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Features of bacterial meningitis
Pathogenesis, common clinical findings, diagnostic approach, neuroimaging findings, and complications of bacterial meningitis.
| Pathogenesis | Bacteria enter subarachnoid space → replication and autolysis → release of bacterial components in CSF → release of proinflammatory host factors |
| Clinical findings | Stiff neck, headache, fever, photophobia, malaise, vomiting, lethargy → deterioration of level of consciousness |
| Diagnosis | Lumbar puncture: elevated opening pressure, polymorphonuclear leukocytic pleocytosis, elevated protein, low glucose, and elevated lactate in postneurosurgical patients, gram-stained smear, CSF culture Blood cultures, CRP/ESR |
| CT/MRI findings | Cerebral edema, hydrocephalus, ventriculitis, vasculitis, septic embolism, sinus venous thrombus causing infarction, intracranial free air due to dural leak |
| Complications | Death with highest mortality in pneumococcal and Listeria meningitis Sensorineural hearing loss Hemiparesis, epileptic seizures, hemianopia, ataxia, cranial nerve palsies |
CSF , Cerebrospinal fluid; CRP , C-reactive protein; ESR , sedimentation rate.
Sources
Data from Roos KL: Meningitis: 100 Maxims. London, Arnold, 1996
