Most common cause for meningitis in adults: September 2009
**Core Concept**
The most common cause of bacterial meningitis in adults is often attributed to a specific pathogen that has a predilection for the central nervous system. This pathogen typically gains entry through the bloodstream and invades the meninges, leading to inflammation and severe symptoms.
**Why the Correct Answer is Right**
Streptococcus pneumoniae is a Gram-positive bacterium that is commonly found in the human respiratory tract. It can cause invasive disease, including meningitis, when it breaches the blood-brain barrier. The polysaccharide capsule of S. pneumoniae is a key virulence factor that enables it to evade host immune defenses and establish infection in the central nervous system. In adults, S. pneumoniae is responsible for the majority of bacterial meningitis cases, often following an upper respiratory tract infection or otitis media.
**Why Each Wrong Option is Incorrect**
**Option A:** *H. influenzae* is a Gram-negative bacterium that is more commonly associated with meningitis in children, particularly those under the age of 5. While it can cause invasive disease in adults, it is not the most common cause of meningitis in this age group.
**Option B:** *N. meningitidis* is a Gram-negative bacterium that is also capable of causing meningitis, but it is more commonly associated with outbreaks and epidemics, particularly in young adults and during the winter months.
**Option C:** *Staph. aureus* is a Gram-positive bacterium that can cause a range of infections, including skin and soft tissue infections, osteomyelitis, and endocarditis. While it can cause meningitis, it is not the most common cause of bacterial meningitis in adults.
**Clinical Pearl / High-Yield Fact**
It is essential to consider the patient's age, immune status, and recent medical history when diagnosing and treating meningitis. For example, children under 5 years are more likely to have *H. influenzae* meningitis, while adults with underlying immunocompromised conditions may be at increased risk of *N. meningitidis* or *L. monocytogenes* meningitis.
**β Correct Answer: D. Streptococcus pneumoniae**