Acute Bacterial Meningitis

A. Definition Bacterial Meningitis is an acute purulent infection within the subarachnoid space and associated with a CNS inflammatory reaction that result in : Decreases consciousness Seizures Raised (ICP) Stroke intracranial pressure

increase the risk such pneumococcal pneumonia.

as

Additional risk factors include coexisting acute or chronic pneumococcal sinusitis or otitis media, alcoholism, diabetes, splenoctomy, hypogammaglobulinemia, complement deficiency, and head trauma with basilar skull fracture and CSF rhinorrhea.

Mortality

rate

despite

antibiotic therapy 2) N. meningitidis, up to 60% cases in children and young adults between the ages of 2 and 20 Petechial or purpuric skin lesions are important clue to diagnosis meningococcal infection The disease may fulminant, progressing to death within hours of symptom onset Initiated by nasopharyngeal infection, which can result in either an asymptomatic carrier state or invasive meningococcal disease (depends on both bacterial virulence factors and host immune defense mechanism, including the hosts capacity to produce antimeningococcal antibodies and to lyse meningococci by both classic and alternative complement payhway) 3) Enteric gram-negative bacilli, are increasingly coomon cause of meningitis in individuals with chronic and debilitating diseases such as diabetes, cirrhosis, or alcoholism and in chronic UTI 4) Group B streptococcus, or S. agalctiae, predominantly in neonates or individuals >50 yr,

The meninges, the subarachnoid space and the brain parenchyma are all frequently involved in the inflammatory reaction (meningoencephalitis) B. Epidemiology Bacterial meningitis is the most common form of suppurative CNS infection due to :

Streptococcus )

pneumoniae

N. meningitidis (

) )

Group B streptococci ( Listeria monocytogenes ( )

H. influenza <10%

With an annual incidence in the US of >2.5 cases/100,000 population C. Etiology 1) S. pneumoniae is the most common cause in adults >20 yr with predisposing condition that

particularly those with underlying disease 5) L. monocytogenes, important cause in neonates (<1 month of age), pregnant women, individuals >60 yr, and immunocompromised individuals of all ages. Infection by ingesting foods contaminated by Listeria 6) H. influenza type b cuse meningitis in unvaccinated children and adults (Hib conjugate vaccine) 7) Staphylococcus aureus and coagulase-negative staphylococci are important causes of meningitis that occurs following invasive neurosurgical procedures or as a complication of the use of subcutaneous Ommaya reservoirs for administration of intrathecal chemotherapy