Features of bacterial meningitis

Features of bacterial meningitis

Pathogenesis, common clinical findings, diagnostic approach, neuroimaging findings, and complications of bacterial meningitis.

PathogenesisBacteria enter subarachnoid space → replication and autolysis → release of bacterial components in CSF → release of proinflammatory host factors
Clinical findingsStiff neck, headache, fever, photophobia, malaise, vomiting, lethargy → deterioration of level of consciousness
DiagnosisLumbar 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 findingsCerebral edema, hydrocephalus, ventriculitis, vasculitis, septic embolism, sinus venous thrombus causing infarction, intracranial free air due to dural leak
ComplicationsDeath 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.


Data from Roos KL: Meningitis: 100 Maxims. London, Arnold, 1996


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