Gaillemin Olivier, McGill Fiona
Practitioner. 2016 Jul-Aug;260(1795):25-30.
Bacterial meningitis and meningococcal sepsis are rare in adults. Any diagnostic delays with subsequent delay to treatment can have disastrous consequences. The decline in bacterial meningitis over the past few decades has not been accompanied by a reduction in case fatality rate which can be as high as 20% for all causes of bacterial meningitis and 30% in pneumococcal meningitis. The classic triad of neck stiffness, fever and altered consciousness is present in < 50% of cases of bacterial meningitis. Patients with viral meningitis also present with signs of meningism (headache, neck stiffness and photophobia) possibly with additional non-specific symptoms such as diarrhoea or sore throat. Suspected cases of meningitis or meningococcal sepsis must be referred for further assessment and consideration of a lumbar puncture. Most patients will fully recover. However, the sequelae of bacterial meningitis and meningococcal disease can be disabling. Many patients feel well at discharge and do not realise that they may not be able to return to all their normal duties and activities straightaway. Fatigue, headaches, sleep disorders and emotional problems are often reported in the weeks and months after discharge.
细菌性脑膜炎和脑膜炎球菌血症在成人中较为罕见。任何诊断延迟以及随之而来的治疗延迟都可能产生灾难性后果。在过去几十年中，细菌性脑膜炎发病率下降，但病死率并未降低，所有原因导致的细菌性脑膜炎病死率可达20%，肺炎球菌性脑膜炎病死率可达30%。不到50%的细菌性脑膜炎病例会出现颈强直、发热和意识改变这一典型三联征。病毒性脑膜炎患者也会出现脑膜刺激征（头痛、颈强直和畏光），可能还伴有腹泻或咽痛等其他非特异性症状。疑似脑膜炎或脑膜炎球菌血症的病例必须转诊以便进一步评估并考虑进行腰椎穿刺。大多数患者会完全康复。然而，细菌性脑膜炎和脑膜炎球菌病的后遗症可能会导致残疾。许多患者出院时感觉良好，并未意识到自己可能无法立即恢复所有正常工作和活动。出院后的数周和数月内，经常会出现疲劳、头痛、睡眠障碍和情绪问题。
