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      Meningitis due to non-steroidal anti-inflammatory drugs: an often-overlooked complication of a widely used medication

      case-report

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          Abstract

          A 40-year-old man developed aseptic meningitis after ibuprofen consumption for tension-type headaches. After a thorough diagnostic workup and lack of improvement on empirical therapy for common aetiologies of meningitis (bacterial and viral infections), we suspected non-steroidal anti-inflammatory drug (NSAID) induced meningitis due to the temporal relationship between drug administration and symptom onset. Two days after NSAID suppression, the evolution was progressively favourable with complete resolution of fever and symptoms. On follow-up, symptoms did not recur and there was no neurological sequela. This article summarises the clinical picture and the complementary exams that led to the difficult-to-make diagnosis of NSAID-induced acute meningitis, in parallel with a brief review of the literature.

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          Incidence, aetiology, and sequelae of viral meningitis in UK adults: a multicentre prospective observational cohort study

          Fiona McGill, Michael J. Griffiths, Laura Bonnett … (2018)
          Summary Background Viral meningitis is increasingly recognised, but little is known about the frequency with which it occurs, or the causes and outcomes in the UK. We aimed to determine the incidence, causes, and sequelae in UK adults to improve the management of patients and assist in health service planning. Methods We did a multicentre prospective observational cohort study of adults with suspected meningitis at 42 hospitals across England. Nested within this study, in the National Health Service (NHS) northwest region (now part of NHS England North), was an epidemiological study. Patients were eligible if they were aged 16 years or older, had clinically suspected meningitis, and either underwent a lumbar puncture or, if lumbar puncture was contraindicated, had clinically suspected meningitis and an appropriate pathogen identified either in blood culture or on blood PCR. Individuals with ventricular devices were excluded. We calculated the incidence of viral meningitis using data from patients from the northwest region only and used these data to estimate the population-standardised number of cases in the UK. Patients self-reported quality-of-life and neuropsychological outcomes, using the EuroQol EQ-5D-3L, the 36-Item Short Form Health Survey (SF-36), and the Aldenkamp and Baker neuropsychological assessment schedule, for 1 year after admission. Findings 1126 patients were enrolled between Sept 30, 2011, and Sept 30, 2014. 638 (57%) patients had meningitis: 231 (36%) cases were viral, 99 (16%) were bacterial, and 267 (42%) had an unknown cause. 41 (6%) cases had other causes. The estimated annual incidence of viral meningitis was 2·73 per 100 000 and that of bacterial meningitis was 1·24 per 100 000. The median length of hospital stay for patients with viral meningitis was 4 days (IQR 3–7), increasing to 9 days (6–12) in those treated with antivirals. Earlier lumbar puncture resulted in more patients having a specific cause identified than did those who had a delayed lumbar puncture. Compared with the age-matched UK population, patients with viral meningitis had a mean loss of 0·2 quality-adjusted life-years (SD 0·04) in that first year. Interpretation Viruses are the most commonly identified cause of meningitis in UK adults, and lead to substantial long-term morbidity. Delays in getting a lumbar puncture and unnecessary treatment with antivirals were associated with longer hospital stays. Rapid diagnostics and rationalising treatments might reduce the burden of meningitis on health services. Funding Meningitis Research Foundation and UK National Institute for Health Research.
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            To test or not to test? Laboratory support for the diagnosis of Lyme borreliosis: a position paper of ESGBOR, the ESCMID study group for Lyme borreliosis.

            R. B. Dessau, A van Dam, V. Fingerle … (2018)
            Lyme borreliosis (LB) is a tick-borne infection caused by Borrelia burgdorferi sensu lato. The most frequent clinical manifestations are erythema migrans and Lyme neuroborreliosis. Currently, a large volume of diagnostic testing for LB is reported, whereas the incidence of clinically relevant disease manifestations is low. This indicates overuse of diagnostic testing for LB with implications for patient care and cost-effective health management.
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              Cross-reactivity in flavivirus serology: new implications of an old finding?

              H W Doerr, P. Emmerich, Roland Schmitz … (2002)
              To investigate the influence of pre-existing antibodies against tick-borne encephalitis (TBE) or yellow fever (YF) viruses on dengue virus antibody test results, we examined sera from vaccinees and from individuals with previous TBE virus infection. Distinct IgG antibody cross-reactivity was found in about 15.1% in the YF-vaccinated group and in about 9.5% in the TBE-vaccinated group. Altogether 15 out of a total of 80 samples tested (18.8%) had detectable dengue virus IgG antibody titres. The serum samples from patients with acute TBE virus infection not only had the highest anti-TBE virus antibodies but were also highly cross-reactive against dengue virus antigens. The high cross-reactivity rate of YF and TBE antibody-positive sera in dengue virus antibody assays should be taken into account in the interpretation of laboratory tests for the diagnosis of flavivirus infections and when undertaking seroepidemiological surveys.
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                Author and article information

                Journal
                Journal ID (nlm-ta): BMJ Case Rep
                Journal ID (iso-abbrev): BMJ Case Rep
                Journal ID (hwp): bmjcr
                Journal ID (publisher-id): bmjcasereports
                Title: BMJ Case Reports
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Electronic): 1757-790X
                Publication date Collection: 2019
                Publication date (Electronic): 7 November 2019
                Publication date PMC-release: 7 November 2019
                Volume: 12
                Issue: 11
                Electronic Location Identifier: e231619
                Affiliations
                [1 ] departmentInfectious Diseases , Centre Hospitalier Universitaire Vaudois , Lausanne, Switzerland
                [2 ] departmentInternal Medicine , Centre Hospitalier Universitaire Vaudois , Lausanne, Switzerland
                Author notes
                [Correspondence to ] Dr Florian Desgranges; florian.desgranges@ 123456chuv.ch
                Article
                Publisher ID: bcr-2019-231619
                DOI: 10.1136/bcr-2019-231619
                PMC ID: 6855853
                PubMed ID: 31704799
                SO-VID: aabb1d78-e460-4d79-82dc-121e8dd3c44c
                Copyright © © BMJ Publishing Group Limited 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
                License:

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

                History
                Date accepted : 04 October 2019
                Categories
                Subject: Rare Disease
                Subject: 1506
                Subject: 1523
                Subject: 200
                Subject: 1560
                Subject: 1323
                Subject: 1330
                Subject: 189
                Series title: Case report
                Custom metadata
                special-feature unlocked

                Keywords: headache (including migraines),contraindications and precautions,meningitis
                Data availability:
                Keywords: headache (including migraines), contraindications and precautions, meningitis

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