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Bacterial Meningitis

Fever, Headache and A Stiff Neck…Looking Pretty Sick

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Introduction to Clinical Infectious Diseases

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Abstract

Bacterial meningitis, an infection associated with leptomeningeal inflammation, can be life-threatening. A thorough history and physical examination are essential to elucidate potential contributing risk factors and to assess the severity of illness. The diagnostic evaluation includes obtaining cerebrospinal fluid for cell count and differential, glucose and protein concentrations, gram stain, and bacterial cultures. Blood and, depending on the clinical presentation, urine cultures should be collected. A complete blood cell count with differential and serum electrolytes round out the minimal appropriate laboratory work-up for patients suspected to have bacterial meningitis. The common bacterial causes of meningitis differ by age. In neonates, the most frequent etiologic agents include Streptococcus agalactiae (Group B streptococcus), Escherichia coli, and other gram-negative enteric rods. Listeria monocytogenes is no longer a common cause of bacterial meningitis in this age group but should still be considered as an uncommon possibility during the initial evaluation of newborns and infants less than 3 months of age. Between the ages of 1 and 3 months, Streptococcus agalactiae, Streptococcus pneumoniae, and Neisseria meningitidis account for the majority of infections. After 3 months of age, invasive infections caused by Streptococcus agalactiae are no longer common. Haemophilus influenzae type b was once the most common cause of bacterial meningitis in children. Presently, cases are only seen in children who are unimmunized or who are subsequently found to have a serious humoral immune deficiency. The pathogens most commonly identified from children, adolescents, and adults with bacterial meningitis are Streptococcus pneumoniae and Neisseria meningitidis. Beyond age 50 years, Listeria monocytogenes reemerges as an important agent of bacterial meningitis. Empiric antibiotic therapy should be started as soon as feasible, usually immediately after the cerebrospinal fluid is collected. Ampicillin is used in combination with either gentamicin or a third-generation cephalosporin (usually cefotaxime) for neonates, while a third-generation cephalosporin (cefotaxime or ceftriaxone) is used in combination with vancomycin for children, adolescents, and young adults. The regimen used for older adults should also include ampicillin to optimize coverage against Listeria monocytogenes. Empiric therapy should be modified to definitive therapy when the etiologic agent has been identified and antibiotic susceptibility testing results are available. Several of the recommended antibiotic regimens used for the treatment of bacterial meningitis include higher doses administered more frequently than those used for serious infections outside of the central nervous system. Careful attention to recommended antibiotic dosing and dosing intervals during both empiric and definitive treatment is essential. Even with appropriate early diagnosis, immediate initiation of appropriate antimicrobial treatment, and the availability of expert supportive care, significant morbidities and deaths occur. The prevention of bacterial meningitis is best accomplished by ensuring timely and complete age-appropriate immunizations and through the appropriate use of post-exposure antibiotic prophylaxis for those exposed to individuals with invasive infections caused by either Neisseria meningitidis or Haemophilus influenzae type b.

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Authors and Affiliations

  1. Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, Division of Infectious Diseases, Cincinnati, OH, USA

    Felicia Scaggs Huang & Rebecca C. Brady

  2. Cincinnati Children’s Hospital Medical Center, Department of Pathology and Laboratory Medicine, Cincinnati, OH, USA

    Joel Mortensen

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  1. Felicia Scaggs Huang
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  2. Rebecca C. Brady
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  3. Joel Mortensen
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Correspondence to Rebecca C. Brady .

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Editors and Affiliations

  1. SUNY Upstate Medical University, Syracuse, NY, USA

    Joseph Domachowske

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Huang, F.S., Brady, R.C., Mortensen, J. (2019). Bacterial Meningitis. In: Domachowske, J. (eds) Introduction to Clinical Infectious Diseases. Springer, Cham. https://doi.org/10.1007/978-3-319-91080-2_23

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  • DOI: https://doi.org/10.1007/978-3-319-91080-2_23

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