Central nervous system (
CNS) infections are frequently encountered at the primary care level, in emergency rooms, medical wards, and intensive care units. Advances in immunization techniques and aggressive prevention campaigns have had an impact on the worldwide incidence of community-acquired
meningitis, limiting this disease to the adult population. In general, a high index of suspicion is required for the diagnosis, but special attention should be given to the immunocompromised host and post-neurosurgical patient in whom the clinical presentation may be nonspecific. Once the diagnosis is made, broad-spectrum antimicrobials should be administered, followed by diagnostic testing, and targeted
antibiotic therapy. Current guidelines for the treatment of
meningitis are clinically effective but are not based on randomized, prospective, controlled trials. Despite current
therapies, the morbidity of
CNS infections is still devastating. Recent trials of the use of
corticosteroids as coadjuvants of
antibiotic therapy showed promising results and decrease in the morbidity associated with bacterial and
tuberculous meningitis. Additional neuroprotective alternatives should be the focus of future research. Similarly, guidelines for the diagnosis and management of post-
neurosurgical procedure meningitis and
ventriculostomy-related
infections are needed.