Staphylococcal meningitis

Definition

Meningitis is an infection of the membranes covering the brain and spinal cord. This covering is called the meninges.

Bacteria are one type of germ that may cause meningitis. The staphylococcal bacteria are one type of bacteria that cause meningitis.

Causes

Staphylococcal meningitis is caused by staphylococcus bacteria. When it is caused by Staphylococcus aureus or Staphylococcus epidermidis bacteria, it usually develops as a complication of surgery or as an infection that spreads through the blood from another site.

Risk factors include:

Infections of heart valves
Past infection of the brain
Past meningitis due to spinal fluid shunts
Recent brain surgery
The presence of a spinal fluid shunt
Trauma
Bloodstream infection with Staphylococcus aureus

Symptoms

Symptoms may come on quickly, and include:

Fever and chills
Mental status changes
Nausea and vomiting
Sensitivity to light (photophobia)
Severe headache
Stiff neck

Other symptoms that can occur with this disease:

Agitation
Bulging fontanelles in infants
Decreased alertness
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 risk factors.

If the doctor thinks meningitis is possible, a lumbar puncture (spinal tap) is done to remove a sample of spinal fluid for testing. If you have a spinal fluid shunt, the sample may be taken from this instead.

Tests may include:

Blood culture
Chest x-ray
CT scan of the head
Gram stain or other special stains, and culture of the spinal fluid

Treatment

Antibiotics will be started as soon as possible. Vancomycin is the first choice for suspected staphylococcal meningitis. Nafcillin is used when tests show that the bacteria are sensitive to this antibiotic.

Often, treatment will include a search for, and removal of, possible sources of bacteria in the body. These include shunts or artificial heart valves.

Outlook (Prognosis)

Early treatment improves the outcome. However, some people do not survive. Young children and adults over age 50 have the highest risk for death.

Staphylococcal meningitis often improves more quickly, with fewer complications, if the source of the infection is removed. The source may include shunts, hardware in joints, or artificial heart valves.

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
Staph infection in another area of the body

When to Contact a Medical Professional

Call 911 or the local emergency number 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

Meningitis can quickly become a life-threatening illness.

Prevention

In high-risk people, taking antibiotics before diagnostic or surgical procedures may help reduce the risk. Discuss this with your doctor.

References

Centers for Disease Control and Prevention website. Meningitis. About bacterial meningitis. www.cdc.gov/meningitis/about/bacterial-meningitis.html. Updated January 9, 2024. Accessed June 17, 2024.

Nath A. Meningitis: bacterial, viral, and other. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 384.

Hasbun R, Van de Beek D, Brouwer MC, Tunkel AR. Acute meningitis. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 87.