Staphylococcal Meningitis Clinical Presentation

  • Author: Lawrence A Zumo, MD; Chief Editor: Karen L Roos, MD   more...
 
Updated: Mar 29, 2011
 

Symptoms

Classic Symptoms of Staphylococcal Meningitis

Classic signs of staphylococcal meningitis include the following:

  • Neck stiffness
  • Altered consciousness (drowsiness, confusion, stupor, coma)
  • Generalized or focal seizures
  • Brudzinski sign (flexion at the hip and knee in response to forced flexion of the neck)
  • Kernig sign (inability to completely extend the legs)
  • Hypotension, very commonly

In immunosuppressed patients, the classic meningeal signs may be absent.

Symptoms of S aureus Septicemia

In S aureus septicemia, look for signs of systemic embolization/seeding, including the following:

  • Roth spots
  • Janeway lesions
  • Petechiae
  • Subconjunctival hemorrhages
  • Cardiac murmurs
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Physical Examination

With a high index of suspicion, making the diagnosis of bacterial meningitis is, in general, not difficult. All febrile patients with lethargy, headache, or confusion of sudden onset, even if fever is only low grade or the patient is a confused alcoholic, should undergo an urgent lumbar puncture, since a definitive diagnosis of meningitis can be made only by examination of CSF.

In patients who have not undergone a neurosurgical procedure, presentation of S aureus meningitis may be similar to that of other types of bacterial meningitis. Patients with septicemia have additional systemic signs and symptoms, including septic shock.

Common presentations of CoNS meningitis include low-grade fever (in 14-92% of cases), malaise, poor feeding, and irritability. Signs of meningeal irritation are not usually present, since no functional communication exists between the infected ventricles and CSF spaces in most cases.

Redness of the skin overlying a shunt, if it occurs, is a highly specific sign. Infections with symptoms referable to the distal portion of the shunt are more specific; shunts that end in a vessel lead to bacteremia, while shunts that end in the pleural or peritoneal space cause peritonitis or pleuritis.

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Contributor Information and Disclosures
Author

Lawrence A Zumo, MD  Neurologist, Private Practice

Lawrence A Zumo, MD is a member of the following medical societies: American Academy of Neurology, American College of Physicians, American Medical Association, and Southern Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Alan Greenberg, MD  Director, Associate Professor, Department of Internal Medicine, Jersey City Medical Center, Seton Hall University

Alan Greenberg, MD is a member of the following medical societies: Alpha Omega Alpha and American College of Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Norman C Reynolds Jr, MD  Neurologist, Veterans Affairs Medical Center of Milwaukee; Clinical Professor, Medical College of Wisconsin

Norman C Reynolds Jr, MD is a member of the following medical societies: American Academy of Neurology, Association of Military Surgeons of the US, Movement Disorders Society, Sigma Xi, and Society for Neuroscience

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Florian P Thomas, MD, MA, PhD, Drmed  Director, Spinal Cord Injury Unit, St Louis Veterans Affairs Medical Center; Director, National MS Society Multiple Sclerosis Center; Director, Neuropathy Association Center of Excellence, Professor, Department of Neurology and Psychiatry, Associate Professor, Institute for Molecular Virology, and Department of Molecular Microbiology and Immunology, St Louis University School of Medicine

Florian P Thomas, MD, MA, PhD, Drmed is a member of the following medical societies: American Academy of Neurology, American Neurological Association, American Paraplegia Society, Consortium of Multiple Sclerosis Centers, and National Multiple Sclerosis Society

Disclosure: Nothing to disclose.

Chief Editor

Karen L Roos, MD  John and Nancy Nelson Professor of Neurology, Professor of Neurological Surgery, Department of Neurology, Indiana University School of Medicine

Karen L Roos, MD is a member of the following medical societies: American Academy of Neurology and American Neurological Association

Disclosure: Nothing to disclose.

References

  1. Spotkov J, Garber SZ, Ruskin J. Staphylococcal meningitis: a complication of psoas abscess. Neurology. Jan 1985;35(1):110-1. [Medline].

  2. Adeloye A. Intracranial suppuration complicating tropical pyomyositis. Report of two cases. Trans R Soc Trop Med Hyg. 1982;76(4):463-4. [Medline].

  3. Roberts FJ, Smith JA, Wagner KR. Staphylococcus aureus meningitis: 26 years' experience at Vancouver General Hospital. Can Med Assoc J. Jun 15 1983;128(12):1418-20. [Medline].

  4. Schlesinger LS, Ross SC, Schaberg DR. Staphylococcus aureus meningitis: a broad-based epidemiologic study. Medicine (Baltimore). Mar 1987;66(2):148-56. [Medline].

  5. Weinstein MP, LaForce FM, Mangi RJ, Quintiliani R. Non-pneumococcal Gram-positive coccal meningitis related to neurosurgery. J Neurosurg. Aug 1977;47(2):236-40. [Medline].

  6. Kilpatrick ME, Girgis NI. Meningitis--a complication of spinal anesthesia. Anesth Analg. May 1983;62(5):513-5. [Medline].

  7. Worthington M, Hills J, Tally F, Flynn R. Bacterial meningitis after myelography. Surg Neurol. Oct 1980;14(4):318-20. [Medline].

  8. Watanakunakorn C, Tisone JC. Antagonism between nafcillin or oxacillin and rifampin against Staphylococcus aureus. Antimicrob Agents Chemother. Nov 1982;22(5):920-2. [Medline].

  9. Faville RJ, Zaske DE, Kaplan EL, et al. Staphylococcus aureus endocarditis. Combined therapy with vancomycin and rifampin. JAMA. Oct 27 1978;240(18):1963-5. [Medline].

  10. Acar JF, Goldstein FW, Duval J. Use of rifampin for the treatment of serious staphylococcal and gram-negative bacillary infections. Rev Infect Dis. Jul-Aug 1983;5 Suppl 3:S502-6. [Medline].

 
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