Meningitis - pneumococcal

Definition

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

Alternative Names

Pneumococcal meningitis

Causes, incidence, and risk factors

Pneumococcal meningitis is caused by the bacterium Streptococcus pneumoniae (also called pneumococcus). The bacteria is the most common cause of bacterial meningitis in adults, and the 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
• 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 and newborns.

Signs and tests

Physical examination will usually show:

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

For any patient who is suspected of having meningitis, it is important to perform a lumbar puncture ("spinal tap"), in which spinal fluid (known as cerebrospinal fluid, or CSF) is collected for testing.

Tests that may be done include:

• Blood culture
• Chest x-ray
• CSF examination for cell count, glucose, and protein
• 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.

Support Groups

Expectations (prognosis)

Early treatment improves the outcome. However, 20% of people who get this disease will die of it and 25 - 50% will have serious long-term brain and nervous system (neurologic) complications.

Complications

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

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

Calling your health care provider

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
• Everyone over age 65
• People at high risk for pneumococcus infection

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References

Swartz MN. Meningitis: bacterial, viral, and other. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 437.