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Infectious meningitis. Why are the leptomeninges preferentially involved? Electron microscopic insights

André P Boezaart1,2, Anna Server3, Richard Shane Tubbs4,5,6,7,8

  • 1Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA.

Clinical Anatomy (New York, N.Y.)
|September 19, 2024
PubMed

Insights

Microorganisms preferentially infect the spinal leptomeninges, not the pachymeninges. Electron microscopy reveals anatomical structures facilitating pathogen introduction, adherence, and proliferation in spinal meningitis.

Area of Science:

  • Neuroscience
  • Microbiology
  • Anatomy

Background:

  • Infectious meningitis typically targets the leptomeninges (pia mater and arachnoid) over the pachymeninges (dura mater).
  • Understanding the ultra-anatomical basis for pathogen localization in spinal meningitis is crucial for diagnosis and treatment.

Purpose of the Study:

  • To provide ultra-anatomical insights into the structures of the human spinal meninges that facilitate pathogen introduction, adherence, colonization, and proliferation.
  • To propose mechanisms underlying selective inflammation and characteristic imaging findings in iatrogenic spinal meningitis.

Main Methods:

  • Analysis of an extensive collection of transmission and scanning electron microscopy images (378 images) of human spinal meninges.
  • Identification of specific anatomical sites and cellular components involved in microbial interaction within the meninges.

Main Results:

  • Identified potential sites for microbial introduction and adherence, including the outer dura, epidural space, and spinal dural sac.
  • Described the formation of an acquired spinal subdural space and a new subarachnoid compartment.
  • Observed immune cells (macrophages, fibroblasts, mast cells, plasma cells) within meningeal layers, contributing to inflammation.

Conclusions:

  • Meningeal layer characteristics influence bacterial adhesion and proliferation, leading to selective inflammation in spinal meningitis.
  • These ultra-anatomical findings help explain preferential magnetic resonance imaging enhancement patterns observed in spinal meningitis.
Keywords:
anatomyarachnoidcomplicationdiseasedura materepidural anesthesiainfectiousleptomeningesmeningitispachymeningespia materspinal anesthesiaspinal meninges

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