Does meningitis affect all age ranges?

From the Guidelines

Meningitis is a serious infection that can affect individuals of all age ranges, from newborns to the elderly, with varying risks and causes depending on the age group. According to the UK Joint Specialist Societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults 1, the incidence of meningitis in adults has remained stable or increased, with the highest incidence in the 45-64 age group. The guideline also notes that the mortality rate of community-acquired bacterial meningitis is high, approximately 20% for all causes and up to 30% in pneumococcal meningitis, increasing with age.

Some key considerations and risk factors for meningitis in different age groups include:

• Infants under 1 month: vulnerable to bacterial meningitis from Group B Streptococcus and E. coli
• Children under 5 years: commonly contract viral meningitis and Haemophilus influenzae type b before vaccination
• Adolescents and young adults (16-23 years): face increased risk from Neisseria meningitidis, especially in crowded living conditions like college dormitories
• Adults over 60 and immunocompromised individuals: susceptible to Listeria monocytogenes and reactivation of latent infections

The treatment and prevention of meningitis vary by causative agent, with bacterial meningitis requiring immediate antibiotics and viral meningitis typically resolving with supportive care 1. Prevention includes age-appropriate vaccinations against Haemophilus influenzae type b, pneumococcal disease, meningococcal disease, and maintaining good hygiene. The age-related vulnerability stems from immune system development and function, with the very young having immature immune responses and the elderly experiencing immune senescence.

The likelihood of any specific aetiology depends on a range of factors, and in many cases (34%-74%), no pathogen is identified 1. However, prompt recognition and treatment of meningitis are crucial to reducing morbidity, mortality, and improving quality of life, regardless of the age group or causative agent.

From the Research

Meningitis and Age Ranges

• Meningitis can affect all age ranges, including infants, children, and adults 2, 3, 4, 5.
• The treatment of meningitis varies depending on the age of the patient, with different antibiotics being recommended for different age groups 2, 3, 4, 5.
• In infants and children, ceftriaxone is effective in treating bacterial meningitis, but it is not recommended in neonates due to concerns about bilirubin displacement 2.
• In adults, ceftriaxone is also effective, but it must be combined with ampicillin initially to cover the possibility of Listeria monocytogenes meningitis 2, 3.
• Other antibiotics, such as meropenem, have also been shown to be effective in treating bacterial meningitis in adults 5.

Treatment Options

• Ceftriaxone and cefotaxime are commonly used to treat bacterial meningitis in children and adults 2, 3, 4.
• Vancomycin is often added to the treatment regimen to cover the possibility of penicillin-resistant pneumococci 3.
• Ampicillin is also used in certain cases, such as in patients with predisposing factors for Listeria monocytogenes infection 3.
• Meropenem has been shown to be effective in treating bacterial meningitis in adults, with a high cure rate and minimal side effects 5.

Special Considerations

• The treatment of meningitis must take into account the possibility of antibiotic-resistant organisms, such as penicillin-resistant pneumococci 3.
• The use of adjunctive agents, such as dexamethasone, may be necessary to prevent the formation of inflammatory cytokines and improve patient outcomes 3.
• The development of new therapeutic modalities, such as monoclonal antibodies to cytokines, is an area of ongoing research in the treatment of bacterial meningitis 3.