Meningitis - staphylococcal

Definition

Staphylococcal meningitis is a bacterial infection of the membranes covering the brain and spinal cord (meninges).

See also:

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

Alternative Names

Staphylococcal meningitis

Causes, incidence, and risk factors

Staphylococcal meningitis is caused by Staphylococcus bacteria. When it is caused by Staphylococcus aureus or Staphylococcus epidermidis bacteria, it usually develops as a complication of a surgical procedure, or as an infection spread by the blood from another site.

Risk factors include:

• Infections of heart valves
• Past infection of the brain
• Past meningitis due to spinal fluid shunts
• Recent brain surgery
• Trauma

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 (meningismus)

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)

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 may 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. Nafcillin is also an effective treatment for staphylococcal meningitis.

If the antibiotic is not working and the health care provider suspects antibiotic resistance, vancomycin may be used.

Often, treatment will include a search for, and removal of, possible sources of bacteria in the body. These include shunts or artificial heart valves.

Support Groups

Expectations (prognosis)

Early treatment improves the outcome. However, 3 - 5% of patients do not survive. Young children and adults over age 50 have the highest risk of death.

Staphylococcal meningitis often improves more quickly, with better results, if the source of the infection is removed. The source may include shunts, hardware in joints, or artificial heart valves.

Complications

• Brain damage
• Buildup of fluid between the skull and brain (subdural effusion)
• Hearing loss
• Hydrocephalus
• Seizures
• Staph infection in another area of the body

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

In high-risk people, taking preventive antibiotics before diagnostic or surgical procedures may help reduce the risk. Discuss this with your doctor.

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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.