Staphylococcus aureus is one of the leading causes of bacterial meningitis in patients with CSF shunts or following neurosurgical procedures or neurologic trauma. Additionally, community-acquired staphylococcal infection, including meningitis, is becoming increasingly common and accounts for significant morbidity and mortality in all age groups. Prompt recognition and treatment can improve outcomes. In this article, we review the clinical manifestations of Staphylococcus aureus infections, with emphasis on neurologic symptoms and key features that can help physicians avoid pitfalls leading to missed or late diagnosis. The most up-to-date treatment recommendations are incorporated into this update.
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• Community-acquired staphylococcal infection accounts for significant morbidity and mortality in all age groups.
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• Staphylococcus aureus is among the leading causes of bacterial meningitis in patients with CSF shunts or following neurosurgical procedures or neurologic trauma.
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• Neurologic complications of Staphylococcus aureus infection may arise contiguously from local foci or hematogenously from widely disseminated disease.
Historical note and terminology
Staphylococci were first identified and cultured by Pasteur and Koch in the late 1800s, but Ogston, in 1881, was the first to study the organism carefully and coin the name (71). “Staphylococcus” comes from the Greek “staphyle,” meaning “bunch of grapes,” and was introduced because of the grape-like clusters that these organisms form when observed in pus from human abscesses. In 1884, Rosenbach was the first to grow this organism in pure culture and added the term “aureus” to the name because of its yellow-orange color in colonies. Staphylococci were initially grouped together with micrococci but differ in several important aspects, including nucleic acid composition, respiratory chain composition, and cell wall structure. Staphylococci now belong to the broad Bacillus-Lactobacillus-Streptococcus cluster (65). Staphylococcus aureus belongs to a subgroup of coagulase-positive staphylococci. The other species of staphylococci relevant to human infection include coagulase-negative organisms, such as Staphylococcus epidermidis and Staphylococcus saprophyticus.