Pathogenesis and pathophysiology of pneumococcal meningitis

BB Mook-Kanamori, M Geldhoff… - Clinical microbiology …, 2011 - Am Soc Microbiol
BB Mook-Kanamori, M Geldhoff, T van der Poll, D van de Beek
Clinical microbiology reviews, 2011Am Soc Microbiol
Pneumococcal meningitis continues to be associated with high rates of mortality and long-
term neurological sequelae. The most common route of infection starts by nasopharyngeal
colonization by Streptococcus pneumoniae, which must avoid mucosal entrapment and
evade the host immune system after local activation. During invasive disease,
pneumococcal epithelial adhesion is followed by bloodstream invasion and activation of the
complement and coagulation systems. The release of inflammatory mediators facilitates …
Summary
Pneumococcal meningitis continues to be associated with high rates of mortality and long-term neurological sequelae. The most common route of infection starts by nasopharyngeal colonization by Streptococcus pneumoniae, which must avoid mucosal entrapment and evade the host immune system after local activation. During invasive disease, pneumococcal epithelial adhesion is followed by bloodstream invasion and activation of the complement and coagulation systems. The release of inflammatory mediators facilitates pneumococcal crossing of the blood-brain barrier into the brain, where the bacteria multiply freely and trigger activation of circulating antigen-presenting cells and resident microglial cells. The resulting massive inflammation leads to further neutrophil recruitment and inflammation, resulting in the well-known features of bacterial meningitis, including cerebrospinal fluid pleocytosis, cochlear damage, cerebral edema, hydrocephalus, and cerebrovascular complications. Experimental animal models continue to further our understanding of the pathophysiology of pneumococcal meningitis and provide the platform for the development of new adjuvant treatments and antimicrobial therapy. This review discusses the most recent views on the pathophysiology of pneumococcal meningitis, as well as potential targets for (adjunctive) therapy.
American Society for Microbiology