Bacterial Meningitis With Cerebral Edema in a Young Adult: A Simulation Case for Medical Students.

Introduction: Simulation in the preclinical medical education setting is a beneficial tool for students to develop clinical skills, supplement preexisting knowledge, and prepare for clinical rotations and beyond. We detail the complete simulation scenario, including a participant postresponse questionnaire, of a 28-year-old male who developed bacterial meningitis after experiencing an upper respiratory infection in the days prior. Methods: Simulation fellows and faculty at the Alabama College of Osteopathic Medicine created a simulation scenario pertaining to bacterial meningitis. The scenario utilized a high-fidelity patient simulator, one standardized participant for patient voiceover, one standardized participant as a patient family member, and one standardized participant as a physician consultant on an as-needed basis. Sixteen preclinical medical students from various specialty interest groups were recruited to participate in the scenario and complete the postscenario questionnaire. Results: The simulation scenario was well received by the participants, and 15 of 16 completed the postscenario questionnaire. Ninety-three percent strongly agreed the simulation was a valuable clinical experience. Additionally, 73% of participants strongly agreed that the simulation experience was realistic, 80% strongly agreed that it tested their clinical reasoning ability, and 53% strongly agreed it was appropriate for their level of clinical knowledge. Discussion: Medical simulation is a valuable educational tool tailored to maximize student learning and supplement the traditional didactic curriculum. The successful development and implementation of our meningitis simulation case further supports the continued use of medical simulation in the preclinical setting.

Diagnosis and management of adult bacterial meningitis.

The early use of appropriate antibiotic therapy is one of the important and explicit steps in the management of potentially fatal adult acute bacterial meningitis (ABM). Changing epidemiology of ABM, especially with regards to the change of the relative frequency of causative pathogens, has been noted in a serial of studies in Taiwan. This change may influence the choice of initial empiric antibiotic treatment. In this review, the authors will discuss the epidemiologic trend, diagnosis and management of ABM in Taiwan. For a better understanding, the clinical and laboratory data of 204 adult ABM cases diagnosed at Chang Gung Memorial Hospital-Kaohsiung, collected over a period of 8 years (1999-2006), were included for analysis. This review may help first-line, primary-care neurologists have a better view on handling this critical central nervous system infection.

Successful treatment of cervical spinal epidural abscess by combined hyperbaric oxygenation.

A 49-year-old man underwent hyperbaric oxygen (HBO) therapy for the treatment of primary spinal epidural abscess. Although the epidural abscess was initially treated with antibiotic (cefozopran) for 5 days, he subsequently developed motor weakness, paresthesia and urinary retention. MRI demonstrated spinal cord compression at the C1-C4 level. HBO therapy was added to the antibiotic regimen, and three days later we found clinical evidence of a response to treatment. Neurological symptoms were relieved 13 days after HBO therapy. This case suggests that HBO therapy is an effective therapeutic adjunct for the treatment of spinal epidural abscess.

Meningitis por Streptococcus agalactiae en el anciano / Streptococcus agalactiae meningitis in the elderly

La meningitis bacteriana continúa siendo una enfermedad con una alta mortalidad en ancianos, a pesar de la moderna antibioterapia. En los últimos años, la meningitis bacteriana ha cambiado y es frecuente en adultos, especialmente en ancianos. El déficit de la función inmunológica relacionada con el envejecimiento y la mayor propensión a padecer enfermedades agudas o crónicas comórbidas pueden predisponer a la infección por estreptococos del grupo B en el anciano. Las manifestaciones clínicas pueden ser atípicas en la población geriátrica. La fiebre, la cefalea y la rigidez de nuca pueden estar ausentes. Presentamos un caso de meningitis por Streptococcus agalactiae en una mujer anciana sin factores comórbidos. Debemos tener presente esta enfermedad como posible diagnóstico ante un paciente anciano con confusión o bajo nivel de conciencia. (AU)

Klebsiella meningitis in adults: clinical features, prognostic factors and therapeutic outcomes.

Sixty adult Klebsiella meningitis patients have been identified at Kaohsiung Chang Gung Memorial Hospital in a period of 13 years. Most cases were associated with debilitating diseases, and devastating metastatic septic abscesses are common in diabetic patients with K. pneumoniae meningitis. Although the mortality rate has been significantly reduced in recent years, there has been an increase in nosocomial infections and the emergence of multi-antibiotic resistant strains. Significant prognostic factors include appropriate antibiotic therapy, the presence of septic shock, disseminated intravascular coagulation, and high cerebrospinal fluid protein levels and white blood cell counts. Initial empiric therapy with a third generation cephalosporin should be considered for community-acquired meningitis while antibiotics such as carbapenems should be considered as initial empiric therapy for patients with postneurosurgical meningitis. Early diagnosis and the use of appropriate antibiotics are of crucial importance.