[Community Acquired Bacterial Meningitis in Adults]

Overview

Journal Inn Med (Heidelb)

Date 2025 Jan 31

PMID 39888404

Authors

Marie Madlener

Insa Joost

Affiliations

Soon will be listed here.

Abstract

Bacterial meningitis is a rare but severe disease with a high mortality. The most frequent pathogens in adults are pneumococcus, meningococcus and Listeria. The most important key symptoms are headache, meningism and fever; however, the absence of individual cardinal symptoms does not exclude the diagnosis. The empirical treatment consists of ceftriaxone and ampicillin, supplemented with dexamethasone as needed. It should be initiated without delay if bacterial meningitis is suspected. Before this, two pairs of blood cultures should be obtained followed by a lumbar puncture. An elevated intracranial pressure must be excluded via cerebral computed tomography before performing a lumbar puncture only in patients with confirmation of impaired consciousness, focal neurological deficits or epileptic seizures. In such cases treatment is initiated immediately after obtaining blood cultures but before the lumbar puncture. The identification and management of a focus are essential and should be conducted on the day of admission.

References

van de Beek D, Cabellos C, Dzupova O, Esposito S, Klein M, Kloek A . ESCMID guideline: diagnosis and treatment of acute bacterial meningitis. Clin Microbiol Infect. 2016; 22 Suppl 3:S37-62. DOI: 10.1016/j.cmi.2016.01.007. View

Koelman D, van Kassel M, Bijlsma M, Brouwer M, van de Beek D, van der Ende A . Changing Epidemiology of Bacterial Meningitis Since Introduction of Conjugate Vaccines: 3 Decades of National Meningitis Surveillance in The Netherlands. Clin Infect Dis. 2020; 73(5):e1099-e1107. PMC: 8423501. DOI: 10.1093/cid/ciaa1774. View

Koelman D, Brouwer M, Ter Horst L, Bijlsma M, van der Ende A, van de Beek D . Pneumococcal Meningitis in Adults: A Prospective Nationwide Cohort Study Over a 20-year Period. Clin Infect Dis. 2021; 74(4):657-667. PMC: 8886910. DOI: 10.1093/cid/ciab477. View

Volk S, Pfirrmann M, Koedel U, Pfister H, Lang T, Scheibe F . Decline in the number of patients with meningitis in German hospitals during the COVID-19 pandemic. J Neurol. 2022; 269(7):3389-3399. PMC: 8938731. DOI: 10.1007/s00415-022-11034-w. View

Bijlsma M, Brouwer M, Kasanmoentalib E, Kloek A, Lucas M, Tanck M . Community-acquired bacterial meningitis in adults in the Netherlands, 2006-14: a prospective cohort study. Lancet Infect Dis. 2015; 16(3):339-47. DOI: 10.1016/S1473-3099(15)00430-2. View

van de Beek D, de Gans J, Spanjaard L, Weisfelt M, Reitsma J, Vermeulen M . Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med. 2004; 351(18):1849-59. DOI: 10.1056/NEJMoa040845. View

Heckenberg S, de Gans J, Brouwer M, Weisfelt M, Piet J, Spanjaard L . Clinical features, outcome, and meningococcal genotype in 258 adults with meningococcal meningitis: a prospective cohort study. Medicine (Baltimore). 2008; 87(4):185-192. DOI: 10.1097/MD.0b013e318180a6b4. View

Domingo P, Pomar V, de Benito N, Coll P . The spectrum of acute bacterial meningitis in elderly patients. BMC Infect Dis. 2013; 13:108. PMC: 3599144. DOI: 10.1186/1471-2334-13-108. View

Kastenbauer S, Pfister H . Pneumococcal meningitis in adults: spectrum of complications and prognostic factors in a series of 87 cases. Brain. 2003; 126(Pt 5):1015-25. DOI: 10.1093/brain/awg113. View

10.

Klein M, Koedel U, Pfefferkorn T, Zeller G, Woehrl B, Pfister H . Arterial cerebrovascular complications in 94 adults with acute bacterial meningitis. Crit Care. 2011; 15(6):R281. PMC: 3388646. DOI: 10.1186/cc10565. View

11.

Edmond K, Clark A, Korczak V, Sanderson C, Griffiths U, Rudan I . Global and regional risk of disabling sequelae from bacterial meningitis: a systematic review and meta-analysis. Lancet Infect Dis. 2010; 10(5):317-28. DOI: 10.1016/S1473-3099(10)70048-7. View

12.

Hasbun R, Abrahams J, JEKEL J, Quagliarello V . Computed tomography of the head before lumbar puncture in adults with suspected meningitis. N Engl J Med. 2001; 345(24):1727-33. DOI: 10.1056/NEJMoa010399. View

13.

de Almeida S, Furlan S, Cretella A, Lapinski B, Nogueira K, Cogo L . Comparison of Cerebrospinal Fluid Biomarkers for Differential Diagnosis of Acute Bacterial and Viral Meningitis with Atypical Cerebrospinal Fluid Characteristics. Med Princ Pract. 2019; 29(3):244-254. PMC: 7315170. DOI: 10.1159/000501925. View

14.

Brouwer M, van de Beek D . Epidemiology of community-acquired bacterial meningitis. Curr Opin Infect Dis. 2017; 31(1):78-84. DOI: 10.1097/QCO.0000000000000417. View

15.

Lesnakova A, Holeckova K, Kolenova A, Streharova A, Kisac P, Beno P . Bacterial meningitis after sinusitis and otitis media: ear, nose, throat infections are still the commonest risk factors for the community acquired meningitis. Neuro Endocrinol Lett. 2007; 28 Suppl 3:14-5. View

16.

Buchholz G, Koedel U, Pfister H, Kastenbauer S, Klein M . Dramatic reduction of mortality in pneumococcal meningitis. Crit Care. 2016; 20(1):312. PMC: 5045860. DOI: 10.1186/s13054-016-1498-8. View

17.

Lummel N, Koch M, Klein M, Pfister H, Bruckmann H, Linn J . Spectrum and Prevalence of Pathological Intracranial Magnetic Resonance Imaging Findings in Acute Bacterial Meningitis. Clin Neuroradiol. 2014; 26(2):159-67. DOI: 10.1007/s00062-014-0339-x. View

18.

Grindborg O, Naucler P, Sjolin J, Glimaker M . Adult bacterial meningitis-a quality registry study: earlier treatment and favourable outcome if initial management by infectious diseases physicians. Clin Microbiol Infect. 2015; 21(6):560-6. DOI: 10.1016/j.cmi.2015.02.023. View

19.

Koster-Rasmussen R, Korshin A, Meyer C . Antibiotic treatment delay and outcome in acute bacterial meningitis. J Infect. 2008; 57(6):449-54. DOI: 10.1016/j.jinf.2008.09.033. View

20.

Brouwer M, McIntyre P, Prasad K, van de Beek D . Corticosteroids for acute bacterial meningitis. Cochrane Database Syst Rev. 2015; (9):CD004405. PMC: 6491272. DOI: 10.1002/14651858.CD004405.pub5. View