CURRENT Essentials of Critical Care.pdf

148 Current Essentials of Critical Care■■■Nonbacterial MeningitisEssentials of Diagnosis• Acute onset of headache, mild neck stiffness, fever (viral meningitis);chronic symptoms with gradual increase in severity overdays to weeks (tuberculous or fungal meningitis)• May have features of underlying disease (viral syndrome or pulmonaryor disseminated tuberculosis or fungal infection)• Viral meningitis: acute onset, resolves within days; cerebrospinalfluid with predominance of lymphocytes, normal glucose;enteroviruses most commonly implicated• Tuberculous meningitis: subacute or chronic onset of symptoms;cerebrospinal fluid with predominance of lymphocytes, low glucose,high protein• Fungal meningitis: subacute or chronic onset of symptoms; cerebrospinalfluid has predominance of lymphocytes; variably lowglucose and high protein (Coccidioides immitis); in Cryptococcusneoformans meningitis, symptoms, signs often unremarkable;may have high CSF opening pressure and positive CSFIndia ink stain, but normal glucose, protein, cell countsDifferential Diagnosis• Carcinomatous meningitis• Partially treated bacterial meningitis• Drug-induced meningitisTreatment• No specific treatment for viral meningitis• Tuberculous meningitis: begin empiric therapy with 3–4 antituberculousdrugs• Cryptococcal meningitis: amphotericin B plus 5-flucytosine followedby fluconazole• Coccidioides meningitis: high dose fluconazole, or fluconazole amphotericin B■ PearlMumps, Herpes simplex, and lymphochoriomeningitis (LCM) meningoencephalitismay cause low CSF glucose levels.ReferenceBeaman MH: Acute community-acquired meningitis and encephalitis. Med JAust 2002;176:389. [PMID: 12041637]