The meninges are the membranes that cover and protect the spinal cord and brain. In meningitis, the meninges are infected, causing them to swell. Viruses are usually responsible for this, but in pneumococcal meningitis the bacterium called Streptococcus pneumoniae is the basis of the infection. This rare but serious disease causes many serious or life-threatening complications. Prompt treatment with antibiotics is necessary to save the patient’s life. Finally, a vaccine is available to reduce the risk of developing the bacterial infection.

• Epidemiology of pneumococcal infection
• Causes: Due to infection with S. pneumoniae bacteria

• Pneumococcal diseases
• Infection of the cerebral membrane

• Risk factors of bacterial meningitis
• Symptoms: Headache, stiff neck and fever
• Diagnosis and examinations
• Treatment: Rapid administration of antibiotics
• Prognosis of pneumococcal meningitis
• Complications of meningeal infection
• Prevention via pneumococcal vaccine

Epidemiology of pneumococcal infection

The incidence of serious pneumococcal infections, including meningitis, has decreased significantly since the introduction of the pneumococcal vaccine in 1995. The annual incidence is approximately 9 in 100,000 persons.

Causes: Due to infection with S. pneumoniae bacteria

Pneumococcal diseases

Streptococcus pneumoniae (S. pneumoniae) is a widespread Gram-negative bacterium found in the throat, mouth and nose. The bacteria causes numerous possible infections such as:

• a blood infection (pneumococcal sepsis)
• an inflammation of the stomach (peritonitis) (rare)
• joint inflammation (arthritis) (rare)
• an inflammation of the heart valve (endocarditis) (rare)
• meningitis (pneumococcal meningitis)
• pneumonia (pneumococcal pneumonia)
• a middle ear infection (otitis media)
• a sinus infection (sinusitis)
• an inflammation of the tracheal branches (bronchitis)
• an inflammation of the eye (conjunctivitis)

1. pneumoniae is the most common cause of bacterial meningitis in adults. It is also one of the leading causes of bacterial meningitis in children under two years of age. About four in ten people carry S. pneumoniae in their body. In the majority of these people, the bacteria are not active and no disease develops, but sometimes pneumococcal infections do occur.

Infection of the cerebral membrane

Pneumococcal meningitis occurs when S. pneumoniae enters a patient’s bloodstream and infects the fluid around the brain or spine. Patients who carry the bacteria in their bodies (whether ill or not) are able to spread the bacteria. The bacteria spread easily through small droplets released from a patient’s nose or mouth. These droplets then come into contact with the person through:

• using lipstick from another patient
• sharing cutlery
• sharing food
• cough
• intimate kissing
• to sneeze

Risk factors of bacterial meningitis

Conditions Certain conditions make patients more susceptible to developing pneumococcal meningitis, including:

• diabetes mellitus
• a chronic heart condition
• a chronic liver disease
• a chronic lung disease
• a cochlear implant
• a history of meningitis
• a head trauma
• an infection of a heart valve with S. pneumoniae
• a recent upper respiratory infection
• a recent pneumonia with S. pneumoniae
• a recent ear infection with S. pneumoniae
• a removed spleen (splenectomy) or a non-functioning spleen (asplenia)
• a weakened immune system due to cancer treatment, an organ transplant, AIDS, long-term treatment with corticosteroids

 Alcohol abuse is a risk factor for the bacterial infection / Source: Jarmoluk, PixabayEnvironmental factors Alcohol abuse, drug abuse and cigarette smoking increase the risk of the infection. Children of African-American descent, Alaska Natives and some Native American groups are at greater risk of developing the disease. Patients who live in close contact with many others are also more likely to develop pneumococcal meningitis. Living in dormitories or other communal living situations are also risk factors for pneumococcal meningitis. Finally, children in day care are affected more often.

Symptoms: Headache, stiff neck and fever

The incubation period (time between contracting the infection and the appearance of symptoms) is approximately three days. Symptoms tend to appear suddenly and include:

• agitation
• an intense headache
• a hypersensitivity to light (photophobia)
• rapid breathing (tachycardia)
• a stiff neck
• a bulging fontanelle in infants: the soft spot on top of the baby’s head bulges (pushes out)
• a loss of consciousness (loss of consciousness) or reduced consciousness
• bend the head and neck backwards
• high fever
• mental changes
• nausea and vomiting
• irritability
• chills
• drowsiness

 A lumbar puncture confirms pneumococcal meningitis / Source: Brainhell, Wikimedia Commons (CC BY-SA-3.0)

Diagnosis and examinations

A doctor performs a physical examination but if he suspects that the patient is suffering from pneumococcal meningitis, he immediately orders a lumbar puncture to confirm the diagnosis. During this examination – also known as an epidural puncture – the doctor removes a small amount of spinal fluid from a patient’s spinal column. A doctor sometimes also orders other tests such as a blood test, a CT scan of the head and an X-ray of the chest (chest x-ray). A quick diagnosis is essential because immediate treatment provides the best possible outcome.

Treatment: Rapid administration of antibiotics

Patients with pneumococcal meningitis receive immediate hospitalization with intravenous antibiotic treatment. In some situations, the doctor also uses corticosteroids to reduce swelling around the brain and spine.

Prognosis of pneumococcal meningitis

Pneumococcal meningitis is a very serious condition. About twenty percent of patients die from this. Young children and people over 65 are at greatest risk. Prompt treatment is necessary to achieve the best results.Reduced vision is one of the possible complications / Source: Nufkin, Flickr (CC BY-2.0)

Complications of meningeal infection

About one in four of those who survive pneumococcal meningitis may still have long-term problems such as:

• reduced vision
• behavioral problems
• amnesia
• hearing loss
• brain damage
• developmental delays
• seizures

Prevention via pneumococcal vaccine

The basic vaccination schedule includes a vaccine against pneumococcal infections. The doctor administers the pneumococcal vaccine to babies aged eight and sixteen weeks and at the age of twelve months. It is not possible to be completely protected with the vaccine, because various bacteria and types or groups are known. The vaccine does provide good protection against the most common forms of pneumococcal meningitis. Furthermore, it is best for patients from risk groups to discuss their personal vaccination policy. These patients – especially those who have no or poorly functioning spleen – are often advised to be vaccinated against pneumococcal infections every five years.

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• Meningitis: Meningitis with headache & stiff neck
• Pneumococcal pneumonia: Pneumonia caused by bacteria
• Pneumococcal disease: Infection by pneumococcal bacteria