Meningitis due to staphylococcus aureus in children

Meningitis due to Staphylococcus aureus is uncommon, occurring primarily in patients with known preexisting abnormalities of the CNS (including patients who have undergone previous neurosurgery or trauma). We reviewed our experience with meningitis due to S. aureus in children seen at two medical centers. Among the 40 patients, 32 (80%) had a known predisposing abnormality of the CNS at the time of diagnosis of S. aureus meningitis; all of these 32 patients had had recent neurosurgery, most for placement or revision of a ventriculoperitoneal shunt. Eight patients had no known predisposing CNS abnormality. Four of these eight patients were known to be immunocompromised. The other four patients all had an occult CNS abnormality demonstrated during subsequent workup. Our series demonstrates that when the diagnosis of S. aureus meningitis is made in the absence of a known predisposing CNS abnormality or immunologic defect, then a timely search for an occult CNS abnormality should be undertaken.