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Meningitis - pneumococcal

Pneumococcal meningitis is an infection that causes swelling and irritation (inflammation) of the membranes covering the brain and spinal cord (meninges).

See also:

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 bacterial meningitis in adult. It is the second most common cause of meningitis in children older than age 2.

Risk factors include:

  • Alcohol use
  • History of meningitis
  • Infection of a heart valve
  • 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:

Other symptoms that can occur with this disease:

  • Agitation
  • Decreased consciousness
  • Poor feeding or irritability in children
  • Rapid breathing
  • Unusual posture, with the head and neck arched backwards (opisthotonos )

Pneumococcal meningitis is an important cause of fever in children.

Signs and tests

The doctor or nurse will examine the patient. This may show:

  • Fast heart rate
  • Fever
  • Mental status changes
  • Stiff neck

If the health care provider thinks meningitis is possible, a lumbar puncture ("spinal tap ") will be done to remove a sample of spinal fluid (known as cerebrospinal fluid, or CSF) for testing.

Tests that may be done include:

Treatment

Treatment with antibiotics 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)

How well a person does depends on how fast treatment is received. About 1 in 5 persons who get this illness will die of it.  About 25-50% will have serious long-term brain and nervous system complications.

Complications

Many patients have long-term complications such as:

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 problems
  • 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
  • Adults age 65 and older
  • People at high risk for pneumococcus infection

References

Thigpen MC, Whitney CG, Messonnier NE, et al. Emerging Infections Programs Network. Bacterial meningitis in the United States, 1998-2007. N Engl J Med. 2011 May 26;364(21):2016-25.

Swartz MN. Meningitis: bacterial, viral, and other. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 360.

Tunkel AR, Van de Beek D, Scheld WM. Acute meningitis. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 84.

Updated: 8/15/2012

David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.


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