Strategies for prevention of brain damage resulting from bacterial meningitis

Multiplication of bacteria within the central nervous system compartment tr iggers a host response with an overshooting inflammatory reaction which lea ds to brain parenchyma damage. Some of the inflammatory and neurotoxic medi ators involved in the processes leading to neuronal injury during bacterial meningitis have been identified in recent years. As a result, the therapeu tic approach to the disease has widened from eradication of the bacterial p athogen with antibiotics to attenuation of the detrimental effects of host defences. Corticosteroids represent an example of the adjuvant therapeutic strategies aimed at downmodulating excessive inflammation in the infected c entral nervous system. Pathophysiological concepts derived from an experime ntal rat model of bacterial meningitis revealed possible therapeutic strate gies for prevention of brain damage. The insights gained led to the evaluat ion of new therapeutic modalities such as anticytokine agents, matrix metal loproteinase inhibitors, antioxidants, and antagonists endothelin and gluta mate. Bacterial meningitis is still associated with persistent neurological sequelae in approximately one third of surviving patients. Future research in the model will evaluate whether the neuroprotective agents identified s o far have the potential to attenuate learning disabilities as a long-term consequence of bacterial meningitis.