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Bacterial Meningitis

Bacterial Meningitis

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Published by: Athit Wutthisanwatthana on Jun 26, 2011
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Athit Wutthisanwatthana

Acute purulent infection within the subarachnoid space


Community-Acquired Bacterial Meningitis
10 15 Streptococcus pneumoniae 50 Neisseria meningitidis Group B streptococci 25 Listeria monocytogenes

Streptococcus pneumoniae #1 in age > 20 years Predisposing conditions #1 Streptococcal pneumonia Acute/chronic pneumococcal sinusitis/otitis media Alchoholism Diabetes Complement deficiency Head trauma with basilar skull fracture and CSF rhinorrhea Mortality ~20% .


Neisseria meningitidis Petechial or purpuric lesion is important clue Some is fulminant Initiated by nasopharyngeal colonization Asymptomatic carrier Invasive meningococcal disease .





Enteric Gram-Negative Bacilli Diabetes mellitus Cirrhosis Alcoholism Chronic urinary tract infection Craniotomy .

Group B Streptococcus Streptococcus agalactiae Neonates Age > 50 years .

Listeria monocytogenes Acquired by food ingestion Cause of meningitis in Neonate Pregnant woman Age > 60 year Immunocompromised patient .

Haemophilus influenzae Unvaccinated children and adults .

Staphylococcus aureus and Coagulase-Negative staphylococci Invasive neurological procedures .

Pathophysiology .





Clinical Manifestation .

Clinical Manifestation Fever Headache Nuchal rigidity Decreased level of consciousness Nausea Vomiting Photophobia Seizures .

Increase intracranial pressure Deceased level of consciousness Papilledema Dilated poorly reactive pupils Sixth nerve palsies Decerebrate posturing Cushing reflex .

Rash of meningococcemia Diffuse erythematous maculopapular rash Petechiae Trunk Lower extremities Mucous membranes Conjuctivae Palms Soles .

Management .

Management Algorithm for Adults with Suspected Bacterial Meningitis .

Empical Antibiotic Indication Antibiotic Immunocompetent children > 3 and Cefotaxime/ceftriaxone + adults < 55 vancomycin Adults > 55 and adult of any age with alcholism or other debilitating illness Cefotaxime/ceftriaxone + vancomycin + Ampicillin .

Total Daily Dose and Dosing Interval Antimicrobial agent Ampicillin Cefotaxime Ceftriaxone Vancomycin 2 g IV q 6 h 2 g IV q 6 h 2 g IV q 12 h 1 g IV q 12 h .


cerebral edema or herniation in CT/MR scan .Contraindication for LP Absolute Signs of raised intracranial pressure Local skin infection Evidence of obstructive hydrocephalus.

warfarin) Neurological deficit GCS ” 8 Epileptic seizure . platelet < 50.Contraindication for LP Relative Sepsis/hypotension (BP <100/<60 mmHg) Coagulation disorder (DIC.000.

Cerebrospinal Fluid Abnormalities in Bacterial Meningitis .

Comparison of CSF of Meningitis .

Timing of Antibiotic As soon as possible Antibiotic few hours before LP will not alter the CSF .

Antibiotic Based on Positive Gram Stain .

Duration of Treatment (A-III) .

04) .03) Death (7% vs.Role of Dexamethasone Decrease inflammatory response Dexamethasone therapy for bacterial meningitis. p = 0. 15%. N Engl J Med 2002 301 cases Unfavorable outcome (15% vs. 25%. p = 0.

p = 0. p = 0. 52%.006) Death (14% vs.Benefit in pneumococcal meningitis subgroup Unfavorable outcome (26% vs. 34%.02) Most beneficial in patient with moderate-severe disease on the Glasgow Coma Scale .

15 mg/kg q6h for 2-4 days Suspected/proven pneumococcal meningitis (A-I) First dose administered 10-20 min before antibiotic .Recommendation by IDSA Dexamethasone 0.


Dexamethasone and Pneumococcal Meningitis Concerns in highly penicillin./ cephalosporinresistant strain Dexamethasone diminishes inflammatory response Dexamethasone be administered to all (B-III) Addition of rifampin (B-III) .

Indications for Repeated Lumbar Puncture Any patient who has not responded clinically after 48 h (A-III) .

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