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ACUTE BACTERIAL MENINGITIS IN ADULTS
ADE WIJAYA, MD – OKTOBER 2020
INTRODUCTION
 Remains a significant burden of disease in adults, with a mortality of up to 30%.
 True medical emergency
 Cerebrospinal fluid is essential for diagnosis
McGill F, Heyderman RS, Panagiotou S, Tunkel AR, Solomon T. Acute bacterial meningitis in adults. The Lancet. 2016 Dec 17;388(10063):3036-47.
ETIOLOGY
 Streptococcus pneumonia (most common)
 Neisseria meningitides
 Haemophilus influenzae type b (Infant and Children)
 Streptococcus suis (South East Asia)
 Enterobacteriaceae (immunocompromised)
 Staphylococcus aureus (immunocompromised)
 Listeria monocytogenes (immunocompromised)
McGill F, Heyderman RS, Panagiotou S, Tunkel AR, Solomon T. Acute bacterial meningitis in adults. The Lancet. 2016 Dec 17;388(10063):3036-47.
PATHOGENESIS
McGill F, Heyderman RS, Panagiotou S, Tunkel AR, Solomon T. Acute bacterial
meningitis in adults. The Lancet. 2016 Dec 17;388(10063):3036-47.
DIAGNOSIS
Viallon A, Botelho-Nevers E, Zeni F. Clinical decision rules for acute bacterial meningitis: current insights. Open access emergency medicine: OAEM. 2016;8:7.
DIAGNOSIS
McGill F, Heyderman RS, Panagiotou S, Tunkel AR, Solomon T. Acute bacterial meningitis in adults. The Lancet. 2016 Dec 17;388(10063):3036-47.
DIAGNOSIS
 Gram stain and culture of the cerebrospinal fluid
 PCR
 Multiplex PCR
McGill F, Heyderman RS, Panagiotou S, Tunkel AR, Solomon T. Acute bacterial meningitis in adults. The Lancet. 2016 Dec 17;388(10063):3036-47.
TREATMENT
McGill F, Heyderman RS, Panagiotou S, Tunkel AR, Solomon T. Acute bacterial meningitis in adults. The Lancet. 2016 Dec 17;388(10063):3036-47.
PROGNOSIS
 Poor prognosis factors:
- Older age
- Reduced conscious level
- Tachycardia
- Cerebrospinal fluid leucocyte count of less than 1000 × 10⁹ cells per mL
- Reduced platelet count
 Prognosis can be improved by instigating both antibiotic and steroid treatment early
Okike IO, Ribeiro S, Ramsay M, Heath PT, Sharland M, Ladhani SN. Trends in bacterial, mycobacterial and fungal meningitis in England and Wales 2004–11: an observational study. Lancet Infect Dis
van de Beek D, de Gans J, Spanjaard L, Weisfelt M, Reitsma JB, Vermeulen M. Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med 2004; 351:
1849–59.
COMPLICATION
 Sequelae are more common in pneumococcal meningitis than meningococcal meningitis
 Hearing loss is one of the most common problems after meningitis, particularly pneumococcal
meningitis
 Other sequelae include limb loss, especially if meningococcal sepsis occurs
 Subdural empyema
 Hydrocephalus
 Seizures
 Other less life-threatening sequelae include neurocognitive dysfunction such as sleep disorders
McGill F, Heyderman RS, Panagiotou S, Tunkel AR, Solomon T. Acute bacterial meningitis in adults. The Lancet. 2016 Dec 17;388(10063):3036-47.
SUMMARY
 True medical emergency
 Need early diagnosis and treatment
 Future direction: vaccine
THANK YOU

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Acute Bacterial Meningitis in Adults

  • 1. ACUTE BACTERIAL MENINGITIS IN ADULTS ADE WIJAYA, MD – OKTOBER 2020
  • 2. INTRODUCTION  Remains a significant burden of disease in adults, with a mortality of up to 30%.  True medical emergency  Cerebrospinal fluid is essential for diagnosis McGill F, Heyderman RS, Panagiotou S, Tunkel AR, Solomon T. Acute bacterial meningitis in adults. The Lancet. 2016 Dec 17;388(10063):3036-47.
  • 3. ETIOLOGY  Streptococcus pneumonia (most common)  Neisseria meningitides  Haemophilus influenzae type b (Infant and Children)  Streptococcus suis (South East Asia)  Enterobacteriaceae (immunocompromised)  Staphylococcus aureus (immunocompromised)  Listeria monocytogenes (immunocompromised) McGill F, Heyderman RS, Panagiotou S, Tunkel AR, Solomon T. Acute bacterial meningitis in adults. The Lancet. 2016 Dec 17;388(10063):3036-47.
  • 4. PATHOGENESIS McGill F, Heyderman RS, Panagiotou S, Tunkel AR, Solomon T. Acute bacterial meningitis in adults. The Lancet. 2016 Dec 17;388(10063):3036-47.
  • 5. DIAGNOSIS Viallon A, Botelho-Nevers E, Zeni F. Clinical decision rules for acute bacterial meningitis: current insights. Open access emergency medicine: OAEM. 2016;8:7.
  • 6. DIAGNOSIS McGill F, Heyderman RS, Panagiotou S, Tunkel AR, Solomon T. Acute bacterial meningitis in adults. The Lancet. 2016 Dec 17;388(10063):3036-47.
  • 7. DIAGNOSIS  Gram stain and culture of the cerebrospinal fluid  PCR  Multiplex PCR McGill F, Heyderman RS, Panagiotou S, Tunkel AR, Solomon T. Acute bacterial meningitis in adults. The Lancet. 2016 Dec 17;388(10063):3036-47.
  • 8. TREATMENT McGill F, Heyderman RS, Panagiotou S, Tunkel AR, Solomon T. Acute bacterial meningitis in adults. The Lancet. 2016 Dec 17;388(10063):3036-47.
  • 9. PROGNOSIS  Poor prognosis factors: - Older age - Reduced conscious level - Tachycardia - Cerebrospinal fluid leucocyte count of less than 1000 × 10⁹ cells per mL - Reduced platelet count  Prognosis can be improved by instigating both antibiotic and steroid treatment early Okike IO, Ribeiro S, Ramsay M, Heath PT, Sharland M, Ladhani SN. Trends in bacterial, mycobacterial and fungal meningitis in England and Wales 2004–11: an observational study. Lancet Infect Dis van de Beek D, de Gans J, Spanjaard L, Weisfelt M, Reitsma JB, Vermeulen M. Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med 2004; 351: 1849–59.
  • 10. COMPLICATION  Sequelae are more common in pneumococcal meningitis than meningococcal meningitis  Hearing loss is one of the most common problems after meningitis, particularly pneumococcal meningitis  Other sequelae include limb loss, especially if meningococcal sepsis occurs  Subdural empyema  Hydrocephalus  Seizures  Other less life-threatening sequelae include neurocognitive dysfunction such as sleep disorders McGill F, Heyderman RS, Panagiotou S, Tunkel AR, Solomon T. Acute bacterial meningitis in adults. The Lancet. 2016 Dec 17;388(10063):3036-47.
  • 11. SUMMARY  True medical emergency  Need early diagnosis and treatment  Future direction: vaccine