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Gram-negative meningitis

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 (especially in the abdomen or urinary tract)
  • 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:

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:

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

Centers for Disease Control and Prevention website. Bacterial meningitis. www.cdc.gov/meningitis/bacterial.html. Updated January 25, 2017. Accessed October 8, 2018.

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.

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      Review Date: 9/22/2018

      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, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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