Department of Neurology, Academic Medical Center, University of Amsterdam, Center of Infection and Immunity Amsterdam (CINIMA), PO Box 22660, 1100DD, Amsterdam, The Netherlands.
Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Acta Neuropathol Commun. 2016 Mar 22;4:26. doi: 10.1186/s40478-016-0297-4.
Pneumococcal meningitis is associated with substantial mortality and morbidity. We systematically assessed brain histopathology of 31 patients who died of pneumococcal meningitis from a nationwide study (median age 67 years; 21 (67 %) were male) using a pathology score including inflammation and vascular damage. Of the 27 patients with known time from the admission to death, 14 patients died within 7 days of admission and 13 after 7 days of admission. Eleven of 25 (44 %) patients had been treated with adjunctive dexamethasone therapy. Observed pathological processes were inflammation of medium-large arteries in 30 brains (97 %), cerebral haemorrhage in 24 (77 %), cerebritis in 24 (77 %), thrombosis in 21 (68 %), infarction in 19 (61 %) and ventriculitis in 19 (of 28 cases, 68 %). Inflammation of medium-large arteries led to obstruction of the vascular lumen in 14 (of 31 cases, 45 %). Vascular inflammation was associated with infarction and thrombosis of brain parenchymal vessels. Hippocampal dentate gyrus apoptosis between patients treated with and without dexamethasone was similar (p = 0.66); however, dexamethasone treated patients had higher total pathology score than non-dexamethasone treated patients (p = 0.003). Our study shows that vascular damage is key in the process of brain damage in pneumococcal meningitis. Data and material of this study will be made open-access for translational research in pneumococcal meningitis (MeninGene-Path).
肺炎球菌性脑膜炎与较高的病死率和发病率相关。我们系统性评估了一项全国性研究中 31 例肺炎球菌性脑膜炎死亡患者的脑组织病理学特征（中位年龄 67 岁；21 例患者为男性，占 67%），该研究采用包括炎症和血管损伤的病理学评分。在 27 例已知从发病到死亡时间的患者中，14 例患者在发病后 7 天内死亡，13 例患者在发病 7 天后死亡。25 例患者中有 11 例接受了辅助地塞米松治疗。观察到的病理过程为 30 例大脑（97%）中型大动脉炎症、24 例（77%）脑实质出血、24 例（77%）脑实质炎、21 例（68%）血栓形成、19 例（61%）脑梗死和 19 例（28 例中的 19 例，68%）脑室炎。14 例（31 例中的 14 例，45%）中型大动脉炎症导致血管腔阻塞。血管炎症与脑实质血管的梗死和血栓形成有关。接受和未接受地塞米松治疗的患者之间齿状回颗粒细胞凋亡无差异（p=0.66）；然而，接受地塞米松治疗的患者总病理学评分高于未接受地塞米松治疗的患者（p=0.003）。本研究表明，血管损伤是肺炎球菌性脑膜炎脑损伤过程中的关键因素。该研究的数据和材料将对肺炎球菌性脑膜炎的转化研究开放获取（MeninGene-Path）。
