Purulent meningitis [Eitrige meningitis]

Acute purulent meningitis still has a high rate of mortality and long-term neurological sequelae. The clinical picture and course of the disease are dependent on the age and the immune status of the patient and on the causative agent. In newborns group B streptococci and E. coli are the dominant bacteria, whereas meningococci and pneumococci are most commonly isolated in older age groups. Neonates typically present with unspecific symptoms. Headache, nuchal rigidity and fever are typical signs in older children. Apart from the clinical assessment, analysis of the cerebrospinal fluid in morphological, laboratory and microbiological tests is of pivotal importance for the diagnosis. The empirical antibiotic therapy is guided by the age of the patient and the medical history. Newborns are initially treated with ampicillin and a third-generation cephalosporin, while from the age of 3 months infants primarily receive a third-generation cephalosporin alone. If bacterial meningitis is suspected adjuvant glucocorticoid therapy should be initiated. © Springer Medizin Verlag 2006.