CURRENT Essentials of Critical Care.pdf

Chapter 10 Infectious Disease 133■■■Bacterial MeningitisEssentials of Diagnosis• Acute-onset fever, headache, neck stiffness, altered sensorium;may have vomiting, seizures; mild to very severe systemic featuresof sepsis (hypotension, cardiovascular collapse, disseminatedintravascular coagulation); N meningitidis may have petechialor ecchymotic skin or mucous membrane rash• Purulent cerebrospinal fluid with increased leukocytes (usuallyneutrophil predominance), increased protein, low glucose(50% of serum); occasionally with bacteria seen on Gram stainof fluid• Culture of bacterial pathogen from cerebrospinal fluid confirmsdiagnosis• In adults, S pneumoniae, N meningitidis, L monocytogenes;gram-negative bacilli in elderly; staphylococcus following neurosurgicalproceduresDifferential Diagnosis• Viral, fungal, or tuberculous meningitis• Carcinomatous meningitis• Drug-induced meningitisTreatment• Supportive care, including treatment of hypotension or shock,respiratory failure• Third-generation cephalosporin (ceftriaxone, cefotaxime)• Add ampicillin if L monocytogenes suspected; add vancomycinfor suspected penicillin-resistant S pneumoniae■ PearlLook for an infection source adjacent to meninges, such as otitis, mastoiditis,sinusitis, vertebral osteomyelitis or abscess requiring surgicaldrainage.ReferenceBeaman MH: Acute community-acquired meningitis and encephalitis. Med JAust 2002;176:389. [PMID: 12041637]