Pneumococcal meningitis

Ravindra Kumar Garg MD (Dr. Garg of King George's Medical University in Lucknow, India, has no relevant financial relationships to disclose.)
Karen L Roos MD FAAN, editor. (Dr. Roos of Indiana University School of Medicine has no relevant financial relationships to disclose.)
Originally released May 2, 2005; last updated November 27, 2017; expires November 27, 2020

Overview

Streptococcus pneumoniae is the leading cause of bacterial meningitis in the United States and accounts for significant morbidity and mortality in essentially all age groups. Prompt recognition and treatment can improve outcomes. In this article, the author reviews the clinical manifestations of S pneumoniae infection, with emphasis on neurologic symptoms and key features that can help avoid pitfalls leading to missed or late diagnosis. Current diagnostic laboratory techniques are evaluated, and up-to-date treatment recommendations based on the most recent research and expert opinion are incorporated. Recent research regarding the importance of endocarditis and bacteremia to neuropathogenesis, as well as the effect of bacterial meningitis on neurogenesis, is presented.

Key points

 

• Globally, community-acquired bacterial meningitis is most frequently caused by Streptococcus pneumoniae.

 

• Following a neurosurgical procedure or penetrating head trauma, Streptococcus pneumoniae remains the most common cause of meningitis.

 

Streptococcus pneumoniae often leads to a severe degree of meningeal inflammation.

 

• Pneumococcal meningitis is treated intravenously with a combination of a third-generation cephalosporin and vancomycin.

 

• Corticosteroids reduce mortality.

 

• Corticosteroids treatment leads to lower rates of hearing loss.

Historical note and terminology

In 1881, Streptococcus pneumoniae was identified simultaneously by Pasteur in France, who named it Microbe septice mique du salive, and by Sternberg in the United States, who called it Micrococcus pasteuri. By the late 1880s, the term pneumococcus had come into general use because of the association between this organism and lobar pneumonia. In 1926, the term Diplococcus was assigned because of the organism's appearance in gram-stained sputum. Finally, in 1974, the organism was renamed, Streptococcus pneumoniae because of its morphology during growth in liquid medium (Watson et al 1993; Musher 2000).

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