The clinical spectrum of bacterial meningitis

Abstract

E PIDEMIC meningitis with a rash of “purple spots” was clearly described by Vieusseux following an outbreak in Geneva in 1805 [7]. In the era before diagnostic bacteriology, meningitis was known to be an occasional complication of pneumonia and tuberculosis. In 1886 Frankel as well as Foa and Bondoni-Uffreduzzi demonstrated the pneumococcus in human spinal fluid. The following year Weichselbaum noted gram-negative diplococci in six cases of acute meningitis. Hemophilus influenza meningitis was described by Slawyk in 1899 [Z]. During the ensuing thirty years many of the less common etiologic agents were isolated, including the staphylococcus and a number of coliform organisms. More recently Mima polymorpha [3-51 and Listeria monocytogenes [6,7] have received attention as occasional causes of bacterial meningitis. logic diagnosis was established by culture of the cerebrospinal fluid. (Table I.) In eight cases the causative organism grew in blood cultures and was seen in the gram stain of the cerebrospinal fluid sediment. In six cases the diagnosis of meningococcal meningitis was made in patients with a purpuric rash and sterile cerebrospinal fluid containing typical gram-negative diplococci. In twenty-two cases the etiologic agent was unknown. In twelve of these, definite organisms were seen in the sediment of the cerebrospinal fluid. In two additional cases the diagnosis of purulent meningitis was confirmed at autopsy. The remaining patients recovered promptly from a clinically typical illness; in each instance the sugar in the cerebrospinal fluid was less than