Bacterial meningitis physical examination: Difference between revisions

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Revision as of 16:18, 9 January 2017

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S [2]

Overview

Physical examination

Physical examination of bacterial meningitis may vary in adults and in infants. Following signs may suggest bacterial meningitis:^[1]^[2]^[3]^[4]^[5]

Adults

The physical examination findings in adults may include the following:

General appearance

Patient may look distressed
Altered mental status-not oriented in time, place and person

Vital signs

Bradycardia may indicate increased intracranial pressure
Increased or decreased temperature

HEENT

Signs of infection indicating sinusitis, mastoiditis, and otitis media may help identify the source of infection and give a clue about diagnosis.
Papilledema may indicate increased intracranial pressure.
Neck stiffness is strongly suggestive of meningitis.

CVS

Decreased heart rate indicates increased intracranial pressure

CNS

Signs of neurological deficit may not be present.

Skin

Presence of skin rash may indicate Neisseria meningitidis infection

Special tests

There are two special tests for meningitis:

Kernig's sign

Postive kernig's sign indicate meningitis.

Brudzinski's sign

Positive brudzinski's sign may suggest meningitis with a sensitivity of and specificity of

Infants

Neck stiffenss
Altered mental status
Bulging fontanelle
Convulsions
Petechial rash

References

↑ Attia J, Hatala R, Cook DJ, Wong JG (1999). "The rational clinical examination. Does this adult patient have acute meningitis?". JAMA. 282 (2): 175–81. PMID 10411200.
↑ https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0047163/ Accessed on Jan 9th, 2017
↑ Brouwer MC, Tunkel AR, van de Beek D (2010). "Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis". Clin Microbiol Rev. 23 (3): 467–92. doi:10.1128/CMR.00070-09. PMC 2901656. PMID 20610819.
↑ 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.
↑ van de Beek D, de Gans J, Spanjaard L, Weisfelt M, Reitsma JB, Vermeulen M (2004). "Clinical features and prognostic factors in adults with bacterial meningitis". N Engl J Med. 351 (18): 1849–59. doi:10.1056/NEJMoa040845. PMID 15509818.

Template:WikiDoc Sources

[pmid10411200-1] Attia J, Hatala R, Cook DJ, Wong JG (1999). "The rational clinical examination. Does this adult patient have acute meningitis?". JAMA. 282 (2): 175–81. PMID 10411200.

[abc-2] ttps://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0047163/ Accessed on Jan 9th, 2017

[pmid20610819-3] Brouwer MC, Tunkel AR, van de Beek D (2010). "Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis". Clin Microbiol Rev. 23 (3): 467–92. doi:10.1128/CMR.00070-09. PMC 2901656. PMID 20610819.

[pmid8416268-4] 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.

[pmid15509818-5] van de Beek D, de Gans J, Spanjaard L, Weisfelt M, Reitsma JB, Vermeulen M (2004). "Clinical features and prognostic factors in adults with bacterial meningitis". N Engl J Med. 351 (18): 1849–59. doi:10.1056/NEJMoa040845. PMID 15509818.

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 ==Overview==
 ==Physical examination==
-Physical examination of bacterial meningitis may vary in adults and in infants. Following signs may suggest bacterial meningitis:<ref name="pmid10411200">{{cite journal| author=Attia J, Hatala R, Cook DJ, Wong JG| title=The rational clinical examination. Does this adult patient have acute meningitis? | journal=JAMA | year= 1999 | volume= 282 | issue= 2 | pages= 175-81 | pmid=10411200 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10411200  }} </ref><ref name=abc>https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0047163/ Accessed on Jan 9th, 2017</ref><ref name="pmid20610819">{{cite journal| author=Brouwer MC, Tunkel AR, van de Beek D| title=Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis. | journal=Clin Microbiol Rev | year= 2010 | volume= 23 | issue= 3 | pages= 467-92 | pmid=20610819 | doi=10.1128/CMR.00070-09 | pmc=2901656 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20610819  }} </ref><ref name="pmid8416268">{{cite journal| author=Durand ML, Calderwood SB, Weber DJ, Miller SI, Southwick FS, Caviness VS et al.| title=Acute bacterial meningitis in adults. A review of 493 episodes. | journal=N Engl J Med | year= 1993 | volume= 328 | issue= 1 | pages= 21-8 | pmid=8416268 | doi=10.1056/NEJM199301073280104 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8416268  }} </ref>
+Physical examination of bacterial meningitis may vary in adults and in infants. Following signs may suggest bacterial meningitis:<ref name="pmid10411200">{{cite journal| author=Attia J, Hatala R, Cook DJ, Wong JG| title=The rational clinical examination. Does this adult patient have acute meningitis? | journal=JAMA | year= 1999 | volume= 282 | issue= 2 | pages= 175-81 | pmid=10411200 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10411200  }} </ref><ref name=abc>https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0047163/ Accessed on Jan 9th, 2017</ref><ref name="pmid20610819">{{cite journal| author=Brouwer MC, Tunkel AR, van de Beek D| title=Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis. | journal=Clin Microbiol Rev | year= 2010 | volume= 23 | issue= 3 | pages= 467-92 | pmid=20610819 | doi=10.1128/CMR.00070-09 | pmc=2901656 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20610819  }} </ref><ref name="pmid8416268">{{cite journal| author=Durand ML, Calderwood SB, Weber DJ, Miller SI, Southwick FS, Caviness VS et al.| title=Acute bacterial meningitis in adults. A review of 493 episodes. | journal=N Engl J Med | year= 1993 | volume= 328 | issue= 1 | pages= 21-8 | pmid=8416268 | doi=10.1056/NEJM199301073280104 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8416268  }} </ref><ref name="pmid15509818">{{cite journal| author=van de Beek D, de Gans J, Spanjaard L, Weisfelt M, Reitsma JB, Vermeulen M| title=Clinical features and prognostic factors in adults with bacterial meningitis. | journal=N Engl J Med | year= 2004 | volume= 351 | issue= 18 | pages= 1849-59 | pmid=15509818 | doi=10.1056/NEJMoa040845 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15509818  }} </ref>
 ===Adults===
 The physical examination findings in adults may include the following: