What is the most common cause of death from meningitis?

From the Guidelines

The most common cause of death from meningitis is septic shock and multi-organ failure, particularly in cases of pneumococcal meningitis, which has a mortality rate of up to 30%. When bacteria or other pathogens invade the meninges, they can trigger a severe inflammatory response that leads to increased intracranial pressure, cerebral edema, and systemic complications. As the infection progresses, bacteria and their toxins can enter the bloodstream, causing septicemia that may evolve into septic shock 1. This condition is characterized by dangerously low blood pressure, inadequate tissue perfusion, and eventual failure of vital organs including the kidneys, liver, and lungs.

Key Considerations

• The incidence of meningitis in adults has remained stable or increased, with the highest incidence in the 45-64 age group 1.
• 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 1.
• Pneumococcal conjugate vaccines have reduced the incidence of pneumococcal meningitis in both children and adults, but the development of reduced susceptibility to penicillin and third-generation cephalosporins of S. pneumoniae is a major concern for the future 1.

Risk Factors and Aetiology

• The likelihood of any specific aetiology depends on a range of factors, including age, immune status, and underlying medical conditions 1.
• Listeria monocytogenes is the third most common cause of bacterial meningitis, particularly in the elderly and immunocompromised patients, and has a poor outcome if not treated promptly with amoxicillin 1.
• Neisseria meningitidis is a major cause of meningococcal meningitis, with serogroup B being the most common in European countries, and serogroup A being the major cause of epidemics in sub-Saharan Africa 1.

Prevention and Treatment

• Early recognition and prompt treatment with appropriate antibiotics are crucial to prevent fatal complications of meningitis 1.
• Vaccination against pneumococcal and meningococcal disease is an effective way to prevent meningitis, particularly in high-risk groups such as the elderly and immunocompromised patients 1.

From the Research

Causes of Death from Meningitis

• The most common cause of death from meningitis is related to Streptococcus pneumoniae, particularly strains that are resistant to antibiotics such as penicillin and cephalosporins 2, 3.
• The increasing resistance of S. pneumoniae to antibiotics has complicated the treatment of pneumococcal meningitis, leading to a higher risk of mortality and morbidity 4, 5.

Risk Factors for Mortality

• The use of inadequate antibiotic therapy, such as cefotaxime or ceftriaxone alone, may not be effective against cephalosporin-resistant S. pneumoniae, leading to a higher risk of mortality 3, 6.
• The addition of vancomycin or rifampin to the antibiotic regimen may improve outcomes, but the optimal treatment strategy is still unclear 2, 3.
• The use of dexamethasone as an adjunctive therapy may not be beneficial in cases of cephalosporin-resistant pneumococcal meningitis, and may even be associated with a higher failure rate 6.

Treatment Outcomes

• The overall in-hospital mortality rate for patients with S. pneumoniae meningitis can be as high as 15.4%, with a significant proportion of patients experiencing sequelae of meningitis 4.
• The choice of antibiotic regimen, including the dose and duration of therapy, can impact treatment outcomes, but the optimal strategy is still a subject of investigation 4, 5.