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Meningitis
Bacterial meningitis
Symptom :
Physical Examination:
Reference
Investigation :
Meningitis is inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges.
-ebmedicine
-uptodate
-medscape.com
Eyes, ENT, bulging fontanel.
Skin, abdomen, arms, and legs.
Temperature and breathing rate.
Listening to the heart and lungs.
Neck for stiffness.
Muscle strength and reflexes.
Kernig & Brudzinski sign.
CBC - CT - LP
blood glucose, blood gas
coagulation screen
U/E
culture : blood, urine, stool, throat
Rapid antigen, PCR
-Viral Infections
-Bacterial Infections
-Fungal Infections
-Inflammatory diseases
(SLE)
-Cancer
-Trauma to head or spine.
meningitis-trust.org
eastmed.co.nz
meningitis.com
ebmedicine.net
Aseptic Meningitis
Indications for Lumbar Puncture
A syndrome characterized by acute onset of meningeal symptoms, fever, and cerebrospinal fluid pleocytosis, with bacteriologically sterile cultures.
Complication:
-Enteroviruses : most common.
-Adenovirus
-Arbovirus
-Measles virus
-Herpes Simplex Virus
-Varicella
-Impaired mental status
-Increased intracranial pressure and cerebral edema
-Seizures
-Focal neurologic deficits (eg, cranial nerve palsy, hemiparesis)
-Cerebrovascular abnormalities
-Sensorineural hearing loss
-Intellectual impairment
-Suspected neonatal sepsis: fever, toxic appearing, seizure, ALTEs
-Febrile illness between 1-2months: difficult to exclude meningitis by exam
-Febrile illness after close contact to patients with a SBI
- Nuchal signs
- Fever and petechiae: LP if unwell
-Immunocompromised
-Dural penetration: craniofacial trauma; LP after CT
- Acute hearing loss
Prevention
Vaccines:
Pneumovax
Meningicoccal vaccine
Both should be administered to any asplenic patient
Exposure to meningococcus:
Rifampin
Only for intimate contacts: household contacts
Not needed for: classmates, co-workers, HCWs (ER personnel, EMTs, etc)
Bashayer AlMohaimeed
Indications for CT scanning b/f LP
- Focal neurological deficit
- Focal seizure
- Marked decreased LOC
- papilledema
- Hx or evidence of head trauma (recent or remote)
- Known intracranial mass
- ALL immunocompromised patients
Steroid
Reduces morbidity and mortality
• Give before or at the same time as the first dose of antibiotics
• Dose studied
– Dexamethazone 10 mg Q6H x 4 days
Treatment:
Viral Meningitis
Treat like bacterial meningitis until
the 72 hr culture comes back negative, or
Enteroviral PCR comes back positive
Consider acyclovir if CSF HSV PCR positive
uspharmacist.com