Focus on the diagnosis and treatment of severe meningitis

Abstract

Meningitis is the most common worldwide infection of the central nervous system, and bacterial meningitis is a potentially life-threatening disease that requires immediate recognition and treatment. Community-acquired bacterial meningitis has an annual incidence of 4–6 cases per 100,000 adults, and Streptococcus pneumoniae and Neisseria meningitidis are responsible for at least 80% of all cases [1], [2]. In a surveillance study conducted in 1995 in USA, the incidence of bacterial meningitis was found to have declined dramatically [2]. This finding was a result of a vaccine-related decline in meningitis caused by Haemophilus influenzae type B vaccine; in the USA and in other industrialised countries, bacterial meningitis is now a disease predominantly of adults rather than infants and children. Moreover, conjugate vaccines against S. pneumoniae are expected to reduce the incidence of childhood pneumococcal meningitis significantly [3]. Bacterial meningitis is also an important problem in hospitalised patients. In a review of 493 episodes of bacterial meningitis in adults at a USA tertiary hospital from 1962 to 1988 inclusive, 40% of episodes were nosocomial in origin, with most cases (38%) caused by Gram-negative bacilli. In that study, the mortality rate remained high over time, and even in the 1980s, almost one quarter of adults with meningitis died, despite the advances in antibiotic therapy. In contrast, it was found that the mortality rate of Gram-negative bacillary meningitis had decreased since the advent of third-generation cephalosporins [4].

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