Meningitis is the inflammation/infection of the coverings of the brain and spinal cord. Pneumococcal Meningitis is caused by the bacteria Streptococcus pneumoniae (also termed pneumococcus). Meningitis caused by pneumococcus is a life-threatening condition that needs immediate medical attention.
What are the other Names for this Condition? (Also known as/Synonyms)
- Acute Meningitis caused by Pneumococcus
- Bacterial Meningitis caused by Pneumococcus
What is Pneumococcal Meningitis? (Definition/Background Information)
- Meningitis is the inflammation/infection of the coverings of the brain and spinal cord. These coverings are also known as meninges. The condition may be caused by bacteria, viruses, fungi, or other parasites
- Pneumococcal Meningitis is caused by the bacteria Streptococcus pneumoniae (also termed pneumococcus). Meningitis caused by pneumococcus is a life-threatening condition that needs immediate medical attention
- Pneumococcal Meningitis usually affects older adults and children, below 2 years of age
- Some of the common risk factors associated with the condition include recent infections, like upper respiratory tract infection, pneumonia, or ear infection with pneumococcus
- The classic signs and symptoms of Pneumococcal Meningitis are high-grade fever, nausea, vomiting, neck stiffness, and altered mental status. The condition may be diagnosed through specific laboratory tests that include cerebrospinal fluid analysis along with blood culture
- Pneumococcal Meningitis is treated using intravenous antibiotics in a hospital setting. If left untreated the condition may cause long-term complications, such as hearing loss, vision abnormalities, problems with the memory, and learning difficulties, especially in children
- A pneumococcal vaccine is the most effective way to prevent Pneumococcal Meningitis
Who gets Pneumococcal Meningitis? (Age and Sex Distribution)
- An infection by S. pneumoniae is the most common cause of meningitis in older adults (mainly those over the age of 65 years) and in children, under the age of 2 years
- Pneumococcal Meningitis also affects adolescents and young adults. It is the second most common type of meningitis affecting them
- Both males and females are equally affected
- Individuals of all ethnic and racial background are equally affected by Pneumococcal Meningitis
What are the Risk Factors for Pneumococcal Meningitis? (Predisposing Factors)
The risk factors associated with Pneumococcal Meningitis are:
- Recent upper respiratory tract infection
- Recent pneumonia (infection of the lungs)
- Recent ear infection
- A previous history of meningitis
- Removal of the spleen (splenectomy) or dysfunctional spleen: The spleen is an organ that is responsible for making antibodies that fight against pneumococcus
- Injury or trauma to the head
- Any leakage of the cerebrospinal fluid (CSF, the fluid that surrounds and cushions the brain and spinal cord), increases the chances of CSF being exposed to bacteria
- Chronic liver disease
- Chronic kidney disease
- Alcohol use
- Diabetes mellitus: Patients with diabetes have suppressed immune system, which increases the chances of being infected with pneumococcus
- Sickle cell disease: Patients with sickle cell disease have a damaged spleen
- Immunosuppression after organ transplantation, such as after a bone marrow transplant, kidney transplant, or heart transplant
- During the later stages of HIV infection with suppressed immune system
- Elderly individual especially over 65 years, and young children below 2 years
- Those living in nursing homes and other long-term care facilities
- Cancer patients receiving chemotherapy having suppressed immune systems
It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.
Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.
What are the Causes of Pneumococcal Meningitis? (Etiology)
- Pneumococcal Meningitis is caused by the bacteria Streptococcus pneumoniae
- S. Pnemoniae is found in the nose and throat of about 5-10% of healthy adults and in about 20-40% of healthy children. Such individuals are also known as healthy carriers
- This bacterium is transmitted from one individual to another during exposure to the respiratory secretions. Thus, if an infected individual coughs or sneezes, others present nearby may contract the disease. Healthy carriers may also transmit the disease
- This microorganism (pneumococcus) has a capsule that makes it resistant to the immune system of the body, especially in individuals with certain risk factors (as described above)
- Once the bacteria enters the blood stream, it travels to different body parts, like to the meninges, joint spaces, bones, peritoneal cavity, causing infections
What are the Signs and Symptoms of Pneumococcal Meningitis?
The symptoms of Pneumococcal Meningitis may appear quickly, or over a period of several days (usually 3-7 days after exposure). The signs and symptoms may include:
- Sudden onset of fever and chills
- Stiff neck
- Altered mental status
- Nausea and vomiting
- Severe headache
- Increase sensitivity to light (photophobia)
Newborns and infants with Pneumococcal Meningitis are not usually present with the classic signs and symptoms. However, they may have:
- Poor feeding, or refusal to feed
- Lethargy and irritability
- Rapid breathing
- Tense or bulging soft spot on the head
- A stiff body with jerky movements, or floppy baby
- Decreased consciousness
- Fever is usually absent in infants less than 3 months of age
How is Pneumococcal Meningitis Diagnosed?
In order to diagnose Pneumococcal Meningitis, the physician will initially perform a physical exam with evaluation of medical history. During physical examination the physician will look for:
- Rapid heart rate
- Mental status changes
- Neck stiffness
Specific diagnostic tests for Pneumococcal Meningitis are:
- Spinal tap (lumbar puncture): Cerebrospinal fluid is collected by a procedure, called spinal tap from the base of spine, under local anesthesia and the fluid is sent to the laboratory for analysis. In individuals with meningitis, CSF often shows low sugar along with an increased protein and increased white blood cell count
- CSF culture and Gram stain: The cerebrospinal fluid is placed on a special dish to see the growth of the bacteria. It is also stained with a special stain (Gram stain), to observe the bacteria under the microscope
- Blood culture and Gram stain: Blood drawn from the vein is sent to the laboratory, where it is placed on a special dish and the growth of the bacteria observed. It is also stained with Gram stain, in order to be observed under the microscope
- Imaging studies: CT scan of the head is done to see the extent of brain swelling/inflammation
- X-ray chest or sinuses: To check for the presence of pneumococcal infection in the lungs and sinuses
Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.
What are the possible Complications of Pneumococcal Meningitis?
The possible complications of Pneumococcal Meningitis are:
- Hearing impairment or deafness
- Vision abnormalities, such as decreased vision or loss of vision
- Memory-related problems
- Learning disabilities
- Intellectual impairment
- Brain damage and edema
- Gait problems
- Loss of balance, or lack of co-ordination
- Kidney failure
- Septic shock: Sometimes, in cases of severe infection, the patients may have low blood pressure with multi-organ failure
Severe complications of Pneumococcal Meningitis may cause fatalities.
How is Pneumococcal Meningitis Treated?
Pneumococcal Meningitis is a serious infection that requires an early and effective treatment within a hospital setting.
- Antibiotics are the mainstay of treatment: Initially, a broad spectrum antibiotic is started, which is then later modified, depending upon the laboratory results
- Steroids are also administered in some cases, especially in children, to decrease the risk of brain damage and other neurological complications
- Other supportive treatment measures, such as oxygen and intravenous fluids are given to stabilize the overall health status of the patient
How can Pneumococcal Meningitis be Prevented?
A pneumococcal vaccine is the most effective way to prevent Pneumococcal Meningitis.
- Vaccine is generally recommended for children under 2 years and elderly adults over 65 years, because they have an increased risk of serious infection
- Children receive this vaccine as part of their recommended schedule of vaccines - at 2 months, 4 months, and 12-13 months of age
- Adults, who are over 65 years, need a single dose, which will protect them for life
- Individuals at risk for Pneumococcal Meningitis are also recommended to take this vaccine
What is the Prognosis of Pneumococcal Meningitis? (Outcomes/Resolutions)
- The prognosis of Pneumococcal Meningitis depends on how quickly the treatment is administered
- Even with prompt diagnosis and treatment, around 50% of the affected individuals develop long-term health issues
- Pneumococcal Meningitis is a serious infection that can cause death, even with proper treatment
- The death rate from Pneumococcal Meningitis is around 20%, according to reports of the Meningitis Foundation of America (MFA)
Additional and Relevant Useful Information for Pneumococcal Meningitis:
- There has been a dramatic decline in serious pneumococcal infections after the introduction of vaccines, for both children and adults
- The pneumococcus bacteria can also cause other types of infections, such as ear infection, sinus infection, pneumonia, and bacteremia (infection of the blood)
What are some Useful Resources for Additional Information?
References and Information Sources used for the Article:
http://www.mayoclinic.org/diseases-conditions/meningitis/basics/definition/con-20019713 (accessed on 09/20/2014)
http://www.nhs.uk/Conditions/vaccinations/Pages/pneumococcal-vaccination.aspx (accessed on 09/20/2014)
http://www.who.int/ith/diseases/pneumococcal/en/ (accessed on 09/20/2014)
http://www.meningitis.org/symptoms (accessed on 09/20/2014)
http://www.nlm.nih.gov/medlineplus/ency/article/000607.htm (accessed on 09/20/2014)
Helpful Peer-Reviewed Medical Articles:
Mook-Kanamori BB, Geldhoff M, Poll T, Beek D. Pathogenesis and pathophysiology of Pneumococcal meningitis. Clinical Microbiology reviews, July 2011, Vol: 24 no: 3, 557-591 doi: 10.1128/CMR.00008-11
Brouwer MC, Tunkel AR, Beek D. Epidemiology, diagnosis and antimicrobial treatment of acute bacterial meningitis. Clinical Microbiology reviews July 2010, Vol 23, no:3, 467-492 doi: 10.1128/CMR.00070-09
Davis LE, Greelee JE. Pneumococcal meningitis: antibiotics essential but insufficient. Brain 2003, Vol: 126 no:5, 1013-1014 doi: 10.1093/brain/awg141
Kasanmoentalib, E. S., Seron, M. V., Morgan, B. P., Brouwer, M. C., & van de Beek, D. (2015). Adjuvant treatment with dexamethasone plus anti-C5 antibodies improves outcome of experimental pneumococcal meningitis: a randomized controlled trial. Journal of neuroinflammation, 12(1), 149.
Olarte, L., Barson, W. J., Barson, R. M., Lin, P. L., Romero, J. R., Tan, T. Q., ... & Mason, E. O. (2015). Impact of the 13-valent pneumococcal conjugate vaccine on pneumococcal meningitis in US children. Clinical Infectious Diseases, 61(5), 767-775.
Savva, A., Brouwer, M. C., Roger, T., Serón, M. V., Le Roy, D., Ferwerda, B., ... & Calandra, T. (2016). Functional polymorphisms of macrophage migration inhibitory factor as predictors of morbidity and mortality of pneumococcal meningitis. Proceedings of the National Academy of Sciences, 201520727.
Levy, C., Varon, E., Béchet, S., & Cohen, R. (2015). Effect of the 13-Valent Pneumococcal Conjugate Vaccine on Pneumococcal Meningitis in Children. Clinical Infectious Diseases, civ692.
Vivas, M., Force, E., Tubau, F., El Haj, C., Ariza, J., & Cabellos, C. (2015). Effect of dexamethasone on the efficacy of daptomycin in the therapy of experimental pneumococcal meningitis. International journal of antimicrobial agents, 46(1), 28-32.
Imöhl, M., Möller, J., Reinert, R. R., Perniciaro, S., van der Linden, M., & Aktas, O. (2015). Pneumococcal meningitis and vaccine effects in the era of conjugate vaccination: results of 20 years of nationwide surveillance in Germany. BMC infectious diseases, 15(1), 1.