BACTERIAL-MENINGITIS - MECHANISMS OF DISEASE AND THERAPY

Bacterial meningitis continues to be a serious infectious disease with a high morbidity and mortality in young children. Early recognition a nd initiation of adequate treatment are the major determinants for a g ood outcome. Recent advances in our understanding of the host inflamma tory response by cytokines may result in the use of new therapeutic st rategies. Such modulation of the inflammatory response may reduce the incidence of sequelae and death. The use of steroids as adjunctive the rapy in children with bacterial meningitis probably has beneficial eff ects although the available data are still controversial. Additionally , studies in experimental meningitis models indicate that non-steroida l anti-inflammatory drugs and monoclonal antibodies against bacterial products, cytokines and CD18 on leucocytes reduce the extent of the me ningeal inflammation. Human studies to evaluate the efficacy of these immune modulators are expected to start soon. However, prevention of b acterial meningitis by conjugate vaccines against Streptococcus pneumo niae and Neisseria meningitidis will be the most promising development in the next decade.