Meningitis/Encephalitis

Question 1

What makes you suspect meningitis clinically?

Suspected pathogens?

Answer 1

2 of 4 (fever, HA, neck stiffness, GCS<14). Jolt accentuation test more sens than Kernig/Bruz.

S.pneumo and N.mening make up 80% of bacterial cases.
- consider listeria in pregnant, >50yo, immunosuppressed

Question 2

Management:

1 - who needs CT before LP

2 - who does not get dexamethasone (10mg QID x4d)

3 - timing of abx? choice?

Answer 2

CT prior to LP if signs of inc ICP/FND, severe immunocompromised, new-onset seizures, AMS (GCS<10). In these patients give empiric abx/dex first

NO dex if pre-treated with abx, hypersensitivity to steroids, recent head injury, CSF shunt
- dexa benefits S.pneumo patients

If acute bac meningitis suspected - dexa abd Abx NOW, prior to LP/imaging. LP soon after to avoid sterilization
- Vanc and high dose Rocephin; if >50 add Ampicillin