| New understandings on the pathophysiology of bacterial meningitis. | |
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MedLine Citation:
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PMID: 20216309 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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PURPOSE OF REVIEW: Currently, dexamethasone is the only adjuvant of proven benefit in bacterial meningitis. Dexamethasone halves the risk of poor outcome, but only in selected patient groups. New therapies based upon an understanding of the pathophysiology are needed. This article summarizes our knowledge on the pathophysiology of bacterial meningitis with special emphasis on pneumococcal meningitis, the experimentally best characterized subtype. RECENT FINDINGS: Experimental studies made clear that the harmful inflammatory reaction is initiated by the interaction of bacterial products with host pattern recognition receptors (PRRs) such as Toll-like receptors. PRR signalling leads to MyD88-dependent production of proinflammatory cytokines of the interleukin-1 family. Secretion of interleukin-1 family cytokines forms a positive feedback loop that boosts MyD88-dependent production of proinflammatory mediators. As a consequence, great numbers of neutrophils are recruited to the subarachnoid space. Activated neutrophils release many potentially cytotoxic agents including oxidants and matrix metalloproteinases that can cause collateral damage to brain tissue. Additionally to the inflammatory response, direct bacterial cytotoxicity has been identified as a contributor to tissue damage. SUMMARY: Promising pathophysiologically targeted approaches for adjunctive therapy of acute bacterial meningitis include limiting the release of toxic bacterial products (e.g. nonbacteriolytic antibiotics) and interfering in the generation of host-derived cytotoxins. |
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Authors:
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Uwe Koedel; Matthias Klein; Hans-Walter Pfister |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't; Review |
Journal Detail:
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Title: Current opinion in infectious diseases Volume: 23 ISSN: 1473-6527 ISO Abbreviation: Curr. Opin. Infect. Dis. Publication Date: 2010 Jun |
Date Detail:
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Created Date: 2010-04-21 Completed Date: 2010-07-12 Revised Date: 2012-01-31 |
Medline Journal Info:
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Nlm Unique ID: 8809878 Medline TA: Curr Opin Infect Dis Country: United States |
Other Details:
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Languages: eng Pagination: 217-23 Citation Subset: IM |
Affiliation:
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Department of Neurology, Klinikum Grosshadern, Ludwig Maximilians University, Munich, Germany. Uwe.Koedel@med.uni-muenchen.de |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Anti-Bacterial Agents
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therapeutic use Humans Inflammation / immunology, pathology Meningitis, Bacterial / drug therapy, immunology, pathology*, physiopathology* Neutrophils / immunology |
| Chemical | |
Reg. No./Substance:
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0/Anti-Bacterial Agents |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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