Do you know any mechanisms in which patients with bacteremia are likely to present with severe headache, although following cerebrospinal fluid examination reveals no evidence of meningitis?
Good morning Nabuhiro.
On could imagine at least two mechanisms that cause headache in patients with severe bacteremia:
1) The increased plasma level of inflammatory mediators that disturb the trigemino-vascular system and create various types of headache as is the case in catamenial migraine (where prostaglandins are involved) or in some thoracic pathologies like aortic dissection (see Kamtchum et al, 2015 / PMID 26082134 / attached file). Moreover, some bacterial toxins might have an intrincic potential to stimulate CNS nociceptors.
2) The activation of the sympathetic system as a part of the body response to physiologic (especially circulatory) perturbations induced by bacteremia. This activation of the sympathetic system could result in an increase in systemic blood pressure that causes headache (as seen in hypertensive encephalopathy, posterior reversible encephalopathy syndrome - PRES, eclampsia or phaeochromocytoma).
I hope this helps for your research. Good luck!
Mr. Bhoj R Singh and Mr. Joseph Kamtchum Tatuene
Thanks very much for kind replies. Your comments as well as the attached file were helpful for my understanding for this condition.
If you have some thought on my question "Should clinicians perform cerebrospinal fluid test in patients with severe headache followed by bacteremia in spite of the absence of clinical signs, such as Kernig's sign or Brudzinski's sign?", please give me some advice if you have some thought.
With regards,
N Takeuchi
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