Complications of Bacterial Meningitis

  • Jay H. Tureen
  • Merle A. Sande
Part of the Clinical Topics in Infectious Disease book series (CLIN.TOP.INFECT)


Acute bacterial meningitis remains an important problem in contemporary medical practice, marked by continued significant mortality and morbidity in spite of antibiotics that are very active against the common pathogens. The age of the patient, infecting organism, and time to diagnosis are the most important determinants of outcome, with death occurring in 3–70% of patients and neurologic residua affecting 10–50% of survivors.1 While survival and level of neurologic function remain the primary considerations when one deals with the complications of meningitis, it is important to recognize that the disease process is a dynamic one, and that different phases present the clinician with varying problems that commonly occur at those times. In order to optimize care, the clinician must manage the patient in an anticipatory fashion, with a thorough understanding of the evolving illness.


Intracranial Pressure Bacterial Meningitis Brain Edema Intracranial Hypertension Brain Abscess 
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  1. 1.
    Klein JO, Feigin RD, McCarcken GH Jr: Report of the Task Force on Diagnosis and Management of Meningitis. Pediatrics 1986; 78: 959–982. 16.Google Scholar
  2. 2.
    Sande MA, Scheld WM, Täuber MG, et al: Pathophysiology of bacterial meningitis: Report of a Symposium. Ped Infect Dis J 1989; 8: 929–933.CrossRefGoogle Scholar
  3. 3.
    Swartz MN, Dodge PR: Bacterial meningitis: A review of selected aspects. N Engl J Med 1965; 17. 272:725,779,842,898,954.CrossRefGoogle Scholar
  4. 4.
    Täuber MG, Khayam-Bashi, Sande MA: Effects of ampicillin and corticosteroids on brain water content, cerebrospinal fluid pressure, and cerebrospinal fluid 18. lactate levels in experimental pneumococcal meningitis. J Infect Dis 1985; 151: 528–534.PubMedCrossRefGoogle Scholar
  5. 5.
    Täuber MG, Shibl AM, Hackbarth CJ, et al: Antibi- 19. otic therapy, endotoxin concentration in cerebrospinal fluid, and brain edema in experimental Escherechia coli meningitis in rabbits. J Infect Dis 1987; 156: 456–462. 20.Google Scholar
  6. 6.
    Tuomanen EI, Tomasz A, Hengstler B, et al: The relative role of bacterial cell wall and capsule in the induction of inflammation in experimental meningitis. J Infect Dis 1985; 151: 535.PubMedCrossRefGoogle Scholar
  7. 7.
    Täuber MG, Borschberg U, Sande MA: Influence of 21. granulocytes on brain edema, intracranial pressure, and cerebrospinal fluid concentration of lactate and protein in experimental meningitis. J. Infect Dis 22. 1988; 157: 456.Google Scholar
  8. 8.
    Tuomanen EI, Saukkonen K, Sande S, et al: Reduction of inflammation, tissue damage, and mortality in bacterial meningitis in rabbits treated with monoclon- 23. al antibodies against adhesion-promoting receptors of leukocytes. J Exp Med 1989; 170: 959–968.PubMedCrossRefGoogle Scholar
  9. 9.
    Minns RA, Engleman HM, Stirling, H: Cerebrospinal fluid pressure in pyogenic meningitis. Arch Dis Child 1989; 64: 814–820.PubMedCrossRefGoogle Scholar
  10. 10.
    Scheid WM, Dacey RG, Winn HR, et al: Cerebrospinal fluid outflow resistance in rabbits with experimental meningitis: Alteration with penicillin and methylprednisolone. J Clin Invest 1980; 66: 243CrossRefGoogle Scholar
  11. 11.
    Tureen JH, Dworkin RJ, Kennedy SL et al: Loss of cerebrovascular autoregulation in experimental meningitis in rabbits. J Clin Invest 1990; 85: 577–581.PubMedCrossRefGoogle Scholar
  12. 12.
    Horwitz SJ, Boxerbaum B, O’Bell J: Cerebral herniation in bacterial meningitis in childhood. Ann Neurol 1980; 7: 524.PubMedCrossRefGoogle Scholar
  13. 13.
    Tureen JH, Stella FB, Clyman RI, et al: Effect of indomethacin on brain water content, cerebrospinal fluid white blood cell response and prostaglandin E2 levels in cerebrospinal fluid in experimental pneumococcal meningitis in rabbits. Ped Infect Dis J 1987; 6: 1151–1153.Google Scholar
  14. 14.
    Lebel MM, Freij BJ, Syrogiannopoulos GA et al: Dexamethasone therapy for bacterial meningitis: Results of two double-bling placebo-controlled trials. N Engl J Med 1988; 319: 964–970.PubMedCrossRefGoogle Scholar
  15. 15.
    Smith AL. Pathogenesis of Haemophilus influenzae, type b meningitis, in Deusch G, Wadstrom T (eds.): Experimental Bacterial and Parasitic Infections. New York, Elsevier Science Publishing, 1983, p 295.Google Scholar
  16. 16.
    Paulson OB, Brodersen P, Hansen El et al: Regional cerebral blood flow, cerebral metabolic rate of oxygen, and cerebrospinal fluid acid-base variables in patients with acute meningitis and with acute encephalitis. Acta Med Scand 1974; 196: 191.PubMedCrossRefGoogle Scholar
  17. 17.
    Brook I, Bricknell KS, Overturf GD, Feingold SM. Measurement of lactic acid in cerebrospinal fluid of patients with infections of the central nervous system. J Infect Dis 1978: 137: 384.PubMedCrossRefGoogle Scholar
  18. 18.
    Feigin RD, Kaplan S: Inappropriate secretion of antidiuretic hormone (ADH) in children with bacterial meningitis. Am J. Clin Nutr 1977; 30: 1482–1484.PubMedGoogle Scholar
  19. 19.
    Tureen JH, Sande MA: Acute bacterial infections of the central nervous system, in Aminoff MJ (ed): Neurology and General Medicine. New York: Churchill Livingstone, 1989; pp 559–575.Google Scholar
  20. 20.
    Whitecar JP Jr., Reddin JL, Spink WW. Recurrent pneumococal meningitis: A review of the literature and studies on a patient who recovered from eleven attacks caused by five serotypes of Diplococcus pneumoniae. N Engl J Med 1966; 274: 1285–1289.CrossRefGoogle Scholar
  21. 21.
    Kirkpatrick M, Wngleman H, Minns RA. Symptoms and signs of progressive hyrdrocephalus. Arch Dis Child 1989; 64: 124–128.PubMedCrossRefGoogle Scholar
  22. 22.
    Finitzo-Hieber T, Simhardi T, Hieber JP: Abnormalities of the auditory brainstem response in postmeningitic infants and children. Int J Pediatr Otorhinolaryngol 1981; 3: 275–286.PubMedCrossRefGoogle Scholar
  23. 23.
    Dodge PR, Davis H, Feigin RD, et al: Prospective evaluation of hearing impairment as a sequela of acute bacterial meningitis. N Engl J Med 1984; 311; 869–874.PubMedCrossRefGoogle Scholar

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© Springer-Verlag New York Inc. 1990

Authors and Affiliations

  • Jay H. Tureen
  • Merle A. Sande

There are no affiliations available

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