BACTERIAL CNS INFECTIONS IN SOUTH LOWER S AXONY - A RETROSPECTIVE STUDY FROM THE DEPARTMENT-OF-NEUROLOGY, UNIVERSITY-OF-GOTTINGEN

All 155 patients with suspected bacterial central nervous system (CNS) infections treated from 1986 to 1991 at the Department of Neurology, University of Gottingen, were evaluated in a retrospective study. Acco rding to the clinical symptoms presented at admission, 7 cases were cl assified as encephalitis, 44 as meningitis, 15 as radiculitis, 19 as v entriculitis, 61 as meningoencephalitis and 9 as meningoradiculitis. I n 78% of these cases, the causative bacteria were either isolated from cerebrospinal fluid (CSF), or other relevant sources (blood, wound sw abs) or identified by serological methods; (all cases of CNS borrelios is, and 3 of the 5 cases of listeriosis were identified by means of th e last mentioned method). CNS infections caused by staphylococci and B orrelia burgdorferi were most frequent, followed by those due to pneum ococci, meningococci and other streptococci. CNS infections caused by Mycobacterium tuberculosis, Listeria monocytogenes, Haemophilus influe nzae and enterobacteriaceae were less frequent. In comparison to the C NS infections due to other bacteria, the pneumococcal and meningococca l meningitic infections were associated with more pronounced CSF alter ations (on the average, there were higher white blood cell counts, and higher CSF protein and lactate). Pneumococci predominated in older pa tients and those with an impaired immune system, or infections of orga ns neighboring the CNS. Meningococci were most frequent in young and p reviously healthy individuals. All patients with CNS listeriosis had p redisposing conditions. Meningococcal meningitis was either fatal or r esolved with or without minimal neurological deficits. Infections caus ed by staphylocci or pneumococci were associated with a high percentag e of neurologic sequelae.