Bacterial meningitis in neonates (BM) is always an acute, severe, life-threatening disease, frequently followed by immediate and/or long-term complications. It is usually an outcome of septicaemia from one or more locations. Bacteriaemia preceding the localisation of the disease, or developing in the course of septicaemia, is not always diagnosed on microbiological examination. This is due to many reasons: short-term presence of bacteria in the blood, difficulty in collecting sufficient material for examination, and, frequently in this group, administration of an antibiotic at the early stage of the disease. Early treatment of the neonate, prior to establishing the aetiology of the disease, is justified by the generally dramatic course of each infection and rapid consecutive stages of septicaemia which are difficult to reverse, or are irreversible. These include shock refractory to treatment, resistance to medication and administered fluids, and multi-organ damage (MODS) characterised by respiratory distress, anuria, acute liver failure, changes in consciousness and dissseminated intravascular coagulation (DIC). Therefore, neonates with presumed septicaemia in their first two weeks of life [hyper- or hypothermia, tachycardia, tachypnoea, leukocytosis or leukopaenia or a disturbed leukocyte ratio (immature cells to total granulocyte count] should undergo lumbar puncture, CFS examination, and blood culture, or possibly the collection of any other biological material available for examination.

Over a period of 11 years (1988-1998), bacterial meningitis was diagnosed in 50 neonates (2.56% of the total number of patients treated at the Department of Neonatal Pathology) (Table 1).

Positive CSF culture was noted in 31 patients (62%), and in 17 of these (54.8%) blood culture grew the same bacteria, which confirmed the diagnosis of septicaemia. In 19 neonates (38%) the CSF culture was negative and the diagnosis was established from complete and chemical CSF examination. In 31 cases microbiological examination confirmed bacterial meningitis: G(-) bacteria were found in 17 patients (54.8%), G(+) organisms in 9 patients (29%), and Candida albicans was isolated in 5 patients (16.2%) (Table 2). In the G(+) group Listeria monocytogenes was isolated in 4 patients (12.9%).