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Steroids in bacterial meningitis: yes

  • Neurology and Preclinical Neurological Studies - CONy Pro/Con debate
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Abstract

Bacterial meningitis is an infectious condition associated with severe morbidity and mortality, even with rapid diagnosis and appropriate antibiotic therapy. Despite decrease in the rate of bacterial meningitis brought about by vaccination programs against Haemophilus influenzae type-B and Streptococcus pneumonia, the incidence of meningitis is still unacceptably high and acute treatment remains the mainstay of therapy. The infection is accompanied by intense inflammatory response, which may carry deleterious effects upon the tissue. This led to the possibility of adjuvant corticosteroid therapy, as an anti-inflammatory agent, in bacterial meningitis. The debate focuses on the rational and evidence supporting and refuting such an approach.

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References

  • Brouwer MC, McIntyre P, de Gans J, Prasad K, van de Beek D (2010) Corticosteroids for acute bacterial meningitis. Cochrane Database Syst Rev 9:CD004405

    PubMed  Google Scholar 

  • Czock D, Keller F, Rasche FM, Häussler U (2005) Pharmacokinetics and pharmacodynamics of systemically administered glucocorticoids. Clin Pharmacokinet 44:61–98

    Article  PubMed  CAS  Google Scholar 

  • Daza P, Banda R, Misoya K, Katsulukuta A, Gessner BD, Katsande R, Mhlanga BR, Mueller JE, Nelson CB, Phiri A, Molyneux EM, Molyneux ME (2006) The impact of routine infant immunization with Haemophilus influenzae type b conjugate vaccine in Malawi, a country with high human immunodeficiency virus prevalence. Vaccine 24:6232–6239

    Article  PubMed  CAS  Google Scholar 

  • de Gans J (2002) Dexamethasone in adults with bacterial meningitis. N Engl J Med 347:1549–1556

    Article  PubMed  Google Scholar 

  • Fitch MT, Silver J (2008) CNS injury, glial scars, and inflammation: inhibitory extracellular matrices and regeneration failure. Exp Neurol 209:294–301

    Article  PubMed  CAS  Google Scholar 

  • Fitch MT, Doller C, Combs CK, Landreth GE, Silver J (1999) Cellular and molecular mechanisms of glial scarring and progressive cavitation: in vivo and in vitroanalysis of inflammation-induced secondary injury after CNS trauma. J Neurosci 19:8182–8198

    PubMed  CAS  Google Scholar 

  • Gross HP, Verner JV, Weller JM (1956) Pneumococcal meningitis treated with hydrocortisone, ACTH, and antibiotics. Med Bull (Ann Arbor) 22:329–331

    CAS  Google Scholar 

  • Hoh TK, Mong CT (1962) The treatment of purulent meningitis with adrenal cortico-steroids. Singapore Med J 3:73–77

    PubMed  CAS  Google Scholar 

  • Kalita J, Misra UK, Ranjan P (2007) Predictors of long-term neurological sequelae of tuberculous meningitis: a multivariate analysis. Eur J Neurol 14:33–37

    Article  PubMed  CAS  Google Scholar 

  • Kastenbauer S (2006) Pneumococcal meningitis: a 21st century perspective. Lancet Neurol 5:104–105

    Article  PubMed  Google Scholar 

  • Koedel U, Scheld WM, Pfister H-W (2002) Pathogenesis and pathophysiology of pneumococcal meningitis. Lancet Infect Dis 2:721–736

    Article  PubMed  Google Scholar 

  • Koedel U, Klein M, Pfister H-W (2010a) New understandings on the pathophysiology of bacterial meningitis. Curr Opin Infect Dis 23:217–223

    Article  PubMed  CAS  Google Scholar 

  • Koedel U, Klein M, Pfister H-W (2010b) Modulation of brain injury as a target of adjunctive therapy in bacterial meningitis. Curr Infect Dis Rep 12:266–273

    Article  PubMed  Google Scholar 

  • Liu L, Johnson H, Cousens S (2012) Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet 379:2151–2161

    Article  PubMed  Google Scholar 

  • Lutsar I (2003) Factors influencing the anti-inflammatory effect of dexamethasone therapy in experimental pneumococcal meningitis. J Antimicrob Chemother 52:651–655

    Article  PubMed  CAS  Google Scholar 

  • Mai N, Chau T, Thwaites G (2007) Dexamethasone in Vietnamese adolescents and adults with bacterial meningitis. Clin Infect Dis 49(9):1387–1392

    Google Scholar 

  • McIntyre PB, Berkey CS, King SM, Schaad UB, Kilpi T, Kanra GY, Perez CM (1997) Dexamethasone as adjunctive therapy in bacterial meningitis. A meta-analysis of randomized clinical trials since 1988. JAMA 278:925–931

    Article  PubMed  CAS  Google Scholar 

  • Molyneux E, Walsh A, Forsyth H, Tembo M (2002) Dexamethasone treatment in childhood bacterial meningitis in Malawi: a randomised controlled trial. Lancet 360(9328):211–218

    Article  PubMed  CAS  Google Scholar 

  • Mustafa MM, Ramilo O, Mertsola J, Risser RC, Beutler B, Hansen EJ, McCracken GH (1989) Modulation of inflammation and cachectin activity in relation to treatment of experimental Hemophilus influenzae type b meningitis. J Infect Dis 160:818–825

    Article  PubMed  CAS  Google Scholar 

  • Nau R, Soto A, Brück W (1999) Apoptosis of neurons in the dentate gyrus in humans suffering from bacterial meningitis. J Neuropathol Exp Neurol 58:265–274

    Article  PubMed  CAS  Google Scholar 

  • Ozen M, Kanra G, Kara A, Bakar EE, Ceyhan M, Secmeer G, Cengiz AB (2006) Long-term beneficial effects of dexamethasone on intellectual and neuropsychological outcome of children with pneumococcal meningitis. Scand J Infect Dis 38:104–109

    Article  PubMed  CAS  Google Scholar 

  • Peltola H (2000) Worldwide Haemophilus influenzae type b disease at the beginning of the 21st century: global analysis of the disease burden 25 years after the use of the polysaccharide vaccine and a decade after the advent of conjugates. Clin Microbiol Rev 13:302–317

    Article  PubMed  CAS  Google Scholar 

  • Quagliarello VJ, Scheld WM (1997) Treatment of bacterial meningitis. N Engl J Med 336:708–716

    Article  PubMed  CAS  Google Scholar 

  • Ribble JC, Braude AI (1958) ACTH and adrenal steroids in the treatment of pneumococcal meningitis in adults. Am J Med 24:68–79

    Article  PubMed  CAS  Google Scholar 

  • Saukkonen K, Sande S, Cioffe C, Wolpe S, Sherry B, Cerami A, Tuomanen E (1990) The role of cytokines in the generation of inflammation and tissue damage in experimental gram-positive meningitis. J Exp Med 171:439–448

    Article  PubMed  CAS  Google Scholar 

  • Scheld W, Koedel U, Nathan B (2002) Pathophysiology of bacterial meningitis: mechanism (s) of neuronal injury. J Infect Dis 186(Suppl 2):S225–S233

    Article  PubMed  CAS  Google Scholar 

  • Schneider O, Michel U, Zysk G, Dubuis O, Nau R (1999) Clinical outcome in pneumococcal meningitis correlates with CSF lipoteichoic acid concentrations. Neurology 53:1584–1587

    Article  PubMed  CAS  Google Scholar 

  • Sharief MK, Ciardi M, Thompson EJ (1992) Blood-brain barrier damage in patients with bacterial meningitis: association with tumor necrosis factor-alpha but not interleukin-1 beta. J Infect Dis 166:350–358

    Article  PubMed  CAS  Google Scholar 

  • Thigpen MC, Whitney CG, Messonnier NE, Zell ER, Lynfield R, Hadler JL, Harrison LH, Farley MM, Reingold A, Bennett NM, Craig AS, Schaffner W, Thomas A, Lewis MM, Scallan E, Schuchat A, Emerging Infections Programs Network (2011) Bacterial meningitis in the United States, 1998–2007. N Engl J Med 364:2016–2025

    Article  PubMed  CAS  Google Scholar 

  • van de Beek D, de Gans J, Spanjaard L, Weisfelt M, Reitsma JB, Vermeulen M (2004) Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med 352(9):950

    Google Scholar 

  • Van Furth A, Roord J (1996) Roles of proinflammatory and anti-inflammatory cytokines in pathophysiology of bacterial meningitis and effect of adjunctive therapy. Infect Immun 64(12):4883–4890

    PubMed  Google Scholar 

  • Weber JR, Tuomanen EI (2007) Cellular damage in bacterial meningitis: an interplay of bacterial and host driven toxicity. J Neuroimmunol 184:45–52

    Article  PubMed  CAS  Google Scholar 

  • Weisfelt M, van de Beek D, Spanjaard L, Reitsma JB, de Gans J (2006) Clinical features, complications, and outcome in adults with pneumococcal meningitis: a prospective case series. Lancet Neurol 5:123–129

    Article  PubMed  Google Scholar 

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Correspondence to Israel Steiner.

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Benninger, F., Steiner, I. Steroids in bacterial meningitis: yes. J Neural Transm 120, 339–342 (2013). https://doi.org/10.1007/s00702-012-0938-0

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  • DOI: https://doi.org/10.1007/s00702-012-0938-0

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