Biology Reference
In-Depth Information
Chapter 10
Meningitis-associated
Escherichia coli
Kwang Sik Kim
Johns Hopkins University School of Medicine, Baltimore, MD, USA
INTRODUCTION
Gram-negative bacillary meningitis continues to be an important cause of
mortality and morbidity throughout the world. Case fatality rates have ranged
between 15% and 40%, and approximately 50% of survivors sustain neuro-
logical sequelae (
Gladstone et al., 1990
;
Unhanand et al., 1993
;
Dawson et al.,
1999
;
Klinger et al., 2000
;
Stevens et al., 2003
). A major contributing factor to
such mortality and morbidity is our incomplete understanding of the pathogene-
sis of this disease (
Kim, 2001, 2002, 2003, 2008, 2010, 2012
). Both clinical and
experimental data indicate limited efficacy with antimicrobial therapy alone for
the treatment of Gram-negative bacillary meningitis (
McCracken et al., 1984
;
Kim, 1985
).
E. coli
is the most common Gram-negative organism that causes
meningitis, particularly during the neonatal period.
An emergence of antibiotic resistance is an additional contributing factor to
mortality and morbidity associated with
E. coli
meningitis. Recent reports of
neonatal meningitis caused by
E. coli
strains producing CTX-M-type or TEM-
type extended-spectrum β-lactamases are a particular concern (
Blanco et al.,
2011
;
Moissenet et al., 2011
). Drug-resistant clonal group ST131 is prevalent
among
E. coli
strains causing extraintestinal infection and some carry CTX-
M-type extended-spectrum β-lactamases (
Blanco et al., 2011
). These findings
indicate that a novel strategy is needed to identify new targets for prevention and
therapy of
E. coli
meningitis.
Several lines of evidence from human cases of
E. coli
meningitis and
animal models of experimental hematogenous
E. coli
meningitis indicate that
E. coli
invasion into the brain follows a high level of bacteremia and cere-
bral capillaries are the portal of entry into the brain (
Berman and Banker,
1966
;
Kim et al., 1992
), but how meningitis-causing
E. coli
strains invade
the blood-brain barrier and penetrate into the brain remains incompletely
understood.
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