Overview
| Pathogens That Cause Meningitis by Age Group | |||||
| Newborns 0-6 mo | Children (> 6 months – < 6 years) | Adults (18 – 40 years) | Seniors (40 – 65 years) | IC | AC |
| GBS E. coliListeria monocytogenes | S. pneumoniaeN. meningitidisH. influenzaeEnteroviruses (coxsackievirus, poliovirus, echovirus) | S. pneumoniae N. meningitidisHSV-1HSV-2Enteroviruses (coxsackievirus, poliovirus, echovirus) | S. pneumoniaeListeria monocytogenes | S. pneumoniaeListeria monocytogenesN. meningitidisCMVJC virusCryptococcus neoformansToxoplasma gondi (brain abscess) | Enteroviruses (coxsackievirus, poliovirus, echovirus)HSV-1HSV-2Naegleria fowleriCryptococcus neoformansWest Nile VirusLCMV |
- Definitions
- meningitis
- inflammation of the meninges
- bacterial meningitis can be life-threatening
- remember: encephalitis is inflammation of the brain parenchyma
- aseptic meningitis (“sterile meningitis”)
- meningitis caused by organisms other than bacteria
- majoriy due to viruses
- enteroviruses are the most common viral cause
- meningitis
- Clinical presentation
- fever, headache, altered mental status, neck stiffness
- there may be variations in clinical presentation
- due to the type of pathogen, patient age, host immune status
- there may be variations in clinical presentation
- fever, headache, altered mental status, neck stiffness
- Bacterial causes of meningitis by age
- ≥ 3 month – < 10 years
- S. pneumoniae and N. meningitidis are common
- H. influenze type B
- incidence decrease since HiB vaccine introduction in 1980s
- ≥ 10 years – 34 years
- S. pneumoniae and N. meningitidis are common
- 18 years – 34 years
- S. pneumoniae and N. meningitidis are common
- > 35 years
- S. pneumoniae is common
- ≥ 3 month – < 10 years
- Meningitis in Immunocompromised (IC)
- S. pneumoniae and L. monocytogenes are common
- Aseptic meningitis
- more common than bacterial
- can occur at all ages
- more common in children
- summer months
- more common in children
- Herpes simplex virus (HSV)
- HSV-1
- more associated with encephalitis
- HSV-2
- more associated with meningitis
- HSV-1
- See also “Meningitis”
- Treatment
- drug choice depends on what is the most likely pathogen causing meningitis
- 0 – 28 day old
- IV ampicillin + cefotaxime or an aminoglycoside (i.e., gentamicin, tobramycin)
- ≥ 1 month old
- IV vancomycin + cefotaxime or ceftriaxone
- if you suspect L. monocytogenes, add ampicillin
- adults
- IV vancomycin + cefotaxime or ceftriaxone
- If > 50 years old, add ampicillin
- 0 – 28 day old
- drug choice depends on what is the most likely pathogen causing meningitis
- Abbreviations
- IC = immunocompromised
- AC = aseptic causes
- blue = common pathogen in chart