IPLab:Lab 9:Bacterial Meningitis
This 45-year-old white female with a history of psychiatric illness sustained self-inflicted third degree burns over 49% of her body surface. After initially doing well under treatment, she developed severe respiratory distress and became comatose. Antemortem blood cultures were positive for Pseudomonas aeruginosa.
At autopsy the principal findings were in the lungs and brain. Bronchopneumonia was present in all lobes of both lungs. The brain weighed 1450 gramsAn average adult female brain weighs 1400 grams (range: 1100 to 1700 grams). and the leptomeninges contained a thick yellow purulent exudate most prominent over the frontoparietal areas and at the base of the brain.
The specific etiologic agent varies with the age of the patient:
- in neonates: the organisms include Escherichia coli and the group B streptococci;
- in infants and children: S. pneumoniae and N. meningitidis pervade in immunized children (H. influenzae type b (Hib) vaccine is routine in the U.S.), while Haemophilus influenzae is more prominent in non-immunized children;
- in adolescents and in young adults: Neisseria meningitidis;
- in the elderly: Streptococcus pneumoniae and Listeria.
Burn patients are at high risk for developing Pseudomonas infections. In this case, the patient was debilitated due to the extensive severe burn and developed a Pseudomonas septicemia which then led to the Pseudomonas meningitis.
Because of the acute inflammatory reaction, there is extravasation of fibrin as well as the recruitment of neutrophils.
- eMedicine Medical Library: Pediatric Bacterial Meningitis
- eMedicine Medical Library: Meningitis
- eMedicine Medical Library: Thermal Burns
- eMedicine Medical Library: Pseudomonas aeruginosa Infections
- Merck Manual: Acute Bacterial Meningitis
- Merck Manual: Burns
- Grände PO, Myhre EB, Nordström CH, Schliamser S. Treatment of intracranial hypertension and aspects on lumbar dural puncture in severe bacterial meningitis. Acta Anaesthesiol Scand 2002 Mar;46(3):264-70.