Pathogenesis and pathophysiology of bacterial meningitis
- Allan R Tunkel, MD, PhD, MACP
Allan R Tunkel, MD, PhD, MACP
- Professor of Medicine
- Warren Alpert Medical School of Brown University
- Section Editors
- Stephen B Calderwood, MD
Stephen B Calderwood, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Bacterial Infections
- Professor of Medicine (Microbiology and Immunobiology)
- Harvard Medical School
- Sheldon L Kaplan, MD
Sheldon L Kaplan, MD
- Editor-in-Chief — Pediatrics
- Section Editor — Pediatric Infectious Diseases
- Professor and Vice Chairman for Clinical Affairs
- Baylor College of Medicine
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 dramatically improve until the advent of systemic antimicrobial therapy in the 1930s .
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".)
The pathogenesis and pathophysiology of bacterial meningitis involve a complex interplay between virulence factors of the pathogens and the host immune response [4-6]. Much of the damage from this infection is believed to result from cytokines released within the CSF as the host mounts an inflammatory response. (See "Neurologic complications of bacterial meningitis in adults".)
The clinically important issues related to the pathogenesis and pathophysiology of bacterial meningitis will be reviewed here. 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. (See "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'.)
Bacterial meningitis develops when virulence factors of the pathogen overcome host defense mechanisms. For the most common pathogens causing bacterial meningitis in adults, such as Streptococcus pneumoniae and Neisseria meningitidis, meningeal invasion is related to several virulence factors that allow the bacteria to colonize host mucosal epithelium, invade and survive within the bloodstream, cross the blood-brain barrier, and multiply within the cerebrospinal fluid (CSF). (See "Microbiology and pathobiology of Neisseria meningitidis" and "Epidemiology of Neisseria meningitidis infection".)
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