Meningitis - pneumococcal

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Alternative names
Pneumococcal meningitis

Definition
Pneumococcal meningitis is an inflammation or infection of the membranes covering the brain and spinal cord caused by Streptococcus pneumoniae (also called pneumococcus).

Causes, incidence, and risk factors

Streptococcus pneumoniae is the most common cause of meningitis in adults, and the second most common cause of meningitis in children older than 6.

The onset of symptoms is usually rapid. Risk factors include recurrent meningitis, meningitis associated with leakage of spinal fluid, Diabetes, injury or trauma to the head, alcohol use, recent pneumonia, recent upper respiratory infection, infection of a heart valve, or recent ear infection. About 15,000 cases occur in the US each year.

Symptoms

• High fever
  
• Severe Headache
  
• Nausea and Vomiting
  
• Stiff neck
  
• Sensitivity to light (photophobia)
  
• Mental status changes

Signs and tests

Physical examination will reveal a fast heart rate, high temperature, stiff neck, and cloudy mental status.

The following tests may be performed:

• Spinal tap will show white blood cells in the spinal fluid (CSF), often with elevated protein and low glucose.
  
• Gram stain of CSF will show white blood cells and sometimes gram-positive bacteria (pneumococcus).
  
• CSF culture may grow pneumococcus.
  
• Blood culture may grow pneumococcus.
  
• A CT scan of the brain, if done, is usually normal.

Treatment
Antibiotic therapy should be started as soon as possible. Ceftriaxone is one of the most commonly used antibiotics. If antibiotic resistance is suspected, vancomycin or rifampin are used. Sometimes systemic corticosteroids may be used, especially in children.

Expectations (prognosis)
With early treatment, the outcome is better. However, 20% of people who contract this disease will die of it and 50% will have serious long-term complications.

Complications

About half of all patients have long-term complications, such as the following:

• Hydrocephalus
  
• Subdural accumulation of fluid
  
• Deafness
  
• Paralysis of various muscles
  
• Mental retardation

Calling your health care provider

Call the local emergency number (such as 911) or go to the emergency room if a young child has persistent unexplained fever, irritability, feeding difficulties, or high-pitched cry and you suspect meningitis.

Call the local emergency number if you develop any of the serious symptoms listed above. Meningitis can quickly become a life-threatening illness.

Prevention

Early treatment of pneumonia and ear infections caused by pneumococcus may decrease the risk of meningitis. There are also two effective vaccines on the market to prevent pneumococcus infection.

The current recommendations are for people at high risk for pneumonia, children, and everyone over the age of 55 to be vaccinated.

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