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Meningitis, Bacterial

Meningitis, Bacterial is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • Life-threatening bacterial infection of the meninges
  • System affected: nervous

Epidemiology

  • Predominant age: neonates, infants, and elderly
  • Predominant sex: male = female

Incidence

Varies by age and pathogen

  • In 2016 year 0.12
  • 0 to 4 years 0.78/100,000
  • 5 to 9 years 0.13/100,000
  • 10 to 14 years 0.09/100,000
  • 15 to 19 years 0.31/100,000
  • 20 to 24 years 0.3/100,000
  • 25 to 29 years 0.18/100,000
  • 30 to 34 years 0.14/100,000
  • 35 to 39 years 0.13/100,000
  • 40 to 44 years 0.13/100,000
  • 45 to 49 years 0.14/100,000
  • 50 to 54 years 0.17/100,000
  • 55 to 59 years 0.16/100,000
  • 60 to 64 years 0.17/100,000
  • 65 to 69 years 0.20/100,000
  • >70 years 0.24 to 0.55/100,000
  • Streptococcus pneumoniae: 0.81/100,000
  • Group B Streptococcus: 0.25/100,000
  • Neisseria meningitidis: 0.19/100,000
  • Haemophilus influenzae: 0.08/100,000
  • Listeria monocytogenes: 0.05/100,000

Etiology and Pathophysiology

Bacterial infection causes inflammation of the pia mater, arachnoid, and ventricular fluid. Age and likely pathogens guide empiric antibiotic choice. Tailor therapy to culture results whenever possible (1):

  • Community-acquired bacterial meningitis is most commonly due to S. pneumoniae (50%) and N. meningitidis (30%).
  • Nosocomial or postsurgical meningitis occurs after manipulation of the CNS space allowing for entry of pathogens.
  • Newborns (<2 months)
    • Group B Streptococcus
    • Escherichia coli
    • L. monocytogenes
  • Infants and children
    • S. pneumoniae
    • N. meningitidis
    • H. influenzae
  • Adolescents and young adults
    • N. meningitidis
    • S. pneumoniae
  • Immunocompromised adults
    • S. pneumoniae, L. monocytogenes, gram-negative bacilli such as Pseudomonas aeruginosa
    • Mixed bacterial infection in <1% of cases
  • Older adults
    • S. pneumoniae 50%
    • N. meningitidis 30%
    • L. monocytogenes 5%
    • 10% gram-negatives bacilli: E. coli, Klebsiella, Enterobacter, P. aeruginosa

Genetics
Some Native American populations appear to have genetic or acquired susceptibility to invasive disease.

Risk Factors

  • Immunocompromised
  • Alcoholism, diabetes, chronic disease
  • Neurosurgical procedure/head injury
  • Close living quarters
  • Neonates: prematurity, low birth weight, premature rupture of membranes, maternal peripartum infection, and urinary tract abnormalities
  • Abnormal communication between nasopharynx and subarachnoid space (congenital, trauma), dural fistula
  • Parameningeal source: otitis, sinusitis, mastoiditis
  • Trauma: skull fracture
  • Adults age >65 years, immunocompromised patients, and pregnant women are at risk for listeriosis.
  • Complement component deficiencies C3, C5 to C9, properdin, factor H, and factor D
  • Functional or anatomic asplenia

General Prevention

  • Consider CSF fistula in cases of recurrent meningitis.
  • Aseptic techniques for head wounds or skull fractures
  • Meningitis caused by H. influenzae type B has decreased 55% with routine vaccination.
  • Conjugate vaccines against S. pneumoniae may reduce the burden of disease in childhood.
  • Chemoprophylaxis for close contacts of meningococcal meningitis patients (2)[A]

Commonly Associated Conditions

Factors associated with a worse prognosis:

  • Alcoholism, old age, infancy, diabetes mellitus, multiple myeloma, head trauma, seizures
  • Coma, sepsis, sinusitis

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Citation

Stephens, Mark B., et al., editors. "Meningitis, Bacterial." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116372/2.1/Meningitis_Bacterial.
Meningitis, Bacterial. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116372/2.1/Meningitis_Bacterial. Accessed June 27, 2019.
Meningitis, Bacterial. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116372/2.1/Meningitis_Bacterial
Meningitis, Bacterial [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 June 27]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116372/2.1/Meningitis_Bacterial.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Meningitis, Bacterial ID - 116372 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116372/2.1/Meningitis_Bacterial PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -