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7. Bacterial diseases
Bacterial meningitis
M eningitis is an acute bacterial infectio n o f the m eninges, which m ay affect the brain
and lead to irreversible neuro lo gical d am age and aud ito ry im p airm ent.
B acterial m eningitis is a m ed ical em ergency . T he treatm ent is based o n early
p arenteral
ad m inistratio n o f antibio tics that p enetrates well into the cerebro sp inal fluid . E m p iric
antibio tic therap y is ad m inistered if the p atho gen canno t be id entified o r while waiting
fo r labo rato ry results.
T he m ain bacteria resp o nsible vary d ep end ing o n age and / o r co ntext:
– M eningitis in a no n-ep id em ic co ntext:
• C hild ren 0 to 3 m o nths:
PCsehuilddormenon≤a7spd apy,sS: aGlmroanmella- nsepgapti)veanbdacgilrloi (upKlBebssiterellap stop cpo ,ccEu.scoli, S. marscesens,
LC. mhioldnroecnyt>og7endesayisso: Sc.cpansieounmaollnyiareesapccoo nusnibtslefofor r5m0 %eninogfitaislldbuarcitnegriathlims p eenrinogditi.s.
• C hild ren 3 m o nths-5 y ears: S. pneumoniae, H. influenza B and N. meningitidis
• C hild ren > 5 y ears and ad ults: S. pneumoniae and N. meningitidis
S p ecial co nd itio ns:
• I m m uno d ep ressed p atients ( H I V , m alno urish ed ) : h igh p ercentage o f G ram -
negative bacilli (sp ecially Salmonella sp p ) and also M. tuberculosis. frequent causes.7
• S ick le cell anaem ia: Salmonella sp p and Staphylococcus aureus are
• M eningitis m ay be related to S. aureus when asso ciated with sk in infectio n o r sk ull
fracture.
– M eningitis in an ep id em ic co ntext:
1
I n th e S ah elian reg io n d uring th e d ry seaso n, ep id em ics o f m eningo co ccal
1
m eningitis ( Neisseria meningitidis A o r C o r W 1 3 5 ) affect child ren fro m 6 m o nths
of
age, ad o lescents and ad ults. In these regio ns, whether d uring ep id em ics o r no t, all
the abo ve p atho gens can be fo und , esp ecially in y o ung child ren.
Clinical features
T he clinical p resentatio n d ep end s o n the p atient's age:
Children over 1 year and adults
– F ever, severe head ache, p ho to p ho bia, neck stiffness
– B rud z insk i's sign (neck flexio n in a sup ine p atient results in invo luntary flexio n o f the
k nees) and K ernig's sign (attem p ts to extend the k nee fro m the flexed -thigh p o sitio n
are m et with stro ng p assive resistance).
– P etechial o r ecchy m o tic p urp ura (usually in m eningo co ccal infectio ns)
– In severe fo rm s: co m a, seiz ures, fo cal signs, p urp ura fulm inans
But not exclusively, e.g. Rwanda, Angola, Brazil
1
165
Bacterial meningitis
M eningitis is an acute bacterial infectio n o f the m eninges, which m ay affect the brain
and lead to irreversible neuro lo gical d am age and aud ito ry im p airm ent.
B acterial m eningitis is a m ed ical em ergency . T he treatm ent is based o n early
p arenteral
ad m inistratio n o f antibio tics that p enetrates well into the cerebro sp inal fluid . E m p iric
antibio tic therap y is ad m inistered if the p atho gen canno t be id entified o r while waiting
fo r labo rato ry results.
T he m ain bacteria resp o nsible vary d ep end ing o n age and / o r co ntext:
– M eningitis in a no n-ep id em ic co ntext:
• C hild ren 0 to 3 m o nths:
PCsehuilddormenon≤a7spd apy,sS: aGlmroanmella- nsepgapti)veanbdacgilrloi (upKlBebssiterellap stop cpo ,ccEu.scoli, S. marscesens,
LC. mhioldnroecnyt>og7endesayisso: Sc.cpansieounmaollnyiareesapccoo nusnibtslefofor r5m0 %eninogfitaislldbuarcitnegriathlims p eenrinogditi.s.
• C hild ren 3 m o nths-5 y ears: S. pneumoniae, H. influenza B and N. meningitidis
• C hild ren > 5 y ears and ad ults: S. pneumoniae and N. meningitidis
S p ecial co nd itio ns:
• I m m uno d ep ressed p atients ( H I V , m alno urish ed ) : h igh p ercentage o f G ram -
negative bacilli (sp ecially Salmonella sp p ) and also M. tuberculosis. frequent causes.7
• S ick le cell anaem ia: Salmonella sp p and Staphylococcus aureus are
• M eningitis m ay be related to S. aureus when asso ciated with sk in infectio n o r sk ull
fracture.
– M eningitis in an ep id em ic co ntext:
1
I n th e S ah elian reg io n d uring th e d ry seaso n, ep id em ics o f m eningo co ccal
1
m eningitis ( Neisseria meningitidis A o r C o r W 1 3 5 ) affect child ren fro m 6 m o nths
of
age, ad o lescents and ad ults. In these regio ns, whether d uring ep id em ics o r no t, all
the abo ve p atho gens can be fo und , esp ecially in y o ung child ren.
Clinical features
T he clinical p resentatio n d ep end s o n the p atient's age:
Children over 1 year and adults
– F ever, severe head ache, p ho to p ho bia, neck stiffness
– B rud z insk i's sign (neck flexio n in a sup ine p atient results in invo luntary flexio n o f the
k nees) and K ernig's sign (attem p ts to extend the k nee fro m the flexed -thigh p o sitio n
are m et with stro ng p assive resistance).
– P etechial o r ecchy m o tic p urp ura (usually in m eningo co ccal infectio ns)
– In severe fo rm s: co m a, seiz ures, fo cal signs, p urp ura fulm inans
But not exclusively, e.g. Rwanda, Angola, Brazil
1
165
