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 Table of Contents  
Year : 2019  |  Volume : 3  |  Issue : 3  |  Page : 108-109

Myelitis and bacterial meningitis

Department of Neurology; Department of Medicine, Federal University of Santa Maria, Santa Maria, Rio Grande Do Sul, Brazil

Date of Web Publication15-Oct-2019

Correspondence Address:
Dr. Jamir Pitton Rissardo
Rua Roraima, Santa Maria, Rio Grande Do Sul
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/LJMS.LJMS_50_19

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How to cite this article:
Rissardo JP, Fornari Caprara AL. Myelitis and bacterial meningitis. Libyan J Med Sci 2019;3:108-9

How to cite this URL:
Rissardo JP, Fornari Caprara AL. Myelitis and bacterial meningitis. Libyan J Med Sci [serial online] 2019 [cited 2023 Feb 7];3:108-9. Available from: https://www.ljmsonline.com/text.asp?2019/3/3/108/269225

Dear Editor,

We read an article published on “Libyan Journal of Medical Sciences” with great interest. Kamal et al. reported an adult male presenting with bacterial meningitis whose strength in the lower limbs was worsened. Magnetic resonance of the spine revealed transverse myelitis.[1]

Spinal cord involvement is an uncommon complication of acute bacterial meningitis. Many causative organisms have already been published in these concomitant pathologies, such as Corynebacterium jeikeium,  Escherichia More Details coli, Haemophilus influenzae, Klebsiella pneumoniae,  Neisseria More Details meningitidis, Streptococcus pneumoniae, and Streptococcus agalactiae.[2]

In this letter, we would like to improve the description of the possible pathological mechanisms of this co-occurrence found in the literature. First, one of the most frequently reported pathogeneses is the mass effect. This could occur when there is direct compression of the spinal cord due to an exudate that gets organized in a localized spinal region. In this context, spinal neuroimaging will show myelitis and a lesion compressing the spine. In addition, the presence of cystic dilations in late images could be a signal of an earlier compression.[2]

Pfister et al. in 1992 performed a prospective study about the cerebrovascular complications in adults with bacterial meningitis. Their study showed that vascular involvement is the most common intracranial complication found in bacterial meningitis, and it occurs in more than 30% of the individuals. They proposed that a cerebral septic venous thrombosis due to bacterial meningitis could affect the venous drainage, which may lead to downward spinal venous dissemination of the bacteria.[3] However, there is no case series that supports the hypothesis of Kastenbauer et al. and Pfister et al. Furthermore, Kamal et al. stated that no organism was isolated from cerebrospinal fluid in their case report.[1] Yet, some studies about tuberculous meningitis revealed cultural growth of Mycobacterium tuberculosis when spinal cord was analyzed in postmortem individuals.[4]

Another possible mechanism could be the bacterial meningitis causing vasculitis of the spinal cord. The vascular assumption is commonly described with myelitis in patients lupus diagnosis that could partially explain the pathogenesis of the transverse myelitis.[2],[3] An example of bacteria leading to inflammation of the arterial blood vessels that nourish spinal cord is N. meningitidis, which is a well-known cause of meningitis.[2] Studies have reported subjects presenting with central or peripheral vasculitis symptoms proved by histological findings that had meningitis by N. meningitis. In addition, Girgis et al. proposed that this occurred due to endotoxins released by the bacteria compromising the peripheral vascular system, which may, in turn, involve the spinal territory, leading to a vascular syndrome of the spinal cord.[5] Moreover, the assumed pathogenesis could be supported by case reports with viral meningitis who developed infarction of the anterior spinal artery territory during their hospitalization.[6]

Acute transverse myelitis is a rare acquired immune spinal cord disorder, which the demyelination is related with some continuum of neuro-inflammatory disorders. In this manner, the last hypothesis that we describe is the misleading immune response. As is already known in others acquired immune disorders, maybe a bacterial meningitis infection could lead to an evoked immune response, which in turn cross-reacts with some components of the spinal cord because of the sharing similar cross-reactive sites.[7]

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There are no conflicts of interest.

  References Top

Kamal I, Minhas B, Eltahir RM, Elzouki AN. Acute meningitis complicated by transverse myelitis: A rare complication. Libyan J Med Sci 2019;3:68-70.  Back to cited text no. 1
  [Full text]  
Kastenbauer S, Winkler F, Fesl G, Schiel X, Ostermann H, Yousry TA, et al. Acute severe spinal cord dysfunction in bacterial meningitis in adults: MRI findings suggest extensive myelitis. Arch Neurol 2001;58:806-10.  Back to cited text no. 2
Pfister HW, Borasio GD, Dirnagl U, Bauer M, Einhäupl KM. Cerebrovascular complications of bacterial meningitis in adults. Neurology 1992;42:1497-504.  Back to cited text no. 3
Garg RK, Malhotra HS, Gupta R. Spinal cord involvement in tuberculous meningitis. Spinal Cord 2015;53:649-57.  Back to cited text no. 4
Girgis NI, Farid Z, Mikhail IA, Farrag I, Sultan Y, Kilpatrick ME, et al. Dexamethasone treatment for bacterial meningitis in children and adults. Pediatr Infect Dis J 1989;8:848-51.  Back to cited text no. 5
Kincaid O, Lipton HL. Viral myelitis: An update. Curr Neurol Neurosci Rep 2006;6:469-74.  Back to cited text no. 6
Kerr DA, Ayetey H. Immunopathogenesis of acute transverse myelitis. Curr Opin Neurol 2002;15:339-47.  Back to cited text no. 7


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