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  • Updated 04.08.2020
  • Released 05.02.2005
  • Expires For CME 04.08.2023

Pneumococcal meningitis

Introduction

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. Treatment guidelines recommend that dexamethasone should be added to initial empiric antibiotic therapy. 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. A report indicated that after pneumococcal meningitis adults are at increased risk of neurologic and neuropsychologic deficits, impaired daily activities, and poor quality of life. Current diagnostic laboratory techniques are evaluated, and up-to-date treatment recommendations based on the most recent research and expert opinion are incorporated. 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.

• Patients with a basilar skull or cribriform fracture with a CSF leak are at increased risk of acquiring pneumococcal 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 (93; 54).

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