Brouwer et al evaluated patients with community-acquired meningitis due to Staphylococcus aureus. This is a serious infection with high mortality rate. The authors are from Academic Medical Centre Amsterdam, University of Amsterdam and the Centre of Infection and Immunity Amsterdam.
Predisposing conditions:
(1) recent head trauma
(2) immunocompromised
(3) injection drug use
(4) CSF leak or shunt
(5) malignancy (lung, colon, etc)
Most patients have a focus of Staphylococcus aureus elsewhere:
(1) pneumonia
(2) endocarditis
(3) sinusitis
(4) urinary tract infection
(5) thrombophlebitis
Clinical findings may include:
(1) temperature >= 38°C (90%)
(2) altered level of consciousness (coma in 22%)
(3) stiff neck (67%)
(4) neurological findings
(5) sepsis
The CSF exam may be negative or nonspecific in a significant percentage of patients, so a high level of suspicion may be needed for diagnosis.
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