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Bacterial meningitis due to pericraneal fistula in adults: thirty years of experience

Abstract number: P1360

Bodro M., Cabellos C., Verdaguer R., Lopez L., Gudiol F., Acebes J., Fernandez Viladrich P.

Objective: To know the etiology, clinical characteristics and outcome of bacterial meningitis due to pericranial fistula.

Methods: In our hospital all cases of bacterial meningitis are routinelly recorded in a 120 variables protocol. Pericranial fistula was diagnosed when pts referred patent rhino or otoliquorrhachia, when a bone defect was present in a CT scan or MRI, when isotopic cisternography revealed a CSF leak or with a history of neurosurgery trough nose or otologic surgery or cranial trauma. CSF and blood cultures were performed by standard methods. Early post surgical fistula was defined as that presenting in the first 20 days after surgery and late fistula as cases presenting later. Traumatic cases were classified in <1 yr, 1–10 yrs and >10 yrs according with the time of traumatic event.

Results: Between 1977 and 2008, 1256 episodes of bacterial meningitis in adults have been treated in our hospital. Among them 141 episodes in 129 pts were due to pericranial fistula. Pericranial fistula related episodes were present in 94 men (66%) and 47 women (34%). Mean age was 46.3 (16–93). Fistula was due to previous surgery in 60 episodes (42%), 31 (51%) due to early fistula and 29 (49%) to late fistula. Previous trauma was present in 67 (47%), 1 yr before in 31 (46.2%), 1 to 10 yrs in 20 (29.8%) and >10 yrs in 16 (24%). 38 episodes were recurrent meningitis. 2 pts presented 3 episodes. Etiology was S. pneumoniae in 63 (44%), H. influenzae in 17 (12%), other streptococcal in 11 (8%), Neisseria spp. in 2 (2%), anaerobical in 1 and unknown in 45 (32%). On admission fever was present in 115 (81%), headache in 113 (80%), nausea/vomiting in 86 (61%), GCS < 8 in 30 (21%), seizures in 19 (13%). Blood cultures were positive in 57 (40%) and CSF culture in 80 (56%). Sequelae were present in 7 (5%). Overall mortality was 8 (5.6%) (4 due to early neurological causes, 1 due to late neurological causes and 3 due to not related causes). Reparative surgery was performed in 52 pts. Among pneumococcal meningitis episodes a comparison was made in mortality among episodes due to fistula or other focus. Mortality was significantly lower in fistula related episodes 5/63 (8%) than in other pneumococcal episodes 56/200 (28%), p < 0.05.

Conclusion: Bacterial meningitis related to pericranial fistula is still due mainly to S. pneumoniae and H. influenzae. Trauma or neurosurgery may be a remote fact. Prognosis is good with a very low mortality and special efforts should be done to repair the fistula to avoid further episodes.

Session Details

Date: 10/04/2010
Time: 00:00-00:00
Session name: Abstracts 20th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Vienna, Austria, 10 - 13 April 2010
Presentation type:
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