Moore, specialist registrar in infectious diseases, and j. Being a subacute illness, early symptoms may be missed leading to clinical deterioration and late presentation. Second, and more importantly, the presentation of viral meningitis may only differ slightly from that of bacterial meningitis, a lifethreatening and highly contagious disorder that. Case report open access clival defect in the pathogenesis of recurrent meningitis. Neisseria meningitidis is remarkable for the diversity of interactions that the bacterium has with the human host, ranging from asymptomatic nasopharyngeal colonisation affecting virtually all members of the population. Necrotic damage to the cerebral cortex is at least partly mediated by ischemia and oxygen radicals and therefore offers a promising target for adjunctive therapeutic intervention. Pigt mutations should be considered a novel pathogenesis of recurrent meningitis of unknown aetiology. Meningococci reach the brain from the bloodstream, implying that the patients immune response has prevented bacterial proliferation in the blood and not suffered overwhelming sepsis. Pdf no bacterial disease has undergone a more dramatic change in epidemiology during the past decade than acute bacterial meningitis.
Dissemination of tb to the brain results in the most severe form of extrapulmonary tb, tuberculous meningitis tbm, which represents a medical emergency associated with high rates of mortality. Pathogenesis of bacterial meningitis sciencedirect. The peripheral white blood cell count alone is not help. In this chapter, we describe a classification system for meningococcal disease based on. Through the use of experimental animal models of infection, a great deal of information. The pathogenesis of tbm is incompletely understood and further understanding is required in order to develop effective vaccines, optimal antibiotic and host directed therapies. Epidemiology, etiology, pathogenesis, and diagnosis of recurrent. For full access to this pdf, sign in to an existing. Summary recurrent bacterial meningitis is a rare phenomenon and generally poses a considerable diagnostic challenge to the clinician.
No bacterial disease has undergone a more dramatic change in epidemiology during the past decade than acute bacterial meningitis. Pneumococcal and meningococcal conjugate vaccines have been implemented, use of enteroviral polymerase chain reaction pcr has become routine in most. Viral pathogens may gain access to the cns via either of 2 main routes. Its typically mild and goes away without treatment. In one study, bacteremia and meningitis developed in 89 and 94%ofanimals, respectively, following the atraumatic intranasal inoculation ofh. Bacterial meningitis remains a disease with associated unacceptable morbidity and mortality rates despite the availability of effective bactericidal antimicrobial therapy. Pdf pathogenesis and pathophysiology of pneumococcal. In patients with suspected herpes simplex virus hsv infection, empiric antiviral therapy is started to prevent complications of hsv encephalitis. See clinical features and diagnosis of acute bacterial meningitis in adults and. Through the use of experimental animal models of infection, a great deal of information has been gleaned concerning the pathogenic and pathophysiologic mechanisms. Bacterial meningitis is the infection of the arachnoid membrane, subarachnoid space, and cerebrospinal fluid by bacteria.
After using the information in your ebook for 3 weeks, it was down within the normal range. Pathogenesis of meningitis caused by streptococcus suis. Pathophysiology of meningococcal meningitis and septicaemia. Pathophysiology and treatment of bacterial meningitis ncbi. Department of internal medicine infectious diseases, medical college of pennsylvania, philadelphia 19129. Infection of the subarachnoid space leads to cerebrospinal fluid csf inflammation, meningeal irritation, and the clinical triad of headache, fever, and meningismus. Pathogenesis a discussion on the pathogenesis of tuberculous meningitis can be directed on two levels. Newer tests like nuclei acid amplification tests naats. Many infectious agents, such as viruses, bacteria, and parasites, can cause inflammation of the central nervous system cns. Bacterial meningitis is the most common serious infection of the central nervous system. Pathophysiology and treatment of bacterial meningitis olaf hoffman and joerg r. Classification and pathogenesis of meningococcal infections. Epidemiology, etiology, pathogenesis, and diagnosis of. Fulltext html pdf over the past several decades, the incidence of bacterial meningitis in children has decreased but there remains a significant burden of disease in adults, with a mortality of up to 30%.
Meningitis is an acute inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges. The most common symptoms are fever, headache, and neck stiffness. Animal models have proven to be extremely valuable in the study of the pathogenesis and pathophysiology of bacterial meningitis, with the hopes of providing new information that may lead to an. Viral meningitis is the most common form of meningitis. Pathogenesis and pathophysiology of pneumococcal meningitis. To establish accurate diagnosis and develop effective vaccines and drugs to overcome this disease, it is important to understand and.
Chapter 2 transmission and pathogenesis of tuberculosis. Background recurrent aseptic meningitis is a rare disease which was first described in 1944 by the french neurologist pierre mollaret. Pathogenesis and pathophysiology of bacterial meningitis uptodate. Pathophysiology of acute meningitis caused by streptococcus pneumoniae and adjunctive therapy approaches. Vasospasm has been as sociated with permanent neurologi cal deficits and death. Pathophysiology of bacterial meningitis international journal of.
Distinguishing between viral and bacterial meningitis is done using blood and csf cultures, as well as lumbar puncture opening pressure which reflects icp and csf analysis. The beginning of this millennium has witnessed the virtual disappearance of haemophilus invasive disease in some countries, emergence of pneumococcal strains that are. However, at the outset of our studies, the mechanism by which ctl caused fatal meningitis in the lcmv system was unknown. Expert opinion and several societal guidelines recommend routine treatment with dexamethasone for communityacquired meningitis of children 0. Pathogenesis and pathophysiology of bacterial meningitis. Clival defect in the pathogenesis of recurrent meningitis. As such, it represents a unique human infectious disease, b. The etiological agent is neisseria meningitidis, a gram negative diplococcus and an obligate human.
Tuberculous meningitis tbm in children may mimic bacterial meningitis in the early stages. Streptococcus pneumoniae and neisseria meningitidis are the most common and most aggressive pathogens of meningitis. Pathogenesis of cryptococcal meningitis researchgate. Encephalitis is an inflammation of the brain parenchyma, which may result in a more advanced and serious disease meningoencephalitis. The most lethal and disabling form of tuberculosis is tuberculous meningitis tbm, for which more than 100,000 new cases are estimated to occur per year. Diagnosis, initial management, and prevention of meningitis. Fifty years after the advent of antibiotics for clinical use, bacterial meningitis remains an important cause of morbidity and mortality. Ultimately, a structured approach and early diagnosis of any underlying pathology are crucial to prevent further episodes and improve the overall outcome for the affected individual. Bacterial meningitis is a medical emergency requiring immediate diagnosis and immediate treatment. Bacterial meningitis is an important cause of mortality and morbidity despite advances in antimicrobial therapy.
Viral meningitis is a virusborne inflammation of the meninges, which are the. Meningococcal meningitis and sepsis are devastating diseases which still affect people with an incidence varying between 0. Although the pathogenesis of bacterial meningitis is not completely understood, knowledge of. Meningococcal meningitis generally has a better prognosis than septicaemia. Thus, our data established the relevance and interest that this experimental model has for investigation of the pathogenesis of human cryptococcal meningitis read more discover more. Despite the availability of bactericidal antibiotics with potent in vitro activity against the major meningeal pathogens, the morbidity and mortality from bacterial meningitis remains unacceptably high. The clinical features, treatment, prognosis, and prevention of bacterial meningitis in adults and children and issues related to chronic and recurrent meningitis are discussed separately. These observations support the concept that in the pathogenesis of meningitis, bacteria may gain access to the cerebrospinal fluid compartment in association with monocytes migrating along normal pathways. Meningitis can be caused by various infectious agents, including viruses, fungi, and protozoans, but bacteria produce the most lifethreatening forms. A key factor that contributes to the high prevalence of this condition is the. The subarachnoid space is bounded externally by the arachnoid membrane and internally by the pia, and dips into the brain along blood vessels in the perivascular virchowrobin spaces. The clinical symptoms induced by neisseria meningitidis reflect compartmentalized intravascular and intracranial bacterial growth and inflammation.
Practice guidelines for the management of bacterial meningitis. The pathogenesis of cerebral vasospasm in bacterial meningitis. Meningitis, inflammation of the meninges, the membranes covering the brain and spinal cord. Tuberculous meningitis tbm is the most serious extrapulmonary manifestation of tuberculosis with mortality rates up to 50% observed in the context of hiv1 coinfection. Infant primates have also been used in the study ofthe pathogenesis ofbacterial meningitis. The pathogenesis of cerebral vasospasm in bacterial meningitis m eisenhut abstract introduction cerebral inflammation in bacterial meningitis has been associated with vasospasms of cerebral arteries and arterioles. I couldnt get my blood sugar below 300 with medication. Cohen, professor, department of infectious diseases and micro biology, imperial college school of medicine, hammersmith hospital, london summary bacterial meningitis is the most common serious infection. Despite the availability of bactericidal antibiotics with potent in vitro activity against the major meningeal pathogens, the morbidity and mor tality from bacterial. Pathogenesis of meningitis caused by streptococcus suis type 2 a. Other symptoms include confusion or altered consciousness, vomiting, and an inability to tolerate light or loud noises.
582 1583 1216 1202 942 1430 1586 1327 955 669 944 354 1620 927 274 912 1024 269 1600 489 659 228 243 598 270 1508 778 621 976 208 754 588 388 375 1104 1520 181 1351 870 246 249 942 746 753 293