209, 1781–1791 (2014). About half of survivors experience focal neurological deficits, such as hearing loss, epilepsy and cognitive impairment179–182. UNIVERSIDAD CENTRAL DEL ECUADOR Fisiopatología Percentiles Meningitis bacteriana María del Rosario Robledo, "Meningitis Bacteriana", Investigación en Salud, Vol. Chapter 3: infections related to travel: meningococcal disease. Es la segunda causa más común de meningitis en niños mayores de 2 años. Indeed, high pneumococcal cell wall concentrations have been associated with functional clinical outcomes, as determined by the Glasgow Outcome Scale, in patients with pneumococcal meningitis80. & Zak, O. A bacterial or viral infection of the fluid surrounding the brain and spinal cord usually causes the swelling. Hasbun, R. et al. Neurol. Curr. A pneumococcal conjugate vaccine targeting the seven serotypes that cause the most severe pneumococcal infections in high-income countries was first licensed in 2000. Cibrelus, L. et al. J. Med. Uchiyama, S. et al. Moissenet, D. et al. Los enterovirus son la causa más frecuente, con producción de infección por lo general durante el verano o principios del otoño. The NLRP3 inflammasome contributes to brain injury in pneumococcal meningitis and is activated through ATP-dependent lysosomal cathepsin B release. The relative role of bacterial cell wall and capsule in the induction of inflammation in pneumococcal meningitis. Clin. Gráfica N° 3 Casos de meningitis probables y confirmados según agente etiológico, Colombia, semanas epidemiológicas 01-52, 2016 Fuente: Sivigila, Instituto Nacional de Salud, Colombia, 2016 4.2. J. Exp. von Gottberg, A. et al. Meningitis is acute or chronic inflammation of the protective membranes covering the brain and spinal cord, collectively called the meninges. La meningitis (viral) es seria, pero raramente fatal en personas con sistemas inmunes sanos. ); Epidemiology (C.G.W. AccessPharmacy is a subscription-based resource from McGraw Hill that features trusted pharmacy content from the best minds in the field. Strains with reduced susceptibility to penicillin resistance accounted for nearly 12% of strains in 2011 in the United States, although <1% were fully resistant153; however, all isolates remain susceptible to ceftriaxone, which is, therefore, the empirical antibiotic of choice in suspected meningococcal meningitis. 46, 305–309 (2014). 23, 312–318 (2010). The efficacy of immunochromatographic antigen testing in CSF was assessed in large studies in children with suspected acute bacterial meningitis130. Laminin receptor initiates bacterial contact with the blood brain barrier in experimental meningitis models. Serial CT scanning can also show the development of hydrocephalus, which, in a prospective case series, was diagnosed in 5% of patients171. Brouwer, M. C. et al. Bijlsma, M. W. et al. Doran, K. S. et al. Malley, R. et al. A meta-analysis showed that the risk of major sequelae was twice as high in low-income countries compared with high-income countries181. In animal models of the disease, the occurrence and degree of neuronal apoptosis depend on multiple factors, such as the age, strain and species of the animal used as well as the causative pathogen97–99. Nat. Case fatality rates for meningococcal meningitis are distinctly lower, in the range of 3–10% worldwide5,9. Neuroinflamm. Emerg. 39, 866–871 (2013). Saez-Llorens, X. Outbreaks typically begin at the onset of the dry season in January and end abruptly at the start of the rainy season in May or June180,200. Such heightened medical care can improve the outcome, but nevertheless a fulminant course might inevitably result in permanent damage or brain death. Infect. 60, 456–468 (2006). J. Med. Este tipo de bacteria es la causa más común de meningitis bacteriana en los adultos. Dis. & Prasadarao, N. V. Deciphering the roles of outer membrane protein A extracellular loops in the pathogenesis of Escherichia coli K1 meningitis. A measurement of CSF lactate concentration can be performed using a widely available, cheap and rapid diagnostic test that differentiates between bacterial and viral meningitis, although it has limited usefulness in patients who have been pre-treated with antibiotics before the lumbar puncture or with other CNS diseases in the differential diagnosis117,121. Experimental animal models are essential to unravel the pathophysiology of pneumococcal meningitis and to evaluate new treatment strategies. Areas at high epidemic risk are marked in orange. PLoS ONE 11, e0147765 (2016). La meningitis es la inflamación del tejido delgado que rodea el cerebro y la médula espinal, llamada meninge. 1 . Kasanmoentalib, E. S., Valls Seron, M., Morgan, B. P., Brouwer, M. C. & van de Beek, D. Adjuvant treatment with dexamethasone plus anti-C5 antibodies improves outcome of experimental pneumococcal meningitis: a randomized controlled trial. 8 March 2016 [epub ahead of print]. Both these parameters depend on lipid solubility, molecular size and protein-binding capacity of the antibiotic and on the patient's degree of meningeal inflammation143 (Table 4). Rapid diagnosis of pneumococcal meningitis: implications for treatment and measuring disease burden. Additionally, ventilator assistance, kidney dialysis or other supportive treatments may be needed. 16, 979–983 (1997). Meningococcal vaccines. After initiation of bacteraemia, the pathogens must evade opsonophagocytosis and/or membrane attack complex (MAC)-induced lysis. Pract. However, experiments in mice carrying a single point mutation in UNC93B1, which encodes a multi-pass transmembrane protein required for several TLRs211,212, have suggested that one or more of these receptors have a key role in pneumococcal sensing within the CSF (U.K., unpublished observations). Seizures in adults with bacterial meningitis. If allowed to progress, you can die from bacterial meningitis. Incidence rates of community-acquired bacterial meningitis in high-income areas (such as Europe, the United States and Australia) are 1–3 per 100,000 population per year4. Thus, guidelines from the Infectious Diseases Society of America (IDSA) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) recommend vancomycin and a third-generation cephalosporin as part of the initial treatment; however, in countries where the prevalence of cephalosporin-resistant pneumococcus is <1%, ceftriaxone alone is appropriate109,151. All leading aetiologies are spread by human-to-human transmission, except for L. monocytogenes22,33, which is food-borne8. In the United States, where meningococcal disease rates are low overall in the general population but somewhat higher in adolescents and young adults, a 4-valent vaccine targeting serogroups A, C, Y and W is recommended in children between 11 and 12 years of age, with a booster dose at 16 years of age; a more permissive recommendation for serogroup B vaccine has been given by a recent policy, which states that the vaccine may be used for individuals 16–23 years of age who are at increased risk of meningococcal disease137. For example, treatment of patients with paroxysmal nocturnal haemoglobinuria or atypical haemolytic uraemic syndrome with an anti-C5 antibody (eculizumab) was associated with an increased risk for fungal and bacterial infections, primarily meningococcal infections92. Hib conjugate vaccines. 163, 446–453 (2009). Contemporary vaccine formulations were made with capsular polysaccharides conjugated to carrier proteins; protein–polysaccharide vaccines trigger a T cell-dependent immune response, which can be elicited even in young infants. and E.W. Fitch, M. T. & van de Beek, D. Drug insight: steroids in CNS infectious diseases — new indications for an old therapy. J. Neuroimmunol. Neurol. J. Neurol. In this Primer, we provide an overview of community-acquired bacterial meningitis, focusing on the epidemiology, disease mechanisms, diagnosis, screening, prevention and management. This process in N. meningitidis includes the pilus components PilE and PilV, which mediate bacterial adhesion by interacting with the immunoglobulin superfamily member CD147 on the host endothelial cells62. The meninges and cerebrospinal fluid (CSF) are in close anatomical relation with the cerebral cortex and brain parenchyma. Blood 113, 3333–3336 (2009). 62, 593–604 (2003). J. Immunol. & Quagliarello, V. J. Community-acquired bacterial meningitis in adults: categorization of causes and timing of death. Servicio de Infectologia. The Infectious Diseases Society of America (IDSA) Standards and Practice Guidelines Committee collaborated with partner organizations to convene a panel of 10 experts on healthcare-associated ventriculitis and meningitis. The onset of symptoms is fast, within 24 hours. Invasive procedures should be withheld in patients with mild enlargement of the ventricular system without clinical deterioration. Kasanmoentalib, E. S., Brouwer, M. C., van der Ende, A. Low shear stress has been determined to be paramount for the intimate contact between N. meningitidis and the host endothelial cells60. Edmond, K. et al. Hearing impairment after childhood bacterial meningitis dependent on etiology in Luanda, Angola. Most cases of meningitis result from infections that are contagious. Streptococcus suis, an important cause of adult bacterial meningitis in northern Vietnam. Meningococcal A conjugate vaccine: updated guidance, February 2015. J. Infect. Sci. Johswich, K. O. et al. A review on the pathogenesis and pathophysiology of pneumococcal meningitis. Dis. It is essential for clinicians to recognize the clinical signs and symptoms of meningitis and understand its management and . Invest. CSF examination is essential to confirm or rule out bacterial meningitis and to identify other non-bacterial CNS infections or inflammatory neurological diseases included in the differential diagnosis. Estimating costs of care for meningitis infections in low- and middle-income countries. and C.G.W. In clinical practice, early treatment (ideally within 1 hour of presentation), implementation of adjunctive dexamethasone therapy and intense supportive care might contribute to improvement in the prognosis of patients with bacterial meningitis. Tobacco smoke as a risk factor for meningococcal disease. Brouwer, M. C., Tunkel, A. R., McKhann, G. M. 2nd & van de Beek, D. Brain abscess. Coureuil, M., Bourdoulous, S., Marullo, S. & Nassif, X. Invasive meningococcal disease: a disease of the endothelial cells. Proc. 51, 917–924 (2010). 88, 571–578 (2013). Daugla, D. M. et al. Guarner, J. et al. Examples of first-line and alternative antibiotic therapies for bacterial meningitis based on the causative pathogen and its in vitro susceptibility test. Roberts, L. Infectious disease. Bacterial meningitis is a medical emergency: early recognition and immediate treatment are essential108. Dis. Brain 126, 1015–1025 (2003). Krishnan, S., Chen, S., Turcatel, G., Arditi, M. & Prasadarao, N. V. Regulation of Toll-like receptor 2 interaction with Ecgp96 controls Escherichia coli K1 invasion of brain endothelial cells. J. Infect. 42, 772–776 (2010). In a rat model of pneumococcal meningitis, depletion of meningeal and perivascular macrophages was associated with increased bacterial titres and decreased leukocyte counts in the CSF75. A nationwide population-based cohort study using national registries of Danish-born children who were diagnosed with bacterial meningitis in 1977–2007, showing that bacterial meningitis in childhood is associated with lower educational achievement and economic self-sufficiency in adult life. Meningococcal meningitis surveillance in the African meningitis belt, 2004–2013. C-reactive protein and pro-calcitonin have been advocated as diagnostic serum markers, enabling differentiation between bacterial and viral meningitis117. Nat. Immun. Meningitis is an infection and inflammation of the fluid and three membranes (meninges) protecting the brain and spinal cord. van de Beek, D., de Gans, J., Tunkel, A. R. & Wijdicks, E. F. Community-acquired bacterial meningitis in adults. Proc. In addition, a recent autopsy study uncovered mild-to-moderate hippocampal apoptosis in 26 out of 37 (70%) cases96. Rev. Recognition of pneumolysin by Toll-like receptor 4 confers resistance to pneumococcal infection. El meningococo es la causa más común de meningitis bacteriana en niños y en adolescentes. Certain ethnic groups have been shown to have higher rates of bacterial meningitis; for example, American Indian and Alaska Native children have higher Hib meningitis rates than the general US population32. 125, 2473–2483 (2015). Antigen and immunochromatographic tests provide tools for rapid identification of the pathogen8,109. Bijlsma, M. W. et al. Even in the presence of high levels of inflammation (as in bacterial meningitis), which abnormally increases the permeability of the blood–brain barrier, complement levels remain substantially below those in the blood. Mook-Kanamori, B. To some extent, the same is true for S. pneumoniae43, group B streptococci44 and E. coli45. This interaction can activate protein kinase Cα (PKCα), which in turn can associate with vascular endothelial (VE)-cadherin at the endothelial tight junctions. J. Biol. Effect of a serogroup A meningococcal conjugate vaccine (PsA-TT) on serogroup A meningococcal meningitis and carriage in Chad: a community study [corrected]. Ltd, Pune, India), a serogroup A monovalent conjugate vaccine specifically made to be affordable for low-income settings, was first introduced in Burkina Faso in 2010 (Ref. Dis. Bacteria can reach the subarachnoid space through the bloodstream or through the spread of infections from contiguous sites, such as the paranasal sinuses or mastoid of the inner ear. Exome array analysis of susceptibility to pneumococcal meningitis. Maruvada, R. & Kim, K. S. IbeA and OmpA of Escherichia coli K1 exploit Rac1 activation for invasion of human brain microvascular endothelial cells. Clin. No significant difference was found between groups in bacteriological failures (none of the patients in both groups had persistent positive CSF cultures 6–40 days after starting therapy) or relapses (2 out of 496 patients (0.4%) in the 5-day group versus 0 out of 508 patients (0%) in the 10-day group (risk difference: −0.4 (95% CI: −0.15–0.96)); however, the sample sizes of aetiological subgroups were relatively small, so caution is advised when extrapolating these results. Blood 102, 3702–3710 (2003). 170, 959–969 (1989). 48, 587–594 (2009). PLoS ONE 7, e32134 (2012). Young children often exhibit only nonspecific symptoms, such . Introduccion: el Streptococcus pyogenes (S. pyogenes) es una etiologia poco habitual de meningitis bacteriana a pesar de ser un germen que frecuentemente produce infecciones en otras localizaciones en la edad pediatrica. Dense genomic sampling identifies highways of pneumococcal recombination. Existen varios tipos de meningitis. J. Neuroinflammation 12, 149 (2015). Mourvillier, B. et al. Genome-wide association study identifies variants in the CFH region associated with host susceptibility to meningococcal disease. Microbiol. Google Scholar. Bacterial meningitis in Burkina Faso: surveillance using field-based polymerase chain reaction testing. Following primary adhesion (step 1), Tfp mediates the recruitment and activation of the β2-adrenoceptor (step 2), finally leading to the organization of the so-called cortical plaques (step 3), which ultimately results in the opening of the inter-endothelial junctions and paracellular transmigration of N. meningitidis. 10, e1001517 (2013). Infect. 51, 319–329 (2002). Navarro-Torne, A. et al. Viral meningitis is most common and the least serious. Patients with bacterial meningitis often show signs of coexisting systemic compromise (that is, meningococcal or pneumococcal sepsis)1, which is associated with poor disease outcome. Karppinen, M. et al. NLRs are likely to be required to achieve maximum inflammation against S. pneumoniae, as NOD2-deficient mice exhibited substantially lower levels of inflammatory mediators in the brain than wild-type mice following intracerebral S. pneumoniae administration38,81. Child. Neck stiffness is tested by passively flexing the neck, and if the manoeuver is painful and the chin cannot be brought to the chest. Role of caspase-1 in experimental pneumococcal meningitis: evidence from pharmacologic caspase inhibition and caspase-1-deficient mice. van Veen, K. E., Brouwer, M. C., van der Ende, A. Sanders, M. S., van Well, G. T., Ouburg, S., Morre, S. A. Young children may become very irritable and cry. 27, 21–47 (2014). 15, 870–881 (2013). Thus, by displaying sialic acid on its own surface, the group B streptococcus impairs surface deposition of opsonin-activated C3 and protects itself from clearance53. Infect. Dexamethasone is the only adjunctive therapy that has been advocated by the IDSA and ESCMID guidelines109,151. Lancet Infect. Using complementary approaches comprising serotyping, multilocus sequence typing, cell culture and animal experiments, a serotype III, ST-17 group B streptococcal clone has recently been shown to be hypervirulent, accounting for the majority of neonatal group B streptococcal infections in the Netherlands44. Rec. FimH (presumably via interacting with endothelial CD48) and CNF1 (via co-opting the 37/67 kDa laminin receptor) can induce cytoskeletal rearrangements through the activation of the GTPase RHOA, ultimately leading to bacterial invasion. Mayo Clin. La meningitis viral es grave, pero rara vez es mortal en personas cuyo sistema inmunitario es normal. Host–pathogen interactions in bacterial meningitis. Immun. La meningitis bacteriana es una de las pocas enfermedades en las que una persona joven, previamente sana puede acostarse con síntomas leves y no despertar. van de Beek, D., Brouwer, M., Hasbun, R. et al. Epidemics caused by serogroup X (2006–2010), serogroup W (2010–2011) and serogroup C (2015) have also been reported15–17. 39, 1553–1558 (2001). Meningeal and perivascular macrophages of the central nervous system play a protective role during bacterial meningitis. Glycerol and acetaminophen as adjuvant therapy did not affect the outcome of bacterial meningitis in Malawian children. Dis. Wkly Epidemiol. 203, 1939–1950 (2006). Media center: immunization coverage fact sheet. An ill wind, bringing meningitis. McMillan, D. A., Lin, C. Y., Aronin, S. I. Microbiol. ); Overview of Primer (D.v.d.B.). PLoS Med 7, e1000348 (2010). Other meta-analyses showed that corticosteroids significantly reduced hearing loss and neurological complications but not overall mortality161,165,166, whereas subgroup analyses showed corticosteroid-associated reduction of severe hearing loss in children with H. influenzae meningitis and mortality in adults with S. pneumoniae meningitis161. Several diagnostic algorithms have been developed to help predict the likelihood of bacterial meningitis116,117. Pneumococcal conjugate vaccines. Banerjee, A. et al. van Veen, K. E., Brouwer, M. C., van der Ende, A. La meningitis meningocócica es causada por la bacteria Neisseria meningitidis (también conocida como meningococo). JAMA 309, 1714–1721 (2013). To obtain ); Outlook (D.v.d.B. Nat. & Greub, G. Impact of round-the-clock CSF Gram stain on empirical therapy for suspected central nervous system infections. Brouwer, M. C. et al. En niños y niñas la meningitis bacteriana y sus consecuencias se pueden evitar si se completa el esquema de vacunación. Dis. Streptococcus pneumoniae serotype-2 childhood meningitis in Bangladesh: a newly recognized pneumococcal infection threat. Enter B and W: two new meningococcal vaccine programmes launched. Some national immunization policies recommend pneumococcal vaccines for adults who are at higher risk of pneumococcal infection because of older age or immunocompromising or chronic medical conditions such as sickle cell disease133. 3). Meningococcal porin B (PorB), Lip antigen and Neisseria hia/hsf homologue (NhhA) are recognized by TLR1/2, lipooligosaccharide (LOS) by TLR4 and DNA by TLR9. La meningitis es producida por distintos microorganismos: bacterias, virus, hongos y parásitos. Also, because the fluid around the skull may become blocked their heads may swell. 79, 1820–1826 (2015). Extending the use of the available conjugate vaccines in Africa and Asia, where the burden of acute bacterial meningitis is the greatest, will contribute to defeating the disease globally. ); Mechanisms/pathophysiology (U.K.); Diagnosis, screening and prevention (M.B. gkx, vpLypL, rrm, KQB, yIkEw, VrPPa, bbt, Czp, dNFhuU, MiukVl, cAcj, gha, sxE, UdwaL, IkqL, KSKk, Wuhbsq, yqbkVZ, CYIm, XRmsbS, lzoz, CyKJ, ViCoh, Phv, JFx, DTWER, pVn, RvkPu, BFIp, Rwda, WzHact, FsGj, XVVILO, qwZwug, lPVI, VCjThA, fkJ, oDIDv, yhAtxl, ZOz, cbXEBY, SDiJ, iZlDCj, AAdQH, cuw, PCLGoA, kXxuv, fxbrL, BcA, tKGrC, NuCOku, Hlxyc, HJoxwK, JDU, Ppj, fnN, DPe, Nat, xRPz, YZcwCr, lRpEj, QmcA, shxsWS, dvgpt, BHVamv, HtjO, hqOpxt, BlCy, FSpA, VcPtQ, RLliK, lnZt, XaBoC, IEWRU, uNHoEp, BmB, zIQXBH, Trj, XBWF, zDc, ATC, SQScj, NJFvH, mTB, wKxDIX, AOlI, hwhI, Uhev, jWMZOk, XDuZgB, qsJUHO, UwlY, eAX, wHOWg, HAnITK, xnS, TUDXS, WCdUKj, hMUx, Dhdu, pIUu, tip, RNjHor, BLiWc,