Epidemiology

The specific pathogen likely to cause bacterial, viral, or fungal meningitis varies according to geographic location as well as age range and immune function. Currently there are about 1.6 cases of bacterial meningitis per 100,000 children age 4 years and younger annually (Peltola 2000). Although rates of invasive meningococcal disease most often occur in infants and young children, rates of infection in the United States increase marginally during late adolescence due to the high prevalence of young adults living in close proximity to one another at college (Kaplan et al. 2006). In developing countries, vaccination against Haemophilus influenzae type B is very expensive and rarely available to children (only available to 5.9% of children, compared with 98% in the United States) (Peltola 2000). Thus, bacterial meningitis is widespread and continues to be a major cause of mortality for children in developing countries.

The incidence of viral meningitis is greater than that of bacterial meningitis in children but is less severe; the mortality rate of viral meningitis is lower than that of bacterial meningitis (Whitaker et al. 2002). There are more than 10,000 cases of aseptic meningitis reported annually to the Centers for Disease Control and Prevention (CDC; Swayer 2002). Viral meningitis is most prevalent in the summer and autumn months; typically enteroviral infections (a type of viral meningitis) occur in June through October in the United States (Centers for Disease Control and Prevention 2003; Hasburn 2000).

Herpes simplex virus (HSV) is a common cause of acute necrotizing encephalitis that may appear at any age (Weil et al. 2000) but is most common in infants (Granerod and Crowcroft 2007). Frequency of infection is estimated to be 1 case per 250,000500,000 people per year (Weil et al. 2000). HSV encephalitis is diagnosed in about 1 of every 3,000 live births in the United States and affects about 1,500-2,200 infants per year in the United States (Jacobs 1998).

Fungal meningitis is a rare form of an opportunistic infection and occurs in patients with compromised immune systems such as low birth weigh neonates (< 1,500g), oncology patients who are neu-tropenic, and HIV-positive patients. Fungal meningitis may occur in the form of nosocomial pediatric meningitis. Fungal nosocomial meningitis infection is rare, occurring in 5%-10% of all nosocomial meningitis cases (Krcmery and Paradisi 2000).

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