Meningitis resident survival guide
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Niloofarsadaat Eshaghhosseiny, MD[2]
Overview
Meningitis is characterized by inflammation of the leptomeninges.Meningitis causes are divided to infectious and non-infectious process.Infectious causes are included,bacterial,viral,fungal,protozoal and,treponemal. non-infectious causes, such as systemic illnesses that may involve CNS (e.g. neoplasms or connective tissue diseases, such as sarcoidosis, systemic lupus erythematosus (SLE), and wegener's) or certain drugs (e.g. nonsteroidal antiinflammatory drugs, intravenous immunoglobulin, intrathecal agents, and trimethoprim-sulfamethoxazole).
Causes
Life Threatening Causes
Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.
Common Causes
Bacterial:[1]
- Streptococcus pneumoniae
- Neisseria meningitis
- Hemophilus influenza
- Group B streptococcus
- Listeria monocytogenes
Viral:[2]
Fungal:
- Cryptococcus neoformans
- Aspergillus sp.
- Blastomyces dermatitidis
- Coccidioides immitis
- Candida spp.
- Histoplasma capsulatum
- Sporothrix schencki
Diagnosis
Adapted from IDSA guidline
| suspicion for bacterial meningitis | |||||||||||||||||||
| yes | |||||||||||||||||||
| Immuncompromised,new onset seizure,History of CNS dis,altered consciousness,papilledema,focal neuorologic deficit,delay in performance of diagnostic of LP | |||||||||||||||||||
| Yes | No | ||||||||||||||||||
| Blood culture stat,CTscan | Blood culture and LP stat | ||||||||||||||||||
| Negative CTscan | |||||||||||||||||||
| LP | |||||||||||||||||||
- Cerebrospinal Fluid Analysis:
Treatment
Adapted from IDSA guidline
| suspicion for bacterial meningitis | |||||||||||||||||||||||||||||||||||||||||
| yes | |||||||||||||||||||||||||||||||||||||||||
| Immuncompromised,new onset seizure,History of CNS dis,altered consciousness,papilledema,focal neuorologic deficit,delay in performance of diagnostic of LP | |||||||||||||||||||||||||||||||||||||||||
| Yes | No | ||||||||||||||||||||||||||||||||||||||||
| Blood culture stat | Blood culture and LP stat | ||||||||||||||||||||||||||||||||||||||||
| Dexamethasone and empirical antibiotic therapy | Dexamethasone and empirical antibiotic therapy | ||||||||||||||||||||||||||||||||||||||||
| Negative CTscan of head | Positive CT scan | Csf findings c/w bacterial meningitis | |||||||||||||||||||||||||||||||||||||||
| Perform LP | Continue therapy or consider alternative diagnosis | Yes | |||||||||||||||||||||||||||||||||||||||
| Continue therapy | |||||||||||||||||||||||||||||||||||||||||
Do's
- The content in this section is in bullet points.
Don'ts
- Do not delay the delivery of empiric antibiotic for clinical investigation.
- ↑ Durand ML, Calderwood SB, Weber DJ, Miller SI, Southwick FS, Caviness VS; et al. (1993). "Acute bacterial meningitis in adults. A review of 493 episodes". N Engl J Med. 328 (1): 21–8. doi:10.1056/NEJM199301073280104. PMID 8416268.
- ↑ Chigusa S, Moroi T, Shoji Y (2017). "State-of-the-Art Calculation of the Decay Rate of Electroweak Vacuum in the Standard Model". Phys Rev Lett. 119 (21): 211801. doi:10.1103/PhysRevLett.119.211801. PMID 29219400.