[Two cases of severe bacterial meningitis with paranasal sinusitis followed by cerebrovascular disease--pathophysiology and treatment of cerebrovascular disease].
We report two cases of pneumococcal meningitis with paranasal sinusitis followed by cerebrovascular disease. Both cases were occupational divers, and had past histories of head trauma and paranasal sinusitis. Despite the combined therapy with antibiotics and dexamethasone, they developed cerebrovascular complications. Case 1 developed cerebral infarction and hemorrhage on day 13, and in case 2 cerebral infarction occurred on day 15. In both cases, serum levels of TNF-alpha and IL-6 were elevated in the early stage of the illness (12 pg/ml and 21.3 pg/ml in case 1, and 50 pg/ml and 7,570 pg/ml in case 2, respectively). In case 2, TNF-alpha, IL-1 beta and IL-6 levels in the cerebrospinal fluid were also elevated on day 4 (25 pg/ml, 320 pg/ml and 6,870 pg/ml, respectively). Thrombocytosis was observed in both cases before the onset of the cerebrovascular complications. These cytokines may play significant roles in thrombocytosis leading to cerebrovascular complications in pneumococcal meningitis. Although the use of steroids as adjunctive therapy for bacterial meningitis has been found to be beneficial, the dosage of dexamethasone administered in our cases may not be enough to suppress the synthesis and release of the cytokines. Therefore, administration of large doses of glucocorticoid should be recommended before the treatment with antibiotics.
Miyazato
M
M
Department of Internal Medicine, Miyazaki Medical College.
Ohi
T
T
Sugimoto
S
S
Nagata
N
N
Matsukura
S
S
D000328:Adult; D000667:Ampicillin / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002561:Cerebrovascular Disorders / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy; D003907:Dexamethasone / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D005839:Gentamicins / Q000008:administration & dosage; D006801:Humans; D007375:Interleukin-1 / Q000378:metabolism; D015850:Interleukin-6 / Q000378:metabolism; D008297:Male; D008586:Meningitis, Pneumococcal / Q000150:complications* / Q000188:drug therapy; D010406:Penicillins / Q000008:administration & dosage; D012852:Sinusitis / Q000150:complications* / Q000188:drug therapy; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
D000900:Anti-Bacterial Agents; D005839:Gentamicins; D007375:Interleukin-1; D015850:Interleukin-6; D010406:Penicillins; D014409:Tumor Necrosis Factor-alpha; D000667:Ampicillin; D003907:Dexamethasone