Name of the Meningitis

Disease
Causative More common : Less common :
organism Streptococcus pneumoniae Listeria monocytogenes
Neisseria meningitidis Streptococcus agalactiae
Haemophilus influenzae Escherichia coli
Pathogenesis Bacterial enters the body through respiratory system / trauma /
bloodstream infections  bacteremia  inflammation of meninges
Clinical features Meningitis triad : Fever, headache, meningismus
Photophobia, seizures
Symptoms starts within’ hours to days
Diagnosis Physical exam Lab exam
1. Altered consciousness 1. CSF
2. Neck rigidity on passive 2. Blood culture
flexion 3. CT scan
3. Kernig sign + 4. Nasopharyngeal swab (if
4. Brudzinski sign + necessary)
5. Focal neurologic deficit
6. Papilledema  high ICP
Treatment Steroids  IV dexamethasone
Empiric antibiotics
 Ceftriaxone + vancomycin + ampicillin
 If allergic to penicillin  replace with moxifloxacin
Complication SIADH, cranial nerve dysfunction (VIII)
 Streptococcus pneumoniae
Type of infectious Bacteria
Type of disease Acute meningitis
Symptoms of Classic : fever, headache, neck rigidity
disease Pneumonia may present
Most common in adults and children 3-12 y.o
Sample CSF, blood
Laboratory Stain : Gram + lancet-shaped diplococci, in pairs or chains,
diagnostic feature encapsulated
Culture : BA, chocolate agar (fastidious)
Biochemical test :
1. Catalase –
2. Small, alpha haemolytic on BA agar, beta haemolytic on
anaerob
3. Optochin sensitive
4. Bile soluble
Antigen detection  C polysaccharide with ELISA on CSF
Virulence factor and Pneumolysin (haemolytic), IgA protease, protein adhesins, C
pathogenicity polysaccharide, F antigen (lipid), phosphorylcholine (cell wall
hydrolysis), amidase (pneumococcal autolysin)
Treatment Vancomycin + ceftriaxone / cefotaxime
Complication None
Prevention 13-valent pneumococcal polysaccharide vaccine  2,4,6,12-15
months
23- valent pneumococcal polysaccharide vaccine  one time 
children >2 years, adults
 Neisseria meningitidis
Type of infectious Bacteria
Type of disease Acute meningitis
Symptoms of Petechial rash may present
disease Very contagious, spread by nasal droplets  families need
prophylaxis antibiotics
Common in adults and children 3-12 y.o (after pneumococcal)
Sample CSF, blood, nasopharyngeal swab
Laboratory Stain : Gram – diplococci, facultative intracelullar
diagnostic feature Culture : Thayer-Martin agar, chocolate agar
Biochemical test :
1. Maltose fermenter +
2. Oxidase +
Serology test :
1. Latex agglutionation  capsular polysaccharide
Virulence factor and Polysaccharide capsule : Serogroup C  epidemic in US, serogroup
pathogenicity B  sporadic
LOS (lipooligosaccharide), porin proteins (PorA, PorB), pili, Opa
proteins, Rmp protein, IgA1 protease
Treatment Aqueous penicillin G, ceftriaxone
Complication Meningococcemia, petechial haemorrhage, DIC, gangrene,
Waterhouse-Friderichsen syndrome (adrenal insufficiency, fever,
DIC, shock)
Prevention Vaccine
Serogroup A,C,Y, and W-135
 MPSV4 (polysaccharide vaccine)  age >55
 MCV4 (conjugate vaccine)  age 2-55
Serogroup B  MenB-FHbp, MenB-4C  age 10-25
Prophylaxis : rifampin 20 mg/kg/day divided 2 doses for 2 days,
ciprofloxacin
 Haemophilus influenzae
Type of infectious Bacteria
Type of disease Acute meningitis
Symptoms of Most common in children <3 years
disease Associated with sinusitis, otitis, transmitted by droplets
Sample CSF, blood, nasopharyngeal swab
Laboratory Stain : Gram - coccobacilli
diagnostic feature Culture : BA, factor X (hemin) and V (NAD+) (fastidious), satellite
phenomenon (grow better with S. aureus that provide factor V
from hemolysis)
Serology test : particle agglutination test  PRP
Virulence factor and PRP (polyribitol phosphate), capsular polysaccharide (serotype a-
pathogenicity f), IgA1 protease, lipid A
Treatment Ceftriaxone
Prophylaxis : rifampin 20 mg/kg/day once for 4 days
Complication None
Prevention Type b capsular polysaccharide conjugate vaccine (conjugated
with diphteria toxoid)  given on 2,3,4,15-18 months
 Listeria monocytogenes
Type of infectious Bacteria
Type of disease Acute meningitis
Symptoms of Common cause in infants, children <3 years, elderly
disease Food-borne  dairy, meats  spread by ingestion of
contaminated food
Sample CSF, blood, vaginal swab
Laboratory Stain : small, short Gram + coccobacilli, facultative intracelullar
diagnostic feature Culture : BA, selective media with cold enrichment
Biochemical test
1. Weak beta haemolytic,
2. CAMP test +  enhanced hemolysis when grow with S.
aureus
3. Motile at 25oC (motility test)
4. Aerob
Virulence factor and Listeriolysin O (pore-forming cytolysin), phospholipase C, ActA
pathogenicity (motility)
Treatment Ampicillin + gentamicin

Streptococcus agalactiae
Type of infectious Bacteria
Type of disease Acute meningitis
Symptoms of Part of normal vagina flora
disease Cause of meningitis in infants <3 months
Sample CSF, blood, vaginal swab
Laboratory Stain : Gram + cocci
diagnostic feature Culture : LIM broth with colistin and nalidixic acid, BA
Biochemical test :
1. Catalase –
2. Large colonies with narrow beta haemolytic zone
3. Bacitracin resistant (Group B strep)
4. Hippurate test +
5. PYR –
Molecular test : PCR from LIM broth (enrichment media)
Virulence factor and Capsular polysaccharide, Lancefield Group B antigen, c protein
pathogenicity (surface antigen)
Treatment Penicillin G
 Escherichia coli
Type of infectious Bacteria
Type of disease Acute meningitis
Symptoms of Cause of meningitis in infants <3 months (neonatal)
disease
Sample CSF, blood, vaginal swab
Laboratory Stain : Gram - bacilli
diagnostic feature Culture : EMB agar
Biochemical test :
1. Fast lactose fermenter  TSI
2. Oxidase -
Virulence factor and K1 capsular antigen
pathogenicity
Treatment Cetriaxone/cefotaxime + gentamicin

References :
1. CMDT 2019
2. LANGE Clinical Neurology
3. Murray Medical Microbiology