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Central nervous system
Central nervous system


Meningitis - staphylococcal

Definition:

Staphylococcal meningitis is a bacterial infection of the thin tissues covering the brain and spinal cord (meninges).

See also:



Alternative Names:

Staphylococcal meningitis



Causes, incidence, and risk factors:

Staphylococcal meningitis is caused by Staphylococcus bacteria. When it is caused by Staphylococcus aureus or Staphylococcus epidermidis bacteria, it usually develops as a surgery complication or an infection spread through the blood from another site.

Risk factors include:

  • Infections of heart valves
  • Past infection of the brain
  • Past meningitis due to spinal fluid shunts
  • Recent brain surgery
  • Spinal fluid shunt
  • Trauma


Symptoms:

Symptoms may come on quickly, and include:

Other symptoms that can occur with this disease:

  • Agitation
  • Bulging fontanelles in infants
  • Decreased alertness
  • Poor feeding or irritability in children
  • Rapid breathing
  • Unusual posture, with the head and neck arched backwards (opisthotonos )


Signs and tests:

The doctor or nurse will examine the patient. This will usually show:

  • Fast heart rate
  • Fever
  • Mental status changes
  • Stiff neck

If the doctor thinks meningitis is possible, a lumbar puncture ("spinal tap ") is done to remove a sample of spinal fluid (cerebrospinal fluid, or CSF) for testing. If you have a spinal fluid shunt, the sample may be taken from this instead.

Tests may include:



Treatment:

Antibiotics should be started as soon as possible. Vancomycin is the first choice for suspected staphylococcal meningitis. Nafcillin is sometimes used instead. 

Often, treatment will include a search for, and removal of, possible sources of bacteria in the body. These include shunts or artificial heart valves.



Support Groups:



Expectations (prognosis):

Early treatment improves the outcome. However, 3 - 5% of patients do not survive. Young children and adults over age 50 have the highest risk of death.

Staphylococcal meningitis often improves more quickly, with better results, if the source of the infection is removed. The source may include shunts, hardware in joints, or artificial heart valves.



Complications:

Calling your health care provider:

Call the local emergency number (such as 911) or go to an emergency room if you suspect meningitis in a young child who has the following symptoms:

  • Feeding problems
  • High-pitched cry
  • Irritability
  • Persistent, unexplained fever

Call the local emergency number if you develop any of the serious symptoms listed above. Meningitis can quickly become a life-threatening illness.



Prevention:

In high-risk people, taking preventive antibiotics before diagnostic or surgical procedures may help reduce the risk. Discuss this with your doctor.



References:

Swartz MN. Meningitis: bacterial, viral, and other. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 360.

Tunkel AR, Van de Beek D, Scheld WM. Acute meningitis. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009: chap 84.

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 May 26; 364(21): 2016-25.




Review Date: 8/15/2012
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.

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