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Bacterial Meningitis

Epidemiology, Pathogenesis and Management Update

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Abstract

Bacterial meningitis continues to be an important disease throughout the world and can be a life-threatening emergency if not suspected, appropriately diagnosed and managed expeditiously. The epidemiology of bacterial meningitis has changed dramatically over the last 20 years, primarily as a result of the introduction of conjugate vaccines against the common meningeal pathogens, such that in the developed world where vaccination is routinely utilized, bacterial meningitis has become a disease of adults rather than of infants and children. The management approach to patients with suspected or proven bacterial meningitis includes emergent cerebrospinal fluid analysis and initiation of appropriate antimicrobial and adjunctive therapies. The choice of empirical antimicrobial therapy is based on the patient’s age and underlying disease status; once the infecting pathogen is isolated, antimicrobial therapy can be modified for optimal treatment. Many patients with suspected or proven bacterial meningitis should also receive adjunctive dexamethasone therapy. This is based on experimental animal model data which demonstrated that the subarachnoid space inflammatory response that results from antimicrobial-induced bacterial lysis can contribute to morbidity and mortality. Clinical studies have demonstrated the benefit of adjunctive dexamethasone in infants and children with Haemophilus influenzae type B meningitis, and adults with pneumococcal meningitis, in which mortality and adverse outcome are reduced. Use of adjunctive dexamethasone in adults ith meningitis caused by other bacteria, and in infants and children with pneumococcal meningitis, is controversial. To be effective, adjunctive dexamethasone should be administered concomitant with or just prior to the first antimicrobial dose for maximal effect on the subarachnoid space inflammatory response.

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References

  1. Schlech III WF, Ward JI, Band JD, et al. Bacterial meningitis in the United States, 1978 through 1981. The National Bacterial Meningitis Surveillance Study. JAMA 1985; 253: 1749–54

    Google Scholar 

  2. Wenger JD, Hightower AW, Facklam RR, et al. Bacterial meningitis in the United States, 1986: report of a multi-state surveillance study. J Infect Dis 1990; 162: 1316–23

    Article  PubMed  CAS  Google Scholar 

  3. Schuchat A, Robinson K, Wenger JD, et al. Bacterial meningitis in the United States in 1995. N Engl J Med 1997; 337: 970–6

    Article  PubMed  CAS  Google Scholar 

  4. Thigpen MC, Rosenstein NE, Whitney CG, et al. Bacterial meningitis in the United States: 1998–2003 [abstract no.65]. 43rd Annual Meeting of the Infectious Diseases Society of America; 2005 Oct 6–9; San Francisco (CA)

  5. Bryan JP, de Silva HR, Tavares A, et al. Etiology and mortality of bacterial meningitis in northeastern Brazil. Rev Infect Dis 1990; 12: 128–35

    Article  PubMed  CAS  Google Scholar 

  6. Noah ND. Epidemiology of bacterial meningitis: UK and USA. In: Williams JD, Burnie J, editors. Bacterial meningitis. London: Academic, 1987: 93–115

    Google Scholar 

  7. Hussein AS, Shafran SD. Acute bacterial meningitis in adults: a 12-year review. Medicine 2000; 79: 360–8

    Article  PubMed  CAS  Google Scholar 

  8. Peltola H. Worldwide Haemophilus influenzae type b disease at the beginning of the 21st century: global analysis of the disease burden 25 years after the use of the poly-saccharide vaccine and a decade after the advent of conjugates. Clin Microbiol Rev 2000; 13: 302–17

    Article  PubMed  CAS  Google Scholar 

  9. Centers for Disease Control and Prevention. Pediatric bacterial meningitis surveillance: African region, 2002–2008. MMWR Morb Mortal Wkly Rep 2009; 58: 493–7

    Google Scholar 

  10. Dery MA, Hasbun R. Changing epidemiology of bacterial meningitis. Curr Infect Dis Rep 2007; 9: 301–7

    Article  PubMed  Google Scholar 

  11. Robbins JB, Schneerson R, Anderson P, et al. Prevention of systemic infections, especially meningitis, caused by Haemophilus influenzae type b. JAMA 1996; 276: 1181–5

    Article  PubMed  CAS  Google Scholar 

  12. Garpenholt O, Silfverdal SA, Hugosson S, et al. The impact of Haemophilus influenzae type b vaccination in Sweden. Scand J Infect Dis 1996; 28: 165–9

    Article  PubMed  CAS  Google Scholar 

  13. Van Alphen L, Spanjaard L, Van der Ende A, et al. Effect of nationwide vaccination of 3-month-old infants in The Netherlands with conjugate Haemophilus influenzae type b vaccine: high efficacy and lack of herd immunity. JPediatr 1997; 131: 869–73

    Article  Google Scholar 

  14. Kyaw MH, Christie P, Jones IG, et al. The changing epidemiology of bacterial meningitis and invasive non-meningitic bacterial disease in Scotland during the period 1983—99. Scand J Infect Dis 2002; 34: 289–98

    Article  PubMed  Google Scholar 

  15. Gessner BD, Sutanto A, Linehan M, et al. Incidences of vaccine-preventable Haemophilus influenzae type b pneumonia and meningitis in Indonesian children: Hamlet-randomized vaccine-probe trial. Lancet 2005; 365: 43–52

    Article  PubMed  Google Scholar 

  16. Cowgill KD, Ndritui M, Nyiro J, et al. Effectiveness of Haemophilus influenzae type b conjugate vaccine into routine childhood immunization in Kenya. JAMA 2006; 296: 671–8

    Article  PubMed  CAS  Google Scholar 

  17. Daza P, Banda R, Misoya K, et al. The impact of routine infant immunization with Haemophilus influenzae type b conjugate vaccine in Malawi, a country with high human immunodeficiency virus prevalence. Vaccine 2006; 24: 6232–9

    Article  PubMed  CAS  Google Scholar 

  18. Adegbola RA, Secko O, Lahai G, et al. Elimination of Haemophilus influenzae type b (Hib) disease from The Gambia after introduction of routine immunization with Hib conjugate vaccine: a prospective study. Lancet 2005; 366: 144–50

    Article  PubMed  Google Scholar 

  19. Franco-Paredes C, Lammoglia L, Hernandez I, et al. Epidemiology and outcome of bacterial meningitis in Mexican children: 10-year experience (1993-2003). Int J Infect Dis 2008; 12: 380–6

    Article  PubMed  Google Scholar 

  20. Centers for Disease Control and Prevention. Recommended immunization schedule for persons aged 0 through 18 years: United States, 2009. MMWR Morb Mortal Wkly Rep 2009; 57: Q1–4

    Google Scholar 

  21. Ribeiro GS, Reis JN, Cordeiro SM, et al. Prevention of Haemophilus influenzae type B (Hib) meningitis and emergence of serotype replacement with type A strains after introduction of Hib immunization in Brazil. J Infect Dis 2003; 187: 109–16

    Article  PubMed  Google Scholar 

  22. Garner D, Weston V. Effectiveness of vaccination for Haemophilus influenzae type B. Lancet 2003; 361: 395–7

    Article  PubMed  Google Scholar 

  23. Steinhoff M, Goldblatt D. Conjugate Hib vaccines. Lancet 2003; 361: 360–1

    Article  PubMed  Google Scholar 

  24. Spagnuolo PJ, Ellner JJ, Lerner PI, et al. Haemophilus influenzae meningitis: the spectrum of disease in adults. Medicine (Baltimore) 1982; 61: 74–85

    CAS  Google Scholar 

  25. Takala AK, Eskola J, van Alphen L. Spectrum of invasive Haemophilus influenzae type b disease in adults. Arch Intern Med 1990; 150: 2573–6

    Article  PubMed  CAS  Google Scholar 

  26. Farley MM, Stephens DS, Brachman PS, et al. Invasive Haemophilus influenzae disease in adults: a prospective, population-based surveillance. Ann Intern Med 1992; 116: 806–12

    PubMed  CAS  Google Scholar 

  27. Centers for Disease Control and Prevention. Prevention and control of meningococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 2005; 54(RR07): 1–21

    Google Scholar 

  28. Rosenstein NE, Perkins BA, Stephens DS, et al. The changing epidemiology of meningococcal disease in the United States, 1992–1996. J Infect Dis 1999; 180: 1894–901

    Article  PubMed  CAS  Google Scholar 

  29. Makras P, Alexiou-Daniel S, Antoniadis A, et al. Outbreak of meningococcal disease after an influenza B epidemic at a Hellenic Air Force recruit training center. Clin Infect Dis 2001; 33: e48–50

    Article  PubMed  CAS  Google Scholar 

  30. Ross SC, Densen P. Complement deficiency states and infection: epidemiology, pathogenesis and consequences of neisserial and other infections in an immune deficiency. Medicine (Baltimore) 1984; 64: 243–73

    Google Scholar 

  31. Zoppi M, Weiss M, Nydegger UE, et al. Recurrent meningitis in a patient with congenital deficiency of the C9 component of complement: first case of C9 deficiency in Europe. Arch Intern Med 1990; 150: 2395–9

    Article  PubMed  CAS  Google Scholar 

  32. Fijen CAP, Kuijper EJ, Tjia HG, et al. Complement deficiency predisposes for meningitis due to nongroupable meningococci and Neisseria-related bacteria. Clin Infect Dis 1994; 18: 780–4

    Article  PubMed  CAS  Google Scholar 

  33. Sjöholm AG, Kuijper EJ, Tijssen CC, et al. Dysfunctional properdin in a Dutch family with meningococcal disease. N Engl J Med 1988; 319: 33–7

    Article  PubMed  Google Scholar 

  34. Snape MD, Pollard AJ. Meningococcal polysaccharide-protein conjugate vaccines. Lancet Infect Dis 2005; 5: 21–30

    Article  PubMed  CAS  Google Scholar 

  35. Miller E, Salisbury D, Ramsay M. Planning outbreak and implementation of an immunization campaign against meningococcal serogroup C disease in the UK: a success story. Vaccine 2001; 20: S58–67

    Article  PubMed  Google Scholar 

  36. Centers for Disease Control and Prevention. Revised recommendations of the Advisory Committee on Immunization Practices to vaccinate all persons aged 11–18 years with meningococcal conjugate vaccine. MMWR Morb Mortal Wkly Rep 2007; 56: 794–5

    Google Scholar 

  37. Garner P. Prevention of meningococcal disease. N Engl J Med 2006; 355: 1466–73

    Article  Google Scholar 

  38. Snape MD, Perrett KP, Ford KJ, et al. Immunogenicity of a tetravalent meningococcal glycoconjuate vaccine in infants. JAMA 2008; 299: 173–84

    Article  PubMed  CAS  Google Scholar 

  39. Fisher MC, Verma R. Bacterial meningitis vaccines: not just for kids. Curr Infect Dis Rep 2009; 11: 302–8

    Article  PubMed  Google Scholar 

  40. Giuliani MM, Adu-Bobie J, Comanducci M, et al. A universal vaccine for serogroup B meningococcus. Proc Natl Acad Sci 2006; 103: 10834–9

    Article  PubMed  CAS  Google Scholar 

  41. Davenport V, Groves E, Horton RE, et al. Mucosal immunity in healthy adults after parenteral vaccination with outer-membrane vesicles from Neisseria meningitidis serogroup B. J Infect Dis 2008; 198: 731–40

    Article  PubMed  CAS  Google Scholar 

  42. Geiseler PJ, Nelson KE, Levin S, et al. Community-acquired purulent meningitis: a review of 1316 cases during the antibiotic era, 1954–1976. Rev Infect Dis 1980; 2: 725–45

    Article  PubMed  CAS  Google Scholar 

  43. Burman LA, Norrby R, Trollfors B. Invasive pneumo-coccal infections: incidence, predisposing factors, and prognosis. Rev Infect Dis 1985; 7: 133–42

    Article  PubMed  CAS  Google Scholar 

  44. Musher DM. Infections caused by Streptococcus pneumoniae: clinical spectrum, pathogenesis, immunity, and treatment. Clin Infect Dis 1992; 14: 801–9

    Article  PubMed  CAS  Google Scholar 

  45. Kragsbjerg P, Kallman J, Olcen P. Pneumococcal meningitis in adults. Scand J Infect Dis 1994; 26: 659–66

    Article  PubMed  CAS  Google Scholar 

  46. Biernath KR, Reefhuis J, Whitney CG, et al. Bacterial meningitis among children with cochlear implants beyond 24 months after implantation. Pediatrics 2006; 117: 284–9

    Article  PubMed  Google Scholar 

  47. Overturf GD. Indications for the immunological evaluation of patients with meningitis. Clin Infect Dis 2003; 36: 189–94

    Article  PubMed  Google Scholar 

  48. Tunkel AR, Turtz AR. Post-traumatic infections of the central nervous system. In: Evans RW, editors. Neurology and trauma. 2nd ed. New York: Oxford University Press, 2006: 628–38

    Google Scholar 

  49. Adriani KS, van de Beek D, Brouwer MC, et al. Community-acquired recurrent bacterial meningitis in adults. Clin Infect Dis 2007; 45: e46–51

    Article  PubMed  Google Scholar 

  50. American Academy of Pediatrics, Committee on Infectious Diseases. Policy statement: recommendations for the prevention of pneumococcal infections, including use of pneumococcal conjugate vaccine (Prevnar), pneumococcal polysaccharide vaccine, and antibiotic prophylaxis. Pediatrics 2000; 106: 362–6

    Article  Google Scholar 

  51. Black S, Shinefield H, Fireman B, et al. Efficacy, safety and immunogenicity of heptavalent pneumococcal conjugate vaccine in children. Pediatr Infect Dis J 2000; 19: 187–95

    Article  PubMed  CAS  Google Scholar 

  52. Whitney CG, Farley MM, Hadler J, et al. Decline in invasive pneumococcal disease after the introduction of protein-polysaccharide conjugate vaccine. N Engl J Med 2003; 348: 1737–46

    Article  PubMed  Google Scholar 

  53. Tsigrelis C, Tleyjeh IM, Lahr BD, et al. Decreases in case-fatality and mortality rates for invasive pneumococcal disease in Olmsted County, Minnesota, during 1995–2007: a population-based study. Clin Infect Dis 2008; 47: 1367–71

    Article  PubMed  Google Scholar 

  54. Tsai CJ, Griffin MR, Nuorti JP, et al. Changing epidemiology of pneumococcal meningitis after introduction of pneumococcal conjugate vaccine in the United States. Clin Infect Dis 2008; 46: 1664–72

    Article  PubMed  Google Scholar 

  55. Hsu HE, Shutt KA, Moore MR, et al. Effect of pneumococcal conjugate vaccine on pneumococcal meningitis. N Engl J Med 2009; 360: 244–56

    Article  PubMed  CAS  Google Scholar 

  56. Lorber B. Listeriosis. Clin Infect Dis 1997; 24: 1–11

    Article  PubMed  CAS  Google Scholar 

  57. Mylonakis E, Hohmann EL, Calderwood SB. Central nervous system infection with Listeria monocytogenes: 33 years’ experience at a general hospital and review of 776 episodes from the literature. Medicine (Baltimore) 1998; 77: 313–36

    Article  CAS  Google Scholar 

  58. Clauss HE, Lorber B. Central nervous system infection with Listeria monocytogenes. Curr Infect Dis Rep 2008; 10: 300–6

    Article  PubMed  Google Scholar 

  59. Decker CF, Simon GL, DiGioia RA, et al. Listeria monocytogenes infections in patients with AIDS: report of five cases and review. Rev Infect Dis 1991; 13: 413–7

    Article  PubMed  CAS  Google Scholar 

  60. Berenguer J, Solera J, Diaz MD, et al. Listeriosis in patients infected with human immunodeficiency virus. Rev Infect Dis 1991; 13: 115–9

    Article  PubMed  CAS  Google Scholar 

  61. Zuniga M, Aguado JM, Vada J. Listeria monocytogenes meningitis in previously healthy adults: long-term follow-up. Q J Med 1992; 85: 911–5

    PubMed  CAS  Google Scholar 

  62. Gottlieb SL, Newbern EC, Griffin PM, et al. Multistate outbreak of listeriosis linked to turkey deli meat and subsequent changes in US regulatory policy. Clin Infect Dis 2006; 42: 29–36

    Article  PubMed  Google Scholar 

  63. Voetsch AC, Angulo FJ, Jones TF, et al. Reduction in the incidence of invasive listeriosis in foodborne diseases active surveillance network sites, 1996–2003. Clin Infect Dis 2007; 44: 513–20

    Article  PubMed  Google Scholar 

  64. Bennion JR, Sorvillo F, Wise ME, et al. Decreasing listeriosis mortality in the United States, 1990–2005. Clin Infect Dis 2008; 47: 867–74

    Article  PubMed  Google Scholar 

  65. Saez-Llorens X, McCracken Jr GH. Bacterial meningitis in children. Lancet 2003; 361: 2139–48

    Article  PubMed  Google Scholar 

  66. Schuchat A. Epidemiology of group B streptococcal disease in the United States: shifting paradigms. Clin Microbiol Rev 1998; 11: 497–513

    PubMed  CAS  Google Scholar 

  67. Dunne DW, Quagliarello V. Group B streptococcal meningitis in adults. Medicine (Baltimore) 1993; 72: 1–10

    CAS  Google Scholar 

  68. Domingo P, Barquet N, Alvarez M, et al. Group B streptococcal meningitis in adults: report of twelve cases and review. Clin Infect Dis 1997; 25: 1180–7

    Article  PubMed  CAS  Google Scholar 

  69. Zangwill KM, Schuchat A, Wenger JD, et al., Streptococcal Disease Study Group. Group B streptococcal disease in the United States, 1990: report from a multistate active surveillance system. MMWR Morb Mortal Wkly Rep 1992; 41: 25–32

    CAS  Google Scholar 

  70. Mangi RJ, Quintiliani R, Andriole VT. Gram-negative bacillary meningitis. Am J Med 1975; 59: 829–36

    Article  PubMed  CAS  Google Scholar 

  71. Cherubin CE, Marr JS, Sierra MF, et al. Listeria and gramnegative bacillary meningitis in New York City, 1972–1979. Am J Med 1981; 71: 199–209

    Article  PubMed  CAS  Google Scholar 

  72. Unhanand M, Mustafa MM, McCracken Jr GH, et al. Gram-negative enteric bacillary meningitis: a twenty-one-year experience. J Pediatr 1993; 122: 15–21

    Article  PubMed  CAS  Google Scholar 

  73. Tang LM, Chen ST. Klebsiella oxytoca meningitis: frequent association with neurosurgical procedures. Infection 1995; 23: 163–7

    Article  PubMed  CAS  Google Scholar 

  74. Chang WN, Tsai YC, Chien CC, et al. Frequent association with neurosurgical conditions in adult Proteus mirabilis meningitis: report of five cases. Clin Neurol Neurosurg 2002; 104: 121–4

    Article  PubMed  Google Scholar 

  75. Reichert MCF, Medeiros EAS, Ferraz FAP. Hospital-acquired meningitis in patients undergoing craniotomy: incidence, evolution, and risk factors. Am J Infect Control 2002; 30: 158–64

    Article  PubMed  Google Scholar 

  76. Schlesinger LS, Ross SC, Schaberg DR. Staphylococcus aureus meningitis: a broad-based epidemiologic study. Medicine (Baltimore) 1987; 66: 148–56

    CAS  Google Scholar 

  77. Jensen AG, Espersen F, Skinhoj P, et al. Staphylococcus aureus meningitis: a review of 104 nationwide, consecutive cases. Arch Intern Med 1993; 153: 1902–8

    Article  PubMed  CAS  Google Scholar 

  78. Lerche A, Rasmussen N, Wandall JH, et al. Staphylococcus aureus meningitis: a review of 28 consecutive community-acquired cases. Scand J Infect Dis 1995; 27: 560–73

    Article  Google Scholar 

  79. Arda B, Yamazhan T, Sipahi OR, et al. Meningitis due to methicillin-resistant Staphylococcus aureus (MRSA): review of 10 cases. Int J Antimicrob Agents 2005; 25: 414–8

    Article  PubMed  CAS  Google Scholar 

  80. Tunkel AR, Wispelwey B, Scheld WM. Bacterial meningitis: recent advances in pathophysiology and treatment. Ann Intern Med 1990; 112: 610–23

    PubMed  CAS  Google Scholar 

  81. Quagliarello V, Scheld WM. Bacterial meningitis: patho-genesis, pathophysiology, and progress. N Engl J Med 1992; 327: 864–72

    Article  PubMed  CAS  Google Scholar 

  82. Tunkel AR. Bacterial meningitis. Philadelphia (PA): Lippincott, Williams & Wilkins, 2001

    Google Scholar 

  83. Tunkel AR, Scheld WM. Pathogenesis and pathophysiology of bacterial meningitis. Clin Microbiol Rev 1993; 6: 118–36

    PubMed  CAS  Google Scholar 

  84. Zwijnenburg PJ, van der Poll T, Roord JJ, et al. Chemotactic factors in cerebrospinal fluid during bacterial meningitis. Infect Immun 2006; 74: 1445–51

    Article  PubMed  CAS  Google Scholar 

  85. Grandgirard D, Leib SL. Strategies to prevent neuronal damage in pediatric bacterial meningitis. Curr Op Pediatr 2006; 18: 112–8

    Article  Google Scholar 

  86. Grandgirard D, Schurch C, Cottagnoud P, et al. Prevention of brain injury by the nonbacteriolytic antibiotic daptomycin in experimental pneumococcal meningitis. Antimicrob Agents Chemother 2007; 51: 2173–8

    Article  PubMed  CAS  Google Scholar 

  87. Frei K, Nadal D, Pfister HW, et al. Listeria meningitis: identification of a cerebrospinal fluid inhibitor of macrophage listericidal function as interleukin-10. J Exp Med 1993; 178: 1255–61

    Article  PubMed  CAS  Google Scholar 

  88. van Furth AM, Seijmonsbergen EM, Langermans JAM, et al. High levels of interleukin-10 and tumor necrosis factor in cerebrospinal fluid during the onset of bacterial meningitis. Clin Infect Dis 1995; 21: 220–2

    Article  PubMed  Google Scholar 

  89. Kornelisse RF, Savelkoul HFJ, Mulder PHG, et al. Interleukin-10 and soluble tumor necrosis factor receptors in cerebrospinal fluid of children with bacterial meningitis. J Infect Dis 1996; 173: 1498–502

    Article  PubMed  CAS  Google Scholar 

  90. Malipiero U, Koedel U, Pfister HW, et al. Bacterial meningitis: the role of transforming growth factor-beta in innate immunity and secondary brain damage. Neurodegener Dis 2007; 4: 43–50

    Article  PubMed  CAS  Google Scholar 

  91. Leib SL, Clements JM, Lindberg RLP, et al. Inhibition of matrix metalloproteinases and tumor necrosis factor converting enzyme a as adjuvant therapy in pneumococcal meningitis. Brain 2001; 124: 1734–42

    Article  PubMed  CAS  Google Scholar 

  92. Spreer A, Gerber J, Hanssen M, et al. Dexamethasone increases hippocampal neuronal apoptosis in a rabbit model of Escherichia coli meningitis. Pediatr Res 2006; 60: 210–5

    Article  PubMed  CAS  Google Scholar 

  93. Leib SL, Heimgartner C, Bifrare YD, et al. Dexamethasone aggravates hippocampal apoptosis and learning deficiency in pneumococcal meningitis infant rats. Pediatr Res 2003; 54: 353–7

    Article  PubMed  CAS  Google Scholar 

  94. Durand ML, Calderwood SB, Weber DJ, et al. Acute bacterial meningitis in adults: a review of 493 episodes. N Engl J Med 1993; 328: 21–8

    Article  PubMed  CAS  Google Scholar 

  95. van de Beek D, de Gans J, Spanjaard L, et al. Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med 2004; 351: 1849–59

    Article  PubMed  Google Scholar 

  96. Verghese A, Gallemore G. Kernig’s and Brudzinski’s signs revisited. Rev Infect Dis 1987; 9: 1187–92

    Article  PubMed  CAS  Google Scholar 

  97. Thomas KE, Hasbun R, Jekel J, et al. The diagnostic accuracy of Kernig’s sign, Brudzinski’s sign, and nuchal rigidity in adults with suspected meningitis. Clin Infect Dis 2002; 35: 46–52

    Article  PubMed  Google Scholar 

  98. Bonadio WA. The cerebrospinal fluid: physiologic aspects and alterations associated with bacterial meningitis. Pediatr Infect Dis J 1992; 11: 423–32

    Article  PubMed  CAS  Google Scholar 

  99. Coll MT, Uriz MS, Pineda V, et al. Meningococcal meningitis with “normal” cerebrospinal fluid. J Infect 1994; 29: 289–94

    Article  PubMed  CAS  Google Scholar 

  100. Spanos A, Harrell Jr FE, Durack DT. Differential diagnosis of acute meningitis: an analysis of the predictive value of initial observation. JAMA 1989; 262: 2700–7

    Article  PubMed  CAS  Google Scholar 

  101. Genton B, Berger JP. Cerebrospinal fluid lactate in 78 cases of adult meningitis. Intensive Care Med 1990; 16: 196–200

    Article  PubMed  CAS  Google Scholar 

  102. Kanegaye JT, Soliemanzadeh P, Bradley JS. Lumbar puncture in pediatric bacterial meningitis: defining the time interval for recovery of cerebrospinal fluid pathogens after parenteral antibiotic pretreatment. Pediatrics 2001; 108: 1169–74

    PubMed  CAS  Google Scholar 

  103. Gray LD, Fedorko DP. Laboratory diagnosis of bacterial meningitis. Clin Microbiol Rev 1992; 5: 130–45

    PubMed  CAS  Google Scholar 

  104. Tunkel AR, Hartman BJ, Kaplan SL, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis 2004; 39: 1267–84

    Article  PubMed  Google Scholar 

  105. Saravolatz LD, Manzor O, VanderVelde N, et al. Broad-range bacterial polymerase chain reaction for early detection of bacterial meningitis. Clin Infect Dis 2003; 36: 40–5

    Article  PubMed  CAS  Google Scholar 

  106. Werno AM, Murdoch DR. Laboratory diagnosis of invasive pneumococcal disease. Clin Infect Dis 2008; 46: 926–32

    Article  PubMed  Google Scholar 

  107. Singhi SC, Mohankumar D, Singhi PD, et al. Evaluation of polymerase chain reaction (PCR) for diagnosing Haemophilus influenzae b meningitis. Ann Trop Pediatr 2002; 22: 347–53

    Article  Google Scholar 

  108. Nathan BR, Scheld WM. The potential roles of C-reactive protein and procalcitonin concentrations in the serum and cerebrospinal fluid in the diagnosis of bacterial meningitis. Curr ClinTop Infect Dis 2002; 22: 155–65

    Google Scholar 

  109. Viallon A, Zeni F, Lambert C, et al. High sensitivity and specificity of serum procalcitonin levels in adults with bacterial meningitis. Clin Infect Dis 1999; 28: 1313–6

    Article  PubMed  CAS  Google Scholar 

  110. Schwarz S, Bertram M, Schwab S, et al. Serum procalcitonin levels in bacterial and abacterial meningitis. Crit Care Med 2000; 28: 1828–32

    Article  PubMed  CAS  Google Scholar 

  111. Saha SK, Darmstadt GL, Yamanaka N, et al. Rapid diagnosis of pneumococcal meningitis: implications for treatment and measuring disease burden. Pediatr Infect Dis J 2005; 24: 1093–8

    Article  PubMed  Google Scholar 

  112. van de Beek D, de Gans J, Tunkel AR, et al. Community-acquired bacterial meningitis in adults. N Engl J Med 2006; 354: 44–53

    Article  PubMed  Google Scholar 

  113. Aronin SI, Peduzzi P, Quagliarello VJ. Community-acquired bacterial meningitis: risk stratification for adverse clinical outcome and effect of antibiotic timing. Ann Intern Med 1998; 129: 862–9

    PubMed  CAS  Google Scholar 

  114. Miner JR, Heegaard W, Mapes A, et al. Presentation, time to antibiotics, and mortality of patients with bacterial meningitis at an urban county medical center. J Emerg Med 2001; 21: 387–92

    Article  PubMed  CAS  Google Scholar 

  115. Lu CH, Huang CR, Chang WN, et al. Community-acquired bacterial meningitis in adults: the epidemiology, timing of appropriate antimicrobial therapy, and prognostic factors. Clin Neurol Neurosurg 2002; 104: 352–8

    Article  PubMed  Google Scholar 

  116. Proulx N, Frechette D, Toye B, et al. Delays in the administration of antibiotics are associated with mortality from adult acute bacterial meningitis. Q J Med 2005; 98: 291–8

    Article  CAS  Google Scholar 

  117. Lepur D, Barsic B. Community-acquired bacterial meningitis in adults: antibiotic timing in disease course and outcome. Infection 2007; 35: 225–31

    Article  PubMed  CAS  Google Scholar 

  118. de Gans J, van de Beek D. Dexamethasone in adults with bacterial meningitis. N Engl J Med 2002; 347: 1549–56

    Article  PubMed  Google Scholar 

  119. Tunkel AR, Scheld WM. Corticosteroids for everyone with meningitis? N Engl J Med 2002; 347: 1613–5

    Article  PubMed  Google Scholar 

  120. Mai NTH, Chau TTH, Thwaites G, et al. Dexamethasone in Vietnamese adolescents and adults with bacterial meningitis. N Engl J Med 2007; 357: 2431–40

    Article  Google Scholar 

  121. Scarborough M, Gordon SB, Whitty CJM, et al. Corticosteroids for bacterial meningitis in adults in sub-Saharan Africa. N Engl J Med 2007; 357: 2441–50

    Article  PubMed  CAS  Google Scholar 

  122. McCracken Jr GH. Rich nations, poor nations, and bacterial meningitis [editorial]. Lancet 2002; 360: 183

    Article  PubMed  Google Scholar 

  123. Greenwood BM. Corticosteroids for acute bacterial meningitis. N Engl J Med 2007; 357: 2507–9

    Article  PubMed  CAS  Google Scholar 

  124. van de Beek D, de Gans J, McIntyre P, et al. Corticosteroids for acute bacterial meningitis [review]. Cochrane Database Syst Rev 2007: CD004405

  125. Ricard JD, Wolff M, Lacherade JC, et al. Levels of van-comycin in cerebrospinal fluid of adult patients receiving adjunctive corticosteroids to treat pneumococcal meningitis: a prospective multicenter observational study. Clin Infect Dis 2007; 44: 250–5

    Article  PubMed  CAS  Google Scholar 

  126. Peltola J, Anttila M, Renkonen OV, The Finnish Study Group. Randomised comparison of chloramphenicol, ampicillin, cefotaxime, and ceftriaxone for childhood bacterial meningitis. Lancet 1989; 1: 1281–7

    Article  PubMed  CAS  Google Scholar 

  127. Saez-Llorens X, Castano E, Garcia R, et al. Prospective randomized comparison of cefepime and cefotaxime for treatment of bacterial meningitis in infants and children. Antimicrob Agents Chemother 1995; 39: 937–40

    Article  PubMed  CAS  Google Scholar 

  128. Saez-Llorens X, O’Ryan M. Cefepime in the empiric treatment of meningitis in children. Pediatr Infect Dis J 2001; 20: 356–61

    Article  PubMed  CAS  Google Scholar 

  129. van Deuren M, Brandtzaeg P, van der Meer JWM. Update on meningococcal disease with emphasis on pathogenesis and clinical management. Clin Microbiol Rev 2000; 13: 144–66

    Article  PubMed  Google Scholar 

  130. Boras A, Bozinovic D, Tenover FC, et al. First report of Neisseria meningitidis intermediately resistant to penicillin in Croatia [letter]. J Clin Microbiol 2001; 39: 823

    Article  PubMed  CAS  Google Scholar 

  131. Punar M, Eraksoy H, Cagatay AA, et al. Neisseria meningitidis with decreased susceptibility to penicillin in Istanbul, Turkey. Scand J Infect Dis 2002; 34: 11–3

    Article  PubMed  Google Scholar 

  132. Jackson LA, Tenover FC, Baker C, et al. Prevalence of Neisseria meningitidis relatively resistant to penicillin in the United States, 1991. J Infect Dis 1994; 169: 438–41

    Article  PubMed  CAS  Google Scholar 

  133. Galimand M, Gerbaud G, Guibourdenche M, et al. Highlevel chloramphenicol resistance in Neisseia meningitidis. N Engl J Med 1998; 339: 868–74

    Article  PubMed  CAS  Google Scholar 

  134. Cubells CL, Garcia JJG, Martinez JR, et al. Clinical data in children with meningococcal meningitis in a Spanish hospital. Acta Paediatr 1997; 86: 26–9

    Article  Google Scholar 

  135. Appelbaum PC. Resistance among Streptococcus pneumoniae: implications for drug selection. Clin Infect Dis 2002; 34: 1613–20

    Article  PubMed  Google Scholar 

  136. Centers for Disease Control and Prevention. Effects of new penicillin susceptibility breakpoints for Streptococcus pneumoniae: United States, 2006–2007. MMWR Morb Mortal Wkly Rep 2008; 57: 1355–5

    Google Scholar 

  137. Odio CM, Puig JR, Feris JM, et al. Prospective, randomized, investigator-blinded study of the efficacy and safety of meropenem versus cefotaxime therapy in bacterial meningitis in children. Pediatr Infect Dis J 1999; 18: 581–90

    Article  PubMed  CAS  Google Scholar 

  138. Buckingham SC, Davis Y, English BK. Pneumococcal susceptibility to meropenem in a mid-South children’s hospital. South Med J 2002; 95: 1293–6

    PubMed  Google Scholar 

  139. Cottagnoud P, Tauber MG. Fluoroquinolones in the treatment of meningitis. Curr Infect Dis Rep 2003; 5: 329–36

    Article  PubMed  Google Scholar 

  140. Saez-Llorens X, McCoig C, Feris JM, et al. Quinolone treatment for pediatric bacterial meningitis: a comparative study of trovafloxacin and ceftriaxone with or without vancomycin. Pediatr Infect Dis J 2002; 21: 14–22

    Article  PubMed  Google Scholar 

  141. Fong IW, Tomkins KB. Review of Pseudomonas aeruginosa meningitis with special emphasis on treatment with ceftazidime. Rev Infect Dis 1985; 7: 604–12

    Article  PubMed  CAS  Google Scholar 

  142. Rodriguez WJ, Khan WN, Cocchetto DM, et al. Treatment of Pseudomonas meningitis with ceftazidime with or without concurrent therapy. Pediatr Infect Dis J 1990; 9: 83–7

    Article  PubMed  CAS  Google Scholar 

  143. O’Neill E, Humphreys H, Phillips J, et al. Third-generation cephalosporin resistance among gram-negative bacilli causing meningitis in neurosurgical patients: significant challenges in ensuring effective antibiotic therapy. J Anti-microb Chemother 2006; 57: 356–9

    Google Scholar 

  144. Katragkou A, Roilides E. Successful treatment of multi-drug-resistant Acinetobacter baumannii central nervous system infections with colistin. J Clin Microbiol 2005; 43: 4916–7

    Article  PubMed  Google Scholar 

  145. Kremery Jr V, Filka J, Uher J, et al. Ciprofloxacin in treatment of nosocomial meningitis in neonates and in infants: report of 12 cases and review. Diagn Microbiol Infect Dis 1999; 35: 75–80

    Article  Google Scholar 

  146. Lipman J, Allworth A, Walis SC. Cerebrospinal penetration of high doses of intravenous ciprofloxacin in meningitis. Clin Infect Dis 2000; 31: 1131–3

    Article  PubMed  CAS  Google Scholar 

  147. Reddy P, Das S, Chandler JP, et al. Stenotrophomonas maltophilia meningitis treated with moxifloxacin: a case report and review of the literature. Infect Dis Clin Practice 2006; 14: 173–6

    Article  Google Scholar 

  148. Chang WN, Lu CH, Wu JJ, et al. Staphylococcus aureus meningitis in adults: a clinical comparison of infections caused by methicillin-resistant and methicillin-sensitive strains. Infection 2001; 29: 245–50

    Article  PubMed  CAS  Google Scholar 

  149. Higa T, Tasaka T, Kubo Y, et al. Successful treatment of meningoencephalitis caused by methicillin-resistant Staphylococcus aureus with intravenous linezolid in an allogeneic cord blood stem cell transplant recipient. Scand J Infect Dis 2008; 40: 990–2

    Article  PubMed  Google Scholar 

  150. Lee DH, Palermo B, Chowdhury M. Successful treatment of methicillin-resistant Staphylococcus aureus meningitis with daptomycin. Clin Infect Dis 2008; 47: 588–90

    Article  PubMed  Google Scholar 

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No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.

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  1. Department of Medicine, Monmouth Medical Center, 300 Second Avenue, Long Branch, New Jersey, 07740, USA

    Yuliya Nudelman &  Allan R. Tunkel

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Correspondence to Allan R. Tunkel.

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Nudelman, Y., Tunkel, A.R. Bacterial Meningitis. Drugs 69, 2577–2596 (2009). https://doi.org/10.2165/11530590-000000000-00000

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