S. pneumoniae is among the most common causes of meningitis in both adults and children. Pneumococcal meningitis can present as a primary syndrome or as a complication of other pneumococcal conditions (e.g., otitis media, infected skull fracture, bacteremia). Pneumococcal meningitis is clinically indistinguishable from pyogenic meningitis of other etiologies.

• Pts have fever, headache, neck stiffness, photophobia, and occasionally seizures and confusion.
• On examination, pts have a toxic appearance, altered consciousness, bradycardia, and hypertension (indicative of increased intracranial pressure). Kernig's or Brudzinski's sign or cranial nerve palsies (particularly of the third and sixth cranial nerves) are noted in a small fraction of adult pts.
• Diagnosis of pneumococcal meningitis relies on examination of CSF, which reveals an elevated protein level, elevated WBC count, and reduced glucose concentration. The etiologic agent can be specifically identified by culture, antigen testing, or PCR. A blood culture positive for S. pneumoniae in conjunction with clinical manifestations of meningitis is also considered confirmatory.