Bacterial meningitis: Difference between revisions
From IDWiki
m (Aidan moved page CNS Bacterial meningitis to Bacterial meningitis without leaving a redirect) |
mNo edit summary |
||
| Line 1: | Line 1: | ||
= Bacterial meningitis = |
= Bacterial meningitis = |
||
= Definition = |
|||
* Bacterial infection of meninges |
* Bacterial infection of meninges |
||
= Etiology = |
|||
* Adults |
* Adults |
||
| Line 21: | Line 21: | ||
** Gram-negatives |
** Gram-negatives |
||
= Risk factors = |
|||
* Immunosuppression |
* Immunosuppression |
||
| Line 33: | Line 33: | ||
* Chronic otitis media |
* Chronic otitis media |
||
= Presentation = |
|||
* Typically, an acute onset of headache with fever and vomiting after viral prodrome |
* Typically, an acute onset of headache with fever and vomiting after viral prodrome |
||
| Line 48: | Line 48: | ||
* Ask about recent travel and sick contacts |
* Ask about recent travel and sick contacts |
||
= Investigations = |
|||
* Lab |
* Lab |
||
| Line 62: | Line 62: | ||
** Lumbar puncture after CT head |
** Lumbar puncture after CT head |
||
== CSF Interpretation == |
|||
* Gram stain positive |
* Gram stain positive |
||
| Line 71: | Line 71: | ||
* PMNs >1180 |
* PMNs >1180 |
||
= Management = |
|||
* Blood cultures before antibiotics |
* Blood cultures before antibiotics |
||
| Line 89: | Line 89: | ||
* Adjust antibiotics based on Gram stain and cultures |
* Adjust antibiotics based on Gram stain and cultures |
||
= Complications = |
|||
* Cerebral edema with raised ICP |
* Cerebral edema with raised ICP |
||
| Line 99: | Line 99: | ||
* Venous sinus thrombosis |
* Venous sinus thrombosis |
||
* Cranial nerve palsies, especially deafness |
* Cranial nerve palsies, especially deafness |
||
[[Category:CNS infections]] |
|||
Revision as of 17:32, 12 August 2019
Bacterial meningitis
Definition
- Bacterial infection of meninges
Etiology
- Adults
- Streptococcus pneumoniae
- Neisseria meningitidis
- Listeria monocytogenes in immunocompromised, elderly, alcoholics, adn diabetes
- Haemophilus influenzae
- Infants:
- Group B Streptococcus
- Escherichia coli
- Haemophilus influenza
- Listeria monocytogenes
- Head trauma or neurosurgery
- Staphylococcus aureus
- Gram-negatives
Risk factors
- Immunosuppression
- Diabetes
- Splenic dysfunction or splenectomy (e.g. sickle cell)
- Alcoholism
- Recent neurosurgery
- CSF leak
- Shunt infections
- Head trauma
- Chronic otitis media
Presentation
- Typically, an acute onset of headache with fever and vomiting after viral prodrome
- Bacterial vs. aseptic/viral meningitis
- Headache or neck pain (70-80%)
- Fever (75%)
- Altered level of consciousness (70%)
- Clinical signs
- Brudzinski's sign (unhelpful)
- Kernig's sign (may be specific)
- Jolt test (very sensitive)
- Seizures or focal neurological deficits (rare, poor prognosis)
- Rash (purpuric with Neisseria)
- Ask about recent travel and sick contacts
Investigations
- Lab
- CBC with differential
- Electrolytes
- Liver enzymes
- Blood cultures
- Imaging
- CT head to rule out abscess or increased ICP
- MRI head if suspicion for herpes encephalitis
- Temporal lobe enhancement (usually unilateral)
- Other
- Lumbar puncture after CT head
CSF Interpretation
- Gram stain positive
- Glucose <1.0
- CSF:blood glucose <0.23
- Protein >2.2
- WBC >2000
- PMNs >1180
Management
- Blood cultures before antibiotics
- Start empiric antibiotics and dexamethasone
- Infants
- Children
- Adults
- Ceftriaxone 2g bid
- vancomycin 1g q12h
- +/- ampicillin 2g 14h if >50
- Dexamethasone 10mg q6h x72h
- +/- acyclovir
- >65 years old
- Treat like immunocompromised
- CT head if reduced or altered level of consciousness
- Lumbar puncture
- Adjust antibiotics based on Gram stain and cultures
Complications
- Cerebral edema with raised ICP
- Hydrocephalus
- Seizures
- Arterial ischemia or infarction
- SIADH
- Subdural effusion or subdural empyema
- Venous sinus thrombosis
- Cranial nerve palsies, especially deafness
