May 7, 2021
Treating bacterial meningitis early with dexamethasone, a corticosteroid hormone that is effective at reducing inflammation, along with antibiotics, leads to full recovery in the shortest time, according to a recently published case report by researchers from Hackensack Meridian Jersey Shore University Medical Center and the Cleveland Clinic.
The case report article, “Earliest Administration of Dexamethasone in a Case Diagnosed with Bacterial Meningitis Along with Antibiotics Leading to Full Recovery in the Shortest Period,” was published recently in the International Journal of Clinical and Medical Cases.
A team of researchers from Jersey Shore University Medical Center, led by Professor of Medicine and Nephrologist Sushil K. Mehandru, M.D., and Tushar Vaccharajani, M.D., professor of Medicine, Cleveland Clinic, reported on a 70-year-old woman who received dexamethasone for severe pain in the large joints, presumed to be due to arthritis, for 72 hours prior to progressing to coma and being diagnosed with Neisseria meningitis, an inflammation of the brain and spinal cord membranes.
“This patient was comatose when admitted to the hospital,” reported Dr. Mehandru and the authors. “She continued to be treated with dexamethasone, and antibiotics were initiated. She was discharged from the ICU within 13 hours of admission, awake, alert and fully oriented without any neurological deficits. After long-term follow-up, a year later, the patient showed no residual neurological consequences from the meningitis.”
It is believed that dexamethasone reduces morbidity and mortality in bacterial meningitis by blunting the inflammatory response secondary to bacterial destruction, which frequently causes detrimental physiological effects. Dr. Mehandru commented that this case represents the earliest use of dexamethasone in bacterial meningitis with dramatic recovery and positive outcome in the short- and long-term. The patient had complete resolution of symptoms of bacterial meningitis and a remarkable recovery with no longstanding neurological or systemic problems.
“While it is challenging to foresee oligoarticular arthritis as the prodromal signs of Neisseria meningitis, as seen in this patient, this case may make physicians more aware of the possibility. It also may help physicians consider dexamethasone earlier upon suspicion of meningitis much prior to culture and sensitivity reports and certainly before administration of antibiotics,” said Dr. Mehandru.
A 2002 study published in The New England Journal of Medicine showed the percentage of patients with bacterial meningitis with unfavorable outcomes was significantly smaller in patients who received dexamethasone versus placebo (15 percent versus 25 percent), and the proportion of patients who died was significantly smaller in the dexamethasone group than in the placebo group.2
The overall benefit of dexamethasone is believed to be substantial. It has been shown that among patients with pneumococcal meningitis, 26 percent in the dexamethasone group had an unfavorable outcome as compared with 52 percent in the placebo group.2
Among patients with meningitis due to Neisseria meningitidis, however, adjuvant treatment with dexamethasone did not provide significant benefit.3 However, as shown in the case report, dexamethasone is beneficial in Neisseria meningitis if the drug is given early, resulting in full recovery within a very short period of time with no neurological sequelae. Dr. Mehandru and the authors concluded their case report by commenting that “…the early use of dexamethasone may be found beneficial in all types of bacterial meningitis.”
Dr. Mehandru and the nephrology team were also recently published for their work in identifying a new syndrome, reducing high blood potassium caused by metabolic acidosis and other conditions, and successfully establishing a new method for battling lactic acidosis in lymphoma.
- Mehandru SK, Kaur S, Sen S, Asif A, Vaccharajani T. Earliest Administration of Dexamethasone in a Case Diagnosed With Bacterial Meningitis Along With Antibiotics Leading to Full Recovery in the Shortest Period. Int J Clin Med Cases. 2020 Nov;3(8):165.
- Beek DVD, Gans JD. Dexamethasone in Adults with Bacterial Meningitis. N Engl J Med. 2002 Nov;347:1549-1556.
- Hasbun R. Update and advances in community acquired bacterial meningitis. Curr Opin Infect Dis. 2019 Jun. 32(3):233-238.