Meet the disease at its first stage. PERSIUS (AD 34–62) Satires

Acute bacterial meningitis remains a significant cause of morbidity and mortality in the United States. It now appears that the microbiologic epidemiology of this potentially devastating disease is changing. We have seen a decrease in the incidence of Haemophilus influenzae meningitis and the emergence of high-level penicillin resistance in Streptococcus pneumoniae –related disease. These developments affect the recommendations for initial empiric therapy of acute bacterial meningitis. This article reviews the epidemiology, clinical presentation, approaches to diagnosis, and the early therapy of acute bacterial meningitis.