Current perspectives in the diagnosis and management of bacterial meningitis. Literature review and update

Introduction: Bacterial meningitis is a serious and potentially fatal disease that has represented a significant challenge to medicine since its identification in the 19th century. Despite advances in antimicrobial treatment, it remains a major cause of morbidity and mortality worldwide. This review aims to update current perspectives on the diagnosis and management of bacterial meningitis, focusing on its pathogenesis, clinical manifestations, diagnostic methods, and therapeutic strategies. Methods: A search for information was carried out in the period August-December 2024 in the SciELO, LILACS, Scopus, PubMed-MedLine databases, the Google Scholar search engine, as well as in the ClinicalKeys services. For the recovery of information, an advanced search strategy was used and the terms “meningitis or bacterial meningitis” were used, as well as their translations into the English language. To combine the terms, Boolean operators were used, with search formulas according to the syntax requested by each database. Furthermore, in order to achieve a review based on the best possible evidence, only studies of the type case series, original articles or systematic reviews were selected. Results and discussion: Bacterial meningitis develops when pathogens overcome the host's defense mechanisms, colonizing mucous membranes, invading the bloodstream and penetrating the subarachnoid space. The main pathogens include Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae. The most common clinical manifestations are fever, headache, stiff neck and altered mental status. Diagnosis is based on analysis of cerebrospinal fluid (CSF), which shows pleocytosis, increased protein and decreased glucose. Empirical treatment includes antibiotics such as cefotaxime, ceftriaxone and vancomycin, together with dexamethasone as adjuvant therapy to reduce inflammation. Conclusions: Bacterial meningitis is a serious infection of the central nervous system, a medical emergency whose mortality and sequelae can be reduced with timely diagnosis and treatment. The key is to start treatment immediately and without delay. Prevention is the cornerstone of its control. Only through multidisciplinary management, which could include an expert infectious disease specialist, an intensive care physician, a specialized nurse and adequate laboratory equipment, can the impact of this devastating disease be mitigated.