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Background: Bacterial meningitis is a severe and feared disease. We have studied bacterial meningitis in children in Sør-Trøndelag county during a 20-year period from 1988 to 2008., Material and Methods: Medical records of children (in-patients) with spinal fluid findings or a clinical diagnosis of bacterial meningitis, at St. Olavs Hospital, were retrospectively reviewed., Results: 112 cases of bacterial meningitis were registered in children below 16 years of age in Sør-Trøndelag county between 1988 and 2008. Children younger than 2 years had the highest occurrence, with a mean annual incidence of 42.3 per 100,000, whereas the incidence among children in the age group 2 to 16 was 5.7 per 100,000. We observed a decline in the occurrence from 19.1 per 100,000 in the period 1988 - 1991, to 6.9 per 100,000 in the period 2003 - 2006. 31 cases of Haemophilus influenzae type B, 26 cases of Neisseria meningitidis group B, 26 of Streptococcus pneumoniae and 19 cases with other pathogens were registered. The occurrence of H influenzae and N meningitidis have declined over the entire period, whereas S pneumoniae has increased. 6/112 children died (5.4 %) and 34 developed sequelae (30.4 %). In a multiple logistic regression analysis, the maximal value of C-reactive protein was associated with an increased risk of developing sequelae, adjusted for age and triggering microbe., Interpretation: The incidence of bacterial meningitis among children in Sør-Trøndelag has decreased significantly over the last 20 years, and meningitis is now a rare disease. Bacterial meningitis is most common among children below the age of two, and is still associated with a substantial mortality and risk of long-term neurological sequalae.

Meningitis and septic shock represent an acute inflammatory response in the subarachnoid space and the vascular tree respectively. Specific molecules in the bacterial outer membrane and exotoxins induce the inflammatory response through various mediator systems. The septic shock is caused by reduced vascular resistance and capillary leakage. Meningitis leads to altered brain metabolism, oedema and circulatory disturbance, which ultimately cause hypoxia. The general practitioner should be aware of the atypical symptomatology of meningitis in infants. Septic shock is related to meningococcal infections, pneumococcal infections in splenectomized persons and toxic shock syndromes. The authors give various advice concerning diagnosis, initial treatment and transport before admission to hospital.