The beginning of this millennium has witnessed the virtual disappearance of haemophilus invasive disease in some countries, emergence of pneumococcal strains that are. Pneumococcal and meningococcal conjugate vaccines have been implemented, use of enteroviral polymerase chain reaction pcr has become routine in most. The etiological agent is neisseria meningitidis, a gram negative diplococcus and an obligate human. See clinical features and diagnosis of acute bacterial meningitis in adults and. Epidemiology, etiology, pathogenesis, and diagnosis of. Streptococcus pneumoniae and neisseria meningitidis are the most common and most aggressive pathogens of meningitis. Meningococcal meningitis and sepsis are devastating diseases which still affect people with an incidence varying between 0. Pathogenesis and pathophysiology of bacterial meningitis. The pathogenesis and pathophysiology of bacterial meningitis involve a. Pathophysiology and treatment of bacterial meningitis olaf hoffman and joerg r.
Second, and more importantly, the presentation of viral meningitis may only differ slightly from that of bacterial meningitis, a lifethreatening and highly contagious disorder that. Thus, our data established the relevance and interest that this experimental model has for investigation of the pathogenesis of human cryptococcal meningitis read more discover more. Chapter 2 transmission and pathogenesis of tuberculosis. Summary recurrent bacterial meningitis is a rare phenomenon and generally poses a considerable diagnostic challenge to the clinician. As such, it represents a unique human infectious disease, b. Pathophysiology of meningococcal meningitis and septicaemia. Animal models have proven to be extremely valuable in the study of the pathogenesis and pathophysiology of bacterial meningitis, with the hopes of providing new information that may lead to an. Pathogenesis and pathophysiology of pneumococcal meningitis. Current concepts in the pathogenesis of meningitis caused. Moore, specialist registrar in infectious diseases, and j. Over the past year, our laboratory set out to gain real time mechanistic insights into this disease process with the hope of better understanding. Distinguishing between viral and bacterial meningitis is done using blood and csf cultures, as well as lumbar puncture opening pressure which reflects icp and csf analysis.
The peripheral white blood cell count alone is not help. Ultimately, a structured approach and early diagnosis of any underlying pathology are crucial to prevent further episodes and improve the overall outcome for the affected individual. Many infectious agents, such as viruses, bacteria, and parasites, can cause inflammation of the central nervous system cns. Bacterial meningitis remains a disease with associated unacceptable morbidity and mortality rates despite the availability of effective bactericidal antimicrobial therapy. Meningococcal meningitis generally has a better prognosis than septicaemia. Case report open access clival defect in the pathogenesis of recurrent meningitis. Pathogenesis and pathophysiology of bacterial meningitis uptodate. Classification and pathogenesis of meningococcal infections. Despite the availability of bactericidal antibiotics with potent in vitro activity against the major meningeal pathogens, the morbidity and mor tality from bacterial. In one study, bacteremia and meningitis developed in 89 and 94%ofanimals, respectively, following the atraumatic intranasal inoculation ofh. The clinical features, treatment, prognosis, and prevention of bacterial meningitis in adults and children and issues related to chronic and recurrent meningitis are discussed separately.
Background recurrent aseptic meningitis is a rare disease which was first described in 1944 by the french neurologist pierre mollaret. Pathogenesis of bacterial meningitis sciencedirect. The most lethal and disabling form of tuberculosis is tuberculous meningitis tbm, for which more than 100,000 new cases are estimated to occur per year. The pathogenesis of tbm is incompletely understood and further understanding is required in order to develop effective vaccines, optimal antibiotic and host directed therapies. The pathogenesis of cerebral vasospasm in bacterial meningitis. In this chapter, we describe a classification system for meningococcal disease based on. Cohen, professor, department of infectious diseases and micro biology, imperial college school of medicine, hammersmith hospital, london summary bacterial meningitis is the most common serious infection. Department of internal medicine infectious diseases, medical college of pennsylvania, philadelphia 19129. The pathogenesis of cerebral vasospasm in bacterial meningitis m eisenhut abstract introduction cerebral inflammation in bacterial meningitis has been associated with vasospasms of cerebral arteries and arterioles. Bacterial meningitis is the infection of the arachnoid membrane, subarachnoid space, and cerebrospinal fluid by bacteria.
Viral pathogens may gain access to the cns via either of 2 main routes. Being a subacute illness, early symptoms may be missed leading to clinical deterioration and late presentation. To establish accurate diagnosis and develop effective vaccines and drugs to overcome this disease, it is important to understand and. Infection of the subarachnoid space leads to cerebrospinal fluid csf inflammation, meningeal irritation, and the clinical triad of headache, fever, and meningismus.
The clinical symptoms induced by neisseria meningitidis reflect compartmentalized intravascular and intracranial bacterial growth and inflammation. Pathogenesis of meningitis caused by streptococcus suis. Tuberculous meningitis tbm in children may mimic bacterial meningitis in the early stages. Bacterial meningitis is the most common serious infection of the central nervous system. Meningitis, inflammation of the meninges, the membranes covering the brain and spinal cord.
Its typically mild and goes away without treatment. Vasospasm has been as sociated with permanent neurologi cal deficits and death. Bacterial meningitis is an important cause of mortality and morbidity despite advances in antimicrobial therapy. Pdf no bacterial disease has undergone a more dramatic change in epidemiology during the past decade than acute bacterial meningitis. Fifty years after the advent of antibiotics for clinical use, bacterial meningitis remains an important cause of morbidity and mortality.
Pigt mutations should be considered a novel pathogenesis of recurrent meningitis of unknown aetiology. These observations support the concept that in the pathogenesis of meningitis, bacteria may gain access to the cerebrospinal fluid compartment in association with monocytes migrating along normal pathways. Clival defect in the pathogenesis of recurrent meningitis. Pathophysiology of bacterial meningitis international journal of. Tuberculous meningitis tbm is the most serious extrapulmonary manifestation of tuberculosis with mortality rates up to 50% observed in the context of hiv1 coinfection. However, at the outset of our studies, the mechanism by which ctl caused fatal meningitis in the lcmv system was unknown. Pathogenesis of cryptococcal meningitis researchgate. For full access to this pdf, sign in to an existing.
The most common symptoms are fever, headache, and neck stiffness. In patients with suspected herpes simplex virus hsv infection, empiric antiviral therapy is started to prevent complications of hsv encephalitis. Bacterial meningitis is a medical emergency requiring immediate diagnosis and immediate treatment. Viral meningitis is a virusborne inflammation of the meninges, which are the. Tuberculous meningitis g thwaites, t t h chau, n t h mai, f drobniewski, k mcadam, j farrar uncertainty and doubt dominate all aspects of tuberculous meningitis tbm. Epidemiology, etiology, pathogenesis, and diagnosis of recurrent. Pdf pathogenesis and pathophysiology of pneumococcal. Neisseria meningitidis is remarkable for the diversity of interactions that the bacterium has with the human host, ranging from asymptomatic nasopharyngeal colonisation affecting virtually all members of the population. Fulltext html pdf over the past several decades, the incidence of bacterial meningitis in children has decreased but there remains a significant burden of disease in adults, with a mortality of up to 30%. No bacterial disease has undergone a more dramatic change in epidemiology during the past decade than acute bacterial meningitis. I couldnt get my blood sugar below 300 with medication. Diagnosis, initial management, and prevention of meningitis. Other symptoms include confusion or altered consciousness, vomiting, and an inability to tolerate light or loud noises. Newer tests like nuclei acid amplification tests naats.
Pathophysiology and treatment of bacterial meningitis ncbi. Meningococci reach the brain from the bloodstream, implying that the patients immune response has prevented bacterial proliferation in the blood and not suffered overwhelming sepsis. A key factor that contributes to the high prevalence of this condition is the. Necrotic damage to the cerebral cortex is at least partly mediated by ischemia and oxygen radicals and therefore offers a promising target for adjunctive therapeutic intervention. Encephalitis is an inflammation of the brain parenchyma, which may result in a more advanced and serious disease meningoencephalitis. Viral meningitis is the most common form of meningitis. Pathogenesis a discussion on the pathogenesis of tuberculous meningitis can be directed on two levels. Dissemination of tb to the brain results in the most severe form of extrapulmonary tb, tuberculous meningitis tbm, which represents a medical emergency associated with high rates of mortality. Pathogenesis of meningitis caused by streptococcus suis type 2 a. Through the use of experimental animal models of infection, a great deal of information has been gleaned concerning the pathogenic and pathophysiologic mechanisms. Experimental studies over the past few years have increased our understanding of the molecular mechanisms underlying the events that ultimately lead to brain damage during meningitis. Despite the availability of bactericidal antibiotics with potent in vitro activity against the major meningeal pathogens, the morbidity and mortality from bacterial meningitis remains unacceptably high. Pathophysiology of acute meningitis caused by streptococcus pneumoniae and adjunctive therapy approaches. Through the use of experimental animal models of infection, a great deal of information.
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