Pneumococcal meningitis (PM) is caused by the Gram-positive bacteria, Streptococcus pneumoniae, which is also called the pneumococcus bacteria. A majority of adult cases of community-acquired bacterial meningitis are caused by this bacteria [1] [2]. PM became the leading cause of meningitis after the Haemophilus influenzae type b vaccine was introduced [3]. Young children, the elderly, patients with chronic diseases, and immunocompromised individuals are at the greatest risk of developing PM [3] [4] [5]. Despite medical advances, the fatality rates for PM range from approximately 2% in children to 25% in adults [3] [6]. Survivors frequently have neurological sequelae like deafness or cognitive deficits [2] [7] [8] [9].

The clinical signs and symptoms of PM depend on the age of the patient. Young babies may present with poor feeding, irritability, lethargy, vomiting, fever, and a bulging anterior fontanel [10]. Children and adults classically have a fever, severe headache, photophobia, neck stiffness, vomiting, confusion, delirium, and seizures, while elderly patients may have atypical features like altered mental status and confusion [1] [2].

• Fever

  Prolonged fever is the term used to describe a fever in excess of 10 days' duration after initiation of treatment, while a secondary fever is a temperature elevation usually greater than 38°C following at least 1 afebrile day after the primary fever. [jamanetwork.com]

  It is imperative to recognize that young infants with bacterial meningitis can present without fever or irritability and manifest signs and symptoms consistent with many other diagnoses. [ncbi.nlm.nih.gov]

  Young babies may present with poor feeding, irritability, lethargy, vomiting, fever, and a bulging anterior fontanel. [symptoma.com]

  Questions will focus on symptoms and possible exposure to someone who might have the same symptoms, such as a stiff neck and fever. If the provider thinks meningitis is possible, a lumbar puncture ( spinal tap ) will likely be done. [medlineplus.gov]

• Chills

  At this point, you would start to experience symptoms like headaches, stiff neck, fever, vomiting, rash, confusion, drowsiness chills, cough, chest pains, and an immediate dislike for bright light. [myjoyonline.com]

  Symptoms include: Fever Chills Low alertness Sepsis is a complication caused by the body’s overwhelming and life-threatening response to an infection, which can lead to tissue damage, organ failure, and death. [cdc.gov]

  Chest pain Meningitis can cause symptoms like: Fever Headache Stiff neck Increased sensitivity to light Feeling confused Not wanting to eat or drink, being less active than usual, and throwing up (in babies) Bacteremia can cause symptoms like: Fever Chills [vaccines.gov]

• High Fever

  None of the patients presented with a chief complaint of irritability, poor feeding, or altered mental status, and no patient had high fever, difficulty consoling, or cirulatory compromise. [ncbi.nlm.nih.gov]

  Symptoms of the disease include stiff neck, high fever, rash, headache, vomiting, and confusion. [graphic.com.gh]

  This includes a high fever, weakness, or signs of an allergic reaction, such as trouble breathing, a fast heartbeat, or dizziness. [webmd.com]

  An infected person may develop the following: chest pain chills confusion a cough a headache a high fever vomiting weakness Other possible symptoms of this form of meningitis include: agitation irritability rapid breathing stiff neck In infants, the soft [healthline.com]

• Fatigue

  Over 12 h, she was fatigued without other symptoms. Low fever accompanied another emesis. A few hours later she was confused, and purpuric rash appeared. Emergency physicians diagnosed sepsis/meningitis and started vancomycin-ceftriaxone. [ncbi.nlm.nih.gov]

  Other symptoms can include headaches, fatigue, feeling sick or vomiting, wheezing, joint and muscle pain, and feeling confused and disorientated (particularly in elderly people). Symptoms can appear very suddenly, or take several days to develop. [vk.ovg.ox.ac.uk]

  […] feel breathless, even when resting rapid heartbeat fever feeling generally unwell sweating and shivering loss of appetite chest pain – which gets worse when breathing or coughing Less common symptoms include: coughing up blood (haemoptysis) headaches fatigue [nhs.uk]

  Multifactorial conditions, such as diabetes mellitus, renal insufficiency, liver cirrhosis, malnutrition, glucocorticosteroid therapy, alcoholism, cold exposure, stress, fatigue and excess likelihood of exposure to S. pneumoniae (such as occurs in daycare [path.upmc.edu]

• Recent Upper Respiratory Infection

  S pneumoniae Recent upper respiratory infection Spleen removal or a spleen that does not function Symptoms usually come on quickly, and may include: Fever and chills Mental status changes Nausea and vomiting Sensitivity to light ( photophobia ) Severe [medlineplus.gov]

  Your risk also increases if you've had a recent upper respiratory infection. Babies, children, and teens are at greatest risk. What Are the Symptoms of Meningococcal Meningitis? Symptoms of meningococcal meningitis may vary from case to case. [webmd.com]

• Vomiting

  Young babies may present with poor feeding, irritability, lethargy, vomiting, fever, and a bulging anterior fontanel. [symptoma.com]

  At age 7, patient developed a morning headache and vomited once. Cefprozil was administered and re-dosed. Over 12 h, she was fatigued without other symptoms. Low fever accompanied another emesis. [ncbi.nlm.nih.gov]

  At this point, you would start to experience symptoms like headaches, stiff neck, fever, vomiting, rash, confusion, drowsiness chills, cough, chest pains, and an immediate dislike for bright light. [myjoyonline.com]

  Signs and symptoms that point toward this condition include: a fast heart rate a fever a stiff neck vomiting If you have pneumococcal meningitis, you’ll immediately be admitted to the hospital. You’ll then be treated with antibiotics. [healthline.com]

• Nausea

  […] of the common risk factors associated with the condition include recent infections, like upper respiratory tract infection, pneumonia, or ear infection with pneumococcus The classic signs and symptoms of Pneumococcal Meningitis are high-grade fever, nausea [dovemed.com]

  Symptoms may include high fever, headache, stiff neck, nausea and vomiting, and sometimes coma. Pneumococcal meningitis is extremely serious and has a high death rate. [betterhealth.vic.gov.au]

  Recent ear infection with S pneumoniae Recent pneumonia with S pneumoniae Recent upper respiratory infection Spleen removal or a spleen that does not function Symptoms usually come on quickly, and may include: Fever and chills Mental status changes Nausea [medlineplus.gov]

• Tachycardia

  A 22-year-old man with incessant ventricular tachycardia (VT) associated with pneumococcal meningitis without obvious heart disease manifesting as febrile sensation and severe headache visited our emergency department. [ncbi.nlm.nih.gov]

  By Antonio Pires, MD, Arber Kodra, MD, Jay Wong, MD, and Steven Mandel, MD A 61-year-old male with a past medical history of hypertension initially presented in the emergency department with fever, chest pain, and tachycardia. [practicalneurology.com]

  On initial physical examination, she was afebrile (36.6°C), but in a hypotensive state (88/55mmHg) with tachycardia (120 beats/minute). [jmedicalcasereports.com]

• Hearing Impairment

  On long-term follow-up, we observed improvements of motor impairment, but not of hearing impairment. [ncbi.nlm.nih.gov]

  About one in 10 children with pneumococcal meningitis die and one in six survivors will have permanent brain damage About one in three children will be left with a hearing impairment after pneumococcal meningitis. [meningitis.org.nz]

  The possible complications of Pneumococcal Meningitis are: Hearing impairment or deafness Vision abnormalities, such as decreased vision or loss of vision Memory-related problems Learning disabilities Intellectual impairment Brain damage and edema Seizures [dovemed.com]

• Neck Pain

  Symptoms of pneumococcal meningitis: Fever, usually high Drowsiness, impaired consciousness Irritability, fussiness, agitation Severe headache Vomiting Stiff neck Pain on moving neck If you suspect meningitis, read m edical emergency. [meningitis.ca]

  This disease takes between two to ten days to show its symptoms, some of which include neck pains, neck stiffness, convulsion and vomiting. [ghana.gov.gh]

  His headache, neck pain, and back pain resolved. Repeat blood cultures were obtained and remained negative for five days. Infectious Disease Service was consulted and recommended eight weeks of intravenous ceftriaxone. [practicalneurology.com]

• Photophobia

  Children and adults classically have a fever, severe headache, photophobia, neck stiffness, vomiting, confusion, delirium, and seizures, while elderly patients may have atypical features like altered mental status and confusion. [symptoma.com]

  The signs and symptoms to watch out for include sudden onset of severe headache, fever, vomiting, neck stiffness and photophobia (dislike for light). Other symptoms include lethargy, coma and convulsions. [pulse.com.gh]

  Recent pneumonia with S pneumoniae Recent upper respiratory infection Spleen removal or a spleen that does not function Symptoms usually come on quickly, and may include: Fever and chills Mental status changes Nausea and vomiting Sensitivity to light ( photophobia [medlineplus.gov]

  Symptoms include: Stiff neck Fever Headache Photophobia (eyes being more sensitive to light) Confusion In babies, meningitis may cause poor eating and drinking, low alertness, and vomiting. Pneumococcal bacteremia is a blood infection. [cdc.gov]

• Headache

  A 61-year-old Japanese woman presented with a headache and appetite loss lasting for nine days and was admitted to our hospital, where she was diagnosed with pneumococcal meningitis associated with acute sphenoid sinusitis. [ncbi.nlm.nih.gov]

• Seizure

  Abstract A 12-month-old girl with occult bacterial meningitis presented with a simple febrile seizure. [ncbi.nlm.nih.gov]

  Seizures are a significant complication because they develop in approximately 30% of patients. Children younger than 1 year are at highest risk, with about 40% affected. Half of patients who develop seizures have more than 1 seizure. [pharmacytimes.com]

• Confusion

  Children and adults classically have a fever, severe headache, photophobia, neck stiffness, vomiting, confusion, delirium, and seizures, while elderly patients may have atypical features like altered mental status and confusion. [symptoma.com]

  Upon admittance, she was considered confused, with a temperature of 39.4 °C and slight neutrophilic leukocytosis, but no neck stiffness. [ncbi.nlm.nih.gov]

  At this point, you would start to experience symptoms like headaches, stiff neck, fever, vomiting, rash, confusion, drowsiness chills, cough, chest pains, and an immediate dislike for bright light. [myjoyonline.com]

• Irritability

  It is imperative to recognize that young infants with bacterial meningitis can present without fever or irritability and manifest signs and symptoms consistent with many other diagnoses. [ncbi.nlm.nih.gov]

  Fever and chills Mental status changes Nausea and vomiting Sensitivity to light ( photophobia ) Severe headache Stiff neck Other symptoms that can occur with this disease: Agitation Bulging fontanelles in infants Decreased consciousness Poor feeding or irritability [medlineplus.gov]

  Other symptoms that may accompany otitis media include sleeplessness, fever and irritability. [meningitis-angels.org]

• Neck Stiffness

  Upon admittance, she was considered confused, with a temperature of 39.4 °C and slight neutrophilic leukocytosis, but no neck stiffness. [ncbi.nlm.nih.gov]

  Neck stiffness is usually seen in a majority of the adults but may be present in only 30% of the children. [symptoma.com]

  Clinical manifestations include fever; headache; neck stiffness; and somnolence followed by seizures; focal neurologic deficits (notably deafness); and coma. [icd9data.com]

  Dr Afreh cited high temperature, fever, headache of sudden onset, neck stiffness, unconsciousness and photo phobia as some of the major symptoms of the disease. [citifmonline.com]

  Neurologic examination showed neck stiffness and right-sided facial nerve palsy. Empirical therapy was started with dexamethasone (10 mg) and penicillin (2 million IU). CT scan of the head showed no abnormalities. [n.neurology.org]

The diagnosis of PM depends on obtaining a detailed medical history, including a history of the patient's immunization status, physical examination, and cerebrospinal fluid (CSF) analysis. Clinically it is difficult to differentiate between bacterial and viral causes of meningitis. During the physical examination, vital signs and a complete neurological assessment should be performed. Neck stiffness is usually seen in a majority of the adults but may be present in only 30% of the children [8] [11]. Although a petechial rash is a common feature of meningococcal meningitis, a majority of patients with other forms of bacterial meningitis also develop a rash within 24 hours of onset of the initial symptoms [1] [2]. There may be evidence of a primary source of infection e.g. otitis media, sinusitis, or pneumonia. Meningeal signs and papilledema can be noted in most of the patients while babies may have a bulging anterior fontanel indicative of raised intracranial pressure.

A computed tomogram of the head should be performed prior to lumbar puncture in cases with neurological deficits, papilledema, and altered sensorium to exclude intracranial abscesses, tumors, or edema [9]. Magnetic resonance imaging (MRI) is performed to diagnose complications associated with the condition and findings include brain infarction, cerebral edema, and hydrocephalus in cases of PM [9].

CSF analysis helps to differentiate between bacterial and viral etiology while CSF culture detects the causative bacteria. Typically in bacterial meningitis, the CSF pressure is elevated with polymorphonuclear leukocytosis, and reduced glucose levels relative to the serum glucose. Inflammatory markers such as serum C-reactive protein (CRP) levels are elevated in bacterial meningitis [8]. Polymerase chain reaction (PCR) test can be performed, if available, as it is more sensitive than microbiological tests in detecting bacterial versus viral DNA. It is also useful in diagnosing a bacterial cause of meningitis in patients who have been treated with antibiotics [12].

• Cerebrospinal Fluid Abnormality

  Cerebrospinal fluid abnormalities in bacterial meningitis include a markedly increased opening pressure (>180 mm H 2 O), increased presence of white blood cells (normal: 0-5 lymphocytes/ mm 3, bacterial meningitis: 10 - 10,000 WBCs/mm 3 with polymorphonuclear [path.upmc.edu]

• Hyponatremia

  Its delayed diagnosis may be associated with hyponatremia and hypernatremia with fatal outcome. A previously healthy nine-month-old Bangladeshi female infant was diagnosed with diarrhea, pneumonia, and convulsion due to hypernatremia. [ncbi.nlm.nih.gov]

  […] isolate displays a minimum inhibitory concentration to cefotaxime/ceftriaxone of 4 mcg/mL or greater Meropenem, chloramphenicol, or a fluoroquinolone is a possible alternative In the acute phase, patients may experience hypotension or shock, hypoxemia, hyponatremia [pharmacytimes.com]

• Hyperglycemia

  CSF glucose values are normally 50-70% of blood glucose values, therefore, use of a CSF/serum glucose ratio can correct for a decreased CSF glucose value masked by hyperglycemia. [path.upmc.edu]

  The primary outcome was the score on the Glasgow Outcome Scale 8 weeks after presentation; secondary outcomes included death, focal neurologic deficits, hearing loss, gastrointestinal bleeding, and hyperglycemia. [clevelandclinicmeded.com]

• Leukocytosis

  Upon admittance, she was considered confused, with a temperature of 39.4 °C and slight neutrophilic leukocytosis, but no neck stiffness. [ncbi.nlm.nih.gov]

  Typically in bacterial meningitis, the CSF pressure is elevated with polymorphonuclear leukocytosis, and reduced glucose levels relative to the serum glucose. [symptoma.com]

  He was found to have leukocytosis (WBC = 12,600/μL, 86% neutrophils). Physical exam was remarkable for tenderness of the lumbar spine. [practicalneurology.com]

  […] with pneumococcal pneumonia experience the acute onset of fever and productive cough,(33) whereas symptoms due to PCP commonly last more than 1 month.(34) In most patients with HIV-1 disease and pneumonia, the complete blood cell count shows a relative leukocytosis [hivinsite.ucsf.edu]

New guidelines for the treatment of meningitis in Israel are suggested. [ncbi.nlm.nih.gov]

Paraplegia is rare in sickle cell disease and the prognosis is not always poor. [ncbi.nlm.nih.gov]

(Outcomes/Resolutions) The prognosis of Pneumococcal Meningitis depends on how quickly the treatment is administered Even with prompt diagnosis and treatment, around 50% of the affected individuals develop long-term health issues Pneumococcal Meningitis [dovemed.com]

Studies including serum levels of immunoglobulin and complements, brain magnetic resonance imaging, and coronal cranial computed tomography (CT) were negative for a specific etiology. [ncbi.nlm.nih.gov]

CSF analysis helps to differentiate between bacterial and viral etiology while CSF culture detects the causative bacteria. [symptoma.com]

(Etiology) Pneumococcal Meningitis is caused by the bacteria Streptococcus pneumoniae S. Pnemoniae is found in the nose and throat of about 5-10% of healthy adults and in about 20-40% of healthy children. [dovemed.com]

The department is conducting laboratory surveillance for bacterial etiology of meningitis since 1993 [10], [11], [26] – [28]. [journals.plos.org]

It is important to maintain epidemiological surveillance to assess the impact of immunization in Argentina. [ncbi.nlm.nih.gov]

: Epidemiology of invasive pneumococcal infections in children in Finland. JAMA 1992, 268 :3323–3327. PubMed CrossRef Google Scholar 4. Dagan R, Englehard D, Piccard E, et al. : Epidemiology of invasive childhood pneumococcal infections in Israel. [link.springer.com]

This review discusses the most recent views on the pathophysiology of pneumococcal meningitis, as well as potential targets for (adjunctive) therapy. [ncbi.nlm.nih.gov]

Center, Seattle, Washington, 98195 Specialized Center of Research-Pulmonary Diseases, University of Washington, Seattle, Washington 98195 Find articles by Beaty, H. in: JCI | PubMed | Google Scholar First published July 1, 1974 - More info Abstract Pathophysiological [jci.org]

: Differences in pathophysiology in experimental meningitis caused by three strains of Streptococcus pneumoniae. J Infect Dis 1991, 163 :806–811. PubMed Google Scholar 17. [link.springer.com]

Pathophysiology of bacterial meningitis: mechanism(s) of neuronal injury. J Infect Dis 2002 ; 186 Suppl 2: S225 –33. Schuchat A, Robinson K, Wenger JK, Harrison LH, Farley M, Reingold Al, et al. Bacterial meningitis in the United States in 1995. [brain.oxfordjournals.org]

Meanwhile, here are five steps which can help prevent Pneumococcal Meningitis: 1. You must avoid overcrowded areas, drink enough water to prevent dryness of the throat, prevent cough and sneezing etiquettes. [pulse.com.gh]

Guidelines for prevention are also reviewed, including a renewed call for utilization of the 23-valent pneumococcal vaccine. [ncbi.nlm.nih.gov]

What is the best way to prevent pneumococcal disease? The single best way to prevent this disease is to be vaccinated. Children should be vaccinated with a pneumococcal conjugate vaccine (PCV13) at 2, 4, and 6 months. [health.ny.gov]

It, therefore, behooves on the individual to be eager to know more about the disease in order to prevent it-for, after all, prevention is better than cure. [ghana.gov.gh]

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