Meningitis resident survival guide: Difference between revisions
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==Overview== | ==Overview== | ||
Meningitis is characterized by inflammation of the leptomeninges.Meningitis causes are divided to infectious and non-infectious process.Infectious | [[Meningitis, meningococcal|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 [[Granulomatosis with polyangiitis|wegener's]]) or certain drugs (e.g. [[nonsteroidal antiinflammatory drugs]], [[intravenous immunoglobulin]], intrathecal agents, and [[Sulfamethoxazole-Trimethoprim|trimethoprim-sulfamethoxazole]]). | causes are included,bacterial,viral,[[fungal]],[[protozoal]] and,[[Treponemal infection|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 [[Granulomatosis with polyangiitis|wegener's]]) or certain drugs (e.g. [[nonsteroidal antiinflammatory drugs]], [[intravenous immunoglobulin]], [[intrathecal]] agents, and [[Sulfamethoxazole-Trimethoprim|trimethoprim-sulfamethoxazole]]). | ||
==Causes== | ==Causes== | ||
===Life Threatening Causes=== | ===Life Threatening Causes=== | ||
Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated. | Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated. | ||
* [[Bacterial]] | |||
* [[Viral]] | *[[Bacterial]] | ||
* [[Fungal]] | *[[Viral]] | ||
*[[Fungal]] | |||
===Common Causes=== | ===Common Causes=== | ||
Bacterial: | Bacterial: | ||
* [[Streptococcus pneumoniae]] | |||
* [[Neisseria meningitis]] | *[[Streptococcus pneumoniae]] | ||
* [[Haemophilus influenzae|Hemophilus influenza]] | *[[Neisseria meningitis]] | ||
* [[Group B streptococcus]] | *[[Haemophilus influenzae|Hemophilus influenza]] | ||
* [[Listeria monocytogenes]] | *[[Group B streptococcus]] | ||
*[[Listeria monocytogenes]] | |||
Viral: | Viral: | ||
* [[Enteroviruses]] | |||
* [[Herpes simplex]] [[viruses]] 1 and 2 | *[[Enteroviruses]] | ||
* [[Arboviruses]] | *[[Herpes simplex]] [[viruses]] 1 and 2 | ||
*[[Arboviruses]] | |||
Fungal: | Fungal: | ||
* [[Cryptococcus neoformans]] | |||
*[[Cryptococcus neoformans]] | |||
*[[Aspergillus]] sp. | *[[Aspergillus]] sp. | ||
*[[Blastomyces dermatitidis]] | *[[Blastomyces dermatitidis]] | ||
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==Treatment== | ==Treatment== | ||
Adapted from IDSA guidline | Adapted from IDSA guidline | ||
{{Family tree/start}} | {{Family tree/start}} | ||
{{Family tree | | | | A01 | | | |A01= suspicion for bacterial meningitis}} | {{Family tree | | | | A01 | | | |A01= suspicion for bacterial meningitis}} | ||
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==Do's== | ==Do's== | ||
* The content in this section is in bullet points. | |||
*The content in this section is in bullet points. | |||
==Don'ts== | ==Don'ts== | ||
<references /> | |||
Revision as of 15:22, 4 November 2020
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:
- Streptococcus pneumoniae
- Neisseria meningitis
- Hemophilus influenza
- Group B streptococcus
- Listeria monocytogenes
Viral:
Fungal:
- Cryptococcus neoformans
- Aspergillus sp.
- Blastomyces dermatitidis
- Coccidioides immitis
- Candida spp.
- Histoplasma capsulatum
- Sporothrix schencki
Diagnosis
| 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 | |||||||||||||||||||
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.