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    Meningitis - pneumococcal

    Pneumococcal meningitis

    Pneumococcal meningitis is an infection that causes swelling and irritation (inflammation) of the membranes covering the brain and spinal cord (meninges).

    See also:

    • Aseptic meningitis
    • Meningitis
    • Meningitis - cryptococcal
    • Meningitis - Gram-negative
    • Meningitis - H. influenzae
    • Meningitis - meningococcal
    • Meningitis - staphylococcal
    • Meningitis - tuberculous

    Causes

    Pneumococcal meningitis is caused by the bacteria Streptococcus pneumoniae (also called pneumococcus). The bacteria is the most common cause of bacterial meningitis in adult. It isthe second most common cause of meningitis in children older than age 2.

    Risk factors include:

    • Alcohol use
    • Diabetes
    • History of meningitis
    • Infection of a heart valve
    • Injury or trauma to the head
    • Meningitis in which there is leakage of spinal fluid
    • Recent ear infection
    • Recent pneumonia
    • Recent upper respiratory infection
    • Spleen removal

    Symptoms

    Symptoms usually come on quickly, and may include:

    • Fever and chills
    • Mental status changes
    • Nausea and vomiting
    • Sensitivity to light (photophobia)
    • Severe headache
    • Stiff neck

    Other symptoms that can occur with this disease:

    • Agitation
    • Bulging fontanelles in infants
    • Decreased consciousness
    • Poor feeding or irritability in children
    • Rapid breathing
    • Unusual posture, with the head and neck arched backwards (opisthotonos)

    Pneumococcal meningitis is an important cause of fever in children.

    Exams and Tests

    The doctor or nurse will examine the patient. This may show:

    • Fast heart rate
    • Fever
    • Mental status changes
    • Stiff neck

    If the health care provider thinks meningitis is possible, alumbar puncture ("spinal tap") will be done to remove a sample ofspinal fluid (known as cerebrospinal fluid, or CSF)for testing.

    Tests that may be done include:

    • Blood culture
    • Chest x-ray
    • CT scan of the head
    • Gram stain, other special stains, and culture of CSF

    Treatment

    Treatment with antibiotics should be started as soon as possible. Ceftriaxone is one of the most commonly used antibiotics.

    If the antibiotic is not working and the health care provider suspects antibiotic resistance, vancomycin or rifampin are used. Sometimes systemic corticosteroids may be used, especially in children.

    Outlook (Prognosis)

    How well a person does depends on how fast treatment is received. About 1 in 5 persons whoget this illness will die of it. About 25-50% will have serious long-term brain and nervous systemcomplications.

    Possible Complications

    Manypatients have long-term complications such as:

    • Brain damage
    • Buildup of fluid between the skull and brain (subdural effusion)
    • Hearing loss
    • Hydrocephalus
    • Seizures

    When to Contact a Medical Professional

    Call the local emergency number (such as 911) or go to an emergency room if you suspect meningitis in a young child who has the following symptoms:

    • Feeding problems
    • High-pitched cry
    • Irritability
    • Persistent unexplained fever

    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 available to prevent pneumococcus infection.

    The following people should be vaccinated, according to current recommendations:

    • Children
    • Adults age 65 and older
    • People at high risk for pneumococcus infection

    References

    Thigpen MC, Whitney CG, Messonnier NE, et al. Emerging Infections Programs Network. Bacterial meningitis in the United States, 1998-2007. N Engl J Med. 2011 May 26;364(21):2016-25.

    Swartz MN. Meningitis: bacterial, viral, and other. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 360.

    Tunkel AR, Van de Beek D, Scheld WM. Acute meningitis. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 84.

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    • Pneumococci organism

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    • Pneumococcal pneumonia

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      • Pneumococci organism

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      • Pneumococcal pneumonia

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      A Closer Look

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          Tests for Meningitis - pneumococcal

            Review Date: 8/15/2012

            Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.

            The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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