Community-acquired acute bacterial meningitis in adults: a clinical update

Abstract

Background Acute bacterial meningitis (ABM) in adults is associated with a mortality that may exceed 30%. Immunization programs have reduced the global burden; in the UK, declining incidence but persistently high mortality and morbidity mean that clinicians must remain vigilant. Sources of data A systematic electronic literature search of PubMed was performed to identify all ABM literature published within the past 5 years. Areas of agreement and controversy Clinical features cannot reliably distinguish between ABM and other important infectious and non-infectious aetiologies. Prompt investigation and empirical treatment are imperative. Lumbar puncture (LP) and cerebrospinal fluid microscopy, biochemistry and culture remain the mainstay of diagnosis, but molecular techniques are increasingly useful. The 2016 UK joint specialist societies’ guideline provides expert recommendations for the management of ABM, yet published data suggest clinical care delivered in the UK is frequently not adherent. Anxiety regarding risk of cerebral herniation following LP, unnecessary neuroimaging, underutilization of molecular diagnostics and suboptimal uptake of adjunctive corticosteroids compromise management. Growing points There is increasing recognition that current antibiotic regimens and adjunctive therapies alone are insufficient to reduce the mortality and morbidity associated with ABM. Areas timely for developing research Research should be focused on optimization of vaccines (e.g. pneumococcal conjugate vaccines with extended serotype coverage), targeting groups at risk for disease and reservoirs for transmission; improving adherence to management guidelines; development of new faster, more accurate diagnostic platforms (e.g. novel point-of-care molecular diagnostics); and development of new adjunctive therapies (aimed at the host-inflammatory response and bacterial virulence factors).

Retrospective analysis of the etiology, clinical characteristics and outcomes of community-acquired bacterial meningitis in the University Infectious Diseases Centre in Lithuania

“…The clinical presentation of CABM varies and depends on the patient's age, coexisting conditions and comorbidities [15,[27][28][29][30][31]. Our study revealed the most common signs of CABMheadache, fever ≥38°C and nausea.…”

Invasive Pneumococcal Disease and COVID-19 With Acute Otitis Media and a Tegmen Tympani Defect

“…S. pneumoniae , an encapsulated, gram-positive bacterium, colonizes the nasopharynx. In rare circumstances, it accesses the bloodstream and may enter CSF [ 4 ]. Meningitis and bacteremia are forms of IPD, which is associated with an increased risk of permanent neurological sequelae and death [ 6 ].…”

“…Much rarer, intracranial extension causes otogenic intracranial sepsis and meningitis [ 8 ]. Bacterial meningitis, most often caused by S. pneumoniae , is associated with a 30% mortality rate in adults [ 4 ]. In one cohort study, S. pneumoniae caused 53.8% of 520 adult cases [ 12 ].…”

“…Streptococcus pneumoniae colonizes the nasopharynx and commonly causes otitis media and pneumonia. Under immunocompromised states, it can access the bloodstream and enter cerebrospinal fluid (CSF) [ 4 ]. Other risk factors for invasive disease include asplenia, CSF leakage from anatomic defects, and damage to the blood-brain barrier due to infections, namely, bacteremia and COVID-19 [ 5 ].…”