Anaerobic Bacterial Meningitis
h4ARK
S. HEEREMA,
MICHAEL DANIRL MAJOR ‘IXMP1.E
E. EIN, M. W. W.
M.D.
Anaerobic meningitis occurred in four patients in whom anaerobic bacteria had not been suspected as a possible cause. The predisposing conditions were typical of those seen in patients previously reported to have this infection and included chronic dtitis media with mastoiditis, chronic sinusitis, recent craniotomy and abdominal trauma. Two of the patients had undergone immunosuppression (immunosuppressed patients); a compromised immune system may facilitate the development of anaerobic meningitis in patients with the ap propriat! underlying conditions. Head and neck neoplasms, head trauma, suppurative pharyngitis and laminectomy wounds are additional situations in which anaerobic meningitis occurs. Anaerobic bacterial meningitis probably occurs more ofted than is recognized. The cerebrospinal fluid should he transported and cultured anaerobically when meningitis develops in a patient with a predisposing condition.
M.D.
MUSHER,
M.D.
BRADSHAW, WII~LIAMk,
M.D. Jr.. M.11.
Meningitis caused by obligate anaerobes is an infrequently recognized disease [l]. Anaerobic meningitis may occur as a complication of a hrain abscess which ruptures into a ventricle or the surface of the brain, but more frequently it occurs as a result of infection which extends into the central nervous system from an adjacent,infectcd area [a]. Most of the reported cases have been associated with a focus of suppuration in the middle ear or the sinuses of the skull. Large reviews of bacterial meningitis generally do not include any cases caused by anaerobic ljacteria. Sophisticated techniques required for the isolation of these organisms are usually not applied to cultures of cerebrospinal fluid, thus, the true incidence of anaerobic meningitis remains u+nown but may not be as small as indicated by recent reviews [l&4]. However, it should be noted that, with rare exceptions, anaerobic bacterial meningitis has not been a focus for sepsis due to anaerobic organisms. In this paper four cases of-meningitis due to anaerobic bacteria are ixcsented. The literature is reviewed, and the clinical setting for this condition is discussed. Recommendations regarding diagnosis and treatment are made. l:rorn The Mcthotlist Hospital. Houston Vctcr:ln’s Atlminiskrtion Iltrspital; ;Intl from tho DCl)artmcnts
of Mctlicinc
Immunology.
Bayl~lr
and MicrolJiologv
and
C~~llcg: of Mctficint!. rcllrih Is shcml~l I)(!
CASE REPORTS Case 1. A 55 fear old y(>ilrs with
I lcolsttrn,‘Texas.Rcq~~csts for
l)os[llral
~~tltlrcssctl to Dr. T. W. Williams. Jr.. Division 01 111fcr:tirlus Disc;isc:s, The Mcthotlist Fltrsl)it;ll. GIfi Bortncr. I lolistcm,‘I’cxls 77031l. bl;lnllsc:ril)l
h4ARK
S. HEEREMA,
MICHAEL DANIRL MAJOR ‘IXMP1.E
E. EIN, M. W. W.
M.D.
Anaerobic meningitis occurred in four patients in whom anaerobic bacteria had not been suspected as a possible cause. The predisposing conditions were typical of those seen in patients previously reported to have this infection and included chronic dtitis media with mastoiditis, chronic sinusitis, recent craniotomy and abdominal trauma. Two of the patients had undergone immunosuppression (immunosuppressed patients); a compromised immune system may facilitate the development of anaerobic meningitis in patients with the ap propriat! underlying conditions. Head and neck neoplasms, head trauma, suppurative pharyngitis and laminectomy wounds are additional situations in which anaerobic meningitis occurs. Anaerobic bacterial meningitis probably occurs more ofted than is recognized. The cerebrospinal fluid should he transported and cultured anaerobically when meningitis develops in a patient with a predisposing condition.
M.D.
MUSHER,
M.D.
BRADSHAW, WII~LIAMk,
M.D. Jr.. M.11.
Meningitis caused by obligate anaerobes is an infrequently recognized disease [l]. Anaerobic meningitis may occur as a complication of a hrain abscess which ruptures into a ventricle or the surface of the brain, but more frequently it occurs as a result of infection which extends into the central nervous system from an adjacent,infectcd area [a]. Most of the reported cases have been associated with a focus of suppuration in the middle ear or the sinuses of the skull. Large reviews of bacterial meningitis generally do not include any cases caused by anaerobic ljacteria. Sophisticated techniques required for the isolation of these organisms are usually not applied to cultures of cerebrospinal fluid, thus, the true incidence of anaerobic meningitis remains u+nown but may not be as small as indicated by recent reviews [l&4]. However, it should be noted that, with rare exceptions, anaerobic bacterial meningitis has not been a focus for sepsis due to anaerobic organisms. In this paper four cases of-meningitis due to anaerobic bacteria are ixcsented. The literature is reviewed, and the clinical setting for this condition is discussed. Recommendations regarding diagnosis and treatment are made. l:rorn The Mcthotlist Hospital. Houston Vctcr:ln’s Atlminiskrtion Iltrspital; ;Intl from tho DCl)artmcnts
of Mctlicinc
Immunology.
Bayl~lr
and MicrolJiologv
and
C~~llcg: of Mctficint!. rcllrih Is shcml~l I)(!
CASE REPORTS Case 1. A 55 fear old y(>ilrs with
I lcolsttrn,‘Texas.Rcq~~csts for
l)os[llral
~~tltlrcssctl to Dr. T. W. Williams. Jr.. Division 01 111fcr:tirlus Disc;isc:s, The Mcthotlist Fltrsl)it;ll. GIfi Bortncr. I lolistcm,‘I’cxls 77031l. bl;lnllsc:ril)l
