Pathophysiology of Bacterial Meningitis: Mechanism(s) of Neuronal Injury

No bacterial disease has undergone a more dramatic change in epidemiology during the past decade than acute bacterial meningitis. This review describes the changing epidemiology and considers some important recent observations that contribute to our understanding of the pathogenesis and pathophysiol...

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Bibliographic Details
Published in:The Journal of infectious diseases 2002-12, Vol.186 (Supplement-2), p.S225-S233
Main Authors: Scheld, W. Michael, Koedel, Uwe, Nathan, Barnett, Pfister, Hans-Walter
Format: Article
Language:English
Subjects:
Adolescent
Adult
Animals
Anti-Inflammatory Agents - therapeutic use
Bacterial diseases
Bacterial diseases of the nervous system. Bacterial myositis
Bacterial meningitis
Biological and medical sciences
Chemokines
Child
Child, Preschool
Cytokines
Cytokines - metabolism
Epidemiology
Human bacterial diseases
Humans
Infant
Infectious diseases
Inflammation - immunology
Inflammation - physiopathology
Leukocytes
Medical sciences
Meningitis, Bacterial - epidemiology
Meningitis, Bacterial - immunology
Meningitis, Bacterial - microbiology
Meningitis, Bacterial - physiopathology
Meningitis, Pneumococcal - immunology
Meningitis, Pneumococcal - microbiology
Meningitis, Pneumococcal - physiopathology
Meningococcal meningitis
Mice
Nervous system diseases
Neurons - microbiology
Neurons - pathology
Pathogens
Pneumococcal meningitis
Rats
Streptococcus pneumoniae - immunology
Subarachnoid space
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Summary:No bacterial disease has undergone a more dramatic change in epidemiology during the past decade than acute bacterial meningitis. This review describes the changing epidemiology and considers some important recent observations that contribute to our understanding of the pathogenesis and pathophysiology of meningitis. The major focus is on the mechanisms of neuronal injury and the pathophysiologic concepts responsible for death and neurologic sequelae. In recent years, experimental studies have amplified our understanding of the substantial body of evidence that now implicates cytokines and chemokines, proteolytic enzymes, and oxidants in the inflammatory cascade leading to tissue destruction in bacterial meningitis. The molecular mechanisms responsible for oxidant-induced neuronal injury in meningitis are explored in some depth. Genetic targeting and/or pharmacologic blockade of the implicated pathways may be a future strategy for therapeutic adjunctive measures to improve outcome and may hold substantial promise, in concert with antimicrobial agents, in humans with acute bacterial meningitis
ISSN:0022-1899
1537-6613
DOI:10.1086/344939