Combined Bacterial Meningitis and Infective Endocarditis: When Should We Search for the Other When Either One is Diagnosed?

Guillaume Béraud, Sarah Tubiana, Marie-Line Erpelding, Vincent Le Moing, Catherine Chirouze, Isabelle Gorenne, Pauline Manchon, Pierre Tattevin, Veronique Vernet, Emmanuelle Varon, Bruno Hoen, Xavier Duval, AEPEI study group, COMBAT study group

Abstract

Introduction: We aimed to describe patients with coexisting infective endocarditis (IE) and bacterial meningitis (BM).

Methods: We merged two large prospective cohorts, an IE cohort and a BM cohort, with only cases of definite IE and community-acquired meningitis. We compared patients who had IE and BM concurrently to patients with IE only and BM only.

Results: Among the 1030 included patients, we identified 42 patients with IE-BM (4.1%). Baseline characteristics of patients with IE-BM were mostly similar to those of patients with IE, but meningitis was the predominant presentation at admission (39/42, 92.3%). Causative pathogens were predominantly Streptococcus pneumoniae (18/42, 42.9%) and Staphylococcus aureus (14/42, 33.3%). All pneumococcal IE were associated with BM (18/18). BM due to oral and group D streptococci, Streptococcus agalactiae, and S. aureus were frequently associated with IE (14/30, 46.7%). Three-month mortality was 28.6% in patients with IE-BM, 20.5% in patients with IE, and 16.6% in patients with BM.

Conclusions: Patients with pneumococcal IE or altered mental status during IE must be investigated for BM. Patients with S. aureus, oral and group D streptococcal or enterococcal BM, or unfavorable outcome in pneumococcal meningitis would benefit from an echocardiography. Patients with the dual infection have the worst prognosis. Their identification is mandatory to initiate appropriate treatment.

Keywords: Austrian syndrome; Bacterial meningitis; Echocardiography; Infective endocarditis; Staphylococcus; Streptococcus.

© 2022. The Author(s).

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References

    1. Lucas Marjolein J, Brouwer Matthijs C, van der Ende A, van de Beek D. Endocarditis in adults with bacterial meningitis. Circulation. 2013;127(20):2056–2062. doi: 10.1161/CIRCULATIONAHA.113.001545.
    1. Selton-Suty C, Célard M, Le Moing V, et al. Preeminence of Staphylococcus aureus in infective endocarditis: a 1-year population-based survey. Clin Infect Dis. 2012;54(9):1230–1239. doi: 10.1093/cid/cis199.
    1. Tubiana S, Varon E, Biron C, et al. Community-acquired bacterial meningitis in adults: in-hospital prognosis, long term disability and determinants of outcome in a multicentre prospective cohort. Clin Microbiol Infect. 2020 doi: 10.1016/j.cmi.2019.12.020.
    1. Li JS, Sexton DJ, Mick N, et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis. 2000;30(4):633–638. doi: 10.1086/313753.
    1. Bijlsma Merijn W, Brouwer Matthijs C, Soemirien KE, et al. Community-acquired bacterial meningitis in adults in the Netherlands, 2006–14: a prospective cohort study. Lancet Infect Dis. 2016;16(3):339–347. doi: 10.1016/S1473-3099(15)00430-2.
    1. Austrian R. Pneumococcal endocarditis, meningitis, and rupture of the aortic valve. AMA Arch Intern Med. 1957;99(4):539–544. doi: 10.1001/archinte.1957.00260040039004.
    1. Gonzalez-Juanatey C, Testa A, Mayo J, Gonzalez-Gay Miguel A. Austrian syndrome: report of two new cases and literature review. Int J Cardiol. 2006;108(2):273–275. doi: 10.1016/j.ijcard.2005.02.045.
    1. Brouwer Matthijs C, Keizerweerd Gabriella D, Brouwer Matthijs C, et al. Community acquired Staphylococcus aureus meningitis in adults. Scand J Infect Dis. 2009;41(5):375–377. doi: 10.1080/00365540902744766.
    1. Le Moing V, Alla F, Doco-Lecompte T, et al. Staphylococcus aureus bloodstream infection and endocarditis–a prospective cohort study. PLoS ONE. 2015;10(5):e0127385. doi: 10.1371/journal.pone.0127385.
    1. Servy A, Valeyrie-Allanore L, Alla F, et al. Prognostic value of skin manifestations of infective endocarditis. JAMA Dermatol. 2014;150(5):494–500. doi: 10.1001/jamadermatol.2013.8727.
    1. Heiro M, Nikoskelainen J, Engblom E, Kotilainen E, Marttila R, Kotilainen P. Neurologic manifestations of infective endocarditis: a 17-year experience in a teaching hospital in Finland. Arch Intern Med. 2000;160(18):2781–2787. doi: 10.1001/archinte.160.18.2781.
    1. Corral I, Martín-Dávila P, Fortún J, et al. Trends in neurological complications of endocarditis. J Neurol. 2007;254(9):1253–1259. doi: 10.1007/s00415-006-0512-5.
    1. Duval X, Iung B, Klein I, et al. Effect of early cerebral magnetic resonance imaging on clinical decisions in infective endocarditis: a prospective study. Ann Intern Med. 2010;152(8):497–504. doi: 10.7326/0003-4819-152-8-201004200-00006.
    1. de Egea V, Patricia M, Maricela V, et al. Characteristics and outcome of Streptococcus pneumoniae endocarditis in the XXI Century: a systematic review of 111 cases (2000–2013) Medicine (Baltimore) 2015;94(39):e1562. doi: 10.1097/MD.0000000000001562.
    1. Schut Ewout S, Lucas Marjolein J, Brouwer Matthijs C, Vergouwen Mervyn DI, van der Ende A, van de Beek D. Cerebral infarction in adults with bacterial meningitis. Neurocrit Care. 2012;16(3):421–427. doi: 10.1007/s12028-011-9634-4.
    1. Dickerman Stuart A, Elias A, Bruno B, et al. The relationship between the initiation of antimicrobial therapy and the incidence of stroke in infective endocarditis: an analysis from the ICE Prospective Cohort Study (ICE-PCS) Am Heart J. 2007;154(6):1086–1094. doi: 10.1016/j.ahj.2007.07.023.
    1. Snygg-Martin U, Rasmussen RV, Hassager C, Bruun NE, Andersson R, Olaison L. Warfarin therapy and incidence of cerebrovascular complications in left-sided native valve endocarditis. Eur J Clin Microbiol Infect Dis. 2011;30(2):151–157. doi: 10.1007/s10096-010-1063-3.
    1. Fernández-Hidalgo N, Almirante B, Tornos P, et al. Prognosis of left-sided infective endocarditis in patients transferred to a tertiary-care hospital–prospective analysis of referral bias and influence of inadequate antimicrobial treatment. Clin Microbiol Infect. 2011;17(5):769–775. doi: 10.1111/j.1469-0691.2010.03314.x.

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