Acute bacterial meningitis in adults.
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%. Although the pathogenesis of bacterial meningitis is not completely understood, knowledge of bacterial invasion and entry into the CNS is improving. Clinical features alone cannot determine whether meningitis is present and analysis of cerebrospinal fluid is essential for diagnosis. Newer technologies, such as multiplex PCR, and novel diagnostic platforms that incorporate proteomics and genetic sequencing, might help provide a quicker and more accurate diagnosis. Even with appropriate antimicrobial therapy, mortality is high and so attention has focused on adjunctive therapies; adjunctive corticosteroids are beneficial in certain circumstances. Any further improvements in outcome are likely to come from either modulation of the host response or novel approaches to therapy, rather than new antibiotics. Ultimately, the best hope to reduce the disease burden is with broadly protective vaccines.
Institute of Infection and Global Health, University of Liverpool, Liverpool, UK; NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, UK; Leeds University Hospitals NHS Trust, Leeds, UK; Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK.
Fiona
F
McGill
Malawi-Liverpool-Wellcome Trust, Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi; Division of Infection and Immunity, University College London, London, UK.
Robert S
RS
Heyderman
Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.
Stavros
S
Panagiotou
Warren Alpert Medical School, Brown University, Providence, RI, USA.
Allan R
AR
Tunkel
Institute of Infection and Global Health, University of Liverpool, Liverpool, UK; The Walton Centre NHS Foundation Trust, Liverpool, UK; NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, UK; Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK. Electronic address: tsolomon@liv.ac.uk.
Tom
T
Solomon
D000208:Acute Disease; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000890:Anti-Infective Agents / Q000627:therapeutic use; D006801:Humans; D016920:Meningitis, Bacterial / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D022242:Pneumococcal Vaccines / Q000008:administration & dosage / Q000145:classification; D013296:Streptococcus pneumoniae
C538862:13-valent pneumococcal vaccine; D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D022242:Pneumococcal Vaccines