Subscribe to RSS
DOI: 10.1055/s-0039-1693159
Bacterial Infections of the Central Nervous System
Publication History
Publication Date:
02 August 2019 (online)
![](https://www.thieme-connect.de/media/sin/201903/lookinside/thumbnails/10-1055-s-0039-1693159_190033-1.jpg)
Abstract
Acute bacterial meningitis and spinal epidural abscess are neurological emergencies. Acute bacterial meningitis may present with symptoms as nonspecific as headache and fever, but rapid progression to an altered level of consciousness is not unusual. Spinal epidural abscess manifests initially as back pain, followed by radicular pain, then weakness, and finally paraplegia. Brain abscess may initially present only with headache, or as a new-onset seizure or with a focal neurological deficit. Bacterial infections of the central nervous system require emergent diagnosis and management. In this article, the pathogenesis, etiological organisms, diagnostic studies, differential diagnosis and management of acute bacterial meningitis, spinal epidural abscess, and brain abscess are discussed.
-
References
- 1 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; 364 (21) 2016-2025
- 2 Brouwer MC, Tunkel AR, van de Beek D. Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis. Clin Microbiol Rev 2010; 23 (03) 467-492
- 3 Meningococcal | Surveillance | CDC. Cdc.gov. Published 2018. Available at: https://www.cdc.gov/meningococcal/surveillance/index.html . Accessed November 8, 2018
- 4 Durand ML, Calderwood SB, Weber DJ. , et al. Acute bacterial meningitis in adults. A review of 493 episodes. N Engl J Med 1993; 328 (01) 21-28
- 5 van de Beek D, de Gans J, Spanjaard L, Weisfelt M, Reitsma JB, Vermeulen M. Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med 2004; 351 (18) 1849-1859
- 6 Weisfelt M, van de Beek D, Spanjaard L, Reitsma JB, de Gans J. Clinical features, complications, and outcome in adults with pneumococcal meningitis: a prospective case series. Lancet Neurol 2006; 5 (02) 123-129
- 7 Thomas KE, Hasbun R, Jekel J, Quagliarello VJ. The diagnostic accuracy of Kernig's sign, Brudzinski's sign, and nuchal rigidity in adults with suspected meningitis. Clin Infect Dis 2002; 35 (01) 46-52
- 8 Henry BM, Roy J, Ramakrishnan PK, Vikse J, Tomaszewski KA, Walocha JA. Procalcitonin as a serum biomarker for differentiation of bacterial meningitis from viral meningitis in children: evidence from a meta-analysis. Clin Pediatr (Phila) 2016; 55 (08) 749-764
- 9 Morales-Casado MI, Julián-Jiménez A, Moreno-Alonso F. , et al. Rendimiento diagnóstico de la procalcitonina y la proteína C reactiva para predecir meningitis bacteriana en los ancianos en urgencias. Enferm Infecc Microbiol Clin 2016; 34 (01) 8-16
- 10 Tunkel AR, Hartman BJ, Kaplan SL. , et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis 2004; 39 (09) 1267-1284
- 11 McGill F, Heyderman RS, Michael BD. , et al. The UK joint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults. J Infect 2016; 72 (04) 405-438
- 12 van de Beek D, Cabellos C, Dzupova O. , et al; ESCMID Study Group for Infections of the Brain (ESGIB). ESCMID guideline: diagnosis and treatment of acute bacterial meningitis. Clin Microbiol Infect 2016; 22 (Suppl. 03) S37-S62
- 13 van Veen KEB, Brouwer MC, van der Ende A, van de Beek D. Bacterial meningitis in patients using immunosuppressive medication: a population-based prospective nationwide study. J Neuroimmune Pharmacol 2017; 12 (02) 213-218
- 14 Weisfelt M, van de Beek D, Spanjaard L, Reitsma JB, de Gans J. Attenuated cerebrospinal fluid leukocyte count and sepsis in adults with pneumococcal meningitis: a prospective cohort study. BMC Infect Dis 2006; 6 (01) 149
- 15 Lukes SA, Posner JB, Nielsen S, Armstrong D. Bacterial infections of the CNS in neutropenic patients. Neurology 1984; 34 (03) 269-275
- 16 Baud MO, Vitt JR, Robbins NM. , et al. Pleocytosis is not fully responsible for low CSF glucose in meningitis. Neurol Neuroimmunol Neuroinflamm 2017; 5 (01) e425
- 17 Xiao X, Zhang Y, Zhang L, Kang P, Ji N. The diagnostic value of cerebrospinal fluid lactate for post-neurosurgical bacterial meningitis: a meta-analysis. BMC Infect Dis 2016; 16 (01) 483
- 18 Liesman RM, Strasburg AP, Heitman AK, Theel ES, Patel R, Binnicker MJ. Evaluation of a commercial multiplex molecular panel for diagnosis of infectious meningitis and encephalitis. J Clin Microbiol 2018; 56 (04) e01927-e17
- 19 UCSF Center for Next-Gen Precision Diagnostics. Published 2018 . Available at: https://nextgendiagnostics.ucsf.edu/our-diagnostic-lab/ . Accessed November 8, 2018
- 20 de Gans J, van de Beek D. ; European Dexamethasone in Adulthood Bacterial Meningitis Study Investigators. Dexamethasone in adults with bacterial meningitis. N Engl J Med 2002; 347 (20) 1549-1556
- 21 Brouwer MC, McIntyre P, Prasad K, van de Beek D. Corticosteroids for acute bacterial meningitis. Cochrane Database Syst Rev 2015; (09) CD004405
- 22 Heckenberg SGB, Brouwer MC, van der Ende A, van de Beek D. Adjunctive dexamethasone in adults with meningococcal meningitis. Neurology 2012; 79 (15) 1563-1569
- 23 Kasanmoentalib ES, Brouwer MC, van der Ende A, van de Beek D. Hydrocephalus in adults with community-acquired bacterial meningitis. Neurology 2010; 75 (10) 918-923
- 24 Zoons E, Weisfelt M, de Gans J. , et al. Seizures in adults with bacterial meningitis. Neurology 2008; 70 (22 Pt 2): 2109-2115
- 25 Lucas MJ, Brouwer MC, van de Beek D. Neurological sequelae of bacterial meningitis. J Infect 2016; 73 (01) 18-27
- 26 Al Masalma M, Lonjon M, Richet H. , et al. Metagenomic analysis of brain abscesses identifies specific bacterial associations. Clin Infect Dis 2012; 54 (02) 202-210
- 27 Heilpern KL, Lorber B. Focal intracranial infections. Infect Dis Clin North Am 1996; 10 (04) 879-898
- 28 Honda H, Warren DK. Central nervous system infections: meningitis and brain abscess. Infect Dis Clin North Am 2009; 23 (03) 609-623
- 29 Sonneville R, Ruimy R, Benzonana N. , et al; ESCMID Study Group for Infectious Diseases of the Brain (ESGIB). An update on bacterial brain abscess in immunocompetent patients. Clin Microbiol Infect 2017; 23 (09) 614-620
- 30 Lu CH, Chang WN, Lui CC. Strategies for the management of bacterial brain abscess. J Clin Neurosci 2006; 13 (10) 979-985
- 31 Hakan T. Management of bacterial brain abscesses. Neurosurg Focus 2008; 24 (06) E4
- 32 Deutschman CS, Haines SJ. Anticonvulsant prophylaxis in neurological surgery. Neurosurgery 1985; 17 (03) 510-517
- 33 Heusner AP. Nontuberculous spinal epidural infections. N Engl J Med 1948; 239 (23) 845-854
- 34 Darouiche R. Spinal epidural abscess and subdural empyema. In: Roos KL, Tunkel AR. , eds. Handbook of Clinical Neurology. Vol. 96. Bacterial Infections of the Central Nervous System. Edinburgh: Elsevier; 2010: 91-99
- 35 Darouiche RO. Spinal epidural abscess. N Engl J Med 2006; 355 (19) 2012-2020
- 36 Akalan N, Ozgen T. Infection as a cause of spinal cord compression: a review of 36 spinal epidural abscess cases. Acta Neurochir (Wien) 2000; 142 (01) 17-23