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A female patient 23 years old was admitted to the medical intensive care unit due to sudden loss of consciousness and seizures. At the time of admition observed lack of consciousness, seizures and severe critical condition was observed. Meningitis and septic shock were diagnosed. Based on computed tomography performed on the first day--inflammation of the sinuses soft tissues was diagnosed. Suspected cause of infection was performed 6 weeks earlier surgical correction of the nasal septum. In the next stage of treatment on the seventh day after admission the functional endoscopic sinus surgery was performed. Due to massive tissue hypoperfusion the necrosis in the skin of the lower limbs occurred. Due to the lack of effectiveness antimicrobial therapy use of intravenous ceftaroline was administrated. Effective treatment allowed in day 11 to wean the patient from the ventilator. At the day 26 the patient was transferred to a hospital in the place of residence., (© 2015 MEDPRESS.)

The most frequent primary infections causing purulent meningitis in older children are both acute and chronic otitis media and sinusitis or upper and lower airways infections. In these cases sometimes purulent meningitis is accompanied with other intracranial complications. Pharmacological treatment of intracranial complications without surgical intervention concerning primary source of infection increases risk of complications including death of a patient and also recurrences of bacterial meningitis. In the paper authors present two uncommon cases of children with purulent meningitis and other intracranial complications of otitis media and sinusitis diagnosed by pediatricians., (Copyright © 2012 Polish Otolaryngology Society. Published by Elsevier Urban & Partner Sp. z.o.o. All rights reserved.)

The authors describe a 9 year-old girl with homozygous deficiency of C2 component, causing null activity of the classical pathway of complement. The girl suffered from several recurrent infections since birth, later developed signs of the Henoch-Schönlein disease. At the age of 1 1/2 years she was hospitalized due-to bacterial meningitis, most probably of Neisseria meningitis etiology.

Our investigations concerned the blood-brain barrier (b.b.b.) in patients with acute bacterial purulent meningitis. For that purpose concentrations of proteins, which are synthesized beyond the central nervous system and in normal cerebrospinal fluid (CSF) exist only in slight amounts, were determined in CSF and in blood serum. Albumin was examined in the CSF of 59 patients and in the serum of 35 of them, transferrin of 40 and 32 patients, respectively. Etiological verification was obtained in 84.7% of patients. The control group consisted of 20 persons. Quantitative analytical tests were carried out by means of immunochemical, turbidimetric methods. High levels of albumin and transferrin in CSF and low in serum of patients with meningitis were observed. The obtained results, confirmed by statistical analysis, demonstrate that in the acute phase of purulent meningitis b.b.b is impaired, what leads to the transfer of the proteins from the blood serum into the cerebrospinal fluid and that transferrins a better indicator of the damage to blood-brain barrier than albumin.

In south-east Poland in the years 1993 till 1995 we observed a decreasing number of meningococcal meningitis in children and a growth of cases caused by Haemophilus influenzae. Changes in ethiology of bacterial meningitis should give a reason for epidemiological research in Poland because there is a chance to reduce number of patients when wider use of new vaccines is introduced.

The authors, basing on the own experience in the treatment of 578 patients with purulent meningitis and encephalitis, discuss etiologic and clinical problems as an early diagnosis of the cause decides on the proper therapy and often on the patient's fate. The authors are convinced that the result of general CSF examination is a crucial diagnostic criterion in meningitis and encephalitis but does not permit identification of the disease causes. Problems with etiological verification is discussed. The authors have found that the infection with N. meningitidis and S. pneumoniae remains the most frequent cause of the disease in adults. However, the cause of the disease cannot be determined in over 50% of patients, and etiological verification of infections caused by H. influenzae and anaerobic organisms is quite unsatisfactory. The authors stress that over 20% of patients had skull injury and meningitis most frequently resulted from the infection with S. pneumoniae in these patients. It is suggested that purulent meningitis and encephalitis as a rule is endogenous disease produced by the activation of endogenous source of the infection.

Four patients with bacterial meningitis, previously anaesthetized epidurally, have been described. In one case the course of the disease was very serious and resulted in irreversible neurological lesion. Although epidural anaesthesia is considered to be a harmless procedure it can cause some purulent complications.

Intraventricular drug administration via the IR is often used in the therapy of leukemic and carcinomatous meningitis. We reviewed our 10-year experience with 32 patients, with IR placed for intraventricular chemotherapy to characterize infectious complications associated with IR. Infectious complications occurred in 9 patients (27.1%). Local cellulitis (S. aureus) occurred at the site of IR in 2 patients. Seven patients (21.8%) had 12 episodes of bacteriologically proven or clinically suspected meningitis, or positive IR CSF cultures without symptoms (4-P. acnes). While patients with local infection may require IR removal, more than half of those with meningitis may be treated with antibiotics alone without IR removal. Patients with positive cultures in the absence of symptoms may require no therapy at all.