Recurrent purulent bacterial meningoencephalitis

Abstract During the period of 25 years there were 55 patients treated in our Institute because of recurrent purulent bacterial meningoencephalitis(rpbme). This group consisted of 42 males (76%) and 13 (24%) females, the prevalent number (53%) of patients being under 21 years of age. The diagnosis of rpbme was based on the commonly accepted criteria and confirmed by the laboratory results of CSF examination. The cause of the recurrences was established considering the skull X-ray examination, CT and MRI. The evaluation of the clinical status was based on the Glasgow Coma Score (GCS). During the first hospitalisation, severe or critic clinical status was noted in 42 patients (76%) and moderate in 13 (24%). The subsequent recurrences were mostly moderate, rarely severe or mild. The number of recurrences varied from 1 to 9. During the first hospitalisation, the etiologic factor was detected in 39 patients (71%), i.e. Streptococcus pneumoniae in 28 (51%), Neisseria meningitidis in 8 (14%), Pseudomonas aeruginosa and Staphylococcus aureus in 2 and 1 patients respectively. In 37 patients (67%) rpbme developed following cranial trauma, in 18 cases (33%) with single or comminuted fractures of the anterior cranial fossa (in 4 cases accompanied by CSF nasal exsudate). In 4 it followed neurosurgical intervention, in 3 it accompanied recurrent purulent highmorities, in 1 case--after removal of the nasal polyps and subsequent CSF nasal exsudate, and in 1 patient with recurrent mastoiditis. In 6 cases (11%) the cause of the recurrences remained unelucidated. The clinical signs and symptoms, diagnostic difficulties and the causative treatment of rpbme are discussed. In the authors' opinion, surgical treatment of the communication between the CSF and the external environment prevents the recurrences and is the only successful way of treatment. Special attention is drawn to the great diagnostic value of CT and MRI. The use of other modern techniques, e.g. positron emission tomography (PET) is recommended, because it is useful not only in the functional evaluation of the cerebral tissue after the injury, but also in assessing the dynamics of pathologic changes.