Strategies to prevent neuronal damage in paediatric bacterial meningitis.
OBJECTIVE
The mortality of bacterial meningitis can reach 30%, and up to 50% of survivors suffer from persisting neurological deficits as a consequence of the disease. The incidence of neurological sequelae of bacterial meningitis has not improved over the last decade. Adjunctive therapeutic options are limited, and ongoing research into the pathophysiology of brain damage in bacterial meningitis aims at providing the scientific basis for future development of more efficient adjunctive options.


RESULTS
In a population with good access to health care, dexamethasone given before or at the time of initiation of antibiotic therapy acts beneficially in paediatric pneumococcal meningitis, but not in meningococcal meningitis. In experimental animal models, brain-derived neurotrophic factor protected against brain injury and improved hearing while melatonin, which has antioxidant properties among other effects, reduced neuronal death. Transgene technology can be used to provide new insights into the pathophysiology of the disease and to identify potential therapeutic targets.


CONCLUSIONS
Although dexamethasone improves outcome of bacterial meningitis under defined circumstances, the morbidity of bacterial meningitis still remains unacceptably high. Experimental models may help to identify new therapeutic strategies to further improve the neurological outcome in young children suffering from bacterial meningitis.
Grandgirard
Denis
D
Institute for Infectious Diseases, University of Bern, Switzerland.
Leib
Stephen L
SL
D000818:Animals; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D017209:Apoptosis / Q000502:physiology; D019208:Brain-Derived Neurotrophic Factor / Q000627:therapeutic use; D002648:Child; D003907:Dexamethasone / Q000627:therapeutic use; D004195:Disease Models, Animal; D006801:Humans; D016920:Meningitis, Bacterial / Q000150:complications* / Q000503:physiopathology; D009474:Neurons / Q000473:pathology*; D051193:Toll-Like Receptors / Q000502:physiology
D000893:Anti-Inflammatory Agents; D019208:Brain-Derived Neurotrophic Factor; D051193:Toll-Like Receptors; D003907:Dexamethasone