Etiology post surgery contamination, pregnant women, neutropenic patients low count of neutrophils, and spirochete agents. Meningitis occurs when the membranes that cover the brain and spinal cord become inflamed. The r ole of caspase casp1 in the pathophysiology of pneu mococcal meningitis has been the subject of recent experiments. This cascade leads to lipid peroxidation, mitochondrial damage and breakdown of the bloodbrain barrier, thus contributing to cell injury during neonatal meningitis. Moore, specialist registrar in infectious diseases, and j. Streptococcus pneumoniae, neisseria meningitidis, and haemophilus influenzae type b hib are the predominant causative pathogens in both adults and children. New understandings on the pathophysiology of bacterial meningitis. Pathophysiology and treatment of bacterial meningitis. Feb 12, 2018 the persistence of neonatal meningitis results from increases in the numbers of infants surviving premature delivery and from limited access to medical resources in developing countries. Zoonotic causes of bacterial meningitis are rare, but important to consider when there is a history of exposure to animals. Dec, 2016 what is meningitis meningitis refers to an inflammatory process of leptomeninges and csf within the subarachnoid space.
The type of treatment depends on the germ that caused the meningitis. Protein leaks into the subarachnoid space from the blood, resulting in markedly increased csf protein levels. Emerging antibiotic resistance is an upcoming challenge. Streptococcus suis, most prevalent in southeast asia, is associated with raw pork meat and pig farming. The clinical features, treatment, prognosis, and prevention of bacterial meningitis in adults and children and issues related to chronic and recurrent meningitis are discussed separately. The patient usually experiences fever, headache, vomiting, irritability, anorexia, and stiffness in the neck. Pathophysiology and treatment of bacterial meningitis olaf hoffman and joerg r. Meningitis is usually caused by a bacterial or viral infection that invades the cerebral spinal fluid csf. Meningitis is an inflammation of the membranes that surround the brain and the spinal cord. Learn more about how you get meningitis, its symptoms, and how its treated at webmd. Animal models have proven to be extremely valuable in the study of the pathogenesis and pathophysiology of bacterial meningitis, with the hopes of providing new information that may lead to an. It can be caused by a variety of organisms that include bacteria, fungi or viruses.
Bacterial meningitis may present acutely symptoms evolving rapidly over 124 hours, sub acutely symptoms evolving over 17days, or chronically symptoms evolving over more than 1 week. We evaluated the data on the pathogenesis, pathophysiology, and treatment of bacterial meningitis and considered in depth the information from animal models that may have potentially important applications in the treatment of human disease. Bacterial meningitis affects the blood vessels that course through the subarachnoid space. Pneumococcal infections and meningococcal infections are the most common causes of bacterial meningitis.
Through the use of experimental animal models of infection, a great deal of information has been gleaned concerning the pathogenic and pathophysiologic mechanisms operable in bacterial meningitis. Pathogenesis and pathophysiology of bacterial meningitis uptodate. In one study, bacteremia and meningitis developed in 89 and 94%ofanimals, respectively, following the atraumatic intranasal inoculation ofh. Bacterial meningitis is an inflammation of the meninges, in particular the arachnoid and the pia mater, associated with the invasion of bacteria into the subarachnoid space, principles known for more than 100 years flexner, 1907. Meningitis is an inflammation of the meninges, the membranes covering the brain and spinal cord. Surgical management is indicated where there is extremely increased intracranial pressure, infection. About 15% of people carry these bacteria in their throats without getting sick. Despite the availability of bactericidal antibiotics with potent in vitro activity against the major meningeal pathogens, the morbidity and mortality from bacterial meningitis remains unacceptably high.
Pdf no bacterial disease has undergone a more dramatic change in epidemiology during the past decade than acute bacterial meningitis. Meningitis is an inflammation of the membranes meninges surrounding your brain and spinal cord. Neurological damage in meningitis may be caused by a mixture of direct bacterial toxicity, indirect inflammatory processes such as cytokine release, neutrophil activation, with resultant vasculitis, and cellular oedema. Treatment is with antibiotics and corticosteroids given as soon as. Pathophysiology and treatment of bacterial meningitis ncbi. Practice guidelines for the management of bacterial meningitis. Dexamethasone halves the risk of poor outcome, but only in selected patient groups. No bacterial disease has undergone a more dramatic change in epidemiology during the past decade than acute bacterial meningitis. Acute bacterial meningitis neurologic disorders merck. Fifty years after the advent of antibiotics for clinical use, bacterial meningitis remains an important cause of morbidity and mortality. In general, there are no medications to fight the germs that cause viral meningitis, so treatment is usually aimed at easing the symptoms. Some cases of meningitis are very serious, leading to permanent neurologic problems, amputation of limbs, loss of hearing, seizures or strokes, and even death. New therapies based upon an understanding of the pathophysiology are needed.
In the past, hib was the most common cause of meningitis in children under five years of age. As such, it represents a unique human infectious disease, b. Pathogenesis ofbacterial meningitis 119 torysituation indicates the ongoingneedto studythepathogenesis and pathophysiology of bacterial meningitis in an attempt to improve the response to conventional antimicrobial therapy 126, 148, 165, 166. Animalmodels experimental animal models have been employed exten. Various bacteria including the major meningeal pathogens e. Infant primates have also been used in the study ofthe pathogenesis ofbacterial meningitis. In addition, the absence of specific clinical findings makes diagnosis of meningitis more difficult in neonates than in older children and adults. Meningitis is an inflammation of the tissue that covers the brain and spinal cord that can be caused by several different types of, as well as viruses and fungibacteria.
Much of the damage from this infection is believed to result from cytokines released within the csf as. Autolysis consists of selfdigestion of the cell wall by peptidoglycan hydrolyases termed autolysins. A key factor that contributes to the high prevalence of this condition is the. Treatment is with antibiotics and corticosteroids given as soon as possible. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Bacterial meningitis symptoms, diagnosis and treatment.
Viral infections are the most common cause of meningitis, followed by bacterial infections and, rarely, fungal infections. In order to improve prognosis of the infection, early diagnosis and prompt treatment are crucial to prevent mortality and the incidence of neurologic sequelae that cause longterm. Neonatal meningitis is often caused by group b streptococcus and is associated with prematurity, gestational age, postnatal age, and geographic region. Some of the most common causes of bacterial meningitis include neisseria meningitidis, streptococcus. Despite the availability of bactericidal antibiotics with potent in vitro activity against the major meningeal pathogens, the morbidity and mor tality from bacterial. The swelling from meningitis typically triggers symptoms such as headache, fever and a stiff neck. Neisseria meningitidis are bacteria that can cause meningococcal disease, a very severe form of meningitis andor blood infection. The pathogenesis and pathophysiology of bacterial meningitis involve a complex interplay between virulence factors of the pathogens and the host immune response 4,5.
Other bacterial causes of meningitis include haemophilus influenza type b. Meningitis is generally caused by an infection, but chemical meningitis may also occur in response to a bacterial irritant injected into the subarachnoid space. Bacterial meningitis leads to a more permeable blood brain barrier due to increased inflammation. Cerebral spinal fluid csf is the fluid within the open spaces of the brain that protect and cushion the brain and. Streptococcus pneumoniae, neisseria meningitidis, and haemophilus influenzae type b hib are the predominant causative pathogens in both adults and children the focus of this topic is on bacterial meningitis acquired in the community. Pathophysiology of neonatal acute bacterial meningitis.
Meningitis, inflammation of the meninges, the membranes covering the brain and spinal cord. Bacterial meningitis is a serious disease that can lead to paralysis, stroke, and even death. Many different kinds of viruses and bacteria germs can cause meningitis. Meningitis is a viral, bacterial, or fungal infection of the lining of the brain and spinal cord, the meninges. Expert opinion and several societal guidelines recommend routine treatment.
In rare cases, however, the bacteria pass through the. This axial nonenhanced computed tomography scan shows mild ventriculomegaly and sulcal effacement. Introduction bacterial meningitis is an inflammation of the leptomeninges, usually causing by bacterial infection. Meningitis can occur at any age, but it has particularly virulence for babies and children. Approximately 10,000 cases of bacterial meningitis occur each year in the united states, whereas other parts of the world have substantially higher incidences. The pathogenesis of bacterial meningitis, including colonization of. Dec 28, 2012 introduction bacterial meningitis is an inflammation of the leptomeninges, usually causing by bacterial infection. Meningococcal disease what meningococcal disease is meningococcal disease is illness caused by the bacterium neisseria meningitidis, also known as meningococcal bacteria.
Pathogenesis and pathophysiology of bacterial meningitis. Bacterial meningitis is an important cause of mortality and morbidity despite advances in antimicrobial therapy. Bacterial meningitis is an inflammation of the meninges, including the pia, arachnoid, and subarachnoid space, that occurs in response to infection with bacteria andor bacterial products. Bacterial meningitis is a potentially catastrophic infectious disease associated with substantial mortality and a risk of permanent disability in survivors. Streptococcus pneumoniae and neisseria meningitidis are now the leading causes of bacterial meningitis. Meningococcal meningitis generally has a better prognosis than septicaemia.
Some of the most common bacteria known to cause meningitis are described below. Bacterial meningitis is a medical emergency requiring immediate diagnosis and immediate treatment. Meningitis about bacterial meningitis infection cdc. Bacterial meningitis remains a disease with associated unacceptable morbidity and mortality rates despite the availability of effective bactericidal antimicrobial therapy. Jul 16, 2019 meningitis is a clinical syndrome characterized by inflammation of the meninges. Most cases of meningitis in the united states are caused by a viral infection, but bacterial, parasitic and fungal infections are other causes.
It usually starts with bacteria that cause a coldlike infection. Because bacterial infections can be lifethreatening, identifying the cause is essential. Cross contamination of bacteria will vary between the ages, all will be affected by the bacterial infection that can lead to meningitis. In addition, sampling csf compartments early during bacterial meningitis demonstrates higher bacterial densities in the lateral ventricles than in the cisterna magna, lumbar subarchnoid space, or supracortical subarachnoid space. Get a printable copy pdf file of the complete article 4. Etiology and mortality of bacterial meningitis in northeastern brazil. Diagnosis, initial management, and prevention of meningitis. Acute bacterial meningitis merck manuals professional edition.
Bacterial meningitis is a serious inflammation of the meninges caused by various bacteria. Bacterial meningitis is very serious and can be deadly. Changing epidemiology of acute bacterial meningitis. Through the use of experimental animal models of infection, a great deal of information. Acute bacterial meningitis is rapidly progressive bacterial infection of the meninges and subarachnoid space. Infection of the subarachnoid space leads to cerebrospinal fluid csf inflammation, meningeal irritation, and the clinical triad of headache, fever, and meningismus. This is normally caused by infection but can also have noninfectious causes. In bacterial meningitis, glucose transport from the blood into the csf is impaired.
Meningitis, pathophysiology search for similar articles you may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search. Bacterial meningitis is the most common serious infection of the central nervous system. This could contribute to the management of the disease through development of effective prevention strategies and treatment guidelines. Findings typically include headache, fever, and nuchal rigidity. Pathogenesis of bacterial meningitis sciencedirect. Despite modern antibiotics and improved critical care, bacterial meningitis bm. Neisseria meningitidis is remarkable for the diversity of interactions that the bacterium has with the human host, ranging from asymptomatic nasopharyngeal colonisation affecting virtually all members of the population. Bacterial meningitis is the most serious type of meningitis.
Cohen, professor, department of infectious diseases and micro biology, imperial college school of medicine, hammersmith hospital, london summary bacterial meningitis is the most common serious infection. The image below depicts acute bacterial meningitis. Since the hib vaccine is now given to all children as part of their routine immunizations, the number of hib infections and related meningitis cases has declined. Department of internal medicine infectious diseases, medical college of pennsylvania, philadelphia 19129. However, permanent disabilities such as brain damage, hearing loss, and learning disabilities can result from the infection. It can cause stroke, hearing loss, and brain damage. Nov 07, 2017 this feature is not available right now. Bacteria that enter the bloodstream and travel to the brain and spinal cord cause acute bacterial meningitis. It is a serious condition that can be life threatening.
Meningitis can be caused by various infectious agents, including viruses, fungi, and protozoan s, but bacteria produce the most lifethreatening forms. Streptococcus pneumoniae and neisseria meningitidis are the most common and most aggressive pathogens of meningitis. Meningococci reach the brain from the bloodstream, implying that the patients immune response has prevented bacterial proliferation in the blood and not suffered overwhelming sepsis. There is also increased anaerobic glycolysis by leukocytes and brain cells. This results in vasculitis which leads to narrowing andor thrombosis of cerebral blood vessels, ischemia, andor infarction of the brain. Pathophysiology of meningococcal meningitis and septicaemia.
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