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Aktuelle klinische Aspekte der bakteriellen Meningitis

Current clinical aspects of bacterial meningitis

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Intensivmedizin und Notfallmedizin

Summary

The most common cerebral complications of bacterial (purulent) meningitis are generalized brain edema, cerebrovascular arterial or venous complications and hydrocephalus. These complications may cause an increase in intracranial pressure. In severe, complicated clinical courses of bacterial meningitis adjunctive therapeutic strategies, e. g., intravenous intravenous administration of hyperosmolar agents (mannitol) and external intraventricular drainage, are used in addition to antibiotics. If septic sinus or cortical venous thrombosis is diagnosed using MRI, dose-adjusted intravenous heparin has to be considered. Recent data from a prospective randomized multicenter trial in adults with bacterial meningitis showed a beneficial effect of intravenous dexamethasone when compared with placebo in patients with pneumococcal meningitis. According to these results, dexamethasone is recommended in adults with suspected bacterial meningitis (i. e., clinical suspicion plus cloudy cerebrospinal fluid (CSF), detection of bacteria in the CSF by means of Gram’s stain, or a CSF pleocytosis of >1000 cells/μl).

Zusammenfassung

Zu den wichtigsten zerebralen Komplikationen der bakteriellen (eitrigen) Meningitis gehören: generalisiertes Hirnödem, zerebrovaskuläre arterielle oder venöse Komplikationen und Hydrozephalus. Diese Komplikationen können zu einem Anstieg des intrakraniellen Drucks führen. Bei schweren, komplizierten klinischen Verläufen der bakteriellen Meningitis werden zusätzlich zu den Antibiotika verschiedene adjuvante Therapiemaßnahmen eingesetzt, z. B. intravenöse Gabe von hyperosmolaren Substanzen (Mannit) und externe intraventrikuläre Liquordrainage. Wenn im Kernspintomogramm eine septische Sinusoder kortikale Venenthrombose nachweisbar ist, sollte die Dosisadaptierte intravenöse Heparintherapie erwogen werden. Die kürzlich publizierten Daten einer prospektiven, randomisierten, multizentrischen Doppelblindstudie bei Erwachsenen mit bakterieller Meningitis zeigten einen günstigen Effekt einer intravenösen Dexamethasontherapie im Vergleich zu Placebo bei Patienten mit Pneumokokkenmeningitis. Aufgrund dieser Studie wird die Gabe von Dexamethason bei erwachsenen Patienten mit V. a. bakterielle Meningitis (d. h. klinischer Verdacht plus trüber Liquor, Nachweis von Bakterien im Liquor in der Gramfärbung oder einer Liquorpleozytose von >1000/μl) empfohlen.

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Authors and Affiliations

  1. Neurologische Klinik Klinikum Großhadern, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Germany

    T. A. Rupprecht &  H.-W. Pfister

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  1. T. A. Rupprecht
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  2. H.-W. Pfister
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Correspondence to H.-W. Pfister.

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Serie: Die Intensivtherapie bei Entzündungen des Nervensystems Herausgegeben von U. Meyding-Lamadé, V. Schuchardt und E. Schmutzhard

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Rupprecht, T.A., Pfister, HW. Aktuelle klinische Aspekte der bakteriellen Meningitis. Intensivmed 41, 565–572 (2004). https://doi.org/10.1007/s00390-004-0549-6

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  • DOI: https://doi.org/10.1007/s00390-004-0549-6

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