Acute Bacterial Meningitis

Larry E. Davis, MD, FAAN Neuroinfectious Disease p. 1264-1283 October 2018, Vol.24, No.5 doi: 10.1212/CON.0000000000000660
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PURPOSE OF REVIEW: While acute bacterial meningitis is becoming less common in developed countries because of the widespread use of vaccines against Streptococcus pneumoniae, Neisseria meningitides, and Haemophilus influenzae, bacterial meningitis still occurs worldwide, with peak incidence in young children and the elderly. Bacterial meningitis is usually lethal unless appropriate antibiotics that cross the blood-brain barrier are given. Clinical suspicion of bacterial meningitis begins when patients present with the abrupt onset of fever, headache, and meningismus.

RECENT FINDINGS: New technologies are being developed for more rapid identification of the bacterial species causing meningitis. When appropriate, administration of adjunctive dexamethasone with the antibiotics often lessens neurologic sequelae in survivors, which may include aphasia, ataxia, paresis, hearing loss, and cognitive impairment.

SUMMARY: Confirmation of the diagnosis of bacterial meningitis comes mainly from examination and culture of CSF obtained from a lumbar puncture. Typically, the CSF shows an elevated neutrophil count, elevated protein, depressed glucose, positive Gram stain, and growth of the bacteria on appropriate culture media. Antibiotic sensitivities of the bacteria determine the appropriate antibiotics, although an educated guess of the best antibiotics to be given promptly must be made until the antibiotic sensitivities return, usually in a few days.

Address correspondence to Dr Larry E. Davis, New Mexico VA Health Care System, 1501 San Pedro Dr SE, Albuquerque, NM 87108, Larry.Davis@VA.gov.

RELATIONSHIP DISCLOSURE: Dr Davis receives publishing royalties from Springer Science+Business Media, LLC.

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Dr Davis reports no disclosure.

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© 2018 American Academy of Neurology