In spite of marked progress in diagnostic procedures, improvement in intensive care and introduction of new antimicrobials, bacterial meningitis still remains a serious, sometimes life-threatening disease in children. A high number of survivors are left with persistent neurological or neuro-psychological sequelae. To improve present strategies and to develop new options in diagnostic, prevention and therapy, knowledge and understanding of pathogenesis and pathophysiology of bacterial meningitis is of utmost importance. It is well established that most cases of bacterial meningitis develop through hematogenous spread of bacteria after crossing peripheral mucosal barriers.
Even though major insights in pathophysiological events have been derived from experimental animal and in vitro models in recent years, many aspects of the subsequent invasion of the central nervous system (CNS), the role of the blood-brain barrier (BBB) and even more the blood-cerebrospi-nal fluid (CSF) barrier, remain incompletely understood.
It has become clear that these anatomical and functional barriers play a central role as a port of entry into the CNS but also as key players in the pathophysiological cascade following bacterial invasion into the brain. They are involved in the often deleterious events secondary to the host immune response and are also important for therapeutic issues.
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