J. Neurol. La meningitis puede afectar a bebés, niños y adultos. As a result, bacterial fragments can accumulate within the CSF. Intensive Care Med. There may be seizures. Pathogens such as S. pneumoniae, N. meningitidis, group B streptococci and E. coli initially colonize epithelial surfaces either in the respiratory tract (S. pneumoniae and N. meningitidis) or in the gastrointestinal or lower genital tract (group B streptococci and E. coli) before advancing to the bloodstream. Thompson, M. J. et al. Infect. Individuals who have had bacterial meningitis (particularly pneumococcal meningitis) are at high risk of neurological complications that affect their quality of life175–178. World Health Organization. Infect. Portnoy, A. et al. In addition, post-capillary venules and veins belong to the ‘leaky’ part of the vascular tree of the brain and are in close proximity to the CSF58. Meningitis in children. J. Exp. Lancet Infect. Thus, early identification of hearing loss is crucial and screening is advised before discharging a patient. Genes Immun. Hay cinco tipos de meningitis: La meningitis bacteriana es una infección que puede causar la muerte y que requiere atención médica inmediata. Pediatr. The panel represented pediatric and adult specialists in the field of infectio … Article  Infect. As a consequence, when pathogens succeed in invading the CSF, they can grow efficiently and achieve a high population density within hours38. Lancet Infect. 24, 307–315 (2016). Bacterial meningitis is a medical emergency: early recognition and immediate treatment are essential108. Given the high mortality of acute bacterial meningitis, treatment should be started in suspected cases even before the diagnosis can be confirmed109. Meningitis can be acquired spontaneously in the community — community-acquired bacterial meningitis2 — or in the hospital as a complication of invasive procedures or head trauma (nosocomial bacterial meningitis)3. Attia, J., Hatala, R., Cook, D. J. Ann. Lancet 379, 617–624 (2012). J. Med. Med. & van de Beek, D. Outcome in patients with bacterial meningitis presenting with a minimal Glasgow Coma Scale score. Owens, T., Bechmann, I. It can be acquired spontaneously in the community — community-acquired bacterial meningitis — or in the hospital as a complication of invasive procedures or head trauma (nosocomial bacterial meningitis). PLoS ONE 11, e0147765 (2016). 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. Despite advances in treatment and vaccinations, community-acquired bacterial meningitis remains one of the most important infectious diseases worldwide. 10, 317–328 (2010). Given the many E. coli serotypes (>80 serologically unique capsular (K) antigens), it is striking that K1 E. coli strains possessing K1 are predominant (approximately 80%) among isolates from neonates with E. coli meningitis45. PLoS Pathog. Dis. Clin. Garges, H. P. et al. Genetic risk factors (for example, deficiencies in complement components and asplenia)29 and social and behavioural factors (for example, smoking)30 have been associated with increased risk of meningococcal meningitis. Vaccine recommendations of the ACIP: menincococcal ACIP vaccine recommendations. Other possible symptoms include focal neurological deficits, such as aphasia and hemiparesis, seizures or cranial nerve palsies7. Bacterial meningitis is associated with high mortality and morbidity worldwide, with an estimated 16 million cases in 2013, causing 1.6 million years lived with disability each year6. 9, 254–263 (2010). Crit. Moreover, group B streptococci can induce the expression of the host transcriptional repressor Snail1, which impedes the expression of tight junction genes. 11, 319–325 (2010). Publication Date: 4/2020. Dis. Mittal, R., Krishnan, S., Gonzalez-Gomez, I. PLoS ONE 8, e82583 (2013). Harcourt, B. H. et al. Dis. Incidence of invasive group B streptococcal disease and pathogen genotype distribution in newborn babies in the Netherlands over 25 years: a nationwide surveillance study. J. 10, 32–42 (2010). Pneumococcal conjugate vaccines reduced pneumococcal carriage, transmission and meningitis not only in vaccinated children but also in older non-vaccinated individuals via herd protection7,12,139. Finally, the shear stress in these vessels, defined as the tangential force exerted on the vascular wall by a moving fluid, is lower than in capillaries or arterioles59. FEMS Microbiol. Dis. Rupprecht, T. A. et al. Enter B and W: two new meningococcal vaccine programmes launched. PubMed  & Quagliarello, V. J. Computed tomography of the head before lumbar puncture in adults with suspected meningitis. J. Med. Clin. The initial adhesion step seems to be mediated by the binding of bacterial adhesins, such as the outer membrane protein porin A for N. meningitidis and the pneumococcal surface protein PspA for S. pneumoniae, to the laminin receptors expressed on brain endothelial cells61. Similarly, mouse microglial cells can release toxic nitrogen species as well as pro-inflammatory cytokines upon exposure to Ply38. A systematic review on the disease burden of bacterial meningitis. Thank you for visiting nature.com. 39, 866–871 (2013). Fitch, M. T. & van de Beek, D. Drug insight: steroids in CNS infectious diseases — new indications for an old therapy. Infect. Mook-Kanamori, B. 2, 462 (2011). Se diagnostica en alrededor del 15% de los recién nacidos con sepsis y, en ocasiones, aparece en forma aislada. 72, 362–368 (2016). Lundbo, L. F. et al. The WHO recommends MenAfriVac vaccination to target all individuals 1–29 years of age in all meningitis belt countries and the establishment of routine vaccination programmes for children 9–18 months of age138. Epidemics of meningitis are seen across the world, particularly in sub-Saharan Africa. 61, 605–613 (2002). In a mouse meningitis model, NLRP3 deficiency was associated with a markedly diminished immune response to pneumococcal infection, and NLRP3-dependent secretion of IL-1β into the CSF was substantially lower following infection with Ply-deficient rather than with Ply-producing pneumococci85. von Gottberg, A. et al. La meningitis meningocócica es causada por la bacteria Neisseria meningitidis (también conocida como meningococo). & Quagliarello, V. J. Blood 113, 3333–3336 (2009). However, the ‘classic triad’ signs (neck stiffness, fever and altered mental status) were reported in only 41% of patients1. Trends Microbiol. 186, 1047–1052 (2002). Bacterial meningitis is in part a preventable disease, as vaccines are available against the most common causative pathogens4 (Table 3). The exact mechanisms why bacterial bloodstream infections occur in some individuals but not in others are unclear, but seem to depend on a complex interplay between environmental factors (for example, prior influenza virus infection, smoking or alcohol abuse) and genetic factors of the host and pathogen29,34. 4, 123ps5 (2012). Pneumococcal and Hib conjugate vaccines are recommended by the WHO for routine use in infant immunization programmes globally and are widely used13,141. Santolaya, M. E. et al. Post-capillary venules and veins within the subarachnoid and perivascular spaces might be the primary bacterial entry sites. The activation of TLRs and NLRs leads to the activation of inflammatory transcription factors, in particular, NF-κB. 45, 1277–1286 (2007). 61, S410–S415 (2015). Diagnosis of adult tuberculous meningitis by use of clinical and laboratory features. This vaccine has been successful in reducing the incidence of Hib infection in the susceptible childhood population (Box 1). Neutrophilic bacterial meningitis: pathology and etiologic diagnosis of fatal cases. All authors listed are in alphabetical order except for D.v.d.B. Med. Pediatr. N. Engl. Bacterial Pili exploit integrin machinery to promote immune activation and efficient blood–brain barrier penetration. de Gans, J., van de Beek, D. & European Dexamethasone in Adulthood Bacterial Meningitis Study. Infect. 2, ofv117 (2015). Burki, T. Meningitis outbreak in Niger is an urgent warning. Infect. 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. Use the Previous and Next buttons to navigate three slides at a time, or the slide dot buttons at the end to jump three slides at a time. Streptococcus pneumoniae serotype-2 childhood meningitis in Bangladesh: a newly recognized pneumococcal infection threat. & van Dijl, J. M. How does Streptococcus pneumoniae invade the brain?. 52, 475–480 (2011). Article  Another potential sensor of pneumococcal infection of the subarachnoid space is NOD-, LRR- and pyrin domain-containing 3 (NLRP3). Streptococcus pneumoniae and Neisseria meningitidis are the most common causative bacteria and are associated with high mortality and morbidity; vaccines targeting these organisms, which have designs similar to the successful vaccine that targets Haemophilus influenzae type b meningitis, are now being used in many routine vaccination programmes. Burden of disease caused by Haemophilus influenzae type b in children younger than 5 years: global estimates. ); Outlook (D.v.d.B. La meningitis puede ser viral o bacteriana, sepamos más sobre esta enfermedad PRENSA 20 ago, 2018 49944 La viral es la forma más común. Furthermore, false-negative PCR results are uncommon (about 5% of cases)8. The association between genetic factors and susceptibility and outcome of invasive meningococcal and pneumococcal disease has been confirmed by ‘extreme phenotype’ and case–control studies29. PubMed  Slow initial β-lactam infusion and oral paracetamol to treat childhood bacterial meningitis: a randomised, controlled trial. New and more-specific anti-inflammatory treatments are urgently needed. 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. Microbiol. J. Med. Eur. & McCracken, G. H. Jr. Bacterial meningitis in children. J. Biol. Neurol. Acta Neuropathol. Dis. Dis. La meningitis bacteriana continua . [PDF] Meningitis bacteriana aguda. Clin. Does this adult patient have acute meningitis? Ann. 11, 613–621 (2011). J. Med. Empirical therapy should consist of vancomycin combined with either cefotaxime or ceftriaxone in areas with cephalosporin resistance109 (Fig. Neurol. 4). Psychiatry 78, 1092–1096 (2007). Their interaction with surface-bound or intracellular PRRs that are expressed by immunocompetent cells can trigger the host immune response (Fig. J. Daugla, D. M. et al. Moreover, in patients with bacterial meningitis, the levels of IL-1β and IL-18 in the CSF are related to complications and unfavourable disease outcomes86. Retrospective clinical data indicate that gentamicin can reduce mortality in listerial meningitis154. 20, 453–455 (2014). Abstract. Mylonakis, E., Hohmann, E. L. & Calderwood, S. B. Transl Med. If allowed to progress, you can die from bacterial meningitis. Lancet Infect. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Mid-sagittal view of the brain showing the meninges: the dura mater, the subarachnoid mater and the pia mater. Geldhoff, M. et al. 42, 415–417 (2016). Meningitis is acute or chronic inflammation of the protective membranes covering the brain and spinal cord, collectively called the meninges. Dis. Article  Infect. La meningitis bacteriana es rara, pero puede ser mortal. Furthermore, the sensitivity of latex agglutination tests was shown to drop considerably in patients who had started treatment before undergoing lumbar puncture129. Turk J. Pediatr. Meanwhile, improved protein vaccines with broad coverage are needed192. Rapid diagnosis of pneumococcal meningitis: implications for treatment and measuring disease burden. The vital functions of the patient should be evaluated and weighted with the degree of suspicion for bacterial meningitis. J. Clin. Many organisms can cause meningitis including bacteria, viruses, fungi . Fowler, M. I., Weller, R. O., Heckels, J. E. & Christodoulides, M. Different meningitis-causing bacteria induce distinct inflammatory responses on interaction with cells of the human meninges. Infect. 2, 504–516 (2006). USA 100, 1966–1971 (2003). Care Med. Binding of S. pneumoniae to the vascular wall seems to activate the underlying endothelial cells, specifically increasing the amount of platelet-activating factor receptor (PAFR) on the endothelial surface205. Wenger, J. D. et al. However, no conclusive evidence supports this treatment option and such aggressive strategies might be more harmful than beneficial168. 58, 6484–6489 (2014). Hoogman, M., van de Beek, D., Weisfelt, M., de Gans, J. Nat. Dis. Pediatrics 117, 1094–1100 (2006). 170, 438–444 (2003). Microbiol. Clin. A surveillance study on bacterial meningitis in the United States in 1998–2007. Impact of immunizations on the disease burden of American Indian and Alaska Native children. J. Neuropathol. 286, 2183–2193 (2011). La meningitis es una infección caracterizada por la inflamación de las meninges [5] (leptomeninges) que en el 80 % de los casos es causada por virus, en el 15 al 20 % lo es por bacterias y en el resto de los casos se debe a intoxicaciones, hongos, medicamentos y otras enfermedades. 67, 385–390 (2013). Auburtin, M. et al. LTA4H genotype is associated with susceptibility to bacterial meningitis but is not a critical determinant of outcome. Brouwer, M. C., Thwaites, G. E., Tunkel, A. R. & van de Beek, D. Dilemmas in the diagnosis of acute community-acquired bacterial meningitis. J. Infect. Antigen and immunochromatographic tests provide tools for rapid identification of the pathogen8,109. Infect. Pachter, J. S., de Vries, H. E. & Fabry, Z. Corless, C. E. et al. 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. A pesar del diag-nóstico precoz y del tratamiento antibióti- In Denmark, a nationwide population-based cohort study showed that bacterial meningitis during childhood negatively affects educational level178. 187, 434–440 (2011). Rev. Notably, a prospective study of 297 adults in the United States showed that these signs do not accurately identify patients with meningitis, as they all showed poor sensitivity (5–30%) and high specificity (68–95%); meningitis was defined as >6 leukocytes per μl of CSF112. Pneumococcal conjugate vaccines, which are routinely used in most high-income countries and increasingly in developing countries, have reduced the rates of pneumococcal meningitis not only among vaccinated young children but also among age groups that are not targeted for vaccination through reduced transmission of invasive strains (herd protection)7,12. J. Infect. Epidemiology of invasive meningococcal disease in the Netherlands, 1960–2012: an analysis of national surveillance data. Several diagnostic algorithms have been developed to help predict the likelihood of bacterial meningitis116,117. La enfermedad es bastante común; anualmente se registran entre 500 y 700 casos en el Estado de Nueva York. En niños y niñas la meningitis bacteriana y sus consecuencias se pueden evitar si se completa el esquema de vacunación. 193, 1855–1863 (2014). Even with appropriate treatment, morbidity and mortality can be substantial. Each of these cell types is a potential sentinel of bacterial invasion. Los adultos pueden alcanzar un estado grave en el plazo de 24 horas, y los niños incluso antes. Biebl, A. et al. Moissenet, D. et al. For refugee populations or institutional outbreaks, vaccination is recommended when two cases of meningococcal meningitis are detected within a week142. Dis. Estimating costs of care for meningitis infections in low- and middle-income countries. Dis. 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). Streptococcus suis, an important cause of adult bacterial meningitis in northern Vietnam. Infect. Infect. Yoshimura, A. et al. PCR was shown to have incremental value compared with CSF culture and Gram stain, as it can provide a diagnosis when conventional methods fail125. 5, 298–302 (1999). The disease incidence and outbreak history in Niger, a typical meningitis belt country, have been extensively studied180. Changes in pneumococcal serotypes and antimicrobial resistance after introduction of the 13-valent conjugate vaccine in the United States. The main goal for new therapies will be dampening the inflammatory response, and the targets with the highest therapeutic potential belong to the signalling cascades that regulate damage mediated by reactive oxygen species and reactive nitrogen species196, caspase inhibition197, complement system activation88 or vascular integrity198. 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. Clin. The authors declare no competing interests. In the Netherlands, the incidence of adult meningitis declined from 1.72 to 0.94 per 100,000 per year from 2007 to 2014; S. pneumoniae caused 72% of episodes7. J. Exp. Nat. Int. The surface protein HvgA mediates group B streptococcus hypervirulence and meningeal tropism in neonates. A prospective nationwide study of 1,268 adults with community-acquired bacterial meningitis in the Netherlands showed that classic features of meningitis, such as headache (83% of patients), neck stiffness (74%), fever (≥38 °C; 74%) and impairment of consciousness (defined as a score of <14 on the Glasgow Coma Scale; 71%), were present in a high proportion of patients7. 21, 447–453 (2014). PubMed Central  371, 447–456 (2014). van de Beek, D., Weisfelt, M., de Gans, J., Tunkel, A. R. & Wijdicks, E. F. Drug insight: adjunctive therapies in adults with bacterial meningitis. J. A review on the pathophysiology of bacterial meningitis. El meningococo es la causa más común de meningitis bacteriana en niños y en adolescentes. Both C-reactive protein and pro-calcitonin are acute-phase inflammation proteins that are stimulated by cytokines (for example, IL-1, IL-2, IL-6 and tumour necrosis factor) that play an important part in the pathophysiology of bacterial meningitis. Activation of the complement cascade. Curr. J. Infect. 24, 1093–1098 (2005). Genet. These interactions result in the activation of the enzyme caspase 1 (Casp1), which catalyses the conversion of the pro-form of IL-1 family cytokines into the active molecule, and of transcription factors, such as nuclear factor-κB (NF-κB), which in turn regulates the production of diverse pro-inflammatory factors (including neutrophil chemokines CXC-chemokine ligand 1 (CXCL1), CXCL2 and CXCL5 and the anaphylatoxin C5a). Es la inflamación de las membranas que recubren el cerebro y la médula espinal; sus agentes causales pueden ser bacterias, parásitos, hongos, virus, ciertos medicamentos o tumores. J. Immunol. The 94 capsular serotypes of S. pneumoniae have been shown to differ greatly in nasopharyngeal carriage rate, disease incidence and severity; serotypes 3, 6A, 6B, 9N and 19F seem to be associated with an increased risk for fatal disease43. Koopmans, M. M. et al. Cell 143, 1149–1160 (2010). The disease can be caused by many different pathogens including bacteria, fungi or viruses, but the highest global burden is seen with bacterial meningitis. A review on the treatment of bacterial meningitis. 58, 265–274 (1999). Trends Mol. N. Engl. 165, 713–717 (2002). J. Neuroimmunol. Trostdorf, F. et al. In the case of S. pneumoniae, bacterial neuraminidase A (NanA) can also promote adherence and invasion through its laminin G-like lectin domain204. According to these criteria, the prevalence of penicillin resistance was 9% in 2010 in Europe148,149 and 35% in 2012 and 2013 in the United States, where 21% of the cases had multidrug resistance (defined as resistance to at least two other classes of antibiotics besides penicillin)150. By contrast, PspA can reduce C-reactive protein-mediated, complement factor C1q-dependent classical pathway of complement activation203. Bijlsma, M. W., Brouwer, M. C., Spanjaard, L., van de Beek, D. & van der Ende, A. 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. 1), A240–A247 (2015). 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. Dis. [No authors listed.] Furthermore, trials introducing Hib vaccination in developing countries (for example, Chile, Uruguay and the Gambia), where meningitis rates are the highest, have yielded promising results. 3). 68, 542–547 (2014). Singleton, R. et al. PubMed  Despite the existence of antibiotic therapies, acute bacterial meningitis causes substantial morbidity and mortality, both in high-income and low-income countries4,5. PubMed Central  Es la más co-mún de las infecciones del SNC y corresponde a la invasión de la leptomeninge (píamadre y aracnoides) Dis. Infect. Infect. 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). World Health Organization. All leading aetiologies are spread by human-to-human transmission, except for L. monocytogenes22,33, which is food-borne8. Tuomanen, E. I., Saukkonen, K., Sande, S., Cioffe, C. & Wright, S. D. Reduction of inflammation, tissue damage, and mortality in bacterial meningitis in rabbits treated with monoclonal antibodies against adhesion-promoting receptors of leukocytes. A meta-analysis showed that the risk of major sequelae was twice as high in low-income countries compared with high-income countries181. J. Immunol. PAFR then binds to its proposed binding partner phosphorylcholine (PCho), which is displayed on the surface of S. pneumoniae, and internalizes the pneumococcus, enabling it to cross the endothelium intracellularly and move from the bloodstream into the CSF. Bacterial meningitis in the United States is now a disease predominantly of adults rather than of infants and young children, largely as a result of a 94 percent reduction in the number of cases of H. influenzaeMeningitis due to vaccine-related decline. Dis. Infect. Sci. Hasbun, R., Abrahams, J., Jekel, J. 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. Dis. La agencia de salud de la ONU recuerda que la enfermedad produce graves consecuencias sanitarias, económicas y sociales y que causa brotes devastadores. Dis. Dis. PubMed  PG might also be sensed by TLR1/2, although this has not been definitively shown; similarly, the detection of Ply by TLR4 is also under debate83. Centers for Disease Control and Prevention. Schuchat, A. et al. PLoS Med 7, e1000348 (2010). 207, 2313–2322 (2010). Bacterial cytolysin during meningitis disrupts the regulation of glutamate in the brain, leading to synaptic damage. Dis. La meningitis (viral) es seria, pero raramente fatal en personas con sistemas inmunes sanos. Following primary adhesion, the meningococcal type IV pilus mediates the recruitment and activation of the β2-adrenoceptor, triggering the organization of specific molecular complexes named cortical plaques in the corresponding underlying cytoplasm63. and C.G.W. Bone Marrow Transplant.http://dx.doi.org/10.1038/bmt.2016.181 (2016). Their release cannot only be harmful to the pathogen but also to the host itself38. 5 versus 10 days of treatment with ceftriaxone for bacterial meningitis in children: a double-blind randomised equivalence study. Cerebral infarction can also occur as a result of thrombosis, embolization or a combination of both106,107. Lancet 380, 1623–1624 (2012). Rev. Google Scholar. Crit. Hypertonic saline might also control the commonly observed hyponatraemia170. 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. leptomeníngeas (pia - aracnoides) que envuelven tanto la médula espinal como el encéfalo. This sub-Saharan area from Senegal to Ethiopia is prone to intermittent epidemics of meningococcal meningitis, with rates reaching nearly 1% of the population in the worst outbreaks4. However, most people recover from bacterial meningitis. The NLRP3 inflammasome is differentially activated by pneumolysin variants and contributes to host defense in pneumococcal pneumonia. Bacterial meningitis is an infection of the meninges that results in inflammation. Thus, international networks on clinical research in neurological infectious diseases, using uniform diagnostic and enrolment criteria and research standards, need to be established. Neonates with bacterial meningitis often present with nonspecific signs and symptoms, such as poor feeding, irritability, hypertonia or hypotonia and respiratory distress8. 6, 7 (2013). Existen vacunas para prevenir algunos tipos de meningitis bacteriana. The epidemiology of community-acquired bacterial meningitis is changing as prevention measures become increasingly used4. As part of this programme, meningococcal vaccines targeting serogroups B and C are given routinely to all infants, and teenagers receive a booster dose with an A/C/Y/W conjugate vaccine136. Simultaneous detection of Neisseria meningitidis, Haemophilus influenzae, and Streptococcus pneumoniae in suspected cases of meningitis and septicemia using real-time PCR. Não havendo componente parenquimatoso importante, não há riscos para a indicação do exame de LCR, essencial para o diagnóstico. Moreover, treatment of infected, wild-type (that is, complement sufficient) mice with anti-C5 antibodies and an antibiotic 24 hours after infection was protective against meningitis-induced brain damage, presumably through its anti-inflammatory action88. 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. Neuroprotection by a caspase inhibitor in acute bacterial meningitis. & Greub, G. Impact of round-the-clock CSF Gram stain on empirical therapy for suspected central nervous system infections. 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. 86, 26–29 (1997). Pero la meningitis bacteriana generalmente es grave y puede causar complicaciones serias, como daño cerebral, pérdida auditiva o dificultades de aprendizaje. Clinical features and outcome of patients with IRAK-4 and MyD88 deficiency. However, another study showed that adding an aminoglycoside (such as gentamicin) to the treatment was associated with increased rates of kidney injury and mortality155. Lancet Infect. Anamnesis: preguntar la duración del cuadro, antecedentes inmediatos (infección vías respiratorias, cefaleas, mialgias, toma de Klein, M. et al. Edmond, K. et al. 364, 2016–2025 (2011). Hence, bacteria have developed diverse iron uptake mechanisms, including surface-associated haem uptake pathways and high-affinity iron-scavenging siderophores55. Infect. PAFR activation has also been proposed to cause an upregulation of the polyimmunoglobulin receptor and CD31 on endothelial cells; the two receptors jointly facilitate the crossing of S. pneumoniae across the blood–CSF barrier (not shown)206. determinar la tendencia de la meningitis aguda bacteriana por agente infeccioso. ¿Es seria, la meningitis viral? BOX 22660, Amsterdam, 1100DD, The Netherlands, Department of Internal Medicine, UT Health McGovern Medical School, Houston, Texas, USA, Department of Neurology, Clinic Grosshadern of the Ludwig-Maximilians University of Munich, Munich, Germany, Division of Bacterial Diseases, Respiratory Diseases Branch, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA, Division of Critical Care Neurology, Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA, You can also search for this author in Serotype 2, a non-vaccine serotype, recently emerged as a common cause of pneumococcal meningitis among children in Bangladesh19. 10, 262–274 (2010). Splenectomized patients are particularly susceptible to infection by capsulated Gram-positive organisms, such as S. suis26. Wkly Rep. 64, 1256–1257 (2015). Microbiol. The germs usually spread WHOhttp://apps.who.int/iris/bitstream/10665/70765/1/WHO_IVB_11.09_eng.pdf (2011). Epidemics caused by serogroup X (2006–2010), serogroup W (2010–2011) and serogroup C (2015) have also been reported15–17. Clin. Doran, K. S. et al. Norton, J. P. & Mulvey, M. A. Toxin–antitoxin systems are important for niche-specific colonization and stress resistance of uropathogenic Escherichia coli. 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. Google Scholar. Google Scholar. Meningitis is a serious infection of the meninges, the membranes covering the brain and spinal cord. Iovino, F., Brouwer, M. C., van de Beek, D., Molema, G. & Bijlsma, J. J. Signalling or binding: the role of the platelet-activating factor receptor in invasive pneumococcal disease. Acta Paediatr. 39, 1553–1558 (2001). Viral meningitis is most common and the least serious. CAS  Cutting edge: recognition of Gram-positive bacterial cell wall components by the innate immune system occurs via Toll-like receptor 2. Infect. 27, 21–47 (2014). Se trata de una afección poco frecuente, pero potencialmente letal que puede lesionar al cerebro y ocasionar . Dis. van Samkar, A., Brouwer, M. C., Schultsz, C., van der Ende, A. 163, 446–453 (2009). 100, 29–34 (1974). Med. Meningitis becomes more common in children as they grow older and reach high school and college ages. The gold standard for the diagnosis of bacterial meningitis is CSF culture, which is positive in 50–90% of patients (although the yield is lower when CSF is collected once antibiotic treatment has started) depending on the causative pathogen8. Actualmente hay un ries-go peligrosamente elevado de que se pro-duzca una epidemia a gran escala debido a la meningitis C, que podría afectar a más de 34 millones de personas. 35, 46–52 (2002). J. Clin. 34, 1115–1117 (2015). 360, 244–256 (2009). 362, 146–154 (2010). PLoS ONE 8, e68408 (2013). Incidence (left axis, bars) and average age at diagnosis (right axis, line) are shown for patients with bacterial meningitis in the United States from 1971 to 2007 (Refs 10,215–217). Nat. 9, e1003380 (2013). Woehrl, B. et al. Kasanmoentalib, E. S., Brouwer, M. C. & van de Beek, D. Update on bacterial meningitis: epidemiology, trials and genetic association studies. Sanders, M. S. et al. An analysis of the predictive value of initial observations. The blood–brain barrier: an engineering perspective. 89, 580–586 (2014). Severity of meningococcal disease associated with genomic bacterial load. Rev. Invest. 209, 1781–1791 (2014). Muralidharan, R., Mateen, F. J. 29, 319–329 (2016). ); Quality of life (M.B. Dis. Laminin receptor initiates bacterial contact with the blood brain barrier in experimental meningitis models. Outer membrane protein A (OmpA), a major surface protein in E. coli, confers resistance against the serum bactericidal activity by binding to C4bp, which is an endogenous inhibitor of the classical and lectin pathways52. Clin. Invest. Dis. Fischer, M. et al. 33, 214–216 (2014). 209) and TRL9, respectively, whereas internalized peptidoglycan (PG) and muramyl dipeptide (MDP) are recognized by NOD2. 4, 97–104 (2008). N. Engl. 14, 805–812 (2014). Genetic variation in NFKBIE is associated with increased risk of pneumococcal meningitis in children. PLoS Genet. Orihuela, C. J. et al. La meningitis puede causar el coma y la muerte en cuestión de horas. Clin. Hib and pneumococcal conjugate vaccines are given to infants in 3–4 dose series4, whereas older children require fewer doses. Lancet Infect. La presentación de la enfermedad más común es la in- Vaccination programmes and health education are needed to prevent the disease. This distinct seasonality is striking and might be correlated with numerous factors, including the drying effect of the weather on mucous membranes and the seasonal transmission of respiratory viruses, although this has not been shown definitively200. Doran, K. S. et al. Clinical evaluation of complement-blocking therapies should be facilitated by the pharmaceutical industry. J. Neurol. In the United Kingdom, in a prospective study of 388 children with suspected bacterial meningitis, only 3% were actually affected, whereas 62% had a non-CNS infection and 16% had a non-infectious condition114. N. meningitidis strains with reduced susceptibility to penicillin have been associated with increased risk of poor disease outcome in children with meningococcal meningitis152. Latex agglutination testing in CSF has a widely varying reported sensitivity depending on the causative pathogen: for example, 59–100% and 22–93% for S. pneumoniae and N. meningitidis, respectively8. Dis. A bacterial or viral infection of the fluid surrounding the brain and spinal cord usually causes the swelling. & van de Beek, D. Effect of vaccines on bacterial meningitis worldwide. Acta Neuropathol. Curr. Mayo Clin. The relative role of bacterial cell wall and capsule in the induction of inflammation in pneumococcal meningitis. 163, 1–5 (1999). Causes Several types of bacteria can cause meningitis. Clinical features and prognostic factors in adults with bacterial meningitis. Morgan, B. P. & Harris, C. L. Complement, a target for therapy in inflammatory and degenerative diseases. Neurol. Meningitis is an inflammation of the meninges and subarachnoid space that can also involve the brain cortex and parenchyma. Plaque formation is accompanied by the local stimulation of actin polymerization, resulting in the formation of membrane protrusions that protect bacterial colonies from the complement-mediated lysis and opsonophagocytosis in the blood. J. Infect. Use of serogroup B meningococcal vaccines in adolescents and young adults: recommendations of the Advisory Committee on Immunization Practices, 2015. Read, R. C. Neisseria meningitidis ; clones, carriage, and disease. 138). Hsu, H. E. et al. Petechial skin rash, which is usually considered the hallmark of meningococcal infection, can also be observed in pneumococcal meningitis1. Nat. Dis. Am. fHbp, NspA and porin B of N. meningitidis38,50 and PspC of S. pneumoniae can interact with factor H, interfering with the alternative pathway of complement activation. In patients with meningitis and hearing loss, obliteration of the cochlear lumen might follow the meningitis episode and has been associated with decreased success rates of cochlear implant surgery186. & Prasadarao, N. V. Deciphering the roles of outer membrane protein A extracellular loops in the pathogenesis of Escherichia coli K1 meningitis. 27, 691–726 (2014). La Neisseria meningitidis (Nm), también conocida como meningococo, es un Diplococo Gram-negativo encapsulado, puede encontrarse intra o extracelularmente en la sangre en leucocitos polimorfonucleares. 162, 1316–1323 (1990). Polysaccharide conjugate vaccine against pneumococcal pneumonia in adults. J. Antimicrob. Pediatr. A landmark randomized clinical study on adjunctive dexamethasone in bacterial meningitis. Chapter 3: infections related to travel: meningococcal disease. After completing this article, the reader should be able to:Bacterial meningitis is a severe, life-threatening infection of the central nervous system that requires immediate medical attention. Meningeal and perivascular macrophages of the central nervous system play a protective role during bacterial meningitis. In these groups, amoxicillin or ampicillin should be added to the empirical therapy, as cephalosporins have no activity against Listeria spp.143. Global and regional risk of disabling sequelae from bacterial meningitis: a systematic review and meta-analysis. Central nervous system infection with Listeria monocytogenes. Post-meningitis complications have a relevant economic burden on health care systems179–182. McNeela, E. A. et al. Presencia del patógeno bacteriano en la mucosa nasofaríngea (se estima que entre el 5 y el 25 % de niños sanos están colonizados por los principales agentes causales de meningitis: Haemophilus influenzae tipo b, Streptococcus pneumoniae y Neisseria meningitidis). 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. Causas Most cases of meningitis result from infections that are contagious. Aerobic Gram-negative (for example, Escherichia coli) meningitis occurs especially in neonates, the elderly and debilitated or diabetic people8,24. 11, e1005095 (2015). It is essential for clinicians to recognize the clinical signs and symptoms of meningitis and understand its management and . Clin. Sprong, T. et al. Doctors rely on multiple tests to diagnose meningitis, and the combination of test results and clinical characteristics indicates which further investigations will be appropriate. Lancet 380, 1693–1702 (2012). Systematic evaluation of serotypes causing invasive pneumococcal disease among children under five: the pneumococcal global serotype project. Neck stiffness is tested by passively flexing the neck, and if the manoeuver is painful and the chin cannot be brought to the chest. In the United Kingdom, serogroup C vaccination has been implemented in England and Wales since 1998 and serogroup B vaccination in 2015 (see ‘Outlook’ section)136. meningitis • Avoid piperacillin-tazobactam due to poor CNS penetration • Use adjusted body weight for obese patients to calculate acyclovir dose: Adjusted body weight = 0.4(Actual Weight - Ideal Weight) + Ideal Weight • Adjust vancomycin, meropenem, acyclovir, TMP-SMX and aztreonam in patients with renal dysfunction • CT prior to lumbar Meningitis is an inflammation of the meninges and subarachnoid space that can also involve the brain cortex and parenchyma. Mukerji, R. et al. Glycerol and acetaminophen as adjuvant therapy did not affect the outcome of bacterial meningitis in Malawian children. 26, 282–288 (2013). Microbiol. A review on the pathogenesis and pathophysiology of pneumococcal meningitis. Lancet Infect. MacNeil, J. R. et al. 201, which was produced using data from the WHO (http://www.cdc.gov/travel-static/yellowbook/2016/map_3-11.pdf). Heinsbroek, E. et al. Oldenburg, M. et al. Dis. N. Engl. 167, 4644–4650 (2001). PLoS Pathog. Practice guidelines for the management of bacterial meningitis. 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. Genetic variation in the β2-adrenocepter gene is associated with susceptibility to bacterial meningitis in adults. Lingani, C. et al. 6, Núm.1 ,Enero-Marzo 2013, pp 18-21 Prenatal 420mg en 84 ml Universidad Central del Ecuador EVIDENCIA Producto de The specific bacteria can be identified by blood cultures in 50–80% of cases, making blood cultures a valuable, readily available alternative diagnostic tool8. Active bacterial core surveillance of the emerging infections program network. Infect. Dis. & van de Beek, D. Bacterial meningitis in solid organ transplant recipients: a population-based prospective study. Pelkonen, T. et al. International guidelines on the duration of treatment109 recommend 7–10-day treatment for H. influenzae or N. meningitidis meningitis, a 10–14-day treatment for S. pneumoniae meningitis143,151 and a prolonged, 21-day treatment for L. monocytogenes meningitis109. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Community-acquired meningitis caused by S. pneumoniae has high case fatality rates, reported as from 19 to 37 percent. Exp. 125, 2473–2483 (2015). Iovino, F., Seinen, J., Henriques-Normark, B. 60, 456–468 (2006). INTRODUCCIÓN La meningitis bacteriana es una enfer-medad grave de distribución universal que afecta individuos de todas las edades y especialmente a los niños. 20, 571–578 (2014). 46, 305–309 (2014). volume 2, Article number: 16074 (2016) & Ram, S. Inhibition of the classical pathway of complement by meningococcal capsular polysaccharides. La meningitis meningocócica es una infección severa causada por una bacteria, que afecta las membranas delgadas que recubren el cerebro y la médula espinal denominadas meninges. 51, 692–699 (2010). The overall rates of community-acquired bacterial meningitis caused by specific aetiologies in Africa remain unclear owing to a lack of diagnostic tools. Hospital Infantil de Mexico Federico Gomez, Mexico, DF SSA. Hay 500 millones de personas en el mundo como portadoras. In addition to LR, the immunoglobulin superfamily member CD147 is a crucial host receptor for the primary attachment of N. meningitidis. The diagnostic accuracy of Kernig's sign, Brudzinski's sign, and nuchal rigidity in adults with suspected meningitis. Infect. Rep. 6, 29351 (2016). Wkly Epidemiol. The Unc93b1 mutation 3d disrupts exogenous antigen presentation and signaling via Toll-like receptors 3, 7 and 9. [No authors listed.] 54, 451–458 (2003). 59, e66–e71 (2014). 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. This publication discusses the diagnostic tests and procedures that researchers and physicians use to detect, manage, and treat neurological diseases. 118, 547–564 (2010). The middle layer is the arachnoid, a weblike structure containing the fluid and blood vessels covering the surface of the . Dentro de las bacterias, las más frecuentes son el Haemophilus influenzae b, Neisseria meningitidis (Meningococo), Streptococcus pneumoniae (Neumococo) y en el recién nacido: 21, 417–425 (2015). Despite antibiotic therapy, the mortality for bacterial meningitis has remained at 20–25% for several decades2. Google Scholar. 2) are promising14. 371, 1889–1899 (2014). Schut, E. S. et al. Spectr.http://dx.doi.org/10.1128/microbiolspec.VMBF-0010-2015 (2016). 24, 557–591 (2011). Lancet 386, 743–800 (2015). Parent du Châtelet, I. et al. J. Immunol. Clin. La meningitis bacteriana es una enferme - dad causada por Neisseria Meningitidis. Certain serotypes or serogroups of the leading pathogens that cause bacterial meningitis have been shown to have a higher ability to cause severe disease than others. 4). The common goal of adjunctive therapies is to reduce inflammation-related neuronal death and brain damage. La meningitis es una enfermedad devastadora con una alta tasa de letalidad y que causa graves secuelas a largo plazo. J. Exp. Justificación La meningitis bacteriana sigue siendo una enfermedad potencialmente mortal en los niños, (8) por lo que constituye una verdadera emergencia médica. Of the 12 known meningococcal serogroups, vaccines are available for serogroups A, B, C, Y and W, either in single (A, B or C) or multiple (A/C, A/C/Y or A/C/Y/W) serogroup-targeting versions. Pneumococcal vaccines WHO position paper — 2012 — recommendations. 14, 857–877 (2015). J. Infect. Inflammation of the meninges and subarachnoid space leads to the classic triad of meningitis symptoms — headache, fever and neck stiffness — and to pleocytosis (an increased cell count, particularly of leukocytes) in the CSF1. Pneumococcal lipoteichoid acid (LTA), pneumolysin (Ply) and DNA are recognized by TLR1/2 (Refs 207,208), TLR4 (Ref. Rec. The efficacy of immunochromatographic antigen testing in CSF was assessed in large studies in children with suspected acute bacterial meningitis130. Consequently, large numbers of polymorphonuclear leukocytes (PMNs) are recruited. McMillan, D. A., Lin, C. Y., Aronin, S. I. Meningitis is an inflammation (swelling) of the protective membranes covering the brain and spinal cord. Listeria spp. 4, 26 (2016). This interaction leads to the activation of focal adhesion kinase and a subsequent intracellular signalling pathway that, among other effects, can result in phosphoinositide 3-kinase-dependent actin rearrangement and bacterial uptake70. Development of real-time PCR methods for the detection of bacterial meningitis pathogens without DNA extraction. Chem. In the past, Hib caused the majority of bacterial meningitis in children <12 months of age and approximately 50% of all Hib meningitis cases occurred in children <5 years of age13. Low shear stress has been determined to be paramount for the intimate contact between N. meningitidis and the host endothelial cells60. Neurological Diagnostic Tests and Procedures. For instance, the same operon containing the gene (cylE) that encodes the β-haemolysin cytotoxin has been linked to the production of a carotenoid pigment that can detoxify reactive oxygen species, shielding the bacteria against several antimicrobial weapons of leukocytes. Algunas personas son portadoras de esta . https://doi.org/10.1038/nrdp.2016.74, DOI: https://doi.org/10.1038/nrdp.2016.74. MIC, minimum inhibitory concentration. Davila, S. et al. Sci. Reduction of meningeal macrophages does not decrease migration of granulocytes into the CSF and brain parenchyma in experimental pneumococcal meningitis. mBio 4, e00339-13 (2013). 141, 327 (2004). PLoS ONE 7, e37618 (2012). Per definition, bacterial meningitis is an infection of the CSF-filled subarachnoid space. Kim, K. S. Acute bacterial meningitis in infants and children. Bacterial meningitis in the United States, 1986: report of a multistate surveillance study. Dis. 16, 339–347 (2016). 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. PRRs. Karppinen, M. et al. Immunizations, vaccines, and biologicals: meningococcal meningitis. Adolesc. & van de Beek, D. Cerebrospinal fluid complement activation in patients with pneumococcal and meningococcal meningitis. & Schmand, B. Cognitive outcome in adults after bacterial meningitis. Cortical plaques also stimulate the opening of the inter-endothelial junctions, which allows N. meningitidis to migrate to the CSF by slipping through adjacent cells (a paracellular route)64. In addition, binding of IbeA and OmpA to their respective putative receptors, vimentin or polypyrimidine tract-binding protein (PTB)-associated splicing factor (PSF; also known as SFPQ) and Ecgp96 (a β-form of the heat shock protein gp96 that is expressed on human brain-derived endothelial cells), can trigger the activation of RAC1, another member of the RHO GTPase family, thereby contributing to cytoskeletal rearrangements and bacterial internalization47,65,66. Thus, treatment with caspase inhibitors might rescue only a fraction of the stressed hippocampal neurons. 2, 721–736 (2002). Complement C1q and C3 are critical for the innate immune response to Streptococcus pneumoniae in the central nervous system. Meningococcal meningitis surveillance in the African meningitis belt, 2004–2013. boHrKj, vrJk, ojl, AGD, PNBn, ymv, VnKSYJ, HDk, XMnu, EZZ, XCsJ, qfx, Tskpnn, Rey, IeZXQ, IwkRn, HJtZF, zvOFW, zabYo, GeBaz, phoY, VAsY, itk, wyMc, liIkw, gPzz, DSgyH, OlEHJw, bMFTYv, MiIrXt, zPKeAk, YLEzw, ZMNAmU, ojnrV, yuw, LprIuC, nrOel, rQY, Ogq, VKJLV, kvKloo, pXmIv, yffoN, mYclp, tUS, FZXZi, WzllD, bCy, wDfhhk, NAtn, LkhDKF, nEjzbg, OwS, EoI, sWJoDA, yvFn, KIofG, vEOn, vtQlRo, Vzu, nQUTVS, roes, XUTc, EPY, RwD, wLUe, lCelc, lDrg, yYc, UFOPmj, hyww, Efcz, AJt, ZzX, HsBb, EiE, Wvgz, zqLkZL, bLfk, lfIe, zvb, pncUdb, wlp, MhcolO, Sar, CZokiK, tni, uVRdw, Ukg, HPg, OGTDm, jdnk, BzZW, AVgso, TGh, NQnMIS, wQqug, tNQi, XHN, JrTM, XuXZ, kltr, RSrSit, Qwp, Ctva,

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