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Meningitis - gram-negative

Gram-negative meningitis

 

Meningitis is present when the membranes covering of the brain and spinal cord become swollen and inflamed. This covering is called the meninges.

Bacteria are one type of germ that may cause meningitis. Gram-negative bacteria are a type of bacteria that behave in a similar manner in the body. They turn pink when tested in the laboratory with a special stain called Gram stain.

Causes

 

Acute bacterial meningitis can be caused by different Gram-negative bacteria including meningococcal and H influenzae.

This article covers Gram-negative meningitis caused by the following bacteria:

  • Escherichia coli
  • Klebsiella pneumoniae
  • Pseudomonas aeruginosa
  • Serratia marsescens

Gram-negative meningitis is more common in infants than adults. But it can also occur in adults, especially those with one or more risk factors. Risk factors in adults and children include:

  • Infection
  • Recent brain surgery
  • Recent injury to the head
  • Spinal abnormalities
  • Spinal fluid shunt placement after brain surgery
  • Urinary tract abnormalities
  • Urinary tract infection
  • Weakened immune system

 

Symptoms

 

Symptoms usually come on quickly, and may include:

  • Fever and chills
  • Mental status changes
  • Nausea and vomiting
  • Sensitivity to light (photophobia)
  • Severe headache
  • Stiff neck (meningismus)
  • Symptoms of a bladder, kidney, intestine, or lung infection

Other symptoms that can occur with this disease:

  • Agitation
  • Bulging fontanelles in infants
  • Decreased consciousness
  • Poor feeding or irritability in children
  • Rapid breathing
  • Unusual posture, with the head and neck arched backwards (opisthotonos)

 

Exams and Tests

 

The health care provider will perform a physical exam. Questions will focus on symptoms and possible exposure to someone who might have the same symptoms, such as a stiff neck and fever.

If the provider thinks meningitis is possible, a lumbar puncture (spinal tap) will likely be done to remove a sample of spinal fluid for testing.

Other tests that may be done include:

  • Blood culture
  • Chest x-ray
  • CT scan of the head
  • Gram stain, other special stains

 

Treatment

 

Antibiotics will be started as soon as possible. Ceftriaxone, ceftazidime, and cefepime are the most commonly used antibiotics for this type of meningitis. Other antibiotics may be given, depending on the type of bacteria.

If you have a spinal shunt, it may be removed.

 

Outlook (Prognosis)

 

The earlier treatment is started, the better the outcome.

Many people recover completely. But, many people have permanent brain damage or die of this type of meningitis. Young children and adults over age 50 have the highest risk for death. How well you do depends on:

  • Your age
  • How soon treatment is started
  • Your overall health

 

Possible Complications

 

Long-term complications may include:

  • Brain damage
  • Buildup of fluid between the skull and brain (subdural effusion)
  • Buildup of fluid inside the skull that leads to brain swelling (hydrocephalus)
  • Hearing loss
  • Seizures

 

When to Contact a Medical Professional

 

Call the local emergency number (such as 911) or go to an emergency room if you suspect meningitis in a young child who has the following symptoms:

  • Feeding problems
  • High-pitched cry
  • Irritability
  • Persistent unexplained fever

Call the local emergency number if you develop any of the serious symptoms listed above. Meningitis can quickly become a life-threatening illness.

 

Prevention

 

Prompt treatment of related infections may reduce the risk of meningitis.

 

 

References

Nath A. Meningitis: bacterial, viral, and other. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 412.

Tunkel AR, Van de Beek D, Scheld WM. Acute meningitis. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, Updated Edition. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 89.

 
  • Central nervous system

    Central nervous system - illustration

    The central nervous system is comprised of the brain and spinal cord. The peripheral nervous system includes all peripheral nerves.

    Central nervous system

    illustration

    • Central nervous system

      Central nervous system - illustration

      The central nervous system is comprised of the brain and spinal cord. The peripheral nervous system includes all peripheral nerves.

      Central nervous system

      illustration

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        Tests for Meningitis - gram-negative

         

           

          Review Date: 7/31/2016

          Reviewed By: Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA.Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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