Question

Which of the following agents is most commonly associated with recurrent meningitis due to CSF leaks?

• A. Meningococci
• B. Pneumococci
• C. Hemophilus influenzae
• D. E. coli

Hint:

CSF leak plus recurrent meningitis equals pneumococcus, the dominant nasopharyngeal coloniser.

Answer 1

The Correct Option is B

Step 1: Understand the mechanism. A CSF leak (for example after a skull base fracture or with a congenital dural defect) creates a direct route between the nasopharynx and the meninges. Organisms that colonize the nasopharynx can then repeatedly seed the CSF, causing recurrent bacterial meningitis.

Step 2: Identify which nasopharyngeal coloniser dominates this setting. Streptococcus pneumoniae (pneumococcus) is the classic and most common organism in recurrent meningitis associated with CSF rhinorrhoea or otorrhoea and with anatomical or post traumatic dural defects.

Step 3: Address the distractors.
Meningococci cause epidemic and sporadic meningitis but are not the typical organism in recurrent CSF leak meningitis.
Haemophilus influenzae type b was an important cause of childhood meningitis before conjugate vaccination, but it is not the characteristic agent linked to CSF leaks.
E. coli is a leading cause of neonatal meningitis (acquired during birth) and is not the organism implicated in recurrent CSF leak meningitis.

Step 4: The classic association is with pneumococcus.

The correct answer is option B, Pneumococci.