- Rodrigo Hasbun, MD, MPH, FIDSA
- Section Editors:
- Allan R Tunkel, MD, PhD, MACP
- Sheldon L Kaplan, MD
- Deputy Editor:
- Jennifer Mitty, MD, MPH
INTRODUCTIONFrom its original recognition in 1805 until the early 1900s, bacterial meningitis due to Haemophilus influenzae and Streptococcus pneumoniae was virtually 100 percent fatal. In 1913, Simon Flexner's introduction of intrathecal meningococcal antiserum decreased the mortality of meningococcal meningitis from 75 to 31 percent, but the clinical outcome did not dramatically improve for all three meningeal pathogens until the advent of systemic antimicrobial therapy in the 1930s .
Despite the effectiveness of antibiotics in clearing bacteria from the cerebrospinal fluid (CSF), bacterial meningitis in adults continues to cause significant morbidity and mortality worldwide. As an example, in the largest prospective study to date of 1412 episodes of community-acquired bacterial meningitis, the case-fatality rate was 17 percent, and unfavorable outcomes occurred in 38 percent . (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 [3,4]. 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'.)
PATHOGENESISBacterial meningitis develops when virulence factors of the pathogen overcome host defense mechanisms [3,5].
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