Meningitis - pneumococcal

• Alternative Names

  Pneumococcal meningitis

• Causes, incidence, and risk factors

  Pneumococcal meningitis is caused by the bacteria Streptococcus pneumoniae (also called pneumococcus). The bacteria is the most common cause of meningitis in adults, and the second most common cause of meningitis in children older than age 6.

  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:

  • High fever
  • Increased sleepiness, confusion
  • Nausea and vomiting
  • Sensitivity to light (photophobia)
  • Severe headache
  • Stiff neck
• Signs and tests

  Physical examination will show:

  • Fast heart rate
  • High temperature
  • Mental status changes
  • Stiff neck

  For any patient with 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
  • CSF culture
  • CT scan of the brain
  • Gram stain of CSF
• Treatment

  Antibiotic therapy 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.

• Expectations (prognosis)

  Early treatment improves the outcome. However, 20% of people who get 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:

  • Deafness
  • Hydrocephalus
  • Mental retardation
  • Paralysis of muscles
  • Build-up of fluid between the skull and brain (subdural accumulation of fluid)
• 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 difficulties
  • 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 55
  • People at high risk for pneumonia
• 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.

Review Date: 9/28/2008

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