Bacterial meningitis is a potentially life-threatening condition caused by a myriad of pathogens. Staphylococcus aureus, a gram-positive bacteria that is responsible for many types of diseases, is rarely described in patients with meningitis. However, it may develop as a community-acquired (CA) infection with a primary source outside of the central nervous system -CNS (skin, soft tissues, heart valves, or bacteremia) [1] [2], or as a nosocomial infection, with head trauma and associated neurosurgical procedures (craniotomy, use of ventricular catheters, intrathecal administration of drugs or infusions, cerebrospinal fluid leakage, etc.) serving as risk factors for the introduction of pathogens in the CNS [1] [3] [4]. In a small number of cases, additional comorbidities, eg. diabetes mellitus, intravenous drug use, and severe alcohol abuse are noticed, possibly contributing to the pathogenesis [1] [3] [5]. Several studies have confirmed that fever is almost universally present in people suffering from Staphylococcus aureus meningitis (SAM), whereas symptoms related to meningeal irritation, such as headaches and nuchal rigidity are not always reported [1] [3] [5]. Furthermore, altered consciousness (ranging from mild alterations in the mental state to coma) and seizures, as well as other focal neurological deficits, vomiting, and a rash are observed in patients who developed SAM [1] [3] [5].

• Fever

  Fever is the main symptom, whereas headaches, vomiting, seizures, nuchal rigidity and altered consciousness are reported in a variable number of cases. [symptoma.com]

  If patient complains of headache and fever after epidural PCA, physician should perform cerebrospinal fluid study to rule out bacterial meningitis. [e-jnc.org]

  At admission, more than 75% of the patients had fever, nuchal rigidity and decreased consciousness. In 57% of cases the focus for the S. aureus infection was endocarditis, pneumonia or skin infections. [ncbi.nlm.nih.gov]

  MM 276-282; ID 1107-1124 ACUTE BACTERIAL MENINGITIS NAME OF DISEASE : Purulent meningitis Bacterial meningitis Epidemic cerebrospinal meningitis Cerebrospinal fever Spotted fever Sleeping Baby Jesus Syndrome ETIOLOGICAL AGENT : "Normal" Adults (6-21 yrs [atsu.edu]

  […] primary purulent infection, systemic infection symptoms, chills and fever, with persistent and severe headache, neck stiffness is more obvious than general meningitis, except for meningeal In addition to symptoms of inflammation, there are localized [healthfrom.com]

• Malaise

  Malaise d. Headache (cephalgia) e. Myalgia 2. Increased intracranial pressure, manifestations of which are: a. Headache b. Vomiting c. Eye effects d. Papilledema (late) e. [atsu.edu]

  […] hospital settings; surface infections include impetigo, folliculitis, abscesses, boils, infected lacerations; deep infections include endocarditis, meningitis, septic arthritis, pneumonia, osteomyelitis; systemic infection may cause fever, headache malaise [msdsonline.com]

  Patient's mother stated he was doing well until early morning when he complained of malaise, fever and headache. Physical examination was positive for temperature of 40.5°C. Other vital signs were normal. [ijcasereportsandimages.com]

  CLINICAL SYMPTOMS: 1- Infectious manifestations: - Chills - Headache - Fever - Myalgia - Malaise 2- Increased intracranial pressure, manifested as - Headache - lethargy - Vomiting -- Papilledema - Unilateral or bilateral 6th nerve palsy, 3- Meningeal [slideshare.net]

  Bacteremia may be characterized by one of more of the following symptoms: fever, chills, malaise, abdominal pain, nausea, vomiting, diarrhea, anxiety, shortness of breath, and confusion. Bacteremia is diagnosed by culturing blood for bacteria. [microbewiki.kenyon.edu]

• Chills

  […] primary purulent infection, systemic infection symptoms, chills and fever, with persistent and severe headache, neck stiffness is more obvious than general meningitis, except for meningeal In addition to symptoms of inflammation, there are localized [healthfrom.com]

  The signature symptoms of meningitis include a severe headache and stiff neck – which, in extreme cases, can cause sufferers to arch backwards – as well as fevers and chills, nausea, sensitivity to light and sound, and sometimes purple or red splotches [giantmicrobes.com]

  She suffered severe, debilitating pain down her leg, vomiting, headache, fever, chills, lethargy and convulsions but was originally diagnosed with sciatica. She tells her story here. [meningitisnow.org]

  Chills accompanying fevers are especially suspicious. Many patients with Pneumonia will also cough up sputum produced by the alveoli. Pneumonia is diagnosed through symptoms and a chest examination. [microbewiki.kenyon.edu]

  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 may come on quickly, and include: Fever and chills Mental status changes Nausea [medlineplus.gov]

• High Fever

  You should get medical care right away if you have A sudden high fever A severe headache A stiff neck Nausea or vomiting Early treatment can help prevent serious problems, including death. [icdlist.com]

  Seek medical care right away if someone has any of these signs or symptoms: Sudden high fever Sudden severe headache Stiff neck that's related to a headache Confusion or seizures Sleepiness or difficulty waking up Sensitivity to light Risk factors Several [columbianeurology.org]

  […] susceptible to scalded skin syndrome (SSS) caused by exfoliative toxins; my be colonized during delivery resulting in sepsis meningitis; toxic shock syndrome is an acute multi-system illness caused by TSST-1 a super antigen; characterized by sudden onset, high [msdsonline.com]

  When produced in large quantities, this toxin can enter the blood stream and cause high fever, vomiting, diarrhea, headache, rash, sore throat, and body aches. [microbewiki.kenyon.edu]

• Epilepsy

  […] elsewhere classified Approximate Synonyms Meningitis, staphylococcal ICD-10-CM G00.3 is grouped within Diagnostic Related Group(s) (MS-DRG v 36.0): 023 Craniotomy with major device implant or acute complex cns pdx with mcc or chemotherapy implant or epilepsy [icd10data.com]

  Experimental models for bloodCNSbarrier observations The best-studied system so far is a human brain microvascular endo-thelial cell line (HBMEC) that has been derived from a brain biopsy of an adult female with epilepsy. [alpfmedical.info]

• Vomiting

  Fever is the main symptom, whereas headaches, vomiting, seizures, nuchal rigidity and altered consciousness are reported in a variable number of cases. [symptoma.com]

  She suffered severe, debilitating pain down her leg, vomiting, headache, fever, chills, lethargy and convulsions but was originally diagnosed with sciatica. She tells her story here. [meningitisnow.org]

  Vomiting c. Eye effects d. Papilledema (late) e. [atsu.edu]

  CLINICAL SYMPTOMS: 1- Infectious manifestations: - Chills - Headache - Fever - Myalgia - Malaise 2- Increased intracranial pressure, manifested as - Headache - lethargy - Vomiting -- Papilledema - Unilateral or bilateral 6th nerve palsy, 3- Meningeal [slideshare.net]

  […] produces a variety of syndromes with a range of clinical manifestations; clinically different in general community, newborns, menstruating women, and hospitalized patients; food intoxication is characterized by abrupt/violent onset, severe nausea, cramps, vomiting [msdsonline.com]

• Nausea

  The signature symptoms of meningitis include a severe headache and stiff neck – which, in extreme cases, can cause sufferers to arch backwards – as well as fevers and chills, nausea, sensitivity to light and sound, and sometimes purple or red splotches [giantmicrobes.com]

  You should get medical care right away if you have A sudden high fever A severe headache A stiff neck Nausea or vomiting Early treatment can help prevent serious problems, including death. [icdlist.com]

  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 may come on quickly, and include: Fever and chills Mental status changes Nausea [medlineplus.gov]

  […] normal flora; produces a variety of syndromes with a range of clinical manifestations; clinically different in general community, newborns, menstruating women, and hospitalized patients; food intoxication is characterized by abrupt/violent onset, severe nausea [msdsonline.com]

• Tachycardia

  Ferri's popular "5 books in 1" format provides quick guidance on vitamin-D deficiency, statin-induced muscle syndrome, postural tachycardia syndrome (POTS), and much more. [books.google.com]

  […] mycobacterial infection A312Disseminated mycobacterium avium-intracellulare complex (DMAC) A318Other mycobacterial infections A319Mycobacterial infection, unspecified PDX Collection 0083:18 codes A33Tetanus neonatorum P290Neonatal cardiac failure P2911Neonatal tachycardia [cms.gov]

  Initial physical examination was remarkable for tachycardia of 123 bpm and temperature of 38°C. No meningeal signs or focal deficits were found on the initial presentation. The remaining physical examination was unremarkable. [ijcasereportsandimages.com]

  Shock: signs of shock include tachycardia and/or hypotension, respiratory distress, altered mental state and poor urine output. Kernig's sign (pain and resistance on passive knee extension with hips fully flexed). [patient.info]

• Photophobia

  […] valves Past infection of the brain Past meningitis due to spinal fluid shunts Recent brain surgery Spinal fluid shunt Trauma Symptoms may come on quickly, and include: Fever and chills Mental status changes Nausea and vomiting Sensitivity to light ( photophobia [medlineplus.gov]

  Photophobia and a general hyperesthesia to all forms of stimuli are present. Venous congestion of the ocular fundi is common. [atsu.edu]

  Stiff neck (generally not present in children under the age of one year or in patients with altered mental state), back rigidity, bulging fontanelle (in infants), photophobia, opisthotonus (if severe). [patient.info]

  Eye affects: - Photophobia - Venous congestion of ocular fundi - Unequal pupils, Pupil dilation - Sluggish reaction to light. 6. [slideshare.net]

• Diplopia

  Diplopia I. Papilledema 6. Mentation a. Delirium b. Drowsiness c. Stupor d. Coma The infant with meningitis may have signs of infection but more commonly is simply fretful and refuses food. [atsu.edu]

• Headache

  Fever is the main symptom, whereas headaches, vomiting, seizures, nuchal rigidity and altered consciousness are reported in a variable number of cases. [symptoma.com]

  If patient complains of headache and fever after epidural PCA, physician should perform cerebrospinal fluid study to rule out bacterial meningitis. [e-jnc.org]

  Volume 1 covers the visual sensory system, the autonomic nervous system, the ocular motor system, the eyelid, facial pain and headache, and nonorganic disease. Volume 2 covers tumors, the phacomatoses, and vascular disease. [books.google.es]

  Most patients had fever (89%), altered mental status (68%), headache (40%), and meningeal signs (29%). The most common CSF findings were pleocytosis (90%), elevated protein level (77%), and hypoglycorrhachia (30%). [ncbi.nlm.nih.gov]

• Seizure

  Fever is the main symptom, whereas headaches, vomiting, seizures, nuchal rigidity and altered consciousness are reported in a variable number of cases. [symptoma.com]

  Seizures: occur more commonly during the acute stage of the disease. [patient.info]

  […] cerebral blood vessels, spinal cord and nerve roots; causative organism varies with age and clinical status (eg, postoperative, immunodeficient, posttraumatic states); clinical manifestations include the acute onset of fever, stiff neck, altered mentation, seizures [fpnotebook.com]

  If patients have focal neurologic deficits, obtundation, seizures, or papilledema (suggesting increased ICP or an intracranial mass effect), defer lumbar puncture pending results of neuroimaging. [merckmanuals.com]

  Patients may present with cranial nerve palsies, seizures, and visual loss as a result of increased intracranial pressure. [ahcmedia.com]

• Irritability

  The picture was that of a predominantly spinal, rather than cerebral, irritation. [scielo.br]

  Several studies have confirmed that fever is almost universally present in people suffering from Staphylococcus aureus meningitis (SAM), whereas symptoms related to meningeal irritation, such as headaches and nuchal rigidity are not always reported. [symptoma.com]

  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 alertness Poor feeding or irritability [medlineplus.gov]

  Symptom Staphylococcus aureus meningitis symptoms common symptoms chills meningeal irritation purulent neck neck scarlet fever-like skin rash meningitis encephalitis-like changes Onset is not very urgent, often occurs in the first few days or weeks after [healthfrom.com]

  In the critical evaluation of case reports of meningitis one has to recognize that pleocytosis and symptoms of meningeal irritation may exist without actual bacterial infection of the cerebrospinal [jamanetwork.com]

• Focal Neurological Deficit

  Furthermore, altered consciousness (ranging from mild alterations in the mental state to coma) and seizures, as well as other focal neurological deficits, vomiting, and a rash are observed in patients who developed SAM. [symptoma.com]

  The initial negative finding on CT scan and the absence of focal neurological deficit contributed to the delay in the diagnosis of brain abscess. [ijcasereportsandimages.com]

  neurologic deficits; death may occur within 24 hours of disease onset; pathologic features include a purulent exudate in the subarachnoid space, and diffuse inflammation of neural and vascular structures. [fpnotebook.com]

  Neurology consult. This assists in determining the level of coma and finding if there are focal neurological deficits. Infectious disease consult. [infectiousdiseaseadvisor.com]

  Paresis, focal neurological deficits (including cranial nerve involvement and abnormal pupils). Seizures. [patient.info]

• Neck Stiffness

  […] associated with bacterial meningitis, such as neck stiffness, photophobia, and vomiting. 2 The elderly more frequently present with altered mental status and focal neurologic deficits, and less often have headache and neck stiffness. 2 In HIV-positive [ahcmedia.com]

  Stiff neck (generally not present in children under the age of one year or in patients with altered mental state), back rigidity, bulging fontanelle (in infants), photophobia, opisthotonus (if severe). [patient.info]

  […] primary purulent infection, systemic infection symptoms, chills and fever, with persistent and severe headache, neck stiffness is more obvious than general meningitis, except for meningeal In addition to symptoms of inflammation, there are localized [healthfrom.com]

  She had neck stiffness with right-sided hemiparesis with left-sided upper motor neuron facial nerve palsy and bladder incontinence. Deep tendon reflexes were brisk bilaterally. She was drowsy but arousable. Other systems were normal. [academic.oup.com]

Mortality rates of Staphylococcus aureus meningitis are about 35% according to different case series [1] [5], suggesting that an early diagnosis and proper treatment can be life-saving. For this reason, the role of the physician in obtaining a detailed history and conducting a thorough physical examination is crucial. During collection of anamnestic data, recent trauma to the head and neck area or neurosurgical procedures can point to S. aureus as the underlying etiology. The presumptive diagnosis of meningitis can be made after conducting a proper neurological examination and the evaluation of meningeal signs, but they may be positive in only 29% cases [5], which is why laboratory studies need to be employed. Examination of the cerebrospinal fluid (CSF) is a vital step that aids in discriminating the etiologic factors of CNS diseases [6]. In bacterial meningitis, typical findings are pleocytosis (with a predominance of polymorphonuclear leukocytes), elevated protein levels, and very low concentrations of sugar (hypoglycorrhachia) [6]. Serum inflammatory parameters: C-reactive protein (CRP) and calcitonin are important markers of an ongoing inflammatory process caused by bacteria, but microbiological exams must be used in order to identify the exact pathogen [6]. The culture of CSF, Gram-staining (useful for culture-negative meningitis as it provides fast results), latex agglutination tests, and polymerase chain reaction (PCR), which detects bacterial DNA in the CSF, are constituents of the microbiological workup [6] [7]. Blood cultures may also provide important information in the presence of a systemic infection [6].

• Hyperglycemia

  Initial laboratory work up was positive for mild hyperglycemia with blood sugar 143 mg/dL, Na 132 mEq/dL and neutrophilia 92% with WBC count 11x10 3 /mm 3. [ijcasereportsandimages.com]

  View Article PubMed Google Scholar Capes SE, Hunt D, Malmberg K, Pathak P, Gerstein HC: Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients: a systematic overview. Stroke. 2001, 32: 2426-2432. [bmcinfectdis.biomedcentral.com]

We conclude that flucloxacillin is an effective treatment for meningitis caused by S. aureus. [ncbi.nlm.nih.gov]

Treatment Staphylococcal meningitis treatment treatment overview Treatment: drug treatment supportive treatment Treatment cycle: 1 month Cure rate: 70% (a) treatment Since S. aureus is resistant to many antibiotics and meningitis is a serious infection [healthfrom.com]

The prognosis was related to the age of the patients and the initial antibiotic treatment. Patients treated with penicillinase-stable penicillins in combination with fusidic acid may have a better prognosis. [ncbi.nlm.nih.gov]

As to termination, he stated that these cases run a "short course and the prognosis is almost entirely unfavorable." [jamanetwork.com]

Prognosis Meningitis kills more UK children under the age of 5 than any other infectious disease. [ 2 ] Prognosis depends on the pathogen, the patient's age and condition and the severity of acute illness. [patient.info]

Examination of the cerebrospinal fluid (CSF) is a vital step that aids in discriminating the etiologic factors of CNS diseases. [symptoma.com]

Use Additional Use Additional Help Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10data.com]

1 Etiological agents include viruses, bacteria, fungi and parasites. [nature.com]

In cases with a negative CSF culture, a positive blood culture with S. aureus associated with a CSF leukocyte count ³ 100 cells/mm3 with > 50 percent neutrophils was considered indicative of S. aureus as the etiologic agent. [scielo.br]

MM 276-282; ID 1107-1124 ACUTE BACTERIAL MENINGITIS NAME OF DISEASE : Purulent meningitis Bacterial meningitis Epidemic cerebrospinal meningitis Cerebrospinal fever Spotted fever Sleeping Baby Jesus Syndrome ETIOLOGICAL AGENT : "Normal" Adults (6-21 yrs [atsu.edu]

The epidemiology, microbiological findings and treatment of this condition are discussed. [ncbi.nlm.nih.gov]

The second section deals with epidemiology, and the third section provides an overview of the varied clinical manifestations of human staphylococcal infections. [books.google.com]

Bacterial meningitis: Pathogenesis, pathophysiology, and progress. N Engl J Med, 327 (1992), pp. 864-869 [19.] A.R. Tunkel, W.M. Scheld. Pathogenesis and pathophysiology of bacterial meningitis. Ann Rev Med, 44 (1993), pp. 103-109 [20.] A.R. [elsevier.es]

“New understandings on the pathophysiology of bacterial meningitis”. Curr Opin Infect Dis. vol. 23. 2010. pp. 217-23. Kim, BJ, Hancock, BM, Bermudez, A, Del Cid, N. “Bacterial induction of Snail1 contributes to blood-brain barrier disruption”. [infectiousdiseaseadvisor.com]

Pathophysiology and clinical presentation Specific features may suggest the aetiology of meningitis. A diffuse maculopapular eruption, which progresses to include petechiae or frank purpura, accompanies 50-60 of cases of meningococcal meningitis. [alpfmedical.info]

Written by internationally recognized experts—many affiliated with the Centers for Disease Control and Prevention—the book is the most comprehensive, up-to-date, authoritative guide to the recognition, management, prevention, and control of infections [books.google.es]

Centers for Disease Control and Prevention. Hib Vaccines. Vaccines.gov. Listeria: Prevention. Centers for Disease Control and Prevention. August 3, 2017. Meningococcal Disease. Centers for Disease Control and Prevention. February 2, 2018. [everydayhealth.com]

There are vaccines to prevent some of the bacterial infections that cause meningitis. [icdlist.com]

Long-term prevention of golden staph Worldwide measures need to be taken to prevent new resistant strains of S. aureus from emerging. [betterhealth.vic.gov.au]

1. Pedersen M, Benfield TL, Skinhoej P, Jensen AG. Haematogenous Staphylococcus aureus meningitis. A 10-year nationwide study of 96 consecutive cases. BMC Infect Dis. 2006;6:49.
2. Pereira NMD, Shah I, Ohri A, Shah F. Methicillin resistant Staphylococcus aureus meningitis. Oxf Med Case Reports. 2015;2015(11):364-366.
3. Chang WN, Lu CH, Huang CR, et al. Epidemiology of adult staphylococcal meningitis in southern Taiwan: a clinical comparison of Staphylococcus aureus infection and coagulase-negative staphylococcal infection. Jpn J Infect Dis. 2007;60(5):262-266.
4. Kim HB. Nosocomial Meningitis: Moving beyond Description to Prevention. Korean J Intern Med. 2012;27(2):154-155.
5. Pintado V, Pazos R, Jiménez-Mejías ME, et al. Methicillin-resistant Staphylococcus aureus meningitis in adults: a multicenter study of 86 cases. Medicine (Baltimore). 2012;91(1):10-17.
6. Brouwer MC, Tunkel AR, van de Beek D. Epidemiology, Diagnosis, and Antimicrobial Treatment of Acute Bacterial Meningitis. Clin Microbiol Rev. 2010;23(3):467-492.
7. Tunkel AR, Hartman BJ, Kaplan SL, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis. 2004;39(9):1267-1284.