Pathogenesis of bacterial meningitis: from bacteraemia to neuronal injury

• Published in: Nature reviews. Neuroscience Vol. 4; no. 5; pp. 376 - 385
• Main Author: Kim, Kwang Sik
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group 01.05.2003
• Subjects: Animals; Antigens; Bacteremia; Bacteria; Bacterial diseases; Bacterial diseases of the nervous system. Bacterial myositis; Bacterial infections; Biological and medical sciences; Biomarkers; Blood-Brain Barrier; Cerebrospinal fluid; E coli; Endothelium, Vascular - cytology; Endothelium, Vascular - metabolism; Escherichia coli - metabolism; Human bacterial diseases; Infectious diseases; Leukocytosis; Medical sciences; Meninges - microbiology; Meningitis; Meningitis, Bacterial - metabolism; Meningitis, Bacterial - mortality; Models, Biological; Morbidity; Mortality; Nervous system; Neurons - metabolism; Neurons - microbiology; Neurons - pathology; Pathogenesis; Permeability; Streptococcus infections; Infection; Nervous system diseases; Pathogenesis; Central nervous system disease; Bacteriosis; Meningitis; Review
• ISSN: 1471-003X; 1471-0048; 1471-0048; 1469-3178
• DOI: 10.1038/nrn1103

Bacterial meningitis is an important cause of mortality and morbidity despite advances in antimicrobial therapy. A key factor that contributes to the high prevalence of this condition is the incomplete understanding of its pathogenesis. Most cases of bacterial meningitis develop as a result of haematogenous spread, but it is unclear how circulating bacteria cross the blood-brain barrier, and how bacterial entry into the central nervous system results in inflammation and in complications such as pleocytosis, blood-brain barrier disruption and neuronal injury. Recent studies have shed light on the pathogenic mechanisms of bacterial translocation across the blood-brain barrier and the meningitis-associated complications. I propose that bacterial translocation, a key step for the development of meningitis, is the result of specific bacteria-host interactions, and that its complications are the result of multiple host responses to the invading microorganism.