Search

Progress has been made in the prevention and treatment of community-acquired bacterial meningitis during the past three decades but the burden of the disease remains high globally. Conjugate vaccines against the three most common causative pathogens (Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae) have reduced the incidence of disease, but with the replacement by non-vaccine pneumococcal serotypes and the emergence of bacterial strains with reduced susceptibility to antimicrobial treatment, meningitis continues to pose a major health challenge worldwide. In patients presenting with bacterial meningitis, typical clinical characteristics (such as the classic triad of neck stiffness, fever, and an altered mental status) might be absent and cerebrospinal fluid examination for biochemistry, microscopy, culture, and PCR to identify bacterial DNA are essential for the diagnosis. Multiplex PCR point-of-care panels in cerebrospinal fluid show promise in accelerating the diagnosis, but diagnostic accuracy studies to justify routine implementation are scarce and randomised, controlled studies are absent. Early administration of antimicrobial treatment (within 1 hour of presentation) improves outcomes and needs to be adjusted according to local emergence of drug resistance. Adjunctive dexamethasone treatment has proven efficacy beyond the neonatal age but only in patients from high-income countries. Further progress can be expected from implementing preventive measures, especially the development of new vaccines, implementation of hospital protocols aimed at early treatment, and new treatments targeting checkpoints of the inflammatory cascade. [ABSTRACT FROM AUTHOR]

Over the past several decades, the incidence of bacterial meningitis in children has decreased but there remains a significant burden of disease in adults, with a mortality of up to 30%. Although the pathogenesis of bacterial meningitis is not completely understood, knowledge of bacterial invasion and entry into the CNS is improving. Clinical features alone cannot determine whether meningitis is present and analysis of cerebrospinal fluid is essential for diagnosis. Newer technologies, such as multiplex PCR, and novel diagnostic platforms that incorporate proteomics and genetic sequencing, might help provide a quicker and more accurate diagnosis. Even with appropriate antimicrobial therapy, mortality is high and so attention has focused on adjunctive therapies; adjunctive corticosteroids are beneficial in certain circumstances. Any further improvements in outcome are likely to come from either modulation of the host response or novel approaches to therapy, rather than new antibiotics. Ultimately, the best hope to reduce the disease burden is with broadly protective vaccines. [ABSTRACT FROM AUTHOR]

The author discusses meningococcal carriage as the dilemma of the multicomponent protein-based vaccine (4CMenB) Bexsero. He says that despite the small carriage reduction, the reproduction number for meningococci should be considered. He also discussed the average number of secondary infections produced by an infected individual and the use of comprehensive disease surveillance to track the efficacy of 4CMenB vaccine.

An ambitious and far-sighted plan focusing for the first time on a universal reduction of the burden of disease caused by meningitis is scheduled for discussion at this year's World Health Assembly in May. The proposal - titled Defeating Meningitis by 2030 - highlights bacterial meningitis, for which progress in the reduction of both mortality and morbidity has substantially lagged behind that made with other vaccine-preventable diseases. For example, the introduction of MenAfriVac, a meningococcal group A conjugate vaccine developed for use in the African meningitis belt, reduced the overall burden of suspected meningitis disease by around 60%. [Extracted from the article]

Paediatric patients introduce a unique challenge for health care: information about symptoms in infants and children is usually obtained second-hand from the parents. AI classification of cough sounds using the unique sound signatures of a child's smartphone-recorded coughs and parent-reported symptoms are under investigation as a potential diagnostic tool for paediatric respiratory conditions. In a prospective study, the AI-based system showed agreement with a consensus clinical diagnosis that took into account hospital chart review and radiology data. [Extracted from the article]

As stated by McGill andcolleagues, use of culture-independentmethods might be useful, particularlywhen cerebrospinal fluid (CSF)examination is done after theinitiation of antibiotherapy. Theseresults by Samra and colleagues havebeen confirmed in a study by Boulosand colleagues.3 Comparing ICT,culture, and quantitative PCR for CSFtesting, Boulos and colleagues foundthat ICT performs substantially betterthan CSF microscopy and culture.3 We believe that ICTs should be seenas a valuable and accurate method,probably not only in the absenceof molecular testing availability. Reliable detection of pneumococcalantigen in CSF with ICT (althoughoriginally developed for urinetesting) in case of pneumococcalacute meningitis has been reported.2Sensitivity is as high as 95.4%, andspecificity is as high as 100%. [Extracted from the article]

The authors talk about the expectations shown by the medical community regarding the use of the Bexsero vaccine to prevent the spread of MenB meningococcal disease. Topics discussed include a description of the Bexsero vaccine, the authors' opinion on the established monitoring process for the vaccine, and their recommendation on the appropriate way to assess the effectiveness of the vaccine in treating the disease.

J Microbiol Methods 2013;93: 116-20. 5 Samra Z, Shmuely H, Nahum E, Paghis D,Ben-Ari J. Use of the NOW Streptococcuspneumoniae urinary antigen test incerebrospinal fluid for rapid diagnosis ofpneumococcal meningitis. ICTs have also been shownto have considerable benefits over latexagglutination.2 However, some of thelimitations to antigen testing are thatthe sensitivity has varied and mightbe as low as 50%,3-5 it only allows thedetection of one organism, and, ofcourse, will not provide any informationabout antimicrobial susceptibilities. Correspondence We thank Frédéric Jacobs andcolleagues for their interest andcomment on our Seminar aboutacute bacterial meningitis in adults.1As Jacobs and colleagues say,immunochromatographic tests(ICTs) for pneumococcal antigenshave been assessed as a potentialdiagnostic test and do indeed haveutility when molecular methods areunavailable. [Extracted from the article]

The article reports on the meningitis epidemic in Niger caused by a serogroup C meningococcus which started in January 2015. Topics discussed include the international health community's claim that not enough vaccine is available to control the epidemic, the factors that exacerbate the spread of the disease in the country and the African countries that are considered vulnerable to bacterial meningitis, particularly during the dry season of January-June. INSET: Panel: Meningitis vaccines and their targets..