| name: | Bacterial Meningitis |
| also known as: | Spinal Meningitis; Brain Infection; ICD 320.9 |
| also see: | Viral Meningitis; Meningitis; Neonatal Meningitis; Encephalitis; Craniotomy; Meningococcemia; ICD |
| description: | Bacterial meningitis is a bacterial infection of the lining of the brain and spinal cord, called the meninges, and is one type of meningitis. It can be caused by any of a number of bacteria, but the most common are neisseria and pneumococcus. The infection usually begins elsewhere in the body, such as the ear, nose or throat and then spreads to the brain. Risk is increased with newborns and infants, those over 60, sinus infection, middle ear infection, poor nutrition, chronic illness, alcoholism. Bacterial meningitis can not be distinguished easily from other causes of meningitis such as viral meningitis. |
| signs & symptoms: | Includes fever, chills, rigors, sweating, headache, stiff neck, irritability, malaise, sensitivity to light called photophobia, vomiting, a red-purple skin rash, confusion, drowsiness, listlessness, unconsciousness as well as the symptoms of the primary infection such as sore throat, sinus infection, etc. |
| diagnosis: | Based on signs, symptoms, history, and exam, as well as blood count and an analysis of the CSF fluid called a spinal tap for culture and gram stain. Often a diagnostic study, such as a CT Scan or an MRI Scan of the brain is performed. The spinal tap should not be performed until after a CT scan has been obtained: A spinal tap should NOT be performed if there is a brain abscess or brain tumor as mass lesions in the brain can cause brainstem herniation while performing a spinal tap. Differential diagnosis includes other causes of meningitis, viral meningitis, brain abscess, encephalitis, sepsis, brain tumor, intracerebral hematoma. |
| treatment: | Requires hospitalization and IV antibiotics based on empiric evidence (see below) until culture results are available. Adjuvant treatment might include dexamethasone which decreases morbidity. Bacterial meningitis can be fatal. If a brain abscess forms, a craniotomy may be necessary. Secondary complications can include respiratory acidosis, SIADH, hypoglycemia, and a coagulation defect leading to bleeding, all of which need to be treated accordingly. Likely bacteria until culture results: 1. age <1 mos. = strep, enterobacter, listeria 2. age 1-3 mos. = strep, enterobacter, listeria, h. flu, pneumococcus, meningococcus 3. age 3 mos-7 years = h. flu, pneumococcus, meningococcus 4. adults = pneumococcus, meningococcus Likely empiric antibiotics based on above: 1. age <1 mos. = ampicillin + tobramycin or ampicillin + cefotaxime + tobramycin 2. age 1-3 mos. = ampicillin + cefotaxime + vancomycin 3. age 3 mos-7 years = ampicillin + ceftriaxone + vancomycin Other choices based on more information: 1. gram+ cocci = vancomycin + ceftriaxone + ampicillin 2. gram- rods = ceftazidime + aminoglycosides 3. meningococcus = penicillin G or ampicillin 4. H. flu = ceftriaxone or cefotaxime 5. strep = vancomycin + ceftriaxone +/- rifampin 6. staph = vancomycin + nafcillin or oxacillin +/- rifampin 7. listeria = ampicillin or penicillin + aminoglycoside or trimethoprim/sulfamethoxazole 8. gram- enterics (e. coli, klebsiella, proteus) = ceftriaxone + aminoglycoside 9. pseudomonas = ceftazidime or ticarcillin + aminoglycoside |
| prevention: | Avoid contact with anyone who has meningitis and obtain prompt and complete treatment of an infection that might have the capabilities of spreading to the brain (ear, nose, throat, sinus, lung). |
| outcome: | Bacterial meningitis if caught early and treated appropriately will result in a cure in several weeks. Unchecked disease can progress to permanent brain damage or death. In neonates, mortality rate approaches 20%. Some permanent neurologic sequelae occurs in up to 25% of patients. |
skynetMD suggests the following:
| if: | If the person has signs of meningitis, such as fever, chills, profuse sweating, headache, stiff neck, irritability, sensitivity to light, vomiting, red-purple skin rash, confusion, drowsiness, listlessness, unconsciousness |
| go to: | Go to the hospital. |
Last updated 7/25/2009