Meningitis

Meningitis:

Suspect in patients with headache, fever, nuchal (neck) rigidity/stiffness, AMS, nausea.

PE: Neck stiffness, Kernig and Brudzinski signs

Lumbar Puncture done acutely (may already be done by the ER physician).

Start Ceftriaxone along with Vancomycin.

Add dexamethasone 10 mg IV q6h.

Run complete work-up on the CSF including: Gram stain and culture, cell count, glucose, protein, AFB smear and culture, India Ink, fungal cx, VDRL, Cryptococcal Ag and cytology.

Keep the patient on droplet isolation initially until meningitis is ruled out.

Start seizure precautions.

SCD for DVT prophylaxis (cases of intracranial hemorrhage were described in acute meningitis with anticoagulation. Especially if patient recently had LP).

  • Lumbar puncture to analyze CSF
  • Consult Infectious Disease
  • Types of Meningitis:
    1. Bacterial meningitis:
      1. LP: low glucose
    2. Viral meningitis:
      • LP: elevated WBC count and elevated lymphocyte count
      • Tx: Ganciclovir
      • Order HSV/PCR
    3. Aseptic meningitis:
      • LP example: CSF lymphocyte count of 95, CSF white cell count of 10, and CSF protein of 71, all of which are elevated.

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