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Updated: May 14 2021

Microbiology of Meningitis

4.1

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  • Overview
      • Pathogens That Cause Meningitis by Age Group
      • Newborns
      • (0-6 mo)
      • Children
      • (> 6 months - < 6 years)
      • Adults
      • (18 - 40 years)
      • Seniors
      • (40 - 65 years)
      • IC
      • AC
      • GBS
      • E. coli
      • Listeria monocytogenes 
      • S. pneumoniae
      • N. meningitidis
      • H. influenzae
      • Enteroviruses (coxsackievirus, poliovirus, echovirus)
      • S. pneumoniae  
      • N. meningitidis
      • HSV-1
      • HSV-2
      • Enteroviruses (coxsackievirus, poliovirus, echovirus) 
      • S. pneumoniae
      • Listeria monocytogenes
      • S. pneumoniae
      • Listeria monocytogenes
      • N. meningitidis
      • CMV
      • JC virus
      • Cryptococcus neoformans
      • Toxoplasma gondi (brain abscess)
      • Enteroviruses (coxsackievirus, poliovirus, echovirus)
      • HSV-1
      • HSV-2
      • Naegleria fowleri
      • Cryptococcus neoformans
      • West Nile Virus
      • LCMV
    • Definitions
      • meningitis
        • inflammation of the meninges
        • bacterial meningitis can be life-threatening
        • remember: encephalitis is inflammation of the brain parenchyma
      • aseptic meningitis ("sterile meningitis")
        • meningitis caused by organisms other than bacteria
        • majoriy due to viruses
          • enteroviruses are the most common viral cause
    • Clinical presentation
      • fever, headache, altered mental status, neck stiffness
        • there may be variations in clinical presentation
          • due to the type of pathogen, patient age, host immune status
    • Bacterial causes of meningitis by age
      • < 1 month
        • Group B streptococcus (GBS), E. coli, L. monocytogenes
          • prominent causes of meningitis in neonates
          • GBS and E. coli are most common
      • ≥ 3 month - < 10 years
        • S. pneumoniae and N. meningitidis are common
        • H. influenze type B
          • incidence decrease since HiB vaccine introduction in 1980s
      • ≥ 10 years - 34 years
        • S. pneumoniae and N. meningitidis are common
      • 18 years - 34 years
        • S. pneumoniae and N. meningitidis are common
      • > 35 years
        • S. pneumoniae is common
    • Meningitis in Immunocompromised (IC)
      • S. pneumoniae and L. monocytogenes are common
    • Aseptic meningitis
      • more common than bacterial
      • can occur at all ages
        • more common in children
          • summer months
    • Herpes simplex virus (HSV)
      • HSV-1
        • more associated with encephalitis
      • HSV-2
        • more associated with meningitis
    • See also "Meningitis"
    • Treatment
      • drug choice depends on what is the most likely pathogen causing meningitis
        • 0 - 28 day old
          • IV ampicillin + cefotaxime or an aminoglycoside (i.e., gentamicin, tobramycin)
        • ≥ 1 month old
          • IV vancomycin + cefotaxime or ceftriaxone
          • if you suspect L. monocytogenes, add ampicillin
        • adults
          • IV vancomycin + cefotaxime or ceftriaxone
          • If > 50 years old, add ampicillin
    • Abbreviations
      • IC = immunocompromised
      • AC = aseptic causes
      • blue = common pathogen in chart
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