Which pair of pathogens are commonly involved in meningitis in older children?

• A. Escherichia coli and Group B Streptococcus
• B. Haemophilus influenzae and Listeria monocytogenes
• C. Staphylococcus aureus and Pseudomonas aeruginosa
• D. Neisseria meningitidis and Streptococcus pneumoniae

Answer: (D)

In older children, meningitis is most commonly caused by two bacteria that are carried by healthy people and can spread in communities: Neisseria meningitidis and Streptococcus pneumoniae. Neisseria meningitidis often affects school-age children and teens and can cause outbreaks, while Streptococcus pneumoniae remains a leading cause of bacterial meningitis in children after infancy. This combination explains the majority of meningitis cases in this age group.

Other options reflect pathogens more typical of different settings or ages: E. coli and Group B Streptococcus are classic neonatal pathogens; Haemophilus influenzae type b used to be common but has declined with vaccination; Listeria monocytogenes is more important in the elderly, newborns, and immunocompromised adults; Staphylococcus aureus and Pseudomonas aeruginosa are usually associated with healthcare-associated meningitis or specific risk factors rather than routine meningitis in healthy older children.