Streptococcus pneumoniae (pneumococcus) is the most common cause of community-acquired pneumonia, meningitis, and bacteremia in children and adults, including the elderly, and is responsible for high rates of morbidity and mortality worldwide. Aim of this paper to review published articles on incidence of pneumococcal meningitis in children less than 5 years of age in Malaysia, Singapore and Thailand, and compare the incidence of pneumococcal meningitis among the children in the three courtiers. Literature searches were conducted using google scholar, PubMed, the World Health Organization (WHO) website of the Weekly Epidemiological Record, and the countries’ Ministry of Health (MOH) website, and were limited to articles written in English. All relevant publications/abstracts published/presented during the period December 2000 through March 2014. Searches were conducted from April 1, 2014, till July 11, 2014 using various combinations of the following search terms “ Pneumococcal diseases” OR “meningococcal” OR “pneumococcal meningitis” OR “meningococcus”. A total of five articles and abstracts described the incidence of pneumococcal meningitis among children 5 years old. These five documents include two conference abstracts from Malaysia, one published paper from Singapore and two published papers from Thailand. The Malaysian, Singaporean and Thai pneumococcal meningitis incidence rate was 3.8-8.6, 2.3 and 0.10-1.8 per 100,000 children respectively. Our review confirmed that the incidence rate of pneumococcal meningitis was vary among the countries. The highest incidence rate of pneumococcal meningitis was found in Malaysia followed by Singapore and Thailand.
Meningitis, Pneumococcal ; Child

Pneumocephalus is defined as "the presence of air or gas within the cranial cavity." Intracranial air may represent an incidental finding of no clinical significance or more aggressive, life-threatening disease. It is usually associated with head trauma and surgery, tumor, brain abscess, postradiation necrosis, or diagnostic procedures. In the absence of head trauma or surgery, meningitis due to gas-forming organisms is an extremely rare cause of pneumocephalus. We report an unusual case of a localized spontaneous pneumocephalus caused by pneumococcal meningitis in the absence of head trauma, surgery, and brain abscess.
Abscess ; Brain Abscess ; Brain Neoplasms ; Craniocerebral Trauma ; Incidental Findings ; Meningitis ; Meningitis, Pneumococcal* ; Necrosis ; Pneumocephalus* ; Streptococcus pneumoniae

There have been a few reports of pneumococcal meningitis complicated by spinal epidural abscess. A 58-year-old female with Streptococcus pneumoniae meningitis underwent a recurrent pleocytosis without apparent clinical deterioration after appropriate antibiotic treatment. Subsequently, she developed a spinal epidural abscess. Spinal epidural abscess is a rare complication of pneumococcal meningitis, and subclinical deterioration of neutrophil-dominant pleocytosis may precede development of a spinal epidural abscess in individuals with bacterial meningitis.
Epidural Abscess* ; Female ; Humans ; Leukocytosis ; Meningitis, Bacterial ; Meningitis, Pneumococcal* ; Middle Aged

Pneumocephalus is a condition characterized by the presence of air in the cranium, and it is mainly caused by trauma or a neurosurgical procedure. In the absence of head trauma or a neurosurgical procedure, meningitis is an extremely rare cause of pneumocephalus. Here, the authors present a rare case of spontaneous pneumocephalus caused by pneumococcal meningitis, in which simple lateral radiography and computed tomography (CT) findings of the skull suggested the diagnosis. Cerebrospinal fluid analysis showed bacterial meningitis which later revealed streptococcus pneumonia. The patient was treated with antibiotics and responded remarkably well. Repeat CT performed after 2 weeks of treatment showed complete resolution of the intracranial gas. Here, the authors report an unusual case of a pneumocephalus caused by meningitis in the absence of head trauma or a neurosurgical procedure.
Anti-Bacterial Agents ; Craniocerebral Trauma ; Humans ; Meningitis ; Meningitis, Bacterial ; Meningitis, Pneumococcal ; Neurosurgical Procedures ; Pneumocephalus ; Pneumonia ; Skull ; Streptococcus

A 59-year-old man treated with pneumococcal meningitis 4 months ago was hospitalized for acute heart failure and performed aortic valve replacement by rupture of aortic valve. The frequent association of pneumococcal meningitis and endocarditis is known as Austrian syndrome. Though Austrian syndrome is a clinically rare disease, the evolution of pneumococcal endocarditis is very aggressive and associated with high mortality, and early recognition for evidence of endocardial lesion in patients with pneumococcal meningitis is important to reduce the complications and mortality rate.
Aortic Valve ; Endocarditis ; Heart ; Heart Failure ; Humans ; Meningitis ; Meningitis, Pneumococcal ; Middle Aged ; Rare Diseases ; Rupture ; Streptococcus pneumoniae

Epidermoid cyst is generally regarded as congenital disease, and commonly related to other congenital spinal anomalies. However, it also develops iatrogenically. We report one rare case of epidermoid cyst that we experineced among intradural extramedullary tumors. A 21-year-old female patient was admitted to the hospital due to low back pain with radiating pain into a right lower extremity that initiated about a month ago. She complained sensory lose and motor weakness (grade 4+) on her right extremity as well as urinary dysfunction and sphincter dysfunction. She had a lumbar puncture three times due to Pneumococcal meningitis when she was 13 years old. The well-circumscribed intradural extramedullary mass of 1.8x1.6x4 cm size was found on the L4-5 in a magnetic resonance image. Gross total tumor removal was garried out after the total laminectomy L5 and partial laminectomy L4. The tumor mass was gray-colored and so fragile that it was easy to be removed. The histological diagnosis confirmed epidermoid cyst without malignancy. After the operation, the patient progressively showed remarkable neurological recovery. In this case, the cause of epidermoid cyst is considered iatrogenic concerning history of several times of lumbar puncture as meningitis.
Diagnosis ; Epidermal Cyst* ; Extremities ; Female ; Humans ; Laminectomy ; Low Back Pain ; Lower Extremity ; Meningitis ; Meningitis, Pneumococcal ; Spinal Puncture ; Young Adult

Despite the advent of new antimicrobial drugs and mordern imaging techniques, mortality and morbidity of bacterial meningitis remain high. The unfavorable clinical outcomes are due to intracranial complications such as cerebrovascular complications, hydrocephalus, cerebral edema, intracerebral hemorrhage, brain abscess, and convulsion. Prompt identification and treatment of each are essential to mininize unfavorable outcomes. We report two cases of cerebral infarctions complicated by Streptococcus pneumoniae meningitis with a brief review of related literatures.
Brain Abscess ; Brain Edema ; Cerebral Hemorrhage ; Cerebral Infarction* ; Hydrocephalus ; Meningitis, Bacterial ; Meningitis, Pneumococcal* ; Mortality ; Seizures ; Streptococcus pneumoniae* ; Streptococcus* ; Thrombosis

BACKGROUND: Despite the widespread emergence of antimicrobial resistance among pneumococcal strains worldwide, clinical implications of in vitro resistance still remain an open question. To evaluate the clinical impact of pneumococcal resistance in Asian countries where the prevalence of pneumococcal resistance was reported to be highest in the world, ANSORP has performed a prospective, multinational surveillance study with cases with invasive pneumococcal diseases in Asian countries. METHODS: In vitro susceptibility of pneumococcal isolates was determined by broth microdilution tests with 16 antimicrobial agents. All enrolled cases of pneumococcal infections were analyzed with regard to demographic data, clinical features, risk factors and mortality. RESULTS: A total of 646 patients with pneumococcal infections were enrolled from 14 centers in 12 countries between the period from November 1999 to August 2001. Pneumonia (58.4%) was the most common clinical disease followed by bacteremia (33.4%), otitis media (10.4%), and meningitis (10.2%). Among 646 isolates, 347 (53.7%) were penicillin non-susceptible (intermediate 23.1%, resistant 30.7%). MIC90s for penicillin ranged from 0.03 (India) to 4.0 microgram/mL (Korea, Taiwan, Vietnam, and Hong Kong). Overall mortality from pneumococcal diseases by penicillin non-susceptible strains was not different from that by susceptible strains. Pneumococcal pneumonia caused by penicillin- or erythromycin-resistant strains showed similar mortality, severity of illness, or complications to that by susceptible strains. Mortality from pneumococcal meningitis caused by penicillin non-susceptible strains was also similar to that by susceptible strains. CONCLUSION: Data suggest that current situation of in vitro resistance to penicillin or macrolides may not affect the mortality from pneumococal pneumonia or meningitis caused by antibiotic-resistant strains.
Anti-Infective Agents ; Asian Continental Ancestry Group* ; Bacteremia ; Humans ; Macrolides ; Meningitis ; Meningitis, Pneumococcal ; Mortality ; Otitis Media ; Penicillins ; Pneumococcal Infections ; Pneumonia ; Pneumonia, Pneumococcal ; Prevalence ; Prospective Studies ; Risk Factors ; Taiwan ; Vietnam

BACKGROUND: Despite the widespread emergence of antimicrobial resistance among pneumococcal strains worldwide, clinical implications of in vitro resistance still remain an open question. To evaluate the clinical impact of pneumococcal resistance in Asian countries where the prevalence of pneumococcal resistance was reported to be highest in the world, ANSORP has performed a prospective, multinational surveillance study with cases with invasive pneumococcal diseases in Asian countries. METHODS: In vitro susceptibility of pneumococcal isolates was determined by broth microdilution tests with 16 antimicrobial agents. All enrolled cases of pneumococcal infections were analyzed with regard to demographic data, clinical features, risk factors and mortality. RESULTS: A total of 646 patients with pneumococcal infections were enrolled from 14 centers in 12 countries between the period from November 1999 to August 2001. Pneumonia (58.4%) was the most common clinical disease followed by bacteremia (33.4%), otitis media (10.4%), and meningitis (10.2%). Among 646 isolates, 347 (53.7%) were penicillin non-susceptible (intermediate 23.1%, resistant 30.7%). MIC90s for penicillin ranged from 0.03 (India) to 4.0 microgram/mL (Korea, Taiwan, Vietnam, and Hong Kong). Overall mortality from pneumococcal diseases by penicillin non-susceptible strains was not different from that by susceptible strains. Pneumococcal pneumonia caused by penicillin- or erythromycin-resistant strains showed similar mortality, severity of illness, or complications to that by susceptible strains. Mortality from pneumococcal meningitis caused by penicillin non-susceptible strains was also similar to that by susceptible strains. CONCLUSION: Data suggest that current situation of in vitro resistance to penicillin or macrolides may not affect the mortality from pneumococal pneumonia or meningitis caused by antibiotic-resistant strains.
Anti-Infective Agents ; Asian Continental Ancestry Group* ; Bacteremia ; Humans ; Macrolides ; Meningitis ; Meningitis, Pneumococcal ; Mortality ; Otitis Media ; Penicillins ; Pneumococcal Infections ; Pneumonia ; Pneumonia, Pneumococcal ; Prevalence ; Prospective Studies ; Risk Factors ; Taiwan ; Vietnam

It is generally believed that tumor necrosis factor alpha (TNF a) plays an crucial role in the pathogenesis of bacterial meningitis through various mechanisms such as endothelial damage, induction of adhesion molecule on the endothelial cell, recruitment of leukocytes in the cerebrospinal fluid(CSF). We performed this study to analyze the relationship of TNF alpha level with the severity of inflammation in the CSF. In a rabbit meningitis model, we attempted to evaluate whether antibiotics induced bacteriolysis can induce the elevation of the TNF alpha level and pleocytosis in CSF, and whether dexamethasone can suppress this elevation of TNF alpha. We also tried to assess the effective administation timing of dexamethasone. Meningitis was induced by intracistemal inoculation of Streptococcus pneumoniae. We designed four groups : Group 1. Untreated conrol (N=5); Group 2. Lone ceftriaxone at 6 hours after inoculation (N=5) ; Group 3. Dexamethasone at 30 minutes before ceftriaxone treatment (N=5); Group 4. Dexamethasone at 30 min. after ceftriaxone treatment (N=5). CSF TNF alpha level and cell count was assessed with regular time interval. The results were as follows: First, the CSF bacterial counts (measured by colony forming units) of group 1 was significantly higher than the other groups after ceftriaxone treatment (P<0. 05). Second, the CSF WBC counts of group 3 and 4 were significantly lower than those of group 1 and 2 at 6 and 14 hours after ceftriaxone treatment (P<0.05). Third, the CSF TNF alpha titers of group 1 and 3 were significantly lower than those of group 2 and 4 at 2 hours after ceftriaxone treatment (P<0.05). Fourth, after 14 hours, the CSF TNF alpha titers of group 1 kept on rising and became significantly higher than those of other groups (Pmeningitis.
Anti-Bacterial Agents ; Bacterial Load ; Bacteriolysis ; Ceftriaxone ; Cell Count ; Dexamethasone* ; Endothelial Cells ; Inflammation* ; Leukocytes ; Leukocytosis ; Meningitis ; Meningitis, Bacterial ; Meningitis, Pneumococcal* ; Streptococcus pneumoniae ; Tumor Necrosis Factor-alpha