meningitis

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Introduction

Inflammation of the membranes of the brain or spinal cord.

Etiology

* bacterial meningitis is most urgent & likely in HIV1 patients on antiretroviral therapy

Clinical manifestations

Laboratory

* blood cultures & administration of antibiotics prior to head CT & lumbar puncture for bacterial meningitis

Radiology

* see lumbar puncture for indications for head CT[10]

* absence of papilledema on fundoscopic examination insufficient to skip head CT prior to lumbar puncture[10]

Differential diagnosis

Management

Follow-up:

  • adults do not need follow-up because neurologic sequellae are rare with appropriate therapy
  • test hearing in children

More general terms

More specific terms

Additional terms

References

  1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 1063-64
  2. Contributions from Robert Libke, MD, Dept of Medicine, UCSF Fresno
  3. Journal Watch 22(24):179, 2002 de Gans J & van de Beek D Dexamethasone in adults with bacterial meningitis. N Engl J Med 347:1549, 2002 PMID: https://www.ncbi.nlm.nih.gov/pubmed/12432041 Tunkel AR & Scheld WM N Engl J Med 347:1613, 2002 (commentary)
  4. Journal Watch 24(24):184, 2004 van de Beek D, de Gans J, Spanjaard L, Weisfelt M, Reitsma JB, Vermeulen M. Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med. 2004 Oct 28;351(18):1849-59. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15509818 b) Swartz MN Bacterial meningitis--a view of the past 90 years. N Engl J Med. 2004 Oct 28;351(18):1826-8. No abstract. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15509815
  5. Journal Watch 24(24):185, 2004 Thwaites GE, Nguyen DB, Nguyen HD, Hoang TQ, Do TT, Nguyen TC, Nguyen QH, Nguyen TT, Nguyen NH, Nguyen TN, Nguyen NL, Nguyen HD, Vu NT, Cao HH, Tran TH, Pham PM, Nguyen TD, Stepniewska K, White NJ, Tran TH, Farrar JJ. Dexamethasone for the treatment of tuberculous meningitis in adolescents and adults. N Engl J Med. 2004 Oct 21;351(17):1741-51. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15496623
  6. Kupila L, Vuorinen T, Vainionpaa R, Hukkanen V, Marttila RJ, Kotilainen P. Etiology of aseptic meningitis and encephalitis in an adult population. Neurology. 2006 Jan 10;66(1):75-80. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16401850
  7. 7.0 7.1 7.2 Smith PB et al, A comparison of neonatal gram-negative rod and gram-positive cocci meningitis. J Perinatol 2006; 26:111 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16435007
  8. 8.0 8.1 Dubos F et al, Serum procalcitonin and other biologic markers to distinguish between bacterial and aseptic meningitis J Pediatr 2006, 149:71 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16860131
  9. 9.0 9.1 Logan SAE and MacMahon E, Viral meningitis BMJ 2008, 336:36 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18174598
  10. 10.00 10.01 10.02 10.03 10.04 10.05 10.06 10.07 10.08 10.09 10.10 Medical Knowledge Self Assessment Program (MKSAP) 14, 15, 16, 17, 18. American College of Physicians, Philadelphia 2006, 2009, 2012, 2015, 2018.
    Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  11. 11.0 11.1 11.2 van de Beek D et al Nosocomial bacterial meningitis. N Engl J Med 2010 Jan 14; 362:146. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20071704
  12. Linder A et al. Heparin-binding protein: A diagnostic marker of acute bacterial meningitis. Crit Care Med 2011 Apr; 39:812. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21200320
  13. Thigpen MC et al. Bacterial meningitis in the United States, 1998-2007. N Engl J Med 2011, May 26; 364:2016. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21612470
  14. 14.0 14.1 ARUP Consult: Acute Meningitis The Physician's Guide to Laboratory Test Selection & Interpretation https://www.arupconsult.com/content/meningitis-acute
  15. 15.0 15.1 Hanson KE, Reckleff J, Hicks L, Castellano C, Hicks CB. Unsuspected HIV infection in patients presenting with acute meningitis. Clin Infect Dis. 2008 Aug 1;47(3):433-4. PMID: https://www.ncbi.nlm.nih.gov/pubmed/18605915 Free Article
  16. 16.0 16.1 16.2 NEJM Knowledge+ Question of the Week. Dec 17, 2019 https://knowledgeplus.nejm.org/question-of-week/4763/
  17. National Institute of Neurological Disorders and Stroke (NINDS) NINDS Encephalitis and Meningitis Information Page https://www.ninds.nih.gov/Disorders/All-Disorders/Meningitis-and-Encephalitis-Information-Page

Patient information

meningitis patient information