Bacterial meningitisBacterial meningitis

IntroductionIntroduction Bacterial meningitis is an inflammation of the Bacterial meningitis is an inflammation of the

leptomenings, usually causing by bacterial infleptomenings, usually causing by bacterial infection.ection.

Bacterial meningitis may present acutely (symBacterial meningitis may present acutely (symptoms evolving rapidly over 1-24 hours), subaptoms evolving rapidly over 1-24 hours), subacutely (symptoms evolving over 1-7days), or ccutely (symptoms evolving over 1-7days), or chronically (symptoms evolving over more thahronically (symptoms evolving over more than 1 week).n 1 week).

IntroductionIntroduction Annual incidence in the developed countries is Annual incidence in the developed countries is

approximately 5-10 per 100000approximately 5-10 per 100000. .

30000 infants and children develop bacterial 30000 infants and children develop bacterial

meningitis in United States each year. meningitis in United States each year.

Approximately 90 per cent of cases occur in Approximately 90 per cent of cases occur in

children during the first 5 years of life.children during the first 5 years of life.

IntroductionIntroduction Cases under age 2 years account for almost Cases under age 2 years account for almost

75% of all cases and incidence is the highest in 75% of all cases and incidence is the highest in

early childhood at age 6-12 months than in early childhood at age 6-12 months than in

any other period of life.any other period of life.

There are significant difference in the There are significant difference in the

incidence of bacterial meningitis by season.incidence of bacterial meningitis by season.

EtiologyEtiology Causative organisms vary with patient age, with Causative organisms vary with patient age, with

three bacteria accounting for over three-quarterthree bacteria accounting for over three-quarter

s of all cases:s of all cases: Neisseria meningitidis (meningococcus)Neisseria meningitidis (meningococcus)

Haemophilus influenzae (if very young and unvaccinHaemophilus influenzae (if very young and unvaccin

ated)ated)

Streptococcus pneumoniae ( pneumococcus)Streptococcus pneumoniae ( pneumococcus)

EtiologyEtiology Other organisms Other organisms

Neonates and infants at age 2-3 months Neonates and infants at age 2-3 months Escherichia coliEscherichia coli B-haemolytic streptococciB-haemolytic streptococci

Staphylococcus aureusStaphylococcus aureus StaphylococcusStaphylococcus epidermidis epidermidis Listeria monocytogenesListeria monocytogenes

EtiologyEtiology Elderly and immunocompromisedElderly and immunocompromised

Listeria monocytogenesListeria monocytogenes

Gram negative bacteriaGram negative bacteria

Hospital-acquired infectionsHospital-acquired infections KlebsiellaKlebsiella

Escherichia coliEscherichia coli

PseudomonasPseudomonas

Staphylococcus aureusStaphylococcus aureus

EtiologyEtiology The most common organisms The most common organisms

Neonates and infants under the age of 2monthsNeonates and infants under the age of 2months Escherichia coli Escherichia coli

Pseudomonas Pseudomonas

Group B StreptococcusGroup B Streptococcus

Staphylococcus aureusStaphylococcus aureus

EtiologyEtiology Children over 2 monthsChildren over 2 months

Haemophilus influenzae type bHaemophilus influenzae type b

Neisseria meningitidisNeisseria meningitidis

Streptococcus pneumoniaeStreptococcus pneumoniae

Children over 12 yearsChildren over 12 years Neisseria meningitidisNeisseria meningitidis

Streptococcus pneumoniaeStreptococcus pneumoniae

EtiologyEtiology Major routes of leptomening infectionMajor routes of leptomening infection

Bacteria are mainly from blood.Bacteria are mainly from blood.

Uncommonly, meningitis occurs by direct extenUncommonly, meningitis occurs by direct exten

sion from nearly focus (mastoiditis, sinusitis) or sion from nearly focus (mastoiditis, sinusitis) or

by direct invasion (dermoid sinus tract, head trby direct invasion (dermoid sinus tract, head tr

auma, meningo-myelocele).auma, meningo-myelocele).

PathogenesisPathogenesis Susceptibility of Susceptibility of bacterial infection on CNSbacterial infection on CNS in in

the children the children Immaturity of immune systemsImmaturity of immune systems

Nonspecific immuneNonspecific immune Insufficient barrierInsufficient barrier ( (Blood-brain barrierBlood-brain barrier)) Insufficient complement activityInsufficient complement activity Insufficient chemotaxis of neutrophilsInsufficient chemotaxis of neutrophils Insufficient function of monocyte-macrophage systemInsufficient function of monocyte-macrophage system Blood levels of diminished interferon (INF) -γand inteBlood levels of diminished interferon (INF) -γand inte

rleukin -8 ( IL-8 ) rleukin -8 ( IL-8 )

PathogenesisPathogenesis Susceptibility of bacterial infection on CNS in thSusceptibility of bacterial infection on CNS in th

e childrene children Specific immuneSpecific immune

Immaturity of both the cellular and humoral immune systImmaturity of both the cellular and humoral immune systemsems

Insufficient antibody-mediated protectionInsufficient antibody-mediated protection Diminished immunologic responseDiminished immunologic response

Bacterial virulence Bacterial virulence

PathogenesisPathogenesis A offending bacterium from blood invades the leptoA offending bacterium from blood invades the lepto

meninges. meninges. Bacterial toxics and Inflammatory mediators are releBacterial toxics and Inflammatory mediators are rele

ased.ased. Bacterial toxicsBacterial toxics

Lipopolysaccharide, LPSLipopolysaccharide, LPS Teichoic acidTeichoic acid Peptidoglycan Peptidoglycan

Inflammatory mediatorsInflammatory mediators Tumor necrosis factor, TNFTumor necrosis factor, TNF Interleukin-1, IL-1Interleukin-1, IL-1 Prostaglandin E2, PGE2Prostaglandin E2, PGE2

PathogenesisPathogenesis Bacterial toxics and inflammatory mediators Bacterial toxics and inflammatory mediators

cause suppurative inflammation.cause suppurative inflammation. Inflammatory infiltrationInflammatory infiltration

Vascular permeability alterVascular permeability alter

Tissue edema Tissue edema

Blood-brain barrierBlood-brain barrier detroydetroy

Thrombosis Thrombosis

PathologyPathology Diffuse bacterial infections involve the leptomeninges, arDiffuse bacterial infections involve the leptomeninges, ar

achnoid membrane and superficial cortical structures, anachnoid membrane and superficial cortical structures, and brain parenchyma is also inflamed.d brain parenchyma is also inflamed.

Meningeal exudate of varying thickness is found.Meningeal exudate of varying thickness is found. There is purulent material around veins and venous sinusThere is purulent material around veins and venous sinus

es, over the convexity of the brain, in the depths of the sules, over the convexity of the brain, in the depths of the sulci, within the basal cisterns, and around the cerebellum, ci, within the basal cisterns, and around the cerebellum, and spinal cord may be encased in pus.and spinal cord may be encased in pus.

Ventriculitis (purulent material within the ventricles) has Ventriculitis (purulent material within the ventricles) has been observed repeatedly in children who have died of thbeen observed repeatedly in children who have died of their disease.eir disease.

PathologyPathology Invasion of the ventricular wall with perivascular cInvasion of the ventricular wall with perivascular c

ollections of purulent material, loss of ependymal liollections of purulent material, loss of ependymal li

ning, and subependymal gliosis mayning, and subependymal gliosis may be noted. be noted.

Subdural empyema may occur.Subdural empyema may occur.

Hydrocephalus is an common complication of meniHydrocephalus is an common complication of meni

ngitis.ngitis. Obstructive hydrocephalus Obstructive hydrocephalus

Communicating hydrocephalusCommunicating hydrocephalus

PathologyPathology Blood vessel walls may infiltrated by inflammatory cells.Blood vessel walls may infiltrated by inflammatory cells.

Endothelial cell injuryEndothelial cell injury

Vessel stenosisVessel stenosis

Secondary ischemia and infarctionSecondary ischemia and infarction

Ventricle dilatationVentricle dilatation which ensues may be associated with which ensues may be associated with

necrosis of cerebral tissue due to the inflammatory procenecrosis of cerebral tissue due to the inflammatory proce

ss itself or to occlusion of cerebral veins or arteries.ss itself or to occlusion of cerebral veins or arteries.

PathologyPathology Inflammatory process may result in cerebral edemInflammatory process may result in cerebral edem

a and damage of the cerebral cortex.a and damage of the cerebral cortex. Conscious disturbanceConscious disturbance ConvulsionConvulsion Motor disturbance Motor disturbance Sensory disturbanceSensory disturbance

Meningeal irritation sign is foundMeningeal irritation sign is found because the spinbecause the spinal nerve root is irritated.al nerve root is irritated.

Cranial nerve may be damagedCranial nerve may be damaged

Clinical manifestationClinical manifestation Bacterial meningitis may present acutely (symptoms evoBacterial meningitis may present acutely (symptoms evo

lving rapidly over 1-24 hours) in most cases.lving rapidly over 1-24 hours) in most cases.

Symptoms and signs of upper respiratory or gastrointesSymptoms and signs of upper respiratory or gastrointes

tinal infection are found before several days when the cltinal infection are found before several days when the cl

nical manifestations of bacterial meningitis happen.nical manifestations of bacterial meningitis happen.

Some patients may access suddenly with shock and DIC.Some patients may access suddenly with shock and DIC.

Clinical manifestationClinical manifestation Toxic symptom all over the bodyToxic symptom all over the body

HyperpyrexiaHyperpyrexia HeadacheHeadache PhotophobiaPhotophobia Painful eye movementPainful eye movement Fatigued and weak Fatigued and weak Malaise, myalgia, anorexia, Malaise, myalgia, anorexia, Vomiting, diarrhea and abdominal painVomiting, diarrhea and abdominal pain Cutaneous rashCutaneous rash Petechiae, purpuraPetechiae, purpura

Clinical manifestationClinical manifestation Clinical manifestation of CNSClinical manifestation of CNS

Increased intracranial pressureIncreased intracranial pressure HeadacheHeadache Projectile vomiting Projectile vomiting Hypertension Hypertension Bradycardia Bradycardia Bulging fontanel Bulging fontanel Cranial sutures diastasisCranial sutures diastasis Coma Coma Decerebrate rigidity Decerebrate rigidity Cerebral herniaCerebral hernia

Clinical manifestationClinical manifestation Clinical manifestation of CNSClinical manifestation of CNS

SeizuresSeizures Seizures occur in about 20%-30% of children witSeizures occur in about 20%-30% of children wit

h bacterial meningitis.h bacterial meningitis. Seizures is often found in haemophilus influenzae Seizures is often found in haemophilus influenzae

and pneumococal infection.and pneumococal infection. SeizuresSeizures is correlative with the inflammation of bra is correlative with the inflammation of bra

in parenchyma, cerbral infarction and electrolyte in parenchyma, cerbral infarction and electrolyte disturbances.disturbances.

Clinical manifestationClinical manifestation Clinical manifestation of CNSClinical manifestation of CNS

Conscious disturbanceConscious disturbance DrowsinessDrowsiness

Clouding of consciousness Clouding of consciousness ComaComa PsychiatricPsychiatric symptomsymptom

Irritation Irritation Dysphoria Dysphoria dullnessdullness

Clinical manifestationClinical manifestation

Clinical manifestation of CNSClinical manifestation of CNS

Meningeal irritation signMeningeal irritation sign

Neck stiffnessNeck stiffness

Positive Kernig’s signPositive Kernig’s sign

Positive Brudzinski’s signPositive Brudzinski’s sign

Clinical manifestationClinical manifestation Clinical manifestation of CNSClinical manifestation of CNS

Transient or permanent paralysis of cranial Transient or permanent paralysis of cranial nerves and limbs may be noted. nerves and limbs may be noted.

Deafness or disturbances in vestibular function Deafness or disturbances in vestibular function are relatively common.are relatively common.

Involvement of the optic nerve, with blindness, is Involvement of the optic nerve, with blindness, is rare. rare.

Paralysis of the 6Paralysis of the 6thth cranial nerve, usually transient, cranial nerve, usually transient, is noted frequently early in the course.is noted frequently early in the course.

Clinical manifestationClinical manifestation Symptom and signs of the infant under the age of 3 mSymptom and signs of the infant under the age of 3 m

onthsonths In some children, particularly young infants under the age In some children, particularly young infants under the age

of 3 months, symptom and signs of meningeal inflammation of 3 months, symptom and signs of meningeal inflammation may be minimal.may be minimal.

Fever is generally present, but its absence or Fever is generally present, but its absence or hypothermiahypothermia in in a infant with meningeal inflammation is common. a infant with meningeal inflammation is common.

Only irritability, restlessness, dullnessOnly irritability, restlessness, dullness, , vomiting, poor feedivomiting, poor feeding, cyanosis, dyspnea, jaundice, seizures, shock and coma ng, cyanosis, dyspnea, jaundice, seizures, shock and coma may be noted. may be noted.

Bulging fontanel may be found, but there is not meningeal iBulging fontanel may be found, but there is not meningeal irritation sign.rritation sign.

ComplicationComplication Subdural effusionSubdural effusion

Subdural effusions occur in about 10%-30% of children Subdural effusions occur in about 10%-30% of children with bacterial meningitis.with bacterial meningitis.

Subdural effusions appear to be more frequent in the chilSubdural effusions appear to be more frequent in the children under the age of 1 year and indren under the age of 1 year and in haemophilus influenzhaemophilus influenzae and pneumococal infection.ae and pneumococal infection.

Clinical manifestations are enlargement in head circumfeClinical manifestations are enlargement in head circumference, bulging fontanel, rence, bulging fontanel, cranial sutures diastasis cranial sutures diastasis and and abnormal transillumination of the skull.abnormal transillumination of the skull.

Subdural effusions may be diagnosed by the examination Subdural effusions may be diagnosed by the examination of CT or MRI and subdural pricking.of CT or MRI and subdural pricking.

ComplicationComplication Ependymitis Ependymitis

Neonate or infant with meningitis Neonate or infant with meningitis Gram-negative bacterial infection Gram-negative bacterial infection Clinical manifestationClinical manifestation

Persistent hyperpyrexia, Persistent hyperpyrexia, Frequent convulsion Frequent convulsion Acute respiratory failure Acute respiratory failure Bulging fontanel Bulging fontanel Ventriculomegaly (CT) Ventriculomegaly (CT) Cerebrospinal fluidCerebrospinal fluid by ventricular punctureby ventricular puncture

WBC>50×10WBC>50×1099/L/L Glucose<1.6mmol/LGlucose<1.6mmol/L Protein>o.4g/LProtein>o.4g/L

ComplicationComplication Cerebullar hyponatremiaCerebullar hyponatremia

Syndrem of inappropriate secretion of anSyndrem of inappropriate secretion of antidiuretic hormone (SIADH)tidiuretic hormone (SIADH) Hyponatremia Hyponatremia Degrade of blood osmotic pressureDegrade of blood osmotic pressure AggravatedAggravated cerebral edema cerebral edema Frequent convulsion Frequent convulsion AggravatedAggravated c conscious disturbanceonscious disturbance

ComplicationComplication Hydrocephalus Hydrocephalus

Increased intracranial pressureIncreased intracranial pressure Bulging fontanelBulging fontanel Augmentation of head circumferenceAugmentation of head circumference Brain function disorder Brain function disorder

Other complicationOther complication Deafness or blindnessDeafness or blindness EpilepsyEpilepsy Paralysis Paralysis Mental retardationMental retardation Behavior disorderBehavior disorder

Laboratory FindingsLaboratory Findings Peripheral hemogramPeripheral hemogram

Total WBC count Total WBC count 20×1020×1099/L /L ～～ 40×1040×1099/L WBC/L WBC Decreased WBC count at severe infectionDecreased WBC count at severe infection

Leukocyte differential countLeukocyte differential count 80%80% ～～ 90% Neutrophils90% Neutrophils

Laboratory FindingsLaboratory Findings Rout Rout eexamination of cerebrospinal fluid (CSF) xamination of cerebrospinal fluid (CSF)

Increased pressure of cerebrospinal fluid Increased pressure of cerebrospinal fluid CloudinessCloudiness Evident Increased total WBC count (>1000×10Evident Increased total WBC count (>1000×1099/L)/L) Evident Increased neutrophils in leukocyte differential counEvident Increased neutrophils in leukocyte differential coun

tt Evident Decreased glucose (<1.1mmol/l)Evident Decreased glucose (<1.1mmol/l) Evident Increased protein levelEvident Increased protein level Decreased or normal chloridateDecreased or normal chloridate CSF film preparation or cultivation : positive result CSF film preparation or cultivation : positive result

Laboratory FindingsLaboratory Findings Especial examination of CSFEspecial examination of CSF

Specific bacterial antigen testSpecific bacterial antigen test Countercurrent immuno-electrophoresisCountercurrent immuno-electrophoresis Latex agglutinationLatex agglutination Immunofluorescent testImmunofluorescent test

Neisseria meningitidis (meningococcus)Neisseria meningitidis (meningococcus)

Haemophilus influenzae Haemophilus influenzae

Streptococcus pneumoniae ( pneumococcus)Streptococcus pneumoniae ( pneumococcus)

Group B streptococcusGroup B streptococcus

Laboratory FindingsLaboratory Findings Especial examination of CSFEspecial examination of CSF

Other test of CSFOther test of CSF LDHLDH Lactic acidLactic acid CRPCRP TNF and IgTNF and Ig Neuron specific enolase (NSE)Neuron specific enolase (NSE)

Laboratory FindingsLaboratory Findings

Other bacterial testOther bacterial test

Blood cultivationBlood cultivation

Film preparation of skin petechiae and purpuraFilm preparation of skin petechiae and purpura

Secretion culture of local lesion Secretion culture of local lesion

Imageology examinationImageology examination

DiagnosisDiagnosis Diagnostic methodsDiagnostic methods

A careful evaluation of history A careful evaluation of history A careful evaluation of infant’s signs and A careful evaluation of infant’s signs and

symptomssymptoms A careful evaluation of information on loA careful evaluation of information on lo

ngitudinal changes in vital signs and labongitudinal changes in vital signs and laboratory indicatorsratory indicators

Rout Rout eexamination of cerebrospinal fluid (CSF)xamination of cerebrospinal fluid (CSF)

Differential diagnosisDifferential diagnosis

Clinical manifestation of bacterial meningitis is similar tClinical manifestation of bacterial meningitis is similar t

o clinical manifestation of viral, tuberculous , fungal and o clinical manifestation of viral, tuberculous , fungal and

aseptic meningitis. aseptic meningitis.

Differentiation of these disorders depends upon careful eDifferentiation of these disorders depends upon careful e

xamination of cerebrospinal fluid obtained by lumbar pxamination of cerebrospinal fluid obtained by lumbar p

uncture and additional immunologic, roentgenographic, uncture and additional immunologic, roentgenographic,

and isotope studies. and isotope studies.

CharacteristicsCharacteristics of CSF on common diseaseof CSF on common disease in CNS in CNS

PM TM VW FM TE

Pressure ↑ ↑ － or↑ ↑↑ ↑ Cloudiness ＋＋ or ＋＋＋ ＋ － ± －

Pandy T ＋＋ or ＋＋＋ ＋ or ＋＋＋ ±or ＋＋ ＋ or ＋＋＋ －

WBC ↑↑↑ N ↑ L － or↑L ↑ M －

Protein ↑ ↑ ↑ ↑ ↑ ↑ － or↑ ↑ ↑ － or ±

Glucos 　 ↓ ↓ ↓ ↓ ↓ － ↓ ↓ －

Chloridate － or ↓ ↓ ↓ ↓ － ↓ ↓ －

Cultivation Bacterium TB Viral Fungus －

TreatmentTreatment Antibiotic TherapyAntibiotic Therapy

Therapeutic principleTherapeutic principle Good permeability for Blood-brain barrier Good permeability for Blood-brain barrier

Drug combination Drug combination

Intravenous drip Intravenous drip

Full dosage Full dosage

Full course of treatmentFull course of treatment

Antibiotic TherapyAntibiotic Therapy Selection of antibioticSelection of antibiotic

No Certainly BacteriumNo Certainly Bacterium Community-acquired bacterial infectionCommunity-acquired bacterial infection

Nosocomial infection acquired in a hospitalNosocomial infection acquired in a hospital

Broad-spectrum antibiotic coverage as noted belowBroad-spectrum antibiotic coverage as noted below Children under age 3 monthsChildren under age 3 months

Cefotaxime and ampicillinCefotaxime and ampicillin

Ceftriaxone and ampicillin (children over age 1months)Ceftriaxone and ampicillin (children over age 1months)

Children over 3 monthsChildren over 3 months

Cefotaxime or Ceftriaxone or ampicillin and chloramphenicolCefotaxime or Ceftriaxone or ampicillin and chloramphenicol

Antibiotic TherapyAntibiotic Therapy Certainly BacteriumCertainly Bacterium

Once the pathogen has been identified and the antibiOnce the pathogen has been identified and the antibiotic sensitivities determined, the most appropriate drotic sensitivities determined, the most appropriate drugsugs should selected.should selected.

N meningitidis : N meningitidis : penicillin,penicillin, tert-tert- cephalosporincephalosporin S pneumoniae: S pneumoniae: penicillin,penicillin, tert-tert- cephalosporin, vancomycincephalosporin, vancomycin H influenzae: H influenzae: ampicillin,ampicillin, tert-tert- cephalosporincephalosporin S aureus: S aureus: penicillin,penicillin, nefcillinnefcillin, , vancomycinvancomycin E coli: E coli: ampicillin,ampicillin, chloramphenicolchloramphenicol, , tert-tert- cephalosporincephalosporin

Antibiotic TherapyAntibiotic Therapy

Course of treatmentCourse of treatment

7 days for meningococcal infection7 days for meningococcal infection

1010 ～～ 14 days for H influenzae or S pneumoniae in14 days for H influenzae or S pneumoniae in

fectionfection

More than 21 days for S aureus or E coli infectionMore than 21 days for S aureus or E coli infection

1414 ～～ 21 days for other organisms21 days for other organisms

TreatmentTreatment General and Supportive MeasuresGeneral and Supportive Measures

Monitor of vital signMonitor of vital sign Correcting metabolic imbalancesCorrecting metabolic imbalances

Supplying Supplying sufficientsufficient heat quantity heat quantity Correcting hypoglycemiaCorrecting hypoglycemia Correcting metabolic acidemiaCorrecting metabolic acidemia Correcting fluids and electrolytes disorderCorrecting fluids and electrolytes disorder

Application of cortical hormoneApplication of cortical hormone Lessening inflammatory reaction Lessening inflammatory reaction Lessening toxic symptom Lessening toxic symptom lessening cerebral edemalessening cerebral edema

General and Supportive MeasuresGeneral and Supportive Measures

Treatment of hyperpyrexia and seizuresTreatment of hyperpyrexia and seizures Pyretolysis by physiotherapy and/or drugPyretolysis by physiotherapy and/or drug Convulsive management Convulsive management

Diazepam Diazepam Phenobarbital Phenobarbital

Subhibernation therapySubhibernation therapy

Treatment of increased intracranial pressureTreatment of increased intracranial pressure Dehydration therapyDehydration therapy

20%Mannitol 5ml/kg vi q6h20%Mannitol 5ml/kg vi q6h Lasix 1-2mg/kg viLasix 1-2mg/kg vi

General and Supportive MeasuresGeneral and Supportive Measures

Treatment of septic shock and DICTreatment of septic shock and DIC Volume expansionVolume expansion Dopamine Dopamine Corticosteroids Corticosteroids Heparin Heparin Fresh frozen plasmaFresh frozen plasma Platelet transfusionsPlatelet transfusions

TreatmentTreatment Complication Measures Complication Measures

Subdural effusions Subdural effusions Subduaral prickingSubduaral pricking

Draw-off effusions on one side is 20-30ml/time.Draw-off effusions on one side is 20-30ml/time. Once daily or every other day is requested. Once daily or every other day is requested. Time cell of pricking may be prolonged after 2 weeks.Time cell of pricking may be prolonged after 2 weeks.

EpendymitisEpendymitis Ventricular puncture — drainageVentricular puncture — drainage

Pressure in ventricle be depressed.Pressure in ventricle be depressed. Ventricular puncture may give ventricle an injection ofVentricular puncture may give ventricle an injection of antibiotic. antibiotic.

Complication MeasuresComplication Measures

HydrocephalusHydrocephalus Operative treatmentOperative treatment

Adhesiolysis Adhesiolysis By-pass operation of cerebrospinal fluid By-pass operation of cerebrospinal fluid Dilatation of aqueductDilatation of aqueduct

SIADH (CerebralSIADH (Cerebral hyponatremia)hyponatremia) Restriction of fluidRestriction of fluid supplement of serum sodium supplement of serum sodium diuretic diuretic

PrognosisPrognosis Appropriate antibiotic therapy reduces the moAppropriate antibiotic therapy reduces the mo

rtality rate for bacterial meningitis in children, rtality rate for bacterial meningitis in children, but mortality remain high.but mortality remain high.

Overall mortality in the developed countries rOverall mortality in the developed countries ranges between 5% and 30%.anges between 5% and 30%.

50 percent of the survivors have some sequelae 50 percent of the survivors have some sequelae of the disease.of the disease.

PrognosisPrognosis Prognosis depends upon many factors:Prognosis depends upon many factors:

AgeAge Causative organismCausative organism Number of organisms and bacterial virulence Number of organisms and bacterial virulence Duration of illness prior to effective antibiotic therapyDuration of illness prior to effective antibiotic therapy Presence of disorders that may compromise host respPresence of disorders that may compromise host resp

onse to infectiononse to infection