Bacterial

infection of
the nervous
system
Nervous
system:
1. Central
nervous
system (CNS)
2. Peripheral
nervous
system
 Central Nervous
System (CNS):
❖ Brain
❖ Spinal cord
❖ Protective coverings:
bones and meninges
❖ The brain and spinal cord
are protected from the
body by the blood brain
barrier:
→ Protect againts infectious
disease
→ Some pathogen can pass
through the blood barrier
Route in to the CNS

1. Hematogenous spread (most common)

Via arterial route and can enter retrogead
veins
2. Direct implantation
Traumatic and congenital CNS malformation
3. Local extention
Occur secondary to established infection in a
near by organ (sinus, tooth, midle air
4. Through peripheral nervous system to
CNS
5. Complication other infection
Pneumonia, pharyngitis, skin abacesses,
infection of endocarditis
CNS infection can be caused by:
Types of CNS infection

1. Normal bacterial flora

1. Meningitis
2. Pathogen acquired through
● Acute bacterial meningitis
ingestion
● Acute viral meningitis
3. Pathogen acquired during birthing
● Chronic meningitis
process
4. Contaminantion of shunts 2. Encephalitis
3. Localized brain abscess
Meningitis
1. Broad category
infection of the fluid
surrounding spinal cord
and brain

2. Usually caused by virus

or bacteria

3. Severity illnes differs →

treatment differs

4. Causative agents are

varies with age
Bacterial meningitis

Bacterial meningitis can be severe Common symptoms

and caused: 1. Begins with a mild cold
1. Brain damage 2. Severe throbbing headache,
2. Hearing loss nausea and vomiting
3. Learning disability 3. Fever
4. Meningism: Stiffness and pain
in the neck and back
Characteristic of CSF (Cerebrospinal fluid);

1. Pressure is increased
2. CSF is cloudy (contains pus)
3. Increased protein
4. Decreased glucose
5. Neutrophils present
6. Bacteria can be found on staining
the CSF
7. Bacteria can be cultured
 Meningococcal Meningitis

➢ Bacteria → Neisseria
meningitides
➢ diagnosis by Immunological
techniques
➢ Gram (-) diplococci
➢ Oxidase (+)
➢ Grows on ordinary blood agar
or chocolate
1. Mild cold followed by sudden onset 3. Shock
of ● leads to death within 24 hours
● severe throbbing headache
● usually progression is slower (can still
● Fever
treat)
● marked pain and stiffness of back
and neck 4. Petechial rash
2. Progression to ● purplish spots
● deafness
● from small hemorrhages
● altered consciousness
● coma
Meningococcal Meningitis - Epidemiology

❏ Usually in epidemics ❏ Frequency by different strains varies a lot

❏ Occurs commonly in infants age 6-11 ❏ Factors
mths 1. immunity of population to previously
❏ Also, often in children and adults →
encountered strains
especially at military bases and
colleges 2. wide use of sulfa drugs producing
resistance
❏ Humans = reservoir and carrier
3. transfer of virulence by transformation
→ isolated from 5-15% of normal
people
❏ Most infections are of the nose and
throat
Other bacterial infection
Streptococcus pneumoniae
● Leading cause of meningitis in the
elderly
● causes of bacterial meningitis in all
adults and children older than 2 months
● Similar :symptomn
● not as rapid and fulminant as that caused
by meningococcal meningitis
Haemophilus influenzae
● particularly serotype B (HiB) → meningitis
in children under the age of 5 years
● a gram-negative rod
● inhabitant of the sinuses, inner and middle
ear, respiratory tract, and bloodstream
● combination of both direct sinus and
hematogenous spread → meningitis
● survivors of HiB meningitis → deafness,
mental retardation
● Diagnose → neurologic examination
Group B Streptococcus (GBS)
● Leading cause meningitis in neonates (7
days - 2 month old)
● Causative agent: Streptococcus
agalactiae
● Infection: during passage through the
vaginal canal
● GBS → frequent colonizer of the
maternal vaginal canal
● USA → infection up to 45.5 per 1000
live births
Escherichia coli
● leading causes of meningitis in neonates
up to 3 months of age
● Symptomp : fever of unexplained origin
● 34.1% of neonatal meningitis → GBS
(E. coli: 28.5% of cases)
● transmitted vertically from mother to
fetus
● Factor risk: premature infants; low birth
weight
Listeria monocytogenes
● Listeria meningitis: birth to 3 months of
age and elderly patients above the age of
65 years
● Factor risk: immunocompromised
patients, pregnant women, and alcoholics
● Also causing: listeriosis, encephalitis and
brain abscess
● Common sources of Listeria infection
include dairy products, such as
unpasteurized milk and soft cheese.
Mycobacterium tuberculosis
● Mycobacterial meningitis is frequently
present in immunocompromised hosts
(HIV, Homeless population)
● hematogenous spread of the organism
through the blood-brain barrier
● CNS tuberculous disease begins →
development of small tuberculous foci in
brain, spinal cord, or the meninges
Risk factors, transmission, and treatment of bacterial
meningitis by pathogen
Empiric therapy for treatment of meningitis by age group