Bacterial meningitis

Bacterial meningitis as the most common serious infection of the CNS continues to be an important cause of morbidity and mortality in children. The causative organism varies with age, immune function and immunization status. The majority of cases are associated with an infection with Streptococcus pneumoniae and Neisseria meningitidis, whereas Haemophilus influenzae type b (Hib) infections have been virtually eradicated as a result of routine vaccination policies. Streptococcus agalactiae, Escherichia coli and Listeria monocytogenes are the most common meningitis pathogens in neonates [1-3]. Bacterial meningitis typically presents with the triad of headache, fever and meningism in adolescents, but the clinical picture can vary widely in younger children [3]. Despite the development of highly effective antibiotics, improvement of early diagnosis and intensive care management, the disease is fatal in 5-40% of the cases depending on the etiological agent and the patient's age [2, 4].

Neurological sequelae develop in up to one third of children and adults who survive an episode of bacterial meningitis [5]. These sequelae can be related to direct damage of neuroacoustic structures with following hearing impairment, and to disturbances of CSF dynamics and cerebral blood flow with consequent hydrocephalus, brain edema and intracranial pressure. They can also be caused by direct damage of brain parenchymal tissue leading to focal sensory-motor deficits, neuropsychological impairment, or seizures [6].

Despite all improvements in early detection and antibiotic treatment, the rate of sequelae has proven to be rather unchanged in recent years [2, 7]. One main reason for this unacceptable rate of complications is the incomplete knowledge about the pathogenesis of this disease, even though experimental studies with cell cultures and animal models have substantially contributed to our understanding of the interactions of bacterial pathogens with mammalian cells and their entry into the CNS.

Figure 1. Pathogenetic cascade of bacterial meningitis [9]. With friendly permission of Springer.
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