Meningitis, bacterial

Meningitis, bacterial
International Classification (ICD) G03.-
Symptoms Limb pain, Light sensitivity, Pain sensitivity, Vomit, Fever, Headache, Meningismus, Neurological symptoms, Vigilance disorder, Cramps, Light shy, Bleeding from the skin (petechiae)
Possible causes Bacteria
Possible risk factors Droplet infection, Immunodeficiency, Spleen removal (splenectomy), neurosurgical interventions, Traumatic brain injury
Possible therapies Antibiotics, Medication

Basics

Infectious diseases of the central nervous system (CNS) can be caused by viral, bacterial and parasitic pathogens as well as fungi. In the case of bacterial meningitis, a bacterial infection causes inflammation of the membranes of the brain and spinal cord. If the inflammation also involves the brain, it is referred to as meningoencephalitis. Bacterial meningitis can also be purulent under certain circumstances. Bacterial meningitis is still a serious disease, despite optimal treatment, and around 15 to 20 % of pneumococcal meningitis cases are fatal.

Kopfschmerz (iStock / Pornpak Khunatorn)

Incidence

In the last 30 years, the frequency (incidence) of bacterial meningitis in Europe has shown a downward trend. The annual incidence is currently around 2 to 6 cases per 100,000 inhabitants. In some areas of Africa (directly north of the equator), the incidence of bacterial meningitis is sometimes as high as 70 cases per 100,000 inhabitants and is therefore much higher. This is also known as the meningitis belt. Epidemics of bacterial meningitis also occur more frequently in this area.

In Austria and Germany, meningococcal meningitis is notifiable. This means that if there is a suspicion of illness or an illness, it must be reported.

Causes

Infection of the membranes of the brain and spinal cord (meninges) can occur either through pathogen transmission via the blood or through direct infection from the paranasal sinuses or the ear.

Severe bacterial meningitis often leads to involvement of the brain, resulting in so-called meningoencephalitis.

The most common pathogens causing bacterial meningitis are

  • meningococci

  • pneumococci

  • listeria

  • Staphylococci

  • Haemophilus influenzae

Meningokokken (iStock / Christoph Burgstedt)

Transmission of meningococcus

Meningococcus is primarily transmitted by droplet infection (e.g. sneezing or coughing). In some cases, however, infection also occurs through direct contact with infectious people. In rare cases, meningitis can also occur as a result of bacteria migrating from infected sinuses or middle ear infections. The incubation period for the majority of meningococcal infections is between two and five days, sometimes up to ten days.

Symptoms

The leading symptoms of bacterial meningitis are

  • Headache (in 83 to 87% of cases)

  • Meningismus (in 75 to 83 % of cases)

  • Fever (in 77% of cases)

  • Vigilance disorder (in around 69% of cases)

Other symptoms that often occur in the course of bacterial meningitis are

  • Nausea

  • vomiting

  • Photophobia (shyness)

  • Confusion

  • Epileptic seizures

  • Skin hemorrhages (petechiae)

  • Impaired consciousness up to loss of consciousness

The symptoms develop within a few hours to a few days. The typical symptoms of meningitis are often absent in infants and young children. The symptoms of viral meningitis are also much more variable and meningeal irritation signs are often less pronounced.

Serious complications can occur during the course of bacterial meningitis in particular. Examples of complications include organ infarctions, bleeding, cerebral edema, thrombosis or inflammation-related swelling of the brain parenchyma.

Diagnosis

Meningitis is often diagnosed with the help of a detailed medical history, a physical examination, a cerebrospinal fluid puncture, a blood test and various imaging procedures (e.g. computer tomography or magnetic resonance imaging). With the help of computer tomography (CT), for example, complications (e.g. brain abscesses) can be quickly identified and, if necessary, treated.

During a lumbar puncture (cerebrospinal fluid puncture), cerebrospinal fluid is removed from the patient's spinal canal using a cannula. These samples can then be further examined for various pathogens and signs of inflammation.

The blood test for meningitis usually includes a bacterial culture, a complete blood count, signs of inflammation, glucose and possibly other laboratory values. In the case of bacterial meningitis, the blood count often shows an increase in white blood cells (leukocytosis) and an increase in C-reactive protein (CRP). A procalcitonin determination can help to differentiate between bacterial and viral meningitis.

Bacterial meningitis can also lead to hearing and balance disorders, which can be checked using audiometric hearing tests, auditory evoked potentials (brainstem audiometry, AEP) and balance tests.

Common pathogens

The most common pathogens causing bacterial meningitis in adults and children are pneumococci and meningococci. Rarer pathogens are listeria (< 5 %), staphylococci (< 5 %) and pseudomonads or gram-negative enterobacteria. Due to the high vaccination rate of children against H. influenzae, Haemophilus meningitis has become much rarer than in the past.

In newborns, around 70 % of meningitis is caused by group B streptococci. Various mixed infections with different pathogens can occur, particularly in patients with immune deficiencies (e.g. HIV, leukemia, various immunodeficiencies) or after open craniocerebral trauma. Splenectomies lead to an increased risk of meningitis caused by pneumococci, meningococci and H. influenzae.

Therapy

It is crucial to start broad antibiotic therapy quickly if bacterial meningitis is clinically suspected. Treatment usually takes place in an inpatient setting. Antibiotics and glucocorticoids can thus be administered intravenously and quickly and effectively. The antibiotic should be able to cross the blood-brain barrier well. As soon as the exact meningitis pathogen has been identified via bacterial culture or CSF diagnostics, antibiotic therapy can be switched to targeted antibiotics.

Recommended antibiotic therapies for various pathogens:

Pathogen

Antibiotic

Neisseria meningitidis (meningococcus)

Penicillin G

Streptococcus pneumoniae (pneumococci)

Penicillin G, ceftriaxone plus vancomycin

Haemophilus influenzae

Ceftriaxone or cefotaxime

Group B streptococci

Penicillin G, ceftriaxone, ampicillin

Pseudomonas aeruginosa

Ceftazidime plus aminoglycoside

Listeria monocytogenes (Listeria)

Ampicillin plus aminoglycoside

Staphylococci

Fosfomycin, vancomycin

The duration of antibiotic treatment varies depending on the pathogen. N. meningitidis (meningococcus) and H. influenzae should be treated with antibiotics for 7 to 10 days. Infections with L. monocytogenes (listeria) and gram-negative enterobacteria often require antibiotic therapy for 14 to 21 days.

According to current guidelines, dexamethasone therapy(glucocorticoid) is particularly recommended for adults with suspected community-acquired meningitis. The mortality rate of pneumococcal meningitis is lower with dexamethasone and hearing impairment in the course of meningitis caused by H. influenzae also occurs less frequently. The dosage is often 4 times 10 mg / day over a period of 4 days. It is started with the first course of antibiotics. This should always be accompanied by gastric protection (e.g. omeprazole) and thrombosis prophylaxis.

Particularly in the case of meningitis caused by pneumococci, a local spread of the pathogen with a new infectious focus (e.g. ear infection, sinusitis) must be considered, which may need to be surgically treated.

Forecast

Acute bacterial meningitis is life-threatening and can lead to serious complications (e.g. cardiovascular shock). In the most severe cases, bacterial meningitis can lead to death within hours, which is why rapid medical diagnosis and treatment are extremely important.

Pneumococcal and listeria meningitis still have a mortality rate of 10 to 30 %, despite adequate medical treatment. In contrast, the mortality rate for meningitis caused by meningococci is around 3 to 8 %.

Brain abscesses are a serious complication of meningitis caused by the spread of pathogens via the blood or through the migration of pathogens to neighboring structures. In the case of a brain abscess, local, invasive relief is often indicated in addition to antibiotic therapy. Another dreaded complication is Waterhouse-Friderichsen syndrome (consumption coagulopathy, adrenal cortical insufficiency), which is usually fatal.

After surviving meningitis, around 10 to 40 % of those affected suffer from persistent sequelae, such as neurological damage, hearing impairment, concentration and memory disorders, paralysis and epilepsy.

Prevent

Preventive measures against meningitis include vaccination against the various meningitis pathogens such as:

  • Meningococcal vaccination

  • pneumococcal vaccination

  • Vaccination against Haemophilus influenzae

Meningokokkenimpfung (iStock / Jovanmandic)

To prevent bacterial meningitis, the Standing Committee on Vaccination of the Robert Koch Institute (STIKO) recommends vaccination for infants and young children.

For adults, this vaccination recommendation only applies if their immune system is weakened by a chronic illness, if they come into contact with infectious material, if they are elderly or if a trip to a country with a high risk of meningitis is planned.

Meningococci are very contagious, so those affected must be temporarily isolated. If meningococci or Haemophilus influenzae are responsible for the meningitis, antibiotic prophylaxis may be necessary for contact persons (family members, hospital staff). Bacterial meningitis or sepsis caused by meningococci, pneumococci or Haemophilus influenzae must also be reported.

Editorial principles

All information used for the content comes from verified sources (recognised institutions, experts, studies by renowned universities). We attach great importance to the qualification of the authors and the scientific background of the information. Thus, we ensure that our research is based on scientific findings.
Dr. med. univ. Moritz Wieser

Dr. med. univ. Moritz Wieser
Author

Moritz Wieser graduated in human medicine in Vienna and is currently studying dentistry. He primarily writes articles on the most common diseases. He is particularly interested in the topics of ophthalmology, internal medicine and dentistry.

Thomas Hofko

Thomas Hofko
Lector

Thomas Hofko is in the final third of his bachelor's degree in pharmacy and is an author and lecturer on pharmaceutical topics. He is particularly interested in the fields of clinical pharmacy and phytopharmacy.

The content of this page is an automated and high-quality translation from DeepL. You can find the original content in German here.

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