Acute Bacterial Meningitis

Abstract

In the past 10 years the epidemiology of bacterial meningitis has changed, with a decreased incidence of meningitis caused by Haemophilus influenzae and an increasing incidence of meningitis caused by penicillin- and cephalosporin-resistant strains of Streptococcus pneumoniae. Meningococcal meningitis has become an increasing threat to college students. Successful outcome from meningitis requires not only eradication of the bacterial pathogen but also management of the neurological complications of raised intracranial pressure, stroke, and seizure activity. In this article, the pathophysiology, etiology, clinical presentation, differential diagnosis, and management of acute bacterial meningitis are reviewed. The present recommendations for the use of dexamethasone in the treatment of this infection, the use of chemoprophylaxis, and the indications for vaccinations are included.

Aquaporin-4 Gene Disruption in Mice Reduces Brain Swelling and Mortality in Pneumococcal Meningitis

“…The needle did not cause significant brain injury as assessed by histological examination of the needle tract, and normal intracranial pressure and neurological function in saline-injected control mice. We chose S. pneumoniae, because it is a major cause of meningitis in humans whose incidence is increasing compared with Neisseria meningitidis and H. influenzae (1)(2)(3)(4)(5). The presence of pneumococcus in the CSF produced marked brain swelling with increased intracranial pressure and brain water content, resulting in impaired neurological function and mouse survival.…”

“…The overall incidence of pneumococcal meningitis is rising (4,5) and the emergence of penicillin-resistant S. pneumoniae makes treatment harder (6,7). Even with effective antibiotic treatment, mortality from pneumococcal meningitis is 10 -30%, with 30 -50% of patients acquiring permanent neurological deficits (1)(2)(3).…”

Discrepancies between brain CT imaging and severely raised intracranial pressure proven by ventriculostomy in adults with pneumococcal meningitis

“…Elevated intracranial pressure (ICP) is a well-known complication of acute bacterial meningitis [4,11,14,23]. Disregard of increased ICP delays adequate adjunctive therapy and fatal cerebral herniation may occur [4,12,13].…”

Role of the urokinase plasminogen activator system in patients with bacterial meningitis

“…1,2 The high morbidity and mortality rates of this disease are mainly due to CNS complications including brain edema, hydrocephalus, and cerebrovascular events. [2][3][4] Pathophysiologic alterations that contribute to CNS complications include breakdown of the blood-brain barrier and leukocyte invasion, followed by an extensive perpetuated inflammation and neuronal damage.…”