Harold W. Spies

Pneumococcal meningitis: the problem of the unseen cerebrospinal fluid leak.

A study was done of all patients treated for pneumococcal meningitis at the Municipal Contagious Disease Hospital, Chicago, Illinois, between 1954 and 1968 to estimate the frequency and differential features of recurrent diseases. Seventeen of 155 patients (11 per cent) had more than one episode of bacterial meningitis. There were 26 deaths in the non-recurrent and none in the recurrent group. Neurological complications occurred in five of 17 patients (29.4 per cent) with recurrent disease and 18 of 138 patients (12.9 per cent) without recurrent meningitis. Recurrent meningitis was more frequent in younger persons and males. Patients with recurrent disease were more likely to have an upper respiratory infection, to be hospitalized early in their illness, and to have positive blood cultures. Although a history of severe head trauma was significantly more frequent in those with recurrent disease (35.3 per cent) than in those without recurrences (9.4 per cent), this history was often overlooked by the patient even in the presence of cerebrospinal fluid rhinorrhea. Most often the trauma occurred six months or more prior to the initial episode of meningitis. The data suggest that each patient presenting with pneumococcal meningitis should be evaluated for evidence of dural tears or other host defense defects. Controlled data concerning surgical or antibiotic prophylaxis are needed.

Bacterial Meningitis: A Review of 1,073 Cases.

Excerpt The course and outcome of 1,073 cases of bacterial meningitis treated in the interval from 1954 to 1965 were reviewed in order to [a] compare the efficacy of tetracycline and chloromycetin ...