Health Encyclopedia

Meningitis - pneumococcal

Definition

Pneumococcal meningitis is a bacterial inflammation or infection of the membranes covering the brain and spinal cord.

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.

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