Bacterial Meningitis: Recent Advances in Pathophysiology and Treatment

Abstract

Future therapy for bacterial meningitis will use recent developments in the understanding of pathogenic and pathophysiologic mechanisms underlying this disease. Additional studies using monoclonal antibodies against specific virulence factors and investigations into the production of inflammatory cytokines in response to bacterial cell products may lead to additional treatments that decrease the high morbidity and mortality in patients with bacterial meningitis.

Steroid Therapy for Bacterial Meningitis

“…In the first three studies, adverse neurological or audiological sequelae were documented in 9 (26%) of 34 patients receiving placebo as compared with 14 (33%) of 43 non-steroid-treated and 3 (9%) of 32 dexamethasone-treated patients (P = .025) in the retrospective analysis. These clinical data are also consistent with results from a model for experimental pneumococcal meningitis [1][2][3]5]. We need additional data on dexamethasone therapy used in conjunction with other classes of antibiotics (such as vancomycin and rifampin) to determine its effect in patients with meningitis due to penicillin-resistant and cephalosporin-resistant pneumococci.…”

“…Bacterial meningitis remains an important cause of death and permanent neurological disability despite advances in antimicrobial therapy, rapid diagnostic techniques, and sup- Data from recent in vitro and animal experiments indicate that the bacteria causing meningitis elaborate outer membrane-active or cell wall-active components that affect monocytes, leukocytes, cerebrovascular endothelial cells, and astrocytes [1][2][3]. These cells, in turn, produce various proinflammatory cytokines or express specific receptors on their surface.…”

“…On the basis of pathophysiological and pharmacokinetic data [1,2,12], and for achievement of maximum benefits and minimum complications, dexamethasone therapy was started 10 minutes before the first dose of ceftriaxone was administered, and it was given every 12 hours for only 2 days. Results from animal studies strongly indicate that the optimal time for adjunctive dexamethasone therapy is just before administration of the first dose of parenteral antibiotics [4][5][6].…”

Prognosis of bacterial meningitis in children

“…Most of the clinical reports on complications and mortality in bacterial meningitis have been done in developed countries 6 " 8 " 14 . In South America and Africa, despite a continued high incidence of meningitis 13 , there are few reports analyzing aspects of neurological morbidity in children with a diagnosis of pyogenic meningitis.…”

Características clínicas e laboratoriais de meningites piogênicas em adultos

“…Entretanto, ao contrário de outros estudos nos quais foi observada maior freqüência de meningite pneumocócica 5,9,10,12 , verificamos que o principal agente etiológico de meningite piogênica em pacientes com idade superior a 14 anos foi o meningococo.…”