Diagnosis of meningococcal meningitis by broadrange bacterial pcr with cerebrospinal fluid. Bacterial meningitis disease plan utah department of health. During the 27year period, 445 adults were treated for 493 episodes of acute bacterial meningitis, of which 197 40 percent were nosocomial. Nosocomial postneurosurgical acinetobacter baumannii. In rare cases, however, the bacteria pass through the. Meningococcal disease is a serious illness caused by the bacterium neisseria meningitidis also known as meningococcus. Urgent clinical care is necessary for people with bacterial meningitis, because death can occur in as little as a few hours without treatment. The clinical symptoms induced by neisseria meningitidis reflect compartmentalized intravascular and intracranial bacterial growth and inflammation. Few cases of gas forming central nervous system infections due to k pneumoniae have been published. In recent years several studies have addressed neurological complications in communityacquired bacterial meningitis cabm including hydrocephalus. A group of viruses called enteroviruses is the most common cause of viral meningitis. Community acquired bacterial meningitis, bacterial meningitis, pyogenic meningitis, streptococcus. Meningitis differential diagnoses medscape reference. Recovering from childhood bacterial meningitis and septicaemia.
The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. Nosocomial ventriculitis and meningitis in neurocritical. Functional expression of the capsule polymerase of neisseria. C bacterial meningitis probably due to streptococcus. Among the bacterial meningitis patients, the isolated organisms on the csf bacterial cultures chocolate, blood, and macconkey agar s. Dec 01, 2004 measurement of csf lactate concentration is not useful in suspected communityacquired bacterial meningitis, but a concentration greater than 4 mmoll may be usefulas routine studies are not as useful in this settingin determining the need to begin empiric antimicrobial therapy in postoperative neurosurgical patients until further data confirm or exclude meningitis.
All patients with bacterial meningitis and many with viral meningitis will be treated in the hospital. These findings should not be generalized to patients who have sustained head trauma, have undergone neurosurgical procedures, or may be immunosuppressed. Kira n aft ab, 1 mari a sho aib 2 1 4th year student, 2 5th year student, dow medical college, dow university of. Untreated, its mortality approaches 100%, and even with current antibiotics and advanced paediatric intensive care, the mortality rate of the disease is approximately 510%. Comparison of meningococcal disease surveillance systems. Over recent decades new vaccines have led to a change in epidemiology of the disease. Managing meningitis epidemics in africa world health organization. In total, 408 children were diagnosed with suspected acute bacterial meningitis. A key feature in pathogenicity is the capsular polysaccharide cps that prevents complement activation and thus supports bacterial survival in the host. These viruses are found in the throat and feces stool of infected people. The yield of lumbar puncture to exclude nosocomial. About 15% of people carry these bacteria in their throats without getting sick. C since it is treatable with antiviral medications.
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 common medical condition in qatar. During the past several decades, mortality rates for adults with bacterial meningitis have not decreased, despite progress in antibiotic therapy. The mean time between surgery and onset of infection was 27 days standard deviation sd 14 multidrug resistance was observed in three cases 50% and carbapenem resistance was noted in two.
Clinical characteristics and therapeutic outcomes of. Nosocomial bacterial meningitis is most often related to either complicated head trauma or invasive procedures, such. Microbiology lectures meningitis is a disease caused by the inflammation of the protective membranes covering the brain and spinal cord known. Rapid diagnosis and treatment of acute communityacquired bacterial meningitis reduces mortality and neurological sequelae, but can be delayed by atypical presentation, assessment of lumbar puncture safety, and poor sensitivity of standard diagnostic microbiology. The most recent national surveillance study 19967 identified an overall mortality of 10% with 50% of cases having some form of disability at 5 year followup 24% serious. Untreated, bacterial meningitis is almost always fatal.
Meningitis arises upon inflammation of the meninges, which consists of the membrane that envelops and protects the central nervous system. All patients except 1 had received broadspectrum antibiotics before onset of meningitis. The most common identifiable bacterial pathogen was. Clinical features and diagnosis, section on causative organisms and epidemiology of bacterial meningitis in adults, section on communityacquired meningitis. Aseptic meningitis is the inflammation of the meninges, a membrane covering the brain and spinal cord in patients whose cerebral spinal fluid test result is negative with routine bacterial cultures. Neisseria meningitidis haemophilus influenzae streptococcus pneumoniae. Bacterial meningitis and meningococcal septicaemia national. Bacterial meningitis hemsley major reference works. Role of clinical presentations and routine csf analysis in.
Meningitis is associated with significant mortality and morbidity in infants in the first 3 months of life. Each year, more than 100 college freshmen like john come down with it. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Jul 16, 2018 kotilainen p, jalava j, meurman o, et al. Aseptic meningitis is caused by viruses, mycobacteria, spirochetes, fungi, medications, and cancer malignancies. Csf outflow resistance is elevated and inhibits csf flow from the subarachnoid space to the dural sinuses.
Research article open access clinical characteristics and therapeutic outcomes of nosocomial superinfection in adult bacterial meningitis chiren huang1, shufang chen1,2, chenghsien lu1, yaochung chuang1, naiwen tsai1, chiungchih chang1,2, hungchen wang3, chunchih chien4 and wenneng chang1 abstract. Bacterial meningitis is a potentially catastrophic infectious disease associated with substantial mortality and a risk of permanent disability in survivors. This article reports six cases of nosocomial acinetobacter baumannii meningitis in patients who had undergone neurosurgical procedures with placing of external ventricular drains. Neisseria meningitidis, often referred to as meningococcus, is a gramnegative bacterium that can cause meningitis and other forms of meningococcal disease such as meningococcemia, a lifethreatening sepsis. Mixed infection in adult bacterial meningitis springerlink. External ventricular drainage evd is frequently necessary in neurological and neurosurgical intensive care patients. The incidence of neisseria meningitidis infection decreased from 0721 per 100 000 people in 1997, to 0123 per 100 000 people in 2010 rr 086, 95% ci 004804284, which has placed this pathogen close to common bacterial causes of nosocomial meningitis such as staphylococcus and gramnegative bacteria and to haemophilus influenzae. Incidence of admittance to hospital due to bacterial meningitis was available in the nis for 50 822 cases reported from 1997 to 2010 for five of the most commonly identified bacterial pathogens. The meningitis was a nosocomial infection, because it presented 2 weeks after hospital admission and was not present or in incubation at admission. This was a case of nosocomial meningitis because the bacteria was identified in a csf analysis performed more than 48 h after the hospitalization, but the.
Viral meningitis, in contrast, tends to resolve spontaneously and is rarely fatal. Each entity is associated with a particular pattern of infecting organisms, presentation, management and. Diagnosis, initial management, and prevention of meningitis. Recent findings advances in diagnostic and treatment approach for different pathogens are presented. Communityacquired escherichia coli meningitis with.
Empirical treatment of adult postsurgical nosocomial meningitis article pdf available in acta neurochirurgica 14410. It can be acquired spontaneously in the community communityacquired. Healthcareassociated bacterial infections are often resistant to a wide range of antibiotics and are often associated with high morbidity and mortality. If meningococcal disease is suspected in primary care, guidelines recommend that benzylpenicillin. Superinfection in adult bacterial meningitis abm is a condition in which the cerebrospinal fluid csf grows new pathogens during the therapeutic course of meningitis 1, 2. Dilemmas in the diagnosis of acute communityacquired. Some of the most common bacteria known to cause meningitis are described below. The most frequent isolated bacteria were acinetobacter baumannii. Viral, fungal, tuberculous, recurrent and nosocomial infections are all classi. With appropriate treatment the risk of death in bacterial meningitis is less than 15%. This retrospective study was conducted at hamad general hospital between. Summary bacterial meningitis is a lifethreatening condition that can affect all ages, but is most common in babies and children. Some children with meningitis may have longterm problems, but this depends on the cause of the infection and the age of the child. Advances in icu care of central nervous system cns infections include application of newer diagnostic methods, improved understanding.
This guideline covers bacterial meningitis and meningococcal septicaemia, focusing on management of these conditions in children and young people aged younger than 16 years in primary and secondary care, and using evidence of direct relevance to these age groups where available. In our case report, investigations were performed to identify the source of p. Bacterial meningitis is a medical emergency characterised by inflammation of the meninges in response to bacterial infection. Comparison of meningococcal disease surveillance systems united states, 20052008. This can cause both meningitis and septicaemia meningococcal disease other types of bacterial meningitis include. Impact of antibiotic therapy in the microbiological yield. This pathogen may also cause overwhelming sepsis, purpura fulminans, or rarely benign meningococcemia. For example, huang et al during a period of 5 years january 1999 to december 2003 found that, from 127 cases of bacterial meningitis enrolled, 14 cases of meningitis were caused by cons. Managing meningococcal disease in the united states.
Nosocomial bacterial meningitis is most often related to either complicated head trauma or invasive procedures, such as craniotomy, placement. Communityacquired gramnegative bacillary meningitis is rare to occur without preexisting conditions like trauma, organ dysfunction, and immunocompromised state, and very few case reports with escherichia coli have been described in literature till now. Bacterial meningitis carried a higher mortality rate 20. These germs usually cause everyday illness, such as an ear infection or pneumonia. In addition, they showed that the therapeutic result of adult cons meningitis had a mortality rate of 14% 214.
Read our information, booklets and documents below, download as a pdf or order online. A major complication of this procedure is an evdrelated venticulitis or meningitis. Diagnosis and management of bacterial meningitis in the. Case fatality rate can be between 3% and 10% in developed countries and as high as 20% in african countries. Rates of the disease have decreased since 2000 and are currently at a historic low 1. In abm management, early and appropriate antibiotic use is an important strategy for better outcomes.
Research article open access clinical characteristics and. Viral meningitis, also called aseptic meningitis, is much more common than bacterial meningitis. In indiana, cases of meningitis and other infections in which the bacteria is isolated from a sterile site, such as the blood or csf caused by the following bacterial agents are reportable. Neisseria meningitidis is an aerobic, gramnegative diplococcus that causes meningococcal diseases such as meningococcemia and bacterial meningitis. Studies show that college freshmen living in dorms are in the highest risk group. Meningococcal disease is a nationally notifiable disease caused by the bacterium neisseria meningitidis. Hydrocephalus is a rare outcome in communityacquired. Gramnegative bacilli other than haemophilus influenzae caused 33 percent of the nosocomial episodes but only 3 percent of the communityacquired episodes. Neisseria meningitidis are bacteria that can cause meningococcal disease, a very severe form of meningitis andor blood infection. The usefulness of imipenemcilastatin for the treatment of bacterial meningitis in children may be limited.
The aim of this study was to describe the clinical characteristics of bacterial meningitis, the frequency of each pathogen, and its sensitivity to antibiotics and risk factors for death. This uncommon situation is rarely examined solely in overview studies of abm 3, 4. Frequently asked meningitis questions i meningitis now. In communityacquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Meningitis all types health conditions directory queensland health. The neurological complications secondary to bacterial meningitis contribute to the high mortality rate and to. Nosocomial bacterial meningitis prevention rather than cure. Epidemiology of bacterial meningitis in the usa from 1997.
Bacterial meningitis is a leading cause of death from infectious disease worldwide. Healthcareassociated ventriculitis and meningitis hcavm is associated with adverse clinical outcomes in the. It can be broadly divided into acute or chronic meningitis and community. E aseptic meningitis from infection with neisseria meningitidis.
Classification and pathogenesis of meningococcal infections. The bacterium is referred to as a coccus because it is round, and more specifically, diplococcus because of its tendency to form pairs. Bacterial meningitis persists in being a substantial cause of high. Viral meningitis is also called aseptic meningitis a to indicate no bacteria are involved. The type of treatment depends on the germ that caused the meningitis.
Neisseria meningitidis georgia department of public health. Communicating hydrocephalus is the most common form and is due to impaired resorption of csf through the arachnoid villi, while obstructive hydrocephalus is rarely reported 5,6. Meningitis bacterial meningitis and meningococcal disease. Bacterial meningitis is bacterial infection of the cerebrospinal fluid within the subarachnoid space. Download booklets, leaflets and documents about how meningitis can affect anyone with information about meningococcal disease, recovery. The most common bacterial cause in the uk is the meningococcus. Neisseria meningitidis the meningococcus causes significant morbidity and mortality in children and young adults worldwide through epidemic or sporadic meningitis andor septicemia. Pattern of the meningococcal meningitis outbreak in northern.
K pneumoniae is a rare cause of bacterial meningitis in europe and the united states but is relatively common in taiwan and korea. Nosocomial bacterial meningitis is infection of the leptomeninges acquired during hospitalization. Lumbar puncture performed in the medical intensive care unit to exclude nosocomial meningitis as the cause of mental status changes has a low yield and rarely changes management. B cryptococcal meningitis due to infection with cryptococcus neoformans. Bacterial meningitis is a serious disease caused by inflammation of the membranes of the brain and spinal cord meninges. Meningitis can be caused by infection from viruses and bacteria germs. Neisseria meningitidis nm is a leading cause of bacterial meningitis and sepsis. Nosocomial meningitis now constitutes a major part of brain infections seen in icus in the developed world. Articles on bacterial meningitis, viral meningitis, fungal meningitis and diagnostic tests such as imaging, lumbar puncture and vaccines are also considered. Paediatric bacterial meningitis is a neurological emergency which, despite advances in medical management, still has a significant morbidity and mortality. Meningitis is an inflammation of the meninges and subarachnoid space that can also involve the brain cortex and parenchyma. Interpretation s pneumoniae continues to be the leading identi. In adults, nosocomial bacterial meningitis usually arises following a neurosurgical postoperative wound infection.
Infections in hospitalized patients are common, especially among neurosurgical patients 1, 2. Neisseria meningitidis about neisseria meningitidis is a bacterium hosted only by humans and is a leading cause of bacterial meningitis in the united states. Bacteriological profile of community acquired acute bacterial. A prospective study of etiology of childhood acute bacterial.
Mechanisms of brain injury in bacterial meningitis. Meningitis is an acute inflammation o the pertective membranes coverin the harn and spinal cord, kent collectively as the meninges references. Pdf empirical treatment of adult postsurgical nosocomial. The neonatal period is usually defined as the first 28 days of life. In this chapter, we describe a classification system for meningococcal disease based on the nature of the clinical symptoms. Its a rare illness, but cases are reported from time to time, including one in january in a rockland county high school student and a year ago in a.
Pdf nosocomial bacterial meningitis prevention rather. Bacterial meningitis also produces effects on blood vessels in the subarachnoid space with resulting vasculitis, vessel narrowing, thrombosis, and ischemia or infarction of the brain. Nosocomial bacterial meningitis is most often related to either complicated head trauma or invasive procedures, such as craniotomy, placement of ventricular catheters, intrathecal infusion of medic. Improving the outcomes in children with bacterial meningitis. Neonatal sepsis is divided into early onset first 5 to 7 days of life and late. Bacterial meningitis is usually serious and requires very prompt. Prospective study of nosocomial fungal meningitis in. Nov 23, 2015 neisseria meningitidis and bacterial meningitis. Most children with viral meningitis recover completely. Journal of meningitis focuses on causative agents, pathophysiology, etiology, preventive measures, treatment, management of meningitis, etc. A health care provider diagnoses meningitis by observing the patients symptoms and testing blood and spinal fluid.
Viral meningitis is more common than bacterial meningitis, but rarely fatal. Risk factors for fungal nosocomial meningitis included cancer 2 children, previous neurosurgery 2 children, cranial trauma 1 case and prematurity with low birthweight 5 cases. Meningitis is an acute inflammation of the protective membranes covering the brain and spinal. A young survivor of meningitis is now active in a campaign to raise awareness of the meningitis vaccine. S pneumoniae, neisseria meningitidis, haemophilus influenzae, staphylococcus species, and gramnegative bacteria. This observation has prompted studies that have investigated meningitis pathophysiology 6, 7, adjunctive therapies to suppress inflammation 1, 4, 7,89, and identification of prognostic indicators for clinical outcome 10, 11. Bacterial meningitis can be treated with antibiotics. Transmission occurs through close contact, droplets, or direct contact with respiratory secretions. Thirtyfour patients presented nosocomial meningitis ventriculitis. With treatment, mortality risk of death from bacterial meningitis depends on the age of the person and the underlying cause. In addition to yeasts, bacteria were isolated from csf of 4 children. In younger patients, however, nosocomial meningitis is usually related to cerebrospinal fluid csf shunt infections. Nosocomial bacterial meningitis is most often related to either complicated head trauma or invasive procedures, such as craniotomy, placement of ventricular catheters. The usefulness of imipenemcilastatin for the treatment of bacterial meningitis.
Pdf bacterial meningitis and neurological complications in. Complete dna sequence of a serogroup a strain of neisseria. Bacterial types are comparatively rare, but extremely dangerous and can be fatal. A small proportion of infected people can develop a serious form of illness, such as meningitis inflammation of the lining of the brain and spinal cord or a bloodstream infection septicemia. Thus, diagnostic dilemmas are common in patients with suspected acute communityacquired bacterial meningitis. An international workshop entitled bacterial meningitis.
Usefulness of polymerase chain reaction pcr in the diagnosis of meningococcal meningitis. Apr 02, 20 bacterial meningitis is the most deadly form. Mar 30, 2000 neisseria meningitidis causes bacterial meningitis and is therefore responsible for considerable morbidity and mortality in both the developed and the developing world. Treatment protocols for bacterial meningitis during meningitis epidemics in africa. The most common type of bacterial meningitis in the developed countries is caused by neisseria meningitidis bacteria, which cause meningococcal meningitis. See bacterial meningitis in children older than one month. Cns infections due to rhodococcus species are unusual, and nosocomial rhodococcus infections have never been reported.
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