Meningitis - pneumococcal
Pneumococcal meningitis; Pneumococcus - meningitis
Meningitis is an infection of the membranes covering the brain and spinal cord. This covering is called the meninges.
Bacteria are one type of germ that can cause meningitis. The pneumococcal bacteria is one kind of bacteria that causes meningitis.
Causes
Pneumococcal meningitis is caused by Streptococcus pneumoniae bacteria (also called pneumococcus, or S pneumoniae ). This type of bacteria is the most common cause of bacterial meningitis in adults. It is the second most common cause of meningitis in children older than age 2.
Risk factors include:
- Alcohol use
-
Diabetes
Diabetes
Diabetes is a chronic disease in which the body cannot regulate the amount of sugar in the blood.
- History of meningitis
- Infection of a heart valve with S pneumoniae
- Injury or trauma to the head
- Meningitis in which there is leakage of spinal fluid
- Recent ear infection with S pneumoniae
-
Recent
pneumonia
with
S pneumoniae
Pneumonia
Pneumonia is a breathing (respiratory) condition in which there is an infection of the lung. This article covers community-acquired pneumonia (CAP). ...
- Recent upper respiratory infection
- Spleen removal or a spleen that does not function
Symptoms
Symptoms usually come on quickly, and may include:
-
Fever
and chills
Fever
Fever is the temporary increase in the body's temperature in response to a disease or illness. A child has a fever when the temperature is at or abov...
-
Mental status changes
Mental status changes
Unconsciousness is when a person is unable to respond to people and activities. Doctors often call this a coma or being in a comatose state. Other c...
- Nausea and vomiting
- Sensitivity to light ( photophobia )
- Severe headache
- Stiff neck
Other symptoms that can occur with this disease:
- Agitation
-
Bulging fontanelles
in infants
Bulging fontanelles
A bulging fontanelle is an outward curving of an infant's soft spot (fontanelle).
- Decreased consciousness
- Poor feeding or irritability in children
- Rapid breathing
-
Unusual posture, with the head and neck arched backwards (
opisthotonos
)
Opisthotonos
Opisthotonos is a condition in which a person holds their body in an abnormal position. The person is usually rigid and arches their back, with thei...
Pneumococcal meningitis is an important cause of fever in infants.
Exams and Tests
The health care provider will perform a physical exam. Questions will focus on symptoms and possible exposure to someone who might have the same symptoms, such as a stiff neck and fever.
If the provider thinks meningitis is possible, a lumbar puncture ( spinal tap ) will likely be done to remove a sample of spinal fluid for testing.
Spinal tap
Cerebrospinal fluid (CSF) collection is a test to look at the fluid that surrounds the brain and spinal cord. CSF acts as a cushion, protecting the b...
Other tests that may be done include:
-
Blood culture
Blood culture
A blood culture is a laboratory test to check for bacteria or other germs in a blood sample.
-
Chest x-ray
Chest x-ray
A chest x-ray is an x-ray of the chest, lungs, heart, large arteries, ribs, and diaphragm.
-
CT scan of the head
CT scan of the head
A head computed tomography (CT) scan uses many x-rays to create pictures of the head, including the skull, brain, eye sockets, and sinuses.
- Gram stain, other special stains
Treatment
Antibiotics will be started as soon as possible. Ceftriaxone is one of the most commonly used antibiotics.
If the antibiotic is not working and the provider suspects antibiotic resistance, vancomycin or rifampin are used. Sometimes, corticosteroids are used, especially in children.
Outlook (Prognosis)
This is a dangerous infection and it can be deadly. The sooner it is treated, the better the chance for recovery. Young children and adults over age 50 have the highest risk for death.
Possible Complications
Long-term complications may include:
- Brain damage
-
Buildup of fluid between the skull and brain (
subdural effusion
)
Subdural effusion
A subdural effusion is a collection of cerebrospinal fluid (CSF) trapped between the surface of the brain and the outer lining of the brain (the dura...
-
Buildup of fluid inside the skull that leads to brain swelling (
hydrocephalus
)
Hydrocephalus
Hydrocephalus is a buildup of fluid inside the skull that leads to brain swelling. Hydrocephalus means "water on the brain. "
- Hearing loss
-
Seizures
Seizures
A seizure is the physical findings or changes in behavior that occur after an episode of abnormal electrical activity in the brain. The term "seizure...
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.
Two effective vaccines
All content below is taken in its entirety from the CDC Information Statement (VIS): www. cdc. gov/vaccines/hcp/vis/vis-statements/pcv13. htmlCDC rev...
The following people should be vaccinated, according to current recommendations:
- Children
- Adults age 65 and older
- People at high risk for pneumococcus infection
References
Tunkel AR, Van de Beek D, Scheld WM. Acute meningitis. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, Updated Edition . 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 89.
Wood JB, Peters TR. Streptococcus pneumoniae (pneumococcus). In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics . 20th ed. Philadelphia, PA: Elsevier; 2016:chap 182.
-
Pneumococci organism - illustration
This picture shows the organism Pneumococci. These bacteria are usually paired (diplococci) or appear in chains. Pneumococci are typically associated with pneumonia, but may cause infection in other organs such as the brain (pneumococcal meningitis) and blood stream (pneumococcal septicemia). (Image courtesy of the Centers for Disease Control and Prevention)
Pneumococci organism
illustration
-
Pneumococcal pneumonia - illustration
This is a photomicrograph of the organism that causes pneumococcal pneumonia. The bacteria are round, but join together to form chains. Frequently, these join together to form pairs and are called diplococci; the prefix di means two.
Pneumococcal pneumonia
illustration
-
Pneumococci organism - illustration
This picture shows the organism Pneumococci. These bacteria are usually paired (diplococci) or appear in chains. Pneumococci are typically associated with pneumonia, but may cause infection in other organs such as the brain (pneumococcal meningitis) and blood stream (pneumococcal septicemia). (Image courtesy of the Centers for Disease Control and Prevention)
Pneumococci organism
illustration
-
Pneumococcal pneumonia - illustration
This is a photomicrograph of the organism that causes pneumococcal pneumonia. The bacteria are round, but join together to form chains. Frequently, these join together to form pairs and are called diplococci; the prefix di means two.
Pneumococcal pneumonia
illustration
Review Date: 7/31/2016
Reviewed By: 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, Boston, MA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.