Bacterial meningitis

Handb Clin Neurol. 2010;96:51-63. doi: 10.1016/S0072-9752(09)96004-3. Epub 2010 Jan 19.


Bacterial meningitis is a neurological emergency. Empiric antimicrobial and adjunctive therapy should be initiated as soon as a single set of blood cultures has been obtained. Clinical signs suggestive of bacterial meningitis include fever, headache, meningismus, vomiting, photophobia, and an altered level of consciousness. The peripheral white blood cell count with a left shift, an elevated serum procalcitonin and C-reactive protein, and a cerebrospinal fluid pleocytosis with a predominance of polymorphonuclear leukocytes, and a decreased glucose concentration are predictive of bacterial meningitis. Patients with documented bacterial meningitis and those in whom the diagnosis is a strong possibility should be admitted to the intensive care unit. Timely recognition of bacterial meningitis and initiation of therapy are critical to outcome.

MeSH terms

  • Anti-Infective Agents / therapeutic use
  • C-Reactive Protein / metabolism
  • Diagnosis, Differential
  • Humans
  • Meningitis, Bacterial* / complications
  • Meningitis, Bacterial* / diagnosis
  • Meningitis, Bacterial* / drug therapy
  • Nervous System Diseases / etiology
  • Nervous System Diseases / microbiology


  • Anti-Infective Agents
  • C-Reactive Protein