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Epidemiology of bacterial meningitis in adults

Allan R Tunkel, MD, PhD, MACP
Section Editor
Stephen B Calderwood, MD
Deputy Editor
Anna R Thorner, MD


From its original recognition in 1805 until the early 1900s, bacterial meningitis was virtually 100 percent fatal. In 1913, Simon Flexner's introduction of intrathecal meningococcal antiserum prevented some deaths, but the clinical outcome did not improve dramatically until the advent of systemic antimicrobial therapy in the 1930s [1].

Despite the effectiveness of current antibiotics in clearing bacteria from the cerebrospinal fluid (CSF), bacterial meningitis continues to cause significant morbidity and mortality worldwide. In two large case series, for example, the case-fatality rate for adults with bacterial meningitis was approximately 25 percent, and transient or permanent neurologic morbidity occurred in 21 to 28 percent of survivors [2,3]. (See "Neurologic complications of bacterial meningitis in adults".)

A number of studies have evaluated the prevalence of different organisms that cause bacterial meningitis. The results vary based upon the type of infection: community acquired, nosocomial, or recurrent.

The epidemiology of bacterial meningitis in adults will be reviewed here. The pathogenesis, clinical features, treatment, prognosis, and prevention of bacterial meningitis in adults and children and issues related to chronic and recurrent meningitis are discussed separately. (See "Pathogenesis and pathophysiology of bacterial meningitis" and "Clinical features and diagnosis of acute bacterial meningitis in adults" and "Initial therapy and prognosis of bacterial meningitis in adults" and "Treatment of bacterial meningitis caused by specific pathogens in adults" and "Bacterial meningitis in children older than one month: Clinical features and diagnosis" and "Bacterial meningitis in children older than one month: Treatment and prognosis" and "Approach to the patient with chronic meningitis" and "Approach to the adult with recurrent infections", section on 'Meningitis'.)


The frequency of the different etiologic organisms of bacterial meningitis varies with age (table 1). In the United States, following the institution of routine infant immunization with the conjugate Haemophilus influenzae type b vaccine in 1990 and the 7-valent Streptococcus pneumoniae (pneumococcus) conjugate vaccine in 2000, bacterial meningitis has decreased in frequency, and the peak incidence of bacterial meningitis has shifted from children under five years of age to adults [4]. (See "Bacterial meningitis in children older than one month: Clinical features and diagnosis", section on 'Epidemiology'.)

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Literature review current through: Nov 2017. | This topic last updated: Sep 09, 2016.
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