Progress and Challenges in Bacterial Meningitis: A Review.

Area of Science:

• Infectious Diseases
• Neurology
• Public Health

Background:

• Bacterial meningitis presents a significant global health challenge, with incidence rates varying widely by socioeconomic status.
• Mortality rates can reach 54% in low-income countries, and survivors often face chronic neurological sequelae.
• Key pathogens include Streptococcus pneumoniae and Neisseria meningitidis in adults, and Escherichia coli and Streptococcus agalactiae in neonates.

Approach:

• Clinical presentation includes headache, fever, stiff neck, and altered mental status.
• Diagnostic suspicion is raised by specific laboratory findings in serum and cerebrospinal fluid (CSF).
• Brain imaging is recommended prior to lumbar puncture in specific patient groups.

Key Points:

• Gram stain sensitivity for bacterial meningitis ranges from 50% to 90%.
• Empirical antibiotic choice depends on local resistance patterns, with vancomycin and ceftriaxone as common choices.
• Adjunctive dexamethasone is recommended but should be discontinued if Listeria monocytogenes is identified.

Conclusions:

• Bacterial meningitis requires urgent medical attention due to its high mortality and morbidity.
• Prompt empirical intravenous antibiotic therapy is the cornerstone of management.
• Adjunctive dexamethasone plays a vital role in improving outcomes for patients with bacterial meningitis.