New Advances in the Pathogenesis and Pathophysiology of Bacterial Meningitis.

Acute bacterial meningitis continues to be a significant health concern, with a fatality rate of more than 30% in some studies. Although the face of bacterial meningitis has changed substantially over the past 15 years, this disease still causes significant mortality (particularly in underdeveloped countries) and neurological sequelae. Our understanding of the pathophysiology of bacterial meningitis continues to develop. Our understanding of the mechanisms of neuronal injury now includes the concept that many of the pathological changes are only secondary to the infection and that the human immune system contributes to the majority of the neuronal death. A complicated series of interactions among immune, vascular and central nervous system cells, cytokines and chemokines, matrix metalloproteinases and free radical molecules are ultimately responsible for many bacterial meningitis changes. We hope that a complete understanding of these processes will ultimately lead to better diagnostic techniques and improved treatments.