TiHo Bibliothek elib - Tierärztliche Hochschule Hannover

Falldarstellung
Adjunctive glucocorticosteroid agents for the treatment of BA or meningitis are still
controversial (Tipold 1997; Han et al. 2004). Their use may lead to a reduced
permeability at the BBB for certain antimicrobials and immune cells leading to
decreased clearance of bacteria from the CNS (Tessier and Scheld 2010).
Corticosteroids may also reduce the penetration and decrease the bactericidal
activity of some antimicrobials, such as vancomycin, in experimental meningitis
(Andes and Craig 1999). Glucocorticosteroids have immunsuppressive effects that
alter the immunological defense system which should be taken into consideration
(Plumb 1999). However, glucocorticosteroids are indicated to reduce brain swelling
and decrease the inflammation caused by proinflammatory bacterial products.
These products induce the production of cytokines and chemokines by CNS cells
inducing leukocyte chemotaxis to the infection focus and facilitate inflammation
resulting in further edema and vasculitis (Sellner et al., 2010). Studies in humans
have demonstrated a beneficial role for the early use of anti-inflammatory doses of
glucocorticosteroids to reduce inflammation and brain edema during bacterial
meningitis (Paris et al. 1994; de Gans and van de Beek 2002).
Patients with raised intracranial pressure, neurological deterioration and lifethreatening
complications, such as imminent cerebral herniation, generally had a
significant improvement in outcome (Jafari and Cracken 1994; de Gans and van de
Beek 2002). High dosage of IV glucocorticosteroids such as methylprednisolone
should be avoided in patients with head trauma due to a higher mortality as Edwards
et al`s study (2005) revealed. One dexamethasone sodium phosphate injection was
given 0.71 mg (0.06mg/kg, IV) once to this patient. While hospitalized, she was
administered prednisolone tablets 5 mg (0.43 mg/kg, PO) twice a day.
Though not previously indicated in the treatment of BA, glucocorticosteroid therapy
was continued at home once a day for one month to control the underlying Addisons
disease. This raises the question, if this additional prednisolone therapy played a role
in the successful outcome in the medical therapy of this brain abscess patient. This
would be similar to the study of Sagmanli et al. (1991), which demonstrated a better
outcome using an antimicrobial therapy combined with dexamethasone medication in
experimentally induced anaerobic BA.
75