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  • Updated 08.26.2021
  • Released 08.26.2021
  • Expires For CME 08.26.2024

Bacterial meningitis

Introduction

Overview

Bacterial meningitis continues to cause significant morbidity and mortality in both high- and low-income countries despite the use of effective antimicrobial agents to treat the infection and vaccinations to prevent disease. Prompt recognition and treatment is critical and empiric therapy with antibiotics and dexamethasone is initiated prior to diagnostic certainty. In this article, the authors review the clinical manifestations of bacterial meningitis with emphasis on neurologic and systemic signs and symptoms that guide diagnosis and management. Diagnostic testing for individual organisms, in addition to broader testing with next-generation metagenomic sequencing, is also discussed. Key mimickers of bacterial meningitis are extensively examined, along with the pathogenesis of the disease, and prevention with vaccination and chemoprophylaxis when available.

Key points

Streptococcus pneumoniae is the most common causative agent of community-acquired bacterial meningitis worldwide.

• When bacterial meningitis is suspected, empiric antimicrobial therapy and dexamethasone should be initiated prior to performing lumbar puncture and obtaining cerebrospinal fluid for analysis.

• Despite significant decreases in morbidity and mortality with antimicrobial therapy, sequelae such as hearing loss, ischemic stroke, epilepsy, focal neurologic deficits, and cognitive impairment are common.

• Vaccinations are available for Streptococcus pneumoniae and Neisseria meningitis, the 2 most common causative organisms of bacterial meningitis.

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