Delayed cerebral vasculopathy in pneumococcal meningitis: epidemiology and clinical outcome. A cohort study
Author
Boix-Palop, Lucía
Fernández, Tamara
Pelegrín, Iván
Obradors, Meritxell
García-Roulston, Kevin
Xercavins Valls, Mariona
García-Somoza, Dolors
Ardanuy, Carmen
Grau, Javier
Calbo Sebastián, Esther
Cabellos, Carmen
Publication date
2020-08ISSN
1201-9712
Abstract
Background: To describe the prevalence, clinical characteristics, impact of systemic steroids exposure and outcomes of delayed cerebral vasculopathy (DCV) in a cohort of adult patients with pneumococcal meningitis (PM). Methods: Observational retrospective multicenter study including all episodes of PM from January 2002 to December 2015. DCV was defined as proven/probable/possible based upon clinical criteria and pathological-radiological findings. DCV-patients and non-DCV-patients were compared by univariate analysis. Results: 162 PM episodes were included. Seventeen (10.5%) DCV-patients were identified (15 possible, 2 probable). At admission, DCV-patients had a longer duration of symptoms (>2 days in 58% vs. 25.5% (p 0.04)), more coma (52.9% vs. 21.4% (p 0.03)), lower median CSF WBC-count (243 cells/uL vs. 2673 cells/uL (p 0.001)) and a higher proportion of positive CSF Gram stain (94.1% vs. 71% (p 0.07)). Median length of stay was 49 vs. 15 days (p 0.001), ICU admission was 85.7% vs. 49.5% (p 0.01) and unfavorable outcome was found in 70.6% vs. 23.8% (p 0.001). DCV appeared 1-8 days after having completed adjunctive dexamethasone treatment (median 2,5, IQR = 1.5-5). Conclusions: One tenth of the PM developed DCV. DCV-patients had a longer duration of illness, were more severely ill, had a higher bacterial load at admission and had a more complicated course. Less than one third of cases recovered without disabilities. The role of corticosteroids in DCV remains to be established.
Document Type
Article
Document version
Published version
Language
English
Subject (CDU)
61 - Medical sciences
616.8 - Neurology. Neuropathology. Nervous system
Keywords
Meningitis
Cervell -- Malalties
Pneumococs
Bacteries
Meningitis
Cerebro -- Enfermedades
Streptococcus pneumoniae
Bacterias
Meningitis
Brain -- Diseases
Pneumococcus
Bacteria
Pages
7
Publisher
Elsevier
Collection
97;
Is part of
International Journal of Infectious Diseases
Citation
Boix-Palop, Lucía; Fernández, Tamara; Pelegrín, Iván [et al.]. Delayed cerebral vasculopathy in pneumococcal meningitis: epidemiology and clinical outcome. A cohort study. International Journal of Infectious Diseases, 2020, 97, p. 283-289. Disponible en: <https://www.sciencedirect.com/science/article/pii/S1201971220304409?via%3Dihub>. Fecha de acceso: 13 may. 2021. DOI: 10.1016/j.ijid.2020.06.005
This item appears in the following Collection(s)
- Ciències de la Salut [745]
Rights
© 2020 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Except where otherwise noted, this item's license is described as https://creativecommons.org/licenses/by-nc-nd/4.0/