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Meningitis, Bacterial

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

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Basics

Description

  • A potentially life-threatening bacterial infection of the meninges
  • System affected: nervous

Epidemiology

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

Incidence
  • <2 months: 80/100,000
  • 2 to 23 months: 7/100,000
  • 2 to 10 years: 0.5/100,000
  • 11 to 17 years: 0.4/100,000
  • 18 to 34 years: 0.66/100,000
  • 35 to 49 years: 0.95/100,000
  • 50 to 64 years: 1.73/100,000
  • ≥65 years: 1.92/100,000
  • Varies with pathogen
    • 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 the fluid of the ventricles. Age and likely pathogens guide empiric choice of antibiotics. Tailor therapy by culture results whenever possible (1):

  • 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
Navajo Indians and American Eskimos appear to have genetic or acquired susceptibility to invasive disease.

Risk Factors

  • Immune compromise
  • Alcoholism, diabetes, chronic disease
  • Neurosurgical procedure/head injury
  • Abdominal surgery
  • 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 of infection: otitis, sinusitis, mastoiditis
  • Trauma: skull fracture

General Prevention

  • Treat infections appropriately.
  • Strict aseptic techniques for patients with head wounds or skull fractures
  • Consider CSF fistula in patients with recurrent meningitis.
  • 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.
  • Close contacts of meningococcal meningitis patients should receive chemoprophylaxis (2)[A].

Commonly Associated Conditions

Conditions associated with a worse prognosis:

  • Alcoholism, old age, infancy
  • Diabetes mellitus, multiple myeloma
  • Head trauma, seizures
  • Coma, bacteremia, sepsis
  • Bacteremia, 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/all/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/all/Meningitis__Bacterial. Accessed April 26, 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/all/Meningitis__Bacterial
Meningitis, Bacterial [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 26]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116372/all/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/all/Meningitis__Bacterial PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -