Severe community-acquired meningitis

Community-acquired meningitis is associated with high morbidity and mortality. The epidemiology of community-acquired meningitis has changed over the past 15 years with the use of new vaccines and with the development of resistance to antibiotics. Bacterial meningitis would appear to be the most frequent by far, but most viral aetiologies are very often poorly recognized. The annual incidence of purulent community-acquired meningitis in France was estimated at 22 cases per million inhabitants in 1993. Age is a major risk factor in bacterial meningitis. The most affected group is children under 2 years of age, in whom the infection rate ranges from 10 to 110 cases per 100000 infants per year. Such cases must be considered as an absolute medical emergency. This review is limited to meningitis in immunocompetent patients.