Acute bacterial meningitis in adults
Open accessAbstract
Over the past several decades, the incidence of bacterial meningitis in children has decreased but there remains a significant burden of disease in adults, with a mortality of up to 30%. Although the pathogenesis of bacterial meningitis is not completely understood, knowledge of bacterial invasion and entry into the CNS is improving. Clinical features alone cannot determine whether meningitis is present and analysis of cerebrospinal fluid is essential for diagnosis. Newer technologies, such as multiplex PCR, and novel diagnostic platforms that incorporate proteomics and genetic sequencing, might help provide a quicker and more accurate diagnosis. Even with appropriate antimicrobial therapy, mortality is high and so attention has focused on adjunctive therapies; adjunctive corticosteroids are beneficial in certain circumstances. Any further improvements in outcome are likely to come from either modulation of the host response or novel approaches to therapy, rather than new antibiotics. Ultimately, the best hope to reduce the disease burden is with broadly protective vaccines.
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Disease also occurs following direct bacterial translocation from the upper respiratory tract to the meninges through the cribriform plate.
“Disease also occurs following direct bacterial translocation from the upper respiratory tract to the meninges through the cribriform plate. 1”
From Community-acquired acute bacterial meningitis in adults: a clinical update (2019) · cites this paper as [1]
The Invasion section says direct spread from respiratory infection to the central nervous system may occur and that entry from the nose through dural defects is possible. It does not identify the cribriform plate as the route, and it presents direct spread as a possibility rather than an established occurrence. No page number is available in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredBloodstream invasion allows bacteria to reach and cross the BBB, either transcellularly or paracellularly, to the CNS.
“Bloodstream invasion allows bacteria to reach and then cross the BBB, either transcellularly or paracellularly to the CNS. 1”
From Community-acquired acute bacterial meningitis in adults: a clinical update (2019) · cites this paper as [1]
The Pathogenesis and Invasion sections describe bloodstream invasion followed by entry into the subarachnoid space, and say most cases probably follow bacteraemia. But Invasion applies transcellular and between-cell routes to entry into the bloodstream, not to bacterial crossing of the blood–brain barrier; the CNS-entry section does not establish those routes across the BBB. No page numbers were supplied. (LLM, conf=0.88)
Experimental — accuracy not yet measuredPrompt recognition, appropriate investigation and treatment save lives in acute bacterial meningitis.
“It is widely acknowledged that prompt recognition, appropriate investigation and treatment save lives. 1”
From Community-acquired acute bacterial meningitis in adults: a clinical update (2019) · cites this paper as [1]
PCR has high sensitivity (87-100%) and specificity (98-100%) for bacterial DNA in CSF.
“PCR has high sensitivity (87-100%) and specificity (98-100%).1”
From Community-acquired acute bacterial meningitis in adults: a clinical update (2019) · cites this paper as [1]
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References 142 · Cited by 274
Part of this paper’s reference list could not be split into single entries.
Research works printed but not linked: 6
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- Authors
- McGill, F., Heyderman, R. S., Panagiotou, S., Tunkel, A. R., & Solomon, T.
- Affiliations
- University of Liverpool (GB)
- University of Malawi (MW)
- Brown University (US)
- Corresponding author
- Solomon, Tom
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2016-12
- Volume
- 388
- Issue
- 10063
- Pages
- 3036-3047
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2413672871
- Cited by
- 274
- References
- 142
- Citations by year
- 2026: 19 · 2025: 29 · 2024: 23 · 2023: 31 · 2022: 21 · 2021: 23 · 2020: 32 · 2019: 38 · 2018: 23 · 2017: 21 · 2016: 1 · 2015: 10 · 2014: 3
- FWCI
- 3.09
- Type
- journal article
- Language
- en
- Open access
- green
- discovery.ucl.ac.uk
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- National Institute for Health and Care Research (IS-HPU-1112−10117, RP-PG-0108-10048, NF-SI-0514-10177)
- National Institutes of Health
- Topics
- Life Sciences › Immunology and Microbiology › Microbiology › Bacterial Infections and Vaccines
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Bacterial Identification and Susceptibility Testing
- Health Sciences › Medicine › Surgery › Infectious Diseases and Tuberculosis
- Keywords
- bacterial meningitis, adults, mortality, pathogenesis, cerebrospinal fluid analysis, multiplex PCR, proteomics, gene sequencing, adjunctive corticosteroid therapy, host response modulation, vaccines, antimicrobial therapy
- MeSH terms
- Acute Disease, Adrenal Cortex Hormones, Anti-Infective Agents, Anti-Bacterial Agents, Humans, Streptococcus pneumoniae, Meningitis, Bacterial, Pneumococcal Vaccines
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