Delayed Cerebral Vasculopathy in Pneumococcal Meningitis: Epidemiology and Clinical Outcome. A Cohort Study

Background: To describe the prevalence, clinical characteristics, impact of systemic steroids exposure and outcomes of delayed cerebral vasculopathy (DCV) in a cohort of adult patients with pneumococcal meningitis (PM). Methods: Observational retrospective multicenter study including all episodes of...

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Autores: Boix Palop, Lucía, Fernández, Tamara, Pelegrín Senent, Iván, Obradors, Meritxell, García Roulston, Kevin, Xercavins, Mariona, García Somoza, Dolors, Ardanuy Tisaire, María Carmen, Garau, Javier, Calbo, Esther, Cabellos Mínguez, Ma. Carmen
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2020
País:España
Institución:Universidad de Barcelona
Repositorio:Dipòsit Digital de la UB
OAI Identifier:oai:diposit.ub.edu:2445/173479
Acceso en línea:https://hdl.handle.net/2445/173479
Access Level:acceso abierto
Palabra clave:Meningitis cerebrospinal epidèmica
Vasculitis
Cerebrospinal meningitis
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spelling Delayed Cerebral Vasculopathy in Pneumococcal Meningitis: Epidemiology and Clinical Outcome. A Cohort StudyBoix Palop, LucíaFernández, TamaraPelegrín Senent, IvánObradors, MeritxellGarcía Roulston, KevinXercavins, MarionaGarcía Somoza, DolorsArdanuy Tisaire, María CarmenGarau, JavierCalbo, EstherCabellos Mínguez, Ma. CarmenMeningitis cerebrospinal epidèmicaVasculitisCerebrospinal meningitisVasculitisBackground: To describe the prevalence, clinical characteristics, impact of systemic steroids exposure and outcomes of delayed cerebral vasculopathy (DCV) in a cohort of adult patients with pneumococcal meningitis (PM). Methods: Observational retrospective multicenter study including all episodes of PM from January 2002 to December 2015. DCV was defined as proven/probable/possible based upon clinical criteria and pathological-radiological findings. DCV-patients and non-DCV-patients were compared by univariate analysis. Results: 162 PM episodes were included. Seventeen (10.5%) DCV-patients were identified (15 possible, 2 probable). At admission, DCV-patients had a longer duration of symptoms (>2 days in 58% vs. 25.5% (p 0.04)), more coma (52.9% vs. 21.4% (p 0.03)), lower median CSF WBC-count (243 cells/uL vs. 2673 cells/uL (p 0.001)) and a higher proportion of positive CSF Gram stain (94.1% vs. 71% (p 0.07)). Median length of stay was 49 vs. 15 days (p 0.001), ICU admission was 85.7% vs. 49.5% (p 0.01) and unfavorable outcome was found in 70.6% vs. 23.8% (p 0.001). DCV appeared 1-8 days after having completed adjunctive dexamethasone treatment (median 2,5, IQR = 1.5-5). Conclusions: One tenth of the PM developed DCV. DCV-patients had a longer duration of illness, were more severely ill, had a higher bacterial load at admission and had a more complicated course. Less than one third of cases recovered without disabilities. The role of corticosteroids in DCV remains to be established. (c) 2020 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).Elsevier Ltd.2020info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://hdl.handle.net/2445/173479Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))reponame:Dipòsit Digital de la UBinstname:Universidad de BarcelonaInglésReproducció del document publicat a: https://doi.org/10.1016/j.ijid.2020.06.005International Journal of Infectious Diseases, 2020, vol. 97, p. 283-289https://doi.org/10.1016/j.ijid.2020.06.005cc by-nc-nd (c) Boix Palop et al., 2020http://creativecommons.org/licenses/by-nc-nd/3.0/es/info:eu-repo/semantics/openAccessoai:diposit.ub.edu:2445/1734792026-05-27T06:46:51Z
dc.title.none.fl_str_mv Delayed Cerebral Vasculopathy in Pneumococcal Meningitis: Epidemiology and Clinical Outcome. A Cohort Study
title Delayed Cerebral Vasculopathy in Pneumococcal Meningitis: Epidemiology and Clinical Outcome. A Cohort Study
spellingShingle Delayed Cerebral Vasculopathy in Pneumococcal Meningitis: Epidemiology and Clinical Outcome. A Cohort Study
Boix Palop, Lucía
Meningitis cerebrospinal epidèmica
Vasculitis
Cerebrospinal meningitis
Vasculitis
title_short Delayed Cerebral Vasculopathy in Pneumococcal Meningitis: Epidemiology and Clinical Outcome. A Cohort Study
title_full Delayed Cerebral Vasculopathy in Pneumococcal Meningitis: Epidemiology and Clinical Outcome. A Cohort Study
title_fullStr Delayed Cerebral Vasculopathy in Pneumococcal Meningitis: Epidemiology and Clinical Outcome. A Cohort Study
title_full_unstemmed Delayed Cerebral Vasculopathy in Pneumococcal Meningitis: Epidemiology and Clinical Outcome. A Cohort Study
title_sort Delayed Cerebral Vasculopathy in Pneumococcal Meningitis: Epidemiology and Clinical Outcome. A Cohort Study
dc.creator.none.fl_str_mv Boix Palop, Lucía
Fernández, Tamara
Pelegrín Senent, Iván
Obradors, Meritxell
García Roulston, Kevin
Xercavins, Mariona
García Somoza, Dolors
Ardanuy Tisaire, María Carmen
Garau, Javier
Calbo, Esther
Cabellos Mínguez, Ma. Carmen
author Boix Palop, Lucía
author_facet Boix Palop, Lucía
Fernández, Tamara
Pelegrín Senent, Iván
Obradors, Meritxell
García Roulston, Kevin
Xercavins, Mariona
García Somoza, Dolors
Ardanuy Tisaire, María Carmen
Garau, Javier
Calbo, Esther
Cabellos Mínguez, Ma. Carmen
author_role author
author2 Fernández, Tamara
Pelegrín Senent, Iván
Obradors, Meritxell
García Roulston, Kevin
Xercavins, Mariona
García Somoza, Dolors
Ardanuy Tisaire, María Carmen
Garau, Javier
Calbo, Esther
Cabellos Mínguez, Ma. Carmen
author2_role author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Meningitis cerebrospinal epidèmica
Vasculitis
Cerebrospinal meningitis
Vasculitis
topic Meningitis cerebrospinal epidèmica
Vasculitis
Cerebrospinal meningitis
Vasculitis
description Background: To describe the prevalence, clinical characteristics, impact of systemic steroids exposure and outcomes of delayed cerebral vasculopathy (DCV) in a cohort of adult patients with pneumococcal meningitis (PM). Methods: Observational retrospective multicenter study including all episodes of PM from January 2002 to December 2015. DCV was defined as proven/probable/possible based upon clinical criteria and pathological-radiological findings. DCV-patients and non-DCV-patients were compared by univariate analysis. Results: 162 PM episodes were included. Seventeen (10.5%) DCV-patients were identified (15 possible, 2 probable). At admission, DCV-patients had a longer duration of symptoms (>2 days in 58% vs. 25.5% (p 0.04)), more coma (52.9% vs. 21.4% (p 0.03)), lower median CSF WBC-count (243 cells/uL vs. 2673 cells/uL (p 0.001)) and a higher proportion of positive CSF Gram stain (94.1% vs. 71% (p 0.07)). Median length of stay was 49 vs. 15 days (p 0.001), ICU admission was 85.7% vs. 49.5% (p 0.01) and unfavorable outcome was found in 70.6% vs. 23.8% (p 0.001). DCV appeared 1-8 days after having completed adjunctive dexamethasone treatment (median 2,5, IQR = 1.5-5). Conclusions: One tenth of the PM developed DCV. DCV-patients had a longer duration of illness, were more severely ill, had a higher bacterial load at admission and had a more complicated course. Less than one third of cases recovered without disabilities. The role of corticosteroids in DCV remains to be established. (c) 2020 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
publishDate 2020
dc.date.none.fl_str_mv 2020
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/173479
url https://hdl.handle.net/2445/173479
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a: https://doi.org/10.1016/j.ijid.2020.06.005
International Journal of Infectious Diseases, 2020, vol. 97, p. 283-289
https://doi.org/10.1016/j.ijid.2020.06.005
dc.rights.none.fl_str_mv cc by-nc-nd (c) Boix Palop et al., 2020
http://creativecommons.org/licenses/by-nc-nd/3.0/es/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv cc by-nc-nd (c) Boix Palop et al., 2020
http://creativecommons.org/licenses/by-nc-nd/3.0/es/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Elsevier Ltd.
publisher.none.fl_str_mv Elsevier Ltd.
dc.source.none.fl_str_mv Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))
reponame:Dipòsit Digital de la UB
instname:Universidad de Barcelona
instname_str Universidad de Barcelona
reponame_str Dipòsit Digital de la UB
collection Dipòsit Digital de la UB
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,301603

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