The etiologies of meningitis range in severity from benign and self-limited to life-threatening with potentially severe morbidity. Bacterial meningitis is a medical emergency that requires prompt recognition and treatment. Mortality remains high despite the introduction of vaccinations for common pathogens that have reduced the incidence of meningitis worldwide. Aseptic meningitis is the most common form of meningitis with an annual incidence of per 100,000 adults. Most cases of aseptic meningitis are viral and require supportive care. Viral meningitis is generally self-limited with a good prognosis. Examination maneuvers such as Kernig sign or Brudzinski sign may not be useful to differentiate bacterial from aseptic meningitis because of variable sensitivity and specificity. Because clinical findings are also unreliable, the diagnosis relies on the examination of cerebrospinal fluid obtained from lumbar puncture. Delayed initiation of antibiotics can worsen mortality. Treatment should be started promptly in cases where transfer, imaging, or lumbar puncture may slow a definitive diagnosis. Empiric antibiotics should be directed toward the most likely pathogens and should be adjusted by patient age and risk factors. Dexamethasone should be administered to children and adults with suspected bacterial meningitis before or at the time of initiation of antibiotics. Vaccination against the most common pathogens that cause bacterial meningitis is recommended. Chemoprophylaxis of close contacts is helpful in preventing additional infections.
Subgroup analyses for causative organisms showed that corticosteroids reduced mortality in Streptococcus pneumoniae ( S. pneumoniae ) meningitis ( RR , 95% CI to ), but not in Haemophilus influenzae ( H. influenzae ) or Neisseria meningitidis ( N. meningitidis ) meningitis. Corticosteroids reduced severe hearing loss in children with H. influenzae meningitis ( RR , 95% CI to ) but not in children with meningitis due to non- Haemophilus species.
Why Do I Need a Bacterial Meningitis Vaccine?
The State passed Senate Bill 1107 in 2011 and recently Senate Bill 62 in 2013, which requires all students under the age of 22 entering an institution of higher education to show proof of having the vaccine. The vaccine must be administered at least 10 days prior to the start of the semester. The vaccine must be no more than 5 years old from the date the student enrolls. The entire text of SB 1107 and SB 62 may be found here: http:///tlodocs/82R/billtext/html/ AND http:///tlodocs/83R/billtext/html/ .