Adult Otogenic Meningitis in the Pneumococcal Conjugated Vaccines Era

Tal Marom; Shay Shemesh; Nadeem Habashi; Ofer Gluck; Sharon Ovnat Tamir

doi:10.1055/s-0039-1697995

International Archives of Otorhinolaryngology, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Int Arch Otorhinolaryngol 2020; 24(02): e175-e181
DOI: 10.1055/s-0039-1697995

Original Research

Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Adult Otogenic Meningitis in the Pneumococcal Conjugated Vaccines Era

Autor*innen

Tal Marom

¹Department of Otolaryngology-Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Ben-Gurion University of the Negev Faculty of Health Sciences, Ashdod, Israel
Shay Shemesh

¹Department of Otolaryngology-Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Ben-Gurion University of the Negev Faculty of Health Sciences, Ashdod, Israel
Nadeem Habashi

¹Department of Otolaryngology-Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Ben-Gurion University of the Negev Faculty of Health Sciences, Ashdod, Israel
Ofer Gluck

¹Department of Otolaryngology-Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Ben-Gurion University of the Negev Faculty of Health Sciences, Ashdod, Israel
Sharon Ovnat Tamir

¹Department of Otolaryngology-Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Ben-Gurion University of the Negev Faculty of Health Sciences, Ashdod, Israel

Abstract

Introduction Streptococcus pneumoniae is a major pathogen of otogenic meningitis (OgM), the most commonly reported intra-cranial complication of otitis media (OM).

Objectives To study the changes in adult OgM patients in the pneumococcal conjugated vaccines (PCVs) era.

Methods Retrospective cohort of adults presenting with concurrent OM and meningitis in a secondary medical care center between 2005 and 2015. Data collected included demographics, OM-related symptoms, cerebrospinal fluid (CSF) and ear culture results, pre- and during hospitalization antibiotic treatment, imaging findings, and complications. We compared the pre-PCV years (2005–2009) with the post-PCV years (2010–2015). Outcomes were 1) incidence of all-cause adult OgM from the total meningitis cases; 2) impact of PCVs on the clinical presentation of OgM and bacteriology.

Results Otogenic meningitis was diagnosed in 26 out of 45 (58%) cases of all-cause meningitis admissions. Of those, 10 (38%) were male, with a mean age of 62.4 years old. Ear-related signs and symptoms were documented in 70% of the patients, and OgM was diagnosed following imaging studies in 6 out of 26 (23%) patients. All of the patients received intravenous antibiotic therapy, and 7 (27%) patients required surgical interventions: 6 required myringotomy and 1 required mastoidectomy. There were 12 (46%) patients in the pre-PCV years and 14 (56%) in the post-PCV years. The positive pneumococcal CSF and ear culture rates remained high and unchanged (∼ 75%). There were no significant changes in the clinical presentation or mortality rates.

Conclusion Micro-otoscopy should be included in the routine work-up of any suspected adult meningitis, because OgM is underdiagnosed. Unlike their impact on pediatric otitis media, PCVs did not change the epidemiology and bacteriology of OgM.

Keywords

otitis media - meningitis - adult - imaging - computed tomography

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Referenzen

References
1 Orji FT, Ukaegbe O, Alex-Okoro J, Ofoegbu VC, Okorafor IJ. The changing epidemiological and complications profile of chronic suppurative otitis media in a developing country after two decades. Eur Arch Otorhinolaryngol 2016; 273 (09) 2461-2466
2 Tawfik KO, Ishman SL, Altaye M, Meinzen-Derr J, Choo DI. Pediatric Acute Otitis Media in the Era of Pneumococcal Vaccination. Otolaryngol Head Neck Surg 2017; 156 (05) 938-945
3 Leskinen K, Jero J. Acute complications of otitis media in adults. Clin Otolaryngol 2005; 30 (06) 511-516
4 Wanna GB, Dharamsi LM, Moss JR, Bennett ML, Thompson RC, Haynes DS. Contemporary management of intracranial complications of otitis media. Otol Neurotol 2010; 31 (01) 111-117
5 Osma U, Cureoglu S, Hosoglu S. The complications of chronic otitis media: report of 93 cases. J Laryngol Otol 2000; 114 (02) 97-100
6 Kangsanarak J, Navacharoen N, Fooanant S, Ruckphaopunt K. Intracranial complications of suppurative otitis media: 13 years' experience. Am J Otol 1995; 16 (01) 104-109
7 Ibrahim SI, Cheang PP, Nunez DA. Incidence of meningitis secondary to suppurative otitis media in adults. J Laryngol Otol 2010; 124 (11) 1158-1161
8 Singh B. The management of lateral sinus thrombosis. J Laryngol Otol 1993; 107 (09) 803-808
9 Pingali SC, Warren JL, Mead AM, Sharova N, Petit S, Weinberger DM. Association Between Local Pediatric Vaccination Rates and Patterns of Pneumococcal Disease in Adults. J Infect Dis 2016; 213 (04) 509-515
10 Wagenvoort GH, Sanders EA, Vlaminckx BJ, de Melker HE, van der Ende A, Knol MJ. Sex differences in invasive pneumococcal disease and the impact of pneumococcal conjugate vaccination in the Netherlands, 2004 to 2015. Euro Surveill 2017; 22 (10) 30481
11 Regev-Yochay G, Katzir M, Strahilevitz J. , et al; IAIPD group. The herd effects of infant PCV7/PCV13 sequential implementation on adult invasive pneumococcal disease, six years post implementation; a nationwide study in Israel. Vaccine 2017; 35 (18) 2449-2456
12 Van der Poel NA, van Spronsen E, Dietz de Loos DA, Ebbens FA. Early signs and symptoms of intracranial complications of otitis media in pediatric and adult patients: A different presentation?. Int J Pediatr Otorhinolaryngol 2017; 102: 56-60
13 Terao K, Cureoglu S, Schachern PA. , et al. Marrow-middle ear connections: a potential cause of otogenic meningitis. Otol Neurotol 2011; 32 (01) 77-80
14 Santos LC, Simões J, Severo M, Vazquez J, Lecour H. Bacterial meningitis in an urban area: etiologic study and prognostic factors. Infection 2007; 35 (06) 406-413
15 Østergaard C, Konradsen HB, Samuelsson S. Clinical presentation and prognostic factors of Streptococcus pneumoniae meningitis according to the focus of infection. BMC Infect Dis 2005; 5: 93
16 Marom T, Bookstein Peretz S, Schwartz O, Goldfarb A, Oron Y, Tamir SO. Impact of Pneumococcal Conjugate Vaccines on Selected Head and Neck Infections in Hospitalized Israeli Children. Pediatr Infect Dis J 2017; 36 (03) 314-318
17 Shinjoh M, Yamaguchi Y, Iwata S. Pediatric bacterial meningitis in Japan, 2013-2015 - 3-5 years after the wide use of Haemophilus influenzae type b and Streptococcus pneumoniae conjugated vaccines. J Infect Chemother 2017; 23 (07) 427-438
18 de Oliveira LH, Camacho LA, Coutinho ES. , et al. Impact and Effectiveness of 10 and 13-Valent Pneumococcal Conjugate Vaccines on Hospitalization and Mortality in Children Aged Less than 5 Years in Latin American Countries: A Systematic Review. PLoS One 2016; 11 (12) e0166736
19 Corcoran M, Vickers I, Mereckiene J. , et al. The epidemiology of invasive pneumococcal disease in older adults in the post-PCV era. Has there been a herd effect?. Epidemiol Infect 2017; 145 (11) 2390-2399
20 Tsaban G, Ben-Shimol S. Indirect (herd) protection, following pneumococcal conjugated vaccines introduction: A systematic review of the literature. Vaccine 2017; 35 (22) 2882-2891
21 Jacobs DM, Yung F, Hart E, Nguyen MNH, Shaver A. Trends in pneumococcal meningitis hospitalizations following the introduction of the 13-valent pneumococcal conjugate vaccine in the United States. Vaccine 2017; 35 (45) 6160-6165
22 Caceres DC, Ortega-Barria E, Nieto J, DeAntonio R. Pneumococcal meningitis trends after pneumococcal conjugate vaccine introduction in Colombia: An interrupted time-series analysis. Hum Vaccin Immunother 2018; 14 (05) 1230-1233
23 Slovik Y, Kraus M, Leiberman A, Kaplan DM. Role of surgery in the management of otogenic meningitis. J Laryngol Otol 2007; 121 (09) 897-901