fast results), latex agglutination tests, and polymerase chain reaction (PCR), which detects bacterial DNA in the CSF, are constituents of the microbiological workup [6] [7]. Blood cultures may also provide important information in the presence of a systemic infection [6].

Treatment

  • We conclude that flucloxacillin is an effective treatment for meningitis caused by S. aureus.[ncbi.nlm.nih.gov]
  • No severe adverse events occurred in either treatment arm of the study. One-month survival of the patients in whom treatment was successful microbiologically was 2/2 in the vancomycin-treated group and 4/7 in the linezolid-treated group.[ncbi.nlm.nih.gov]
  • After 1 week of linezolid treatment, blood and CSF cultures were sterile. Intravenous treatment was administered for a total of 3 weeks, after which the patient was treated with oral linezolid for 3 months.[ncbi.nlm.nih.gov]
  • High-dose cefuroxime has been the systemic treatment used in the study region, and a retrospective record review was conducted to determine its clinical efficacy.[ncbi.nlm.nih.gov]
  • Only one patient receiving initial treatment with a penicillinase-resistant penicillin died of meningitis, whereas six of 12 patients not so treated died.[ncbi.nlm.nih.gov]

Prognosis

  • The prognosis was related to the age of the patients and the initial antibiotic treatment. Patients treated with penicillinase-stable penicillins in combination with fusidic acid may have a better prognosis.[ncbi.nlm.nih.gov]
  • The infrequency of this infection has made its study difficult and has complicated the issues of treatment and prognosis. We reviewed 28 cases of S. aureus meningitis occurring over a 10-year period at three hospitals.[ncbi.nlm.nih.gov]
  • As to termination, he stated that these cases run a "short course and the prognosis is almost entirely unfavorable."[jamanetwork.com]
  • The prognosis was poor both if the patient had just one predisposing condition and if there where more than one.[bmcinfectdis.biomedcentral.com]

Etiology

  • Examination of the cerebrospinal fluid (CSF) is a vital step that aids in discriminating the etiologic factors of CNS diseases.[symptoma.com]
  • Pathogen Staphylococcal meningitis etiology Staphylococcus aureus infection (35%): Meningitis caused by Staphylococcus aureus is mostly secondary to S. aureus septicemia, and is particularly prevalent in patients with left endocarditis.[healthfrom.com]
  • Use Additional Use Additional Help Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology.[icd10data.com]
  • . 1 Etiological agents include viruses, bacteria, fungi and parasites.[nature.com]
  • Various series report Staphylococcus aureus as the fourth or fifth most common etiology for neuro-infection; more commonly as cause of brain abscess and less commonly as an isolated cause of meningitis (less than 5%). [1] [2] [3] [4] [5] [12] In either[ijcasereportsandimages.com]

Epidemiology

  • The epidemiology, microbiological findings and treatment of this condition are discussed.[ncbi.nlm.nih.gov]
  • In an effort to ascertain important epidemiologic and prognostic risk factors, we analyzed 33 cases of Staphylococcus aureus meningitis occurring over an 8-year period (1976 to 1984).[ncbi.nlm.nih.gov]
  • Methicillin-resistant Staphylococcus aureus (MRSA) meningitis is an uncommon disease, and little is known about its epidemiology, clinical features, therapy, and outcome. We performed a multicenter retrospective study of MRSA meningitis in adults.[ncbi.nlm.nih.gov]
  • Abstract Staphylococcus aureus meningitis is a challenging disease and little is known about its epidemiology. There are no established management guidelines.[ncbi.nlm.nih.gov]
  • Clinical and Epidemiological Study 279 Downloads 32 Citations Abstract Background: This study was undertaken to compare the clinical characteristics of adult methicillin-sensitive Staphylococcus aureus (MSSA) meningitis and adult methicillin-resistant[link.springer.com]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology Most commonly, bacteria reach the subarachnoid space and meninges via hematogenous spread.[merckmanuals.com]
  • "New understandings on the pathophysiology of bacterial meningitis". Curr Opin Infect Dis. vol. 23. 2010. pp. 217-23. Kim, BJ, Hancock, BM, Bermudez, A, Del Cid, N. "Bacterial induction of Snail1 contributes to blood-brain barrier disruption".[infectiousdiseaseadvisor.com]
  • Pathophysiology and clinical presentation Specific features may suggest the aetiology of meningitis. A diffuse maculopapular eruption, which progresses to include petechiae or frank purpura, accompanies 50-60 of cases of meningococcal meningitis.[alpfmedical.info]

Prevention

  • Written by internationally recognized experts—many affiliated with the Centers for Disease Control and Prevention—the book is the most comprehensive, up-to-date, authoritative guide to the recognition, management, prevention, and control of infections[books.google.es]
  • Prevention Staphylococcus aureus meningitis prevention 1. As S. aureus is resistant to many antibiotics and meningitis is a serious infection, bacteria should be cultivated for susceptibility testing to guide rational drug use. 2.[healthfrom.com]
  • Rapidly find the answers you need with separate sections on diseases and disorders, differential diagnosis, clinical algorithms, laboratory results, and clinical preventive services, plus an at-a-glance format that uses cross-references, outlines, bullets[books.google.de]
  • Practices should provide equal focus on prevention and management of both MRSA and MSSA infections among VLBW infants.[pediatrics.aappublications.org]

References

Article

  1. Pedersen M, Benfield TL, Skinhoej P, Jensen AG. Haematogenous Staphylococcus aureus meningitis. A 10-year nationwide study of 96 consecutive cases. BMC Infect Dis. 2006;6:49.
  2. Pereira NMD, Shah I, Ohri A, Shah F. Methicillin resistant Staphylococcus aureus meningitis. Oxf Med Case Reports. 2015;2015(11):364-366.
  3. Chang WN, Lu CH, Huang CR, et al. Epidemiology of adult staphylococcal meningitis in southern Taiwan: a clinical comparison of Staphylococcus aureus infection and coagulase-negative staphylococcal infection. Jpn J Infect Dis. 2007;60(5):262-266.
  4. Kim HB. Nosocomial Meningitis: Moving beyond Description to Prevention. Korean J Intern Med. 2012;27(2):154-155.
  5. Pintado V, Pazos R, Jiménez-Mejías ME, et al. Methicillin-resistant Staphylococcus aureus meningitis in adults: a multicenter study of 86 cases. Medicine (Baltimore). 2012;91(1):10-17.
  6. Brouwer MC, Tunkel AR, van de Beek D. Epidemiology, Diagnosis, and Antimicrobial Treatment of Acute Bacterial Meningitis. Clin Microbiol Rev. 2010;23(3):467-492.
  7. Tunkel AR, Hartman BJ, Kaplan SL, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis. 2004;39(9):1267-1284.

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!
Last updated: 2018-06-21 18:15