Meningitis: a few morsels
* Symptoms:
- HA 90% occurence w/ meningitis
- Fever 80%
- AMS 70%
--> TWO of HA/fever/meningismus/AMS = 95% occurrence rate
* Peds vs Adults:
- Sick kids are sick until proven otherwise
- BGM BGM BGM BGM BGM BGM BGM
- Peds more likely to show first with myalgia, cold or mottled extremities --> rapidly spreading purpura/AMS/hemodynamic instability
= TREAT IMMEDIATELY
= DO NOT WAIT FOR LP (talk to your attending)
- Consider CSF-CRP to help determine viral vs bacterial meningitis; early evidence shows it might help in stain negative samples
- With moderate suspicion, if WBC and/or ESR is elevated, treat immediately (EBM recommendation; consider this in context)
* Diagnosis:
- CSF gram stain only 60-90% sensitive
* Treatment:
- Steroids??
= Highly controversial. EBMedicine says consider giving to adults if HIGH SUSPICION ofpneumococcal infection (only if you can give with first dose abx too)
- Ceftriaxone, fluids; add other abx prn
- Close contacts: rifampicin (routine) or cipro (women on OCP)