Meningitis

  • CNS infection should be considered in all patients with a headache, neck stiffness, fever, altered sensorium, or diffuse or focal neurological findings.
  • pneumoniae is one of the two leading causes of bacterial meningitis in adults. Mortality from S. pneumoniae is 30%.
  • pay close attention to cranial nerves 2, 3, 4, and 6
  • Altered mental status in a patient with suspected meningitis can be a sign of increased ICP or encephalitis.
  • You’ve got to get the LP! Only true way to assess for meningitis
  • Early initiation of empirical antimicrobial therapy is recommended in cases of suspected acute CNS infection. Antibiotic administration should not be delayed for CSF analysis or performance of neuroimaging studies.
  • Antibiotic chemoprophylaxis should be assured for close contacts of patients with meningitis resulting from N. meningitidis or H. in uenza.
  • Concomitant CNS infection should be strongly considered in any symptomatic patient with another severe systemic infection, such as urinary tract infection or pneumonia.
  • First line treatment for bacterial meningitis is ceftriaxone plus vancomycin.
  • Acyclovir is recommended for patients with suspected meningoencephalitis.
  • Dexamethasone is recommended prior to treatment with antibiotics in adults (controversial)

 

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