What are the other Names for this Condition? (Also known as/Synonyms)

• Staph Meningitis
• Staphylococcal Aureus Meningitis
• Staphylococcus Epidermidis Meningitis

What is Staphylococcal Meningitis? (Definition/Background Information)

• Staphylococcal Meningitis is a rare but serious bacterial infection that affects the membranes surrounding the brain and spinal cord. It is a medical emergency caused by Staphylococcus bacteria, chiefly Staphylococcus aureus. The disease is usually observed in individuals with poor immunity or underlying health conditions
• Staphylococcal Meningitis can occur when the bacteria spread from another infection site, such as a skin infection or surgical wound, into the bloodstream and reaches the central nervous system. The disease generally occurs in a healthcare or community setting
• The common signs and symptoms of Staphylococcal Meningitis include fever, severe headache, neck stiffness, photophobia (sensitivity to light), and altered mental status. Individuals may also experience nausea and vomiting 
• Prompt medical intervention with intravenous antibiotics is essential for treating Staphylococcal meningitis. The choice of antibiotics is guided by the specific strain of Staphylococcus and its susceptibility to medications. Immediate medical attention is crucial for early diagnosis and appropriate treatment
• The preventive measures for Staphylococcal Meningitis include practicing good hygiene, particularly handwashing, and maintaining a clean environment. Timely treatment of skin infections and other conditions caused by Staphylococcus can reduce the risk of secondary meningitis
• The prognosis of Staphylococcal Meningitis depends on various factors, including the speed of diagnosis, the choice of appropriate antibiotics, and the individual's overall health. Complications can include long-term neurological issues, including brain damage, and severe complications can lead to fatalities

Who gets Staphylococcal Meningitis? (Age and Sex Distribution)

• Staphylococcal Meningitis can affect individuals of any age. In general, bacterial meningitis more commonly affects children than adults
• Males and females are affected equally
• The infection is observed worldwide, and individuals of all races and ethnic groups are at risk

What are the Risk Factors for Staphylococcal Meningitis? (Predisposing Factors)

The risk factors for Staphylococcal Meningitis may include:

• Individuals with weakened immune systems
• Certain underlying health conditions, such as diabetes, cancer, and HIV infection
• Those who have undergone recent surgical procedures, including recent brain surgery. It is usually associated with neurosurgical procedures, such as cerebrospinal fluid shunting. Other procedures include intravascular grafting, perirectal abscess drainage, etc.
• Infections that can increase the risk include:
  • Decubitus ulcers or pressure ulcers
  • Osteomyelitis (infection of the bone)
  • Cellulitis
  • Infected heart valves
  • Previous infection of the brain
• Chronic alcoholism
• Trauma
• Community setting where many individuals are together, leading to close contact (provoked by activities such as eating, sneezing, coughing, kissing, etc.)
• Working with meningitis-prone pathogens; for example, microbiologists have a higher risk
• Premature birth weight babies are also at increased risk

It is important to note that having a risk factor does not mean one will get the condition. A risk factor increases one’s 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 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 Staphylococcal Meningitis? (Etiology)

Staphylococcal bacteria is responsible for Staphylococcal Meningitis. The bacteria can enter the bloodstream and reach the meninges (membranes surrounding the brain), causing inflammation.

• The inflammation may be caused by the bacteria Staphylococcus aureus (in many cases) and Staphylococcus epidermidis (in some cases)
• Infection of the bloodstream (bacteremia) and subsequent hematogenous seeding/spread into the central nervous system and meninges takes place
• Staphylococcus bacteria is spread mainly during surgical procedures, and Staphylococcal Meningitis is generally observed in a healthcare setting (hospital-acquired infection)
• The incubation period (period from infection to disease manifestation) is usually between 2 to 10 days

What are the Signs and Symptoms of Staphylococcal Meningitis?

The signs and symptoms of Staphylococcal Meningitis may vary from individual to individual and may include:

• Headache is the most common symptom
• Nausea and vomiting
• Skin rash
• Neck stiffness/rigidity
• Sudden high fever
• Poor feeding and irritability in children
• High-pitched cry
• Photophobia and phonophobia (intolerance to bright light and loud noise, respectively)
• Confusion
• Personality changes
• Hallucinations (seeing or hearing imaginary things)
• Bulging fontanelles: In infants up to 6 months of age, a soft swelling on the top of the head is seen, known as bulging of the fontanelle
• Poor/abnormal posture with head and neck arched backward, called opisthotonos
• Agitation
• Rapid breathing and increased heart rate

How is Staphylococcal Meningitis Diagnosed?

The diagnosis of Staphylococcal Meningitis is generally challenging. It may involve wide-ranging tests and exams, including:

• Complete physical examination and evaluation of personal medical history, including recent surgical history
• If one of the below two tests is positive, then it helps to rule out other causes of neck stiffness like muscle spasm
  • Kernig‘s sign: The hip and knee are flexed at 90 degrees while the patient lies supine; extension of the bent knee causes pain
  • Brudzinski sign: Flexion of the neck causes involuntary extension of the knee and hip
• Jolt accentuation maneuver is a test to rule out other causes of fever and headaches. The patient is made to rotate their head sideways rapidly; if it worsens the headache, meningitis is the likely cause 
• Blood tests are performed as markers of inflammation-
  • Complete blood count (CBC) test
  • C-reactive protein (CRP) test
  • Blood culture
  • Serum electrolytes test
• Other special tests may include:
  • Polymerase chain reaction (PCR) test
  • Latex particle agglutination
• Radiological imaging studies: MRI or CT brain may be performed to assess the complications of meningitis
  • MRI of the brain may reveal infection of the sinuses or mastoid and complications
  • CT brain may reveal swelling and inflammation
  • Chest X-ray, if required
• Lumbar puncture: It is important to examine the cerebrospinal fluid (CSF) by spinal tap procedure, also known as a lumbar puncture
  • Cerebrospinal fluid culture may be requested
  • Gram stain of the CSF may help identify the organism causing meningitis

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 Staphylococcal Meningitis?

The sooner the treatment, the less severe the complications. The complications of Staphylococcal Meningitis may include the following:

• Inflammation and swelling of the brain leading to decreased consciousness
• Altered mental status
• Hearing issues that may persist after the episode of meningitis has resolved
• Convulsions
• Learning difficulty
• Brain damage
• Subdural hematoma: Build-up of blood between the skull and brain called 
• Hydrocephalus: Fluid accumulation in the cavities of the brain called 
• Staphylococcal Infection at other sites in the body
• Parenchymal abscess (abscess in the brain tissues)
• Ventriculitis (infection within the cavities of the brain)
• Treatment-related complications

How is Staphylococcal Meningitis Treated?

Staphylococcal Meningitis is an emergency medical condition that requires immediate treatment. The treatment must be started promptly and should not be delayed while waiting for the results of investigations.

• The infection is usually treated with an intravenous cephalosporin group of antibiotics, such as ceftriaxone, for about 10-14 days
• In children under 18 and adults over 50, a combination of ampicillin and may be used
• It may also be treated with Nafcillin, a penicillin group of antibiotics. In cases where penicillin resistance is suspected, vancomycin may be used
• If an allergy to penicillin or cephalosporin exists, then Chloramphenicol is used
• Steroids are not recommended in Staphylococcal Meningitis
• Treating the underlying condition is important
• Intravenous fluid is administered if low blood pressure and shock are present
• Symptomatic treatment: Treatment may also be administered for brain swelling, shock, convulsion, swelling, and dehydration
• Abscess drainage: Infected sinuses and mastoid bone (mastoiditis) that connect the middle ear to the outer ear may need to be drained. Infection between the brain and its meninges may also need to be drained

How can Staphylococcal Meningitis be Prevented?

Preventing Staphylococcal Meningitis involves a combination of general hygiene practices and addressing specific risk factors. Some key preventive measures include:

• Hand hygiene: Practicing good hand hygiene is crucial. Regularly wash hands with soap and water for at least 20 seconds, especially after using the restroom, before eating, and after coughing or sneezing.
• Wound care: Proper care of wounds and skin infections is important. Keep wounds clean, apply antiseptic ointments, and cover them with dry bandages. Seek medical attention for any signs of infection
• Infection control in healthcare settings: Hospitals and healthcare facilities should follow strict infection control measures, including proper sterilization of medical equipment and adherence to protocols to prevent the spread of infections
• Avoiding close contact with sick individuals: Limiting close contact with individuals who have active Staphylococcal infections, especially skin infections, can reduce the risk of transmission
• Maintaining a healthy immune system: A robust immune system is better equipped to prevent infections. Adopting a healthy lifestyle with regular exercise, a balanced diet, adequate sleep, and stress management can contribute to overall immune health
• Vaccination: While there is no specific vaccine for Staphylococcal Meningitis, certain vaccines can prevent other types of bacterial meningitis. Following recommended vaccination schedules, especially for meningococcal vaccines, is important
• Intranasal mupirocin: In specific cases, healthcare providers may use intranasal mupirocin, an antibiotic ointment, to decolonize Staphylococcus aureus from the nasal passages in certain individuals at increased risk of infection
• For older adults and diabetics, taking prophylactic antibiotics before certain surgical procedures can help decrease the risk of Staphylococcal infection

It is important to note that preventing Staphylococcal Meningitis involves a combination of general infection prevention practices and addressing specific risk factors. Individuals with certain medical conditions, recent surgeries, or compromised immune systems may have an increased risk and should follow medical advice to reduce their susceptibility to Staphylococcal infections.

What is the Prognosis of Staphylococcal Meningitis? (Outcomes/Resolutions)

The prognosis of Staphylococcal Meningitis can vary based on several factors, including the speed of diagnosis, prompt initiation of appropriate treatment, the overall health of the affected individual, and any complications. Here are critical considerations regarding the prognosis:

• Timely treatment: Early recognition and prompt administration of appropriate antibiotics significantly improve the prognosis. Delayed treatment can lead to more severe outcomes
• Antibiotic sensitivity: The choice of antibiotics is crucial, and the effectiveness of the selected medication depends on the specific strain of Staphylococcus causing the infection and its susceptibility to the prescribed antibiotics
• Complications: Staphylococcal Meningitis can be associated with complications, such as long-term neurological issues, hearing loss, and other complications related to bacterial meningitis. The severity of complications can impact the overall prognosis
• Individual health status: The affected individual's overall health affects the prognosis. Individuals with weakened immune systems, underlying medical conditions, or other risk factors may have a more challenging recovery
• Pre-existing conditions: Pre-existing health conditions or comorbidities can influence the prognosis. Patients with multiple health issues may face additional challenges in recovery

The prognosis can be significantly improved with swift and appropriate medical intervention. However, complications can arise due to the potential severity of bacterial meningitis, and close medical monitoring during and after treatment is essential for the best possible outcomes.

Fatalities have been reported, and children and older adults over 50 are more at risk of death from Staphylococcal Meningitis. According to the World Health Organization (WHO), bacterial meningitis is a matter of grave concern, as about 20% face severe complications, and 17% of the individuals diagnosed with this form do not survive.

Additional and Relevant Useful Information for Staphylococcal Meningitis:

The following DoveMed website link is a helpful resource for additional information:

https://www.dovemed.com/diseases-conditions/bacterial-meningitis