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Bacterial meningitis

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Bacterial meningitis is a form of meningitis caused by bacteria

The types of bacteria that cause bacterial meningitis vary by age group. In premature babies and newborns up to three months old, common causes are group B streptococci (subtypes III which normally inhabit the vagina and are mainly a cause during the first week of life) and those that normally inhabit the digestive tract such as Escherichia coli (carrying K1 antigen). Listeria monocytogenes (serotype IVb) may affect the newborn and occurs in epidemics. Older children are more commonly affected by Neisseria meningitidis (meningococcus), Streptococcus pneumoniae (serotypes 6, 9, 14, 18 and 23) and those under five by Haemophilus influenzae type B (in countries that do not offer vaccination, see below). [1] [2]

In adults, N. meningitidis and S. pneumoniae together cause 80% of all cases of bacterial meningitis, with increased risk of L. monocytogenes in those over 50 years old.[2][3]  Since the pneumococcal vaccine was introduced, however, rates of pneumococcal meningitis have declined in children and adults.[4]

Recent trauma to the skull gives bacteria in the nasal cavity the potential to enter the meningeal space. Similarly, individuals with a cerebral shunt or related device (such as an extraventricular drain or Ommaya reservoir) are at increased risk of infection through those devices. In these cases, infections with staphylococci are more likely, as well as infections by pseudomonas and other Gram-negative bacilli.[2] The same pathogens are also more common in those with an impaired immune system.[1] In a small proportion of people, an infection in the head and neck area, such as otitis media or mastoiditis, can lead to meningitis.[2] Recipients of cochlear implants for hearing loss are at an increased risk of pneumococcal meningitis.[5]

Tuberculous meningitis, meningitis due to infection with Mycobacterium tuberculosis, is more common in those from countries where tuberculosis is common, but is also encountered in those with immune problems, such as AIDS.[6]

Recurrent bacterial meningitis may be caused by persisting anatomical defects, either congenital or acquired, or by disorders of the immune system.[7] Anatomical defects allow continuity between the external environment and the nervous system. The most common cause of recurrent meningitis is skull fracture,[7] particularly fractures that affect the base of the skull or extend towards the sinuses and petrous pyramids.[7] A literature review of 363 reported cases of recurrent meningitis showed that 59% of cases are due to such anatomical abnormalities, 36% due to immune deficiencies (such as complement deficiency, which predisposes especially to recurrent meningococcal meningitis), and 5% due to ongoing infections in areas adjacent to the meninges.[7]

References

  1. 1.0 1.1 Sáez-Llorens X, McCracken GH (June 2003). Bacterial meningitis in children. Lancet 361 (9375): 2139–48.
  2. 2.0 2.1 2.2 2.3 Tunkel AR, Hartman BJ, Kaplan SL, et al. (November 2004). Practice guidelines for the management of bacterial meningitis. Clinical Infectious Diseases 39 (9): 1267–84.
  3. Cite error: Invalid <ref> tag; no text was provided for refs named NEJM
  4. Hsu HE, Shutt KA, Moore MR, et al. (2009). Effect of pneumococcal conjugate vaccine on pneumococcal meningitis.. N Engl J Med 360 (3): 244–256.
  5. Wei BP, Robins-Browne RM, Shepherd RK, Clark GM, O'Leary SJ (January 2008). Can we prevent cochlear implant recipients from developing pneumococcal meningitis?. Clin. Infect. Dis. 46 (1): e1–7.
  6. Thwaites G, Chau TT, Mai NT, Drobniewski F, McAdam K, Farrar J (March 2000). Tuberculous meningitis. Journal of Neurology, Neurosurgery, and Psychiatry 68 (3): 289–99.
  7. 7.0 7.1 7.2 7.3 Tebruegge M, Curtis N (July 2008). Epidemiology, etiology, pathogenesis, and diagnosis of recurrent bacterial meningitis. Clinical Microbiology Reviews 21 (3): 519–37.

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