Meningitis - Acute, Bacterial Disease Summary

Overview

Meningitis is the infection of the meninges and subarachnoid space that is usually caused by bacteria (eg Haemophilus influenzae type B [Hib], Neisseria meningitidis, Streptococcus pneumoniae, Listeria monocytogenes), as stated in the Introduction section.  

The epidemiology of meningitis globally is highly dynamic, and changes have been influenced by the widespread use of vaccines, antiretroviral and antibacterial treatment, including preventive methods and improved health care. A detailed discussion about the prevalence of acute bacterial meningitis is in the Epidemiology section.  

Meningitis is usually caused by bacteria such as Haemophilus influenzae type B [Hib], Neisseria meningitidis, Streptococcus pneumoniae, and Listeria monocytogenes. Alternative causes of meningitis are also listed in the Etiology section.  

The Pathophysiology section states that meningitis primarily occurs through colonization of the nasopharynx with subsequent blood and central nervous system invasion, bacteremia due to a localized source resulting in central nervous system (CNS) invasion, direct entry of organisms into the CNS from a contiguous infection and by trauma or cerebrospinal fluid (СЅF) leak.  

The Risk Factor section explains the predisposing factors in the development of meningitis depending on the causative agent.

Meningitis - Acute, Bacterial_Disease Summary

History and Physical Examination

The Clinical Presentation section describes the classic triad of fever, neck stiffness and altered level of consciousness in the diagnosis of acute bacterial meningitis. Other clinical features of bacterial meningitis are discussed in this section.

The patient’s history should be obtained prior to initiation of antimicrobial therapy for presumed bacterial meningitis, as stated in the History section.

The Physical Examination section discusses the importance of a complete neurological exam, mental status exam and evaluation to determine meningeal irritation and increased intracranial pressure in the diagnosis of acute bacterial meningitis.

Diagnosis

Discussions on lumbar puncture, cerebrospinal fluid examination, and other tests in the diagnosis of acute bacterial meningitis are in the Laboratory Tests and Ancillaries section.

The Imaging section explains indications for requesting head computed tomography scan and magnetic resonance imaging in the evaluation of bacterial meningitis.

Other diseases that should be ruled out in the diagnosis of acute bacterial meningitis are listed in the Differential Diagnosis section.

Management

General principles of antibiotic therapy in the management of acute bacterial meningitis are in the Principles of Therapy section.

The Pharmacological Therapy section discusses in detail the use of antibiotic therapy depending on the causative agent, and adjunctive therapy in the treatment of acute bacterial meningitis.

The Nonpharmacological section includes supportive measures and maneuvers in decreasing elevated intracranial pressure in the management of acute bacterial meningitis. Preventive measures are also discussed in this section.

The Monitoring section discusses observing patients for neurologic sequelae, providing appropriate supportive therapy and indications for neurologist referral in patients diagnosed with acute bacterial meningitis.