Meningitis is an infection of the meninges, the membrane covering the brain. First, the introduction of conjugate vaccines in europe resulted in the virtual disappearance of. Bacterial meningitis is a medical emergency requiring immediate diagnosis and immediate treatment. Streptococcus pneumoniae and neisseria meningitidis are the most common and most aggressive pathogens of meningitis. Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis. Diagnosis, initial management, and prevention of meningitis aafp. The 2005 guideline from the infectious diseases society of america recommended that asb should be screened. Meningitis is an inflammation of the meninges, the membranes covering the brain and spinal cord. Thomas karen e, hasbun rodrigo, jekel james, quagliarello vincent j. A lumber puncture lp is essential to confirm the diagnosis of meningitis and establish the cause. Di lemmas exist in the diagnosis of patients with bacterial meningitis. Bacterial meningitis is a severe infectious disease of the membranes lining the brain resulting in a high mortality and morbidity throughout the world. Other bacterial causes of meningitis include haemophilus influenza type b.
Google scholarthomas karen e, hasbun rodrigo, jekel james, quagliarello vincent j. In one study, 95% of bacterial meningitis patients had at least two symptoms of headache, neck stiffness, fever and altered consciousness. Military personnel and recruits are generally a highrisk group for meningococcal disease, with a reported incidence of four to. Your doctor will check your neck for stiffness and will exam hip and knee flexion. Rapid diagnosis and treatment of acute communityacquired bacterial meningitis reduces mortality and neurological sequelae, but can be delayed by atypical presentation, assessment of lumbar puncture safety, and poor sensitivity of standard diagnostic microbiology. Paediatric bacterial meningitis is a neurological emergency which, despite advances in medical management, still has a significant morbidity and mortality. It is important to know the specific cause of meningitis so the doctors know how to treat it. Pdf diagnosis and treatment of bacterial meningitis. Quick diagnosis and effective treatment is the key to success. Serogroup a, b, c, y, and w5 polysaccharide antigen can be detected by latex agglutination in 22% to 93% of patients with meningococcal meningitis. Your doctor will look for a purple or red rash on the skin. Bacterial meningitis is inflammation of the lining that surrounds and protects your brain and spinal cord.
In people with meningitis, the csf often shows a low sugar glucose level along with an increased white blood cell count and increased protein. The illness course varies, with progression over hours to several days. Laboratory diagnosis of bacterial meningitis 1 dura mater fig. Meningitis occurs when the membranes that cover the brain and spinal cord become inflamed. Mri may show cortical meningeal or meningovascular enhancement fig.
Asymptomatic bacteriuria asb is a common finding in many populations, including healthy women and persons with underlying urologic abnormalities. They are spread from an infected person to another by. Most guidelines recommend dexamethasone plus ceftriaxone in the initial empirical treatment of community. Dilemmas in the diagnosis of acute communityacquired. Bacterial meningitis diagnosis and tests cleveland clinic. Practice guidelines for the management of bacterial meningitis.
Bacterial meningitis remains one of the most dreaded infections, but rapid diagnosis and early treatment can significantly reduce both the mortality and longterm neurological sequelae. Bacterial meningitis is suspected on the basis of clinical presentation and physical findings. With treatment, mortality risk of death from bacterial meningitis depends on the age of the person and the underlying cause. This bacterium is another leading cause of bacterial meningitis. Some of the most common causes of bacterial meningitis include neisseria meningitidis, streptococcus.
In addition to antibiotics, dexamethasone a steroid may also be given to children over six weeks of age who have acute bacterial meningitis. Meningococcal disease but also other bacterial infections can present with both. This infection justifiably elicits strong emotional reactions and, hopefully, immediate medical intervention. This is normally caused by infection but can also have non. Pathophysiology and treatment of bacterial meningitis. Viral meningitis, in contrast, tends to resolve spontaneously and is rarely fatal. What is the bacterial meningitis score for diagnosis of. It can be caused by a variety of organisms that include bacteria, fungi or viruses. The epidemiology, etiology, clinical features, and diagnosis of bacterial meningitis in the neonate will be discussed here. We evaluated realtime pcr and fish for their applicability to. The symptoms may include high temperature, poor feeding, vomiting, lethargy, and irritability. Clinical features alone cannot confirm the diagnosis of meningitis.
Diagnosis, initial management, and prevention of meningitis. In combination with a clinical picture and csf examination consistent with bacterial meningitis, a presumptive diagnosis of bacterial meningitis caused by n. Meningitis is diagnosed by confirming inflammation or by identifying an infection in the cerebrospinal fluid the fluid that surrounds the brain. The bacteria are found in the mouth, throat, or nose. Bacterial meningitis is very serious because its onset is rapid and the infection is associated with a significant risk of death. Laboratory methods for the diagnosis of meningitis cdc. Meningococcal disease but also other bacterial infections can present with both meningitis and sepsis. Management, prognosis, and prevention in children view in chinese reliably differentiate viral from bacterial meningitis. It is a serious condition that can be life threatening.
Csf analysis may also help your doctor identify which bacterium caused the meningitis. Pediatric bacterial meningitis is a lifethreatening illness that results from bacterial infection of the meninges and leaves some survivors with significant sequelae. Components of the bacterial meningitis scoreref1 are as follows. Bacterial meningitis an overview sciencedirect topics. Pdf diagnosis and treatment of bacterial meningitis researchgate. Neurological outcome and survival depend largely on damage to cns prior to effective antibacterial treatment.
For a definitive diagnosis of meningitis, youll need a spinal tap to collect cerebrospinal fluid csf. Duration of symptoms and outcome in bacterial meningitis. Over recent decades new vaccines have led to a change in epidemiology of the disease. Treatment for bacterial meningitis usually involves intravenous iv antibiotics. Untreated, bacterial meningitis is almost always fatal. Diagnosis of bacterial meningitis sirjames berkley and colleagues june 2, p 17531 make an important observation on the inadequacy of current diagnostic tools for bacterial meningitis typical of lessdeveloped countries. Most commonly affects extremes of age 60 years because of impaired or waning immunity. Thus, diagnostic dilemmas are common in patients with suspected acute communityacquired bacterial meningitis. Bacterial meningitis symptoms, diagnosis and treatment. This bacterium is the most common cause of bacterial meningitis in infants, young children and adults in the united states.
It is essential for clinicians to recognize the clinical signs and symptoms of meningitis and understand its management and prevention. Even with appropriate treatment, morbidity and mortality can be substantial. Diagnosis and treatment of bacterial meningitis archives. Transmission usually requires either frequent or prolonged close contact. In the past decades the epidemiology and treatment strategies for communityacquired bacterial meningitis have significantly changed. A laboratory will test the samples to see what is causing the infection.
It is not a substitute for professional medical advice, diagnosis or treatment and should not be relied on to make decisions about your health. Chapter 6 primary culture and presumptive identification. Introduction acute communityacquired bacterial meningitis is a medical emergency, and patients with this disease need immediate medical assessment and treatment. Novel molecular methods offer the opportunity to establish a quick and reliable diagnosis. To find out if your teenager has meningitis, his doctor may ask him to get a procedure called a lumbar puncture, or spinal tap. Meningitis differential diagnoses medscape reference. Laboratory diagnosis of bacterial meningitis bacterial meningitis is a significant cause of mortality and morbidity worldwide. This guideline is written for all clinicians involved in diagnosis, treatment and followup of bacterial meningitis in adults and children with communityacquired bacterial meningitis in the context of hospital care, including infectious disease specialists, neurologists, intensive care. If a doctor suspects meningitis, they will collect samples of blood or cerebrospinal fluid fluid near the spinal cord. The inflammation is caused by a bacterial infection and can be lifethreatening. A lumbar puncture to obtain cerebrospinal fluid is the most important investigation when a diagnosis of bacterial meningitis is. Bacterial meningitis is a severe, lifethreatening infection of the central nervous system that requires immediate medical attention. Pathophysiology and treatment of bacterial meningitis olaf hoffman and joerg r. Infections of the central nervous system cns can be divided into 2 broad categories.
Meningitis can occur at any age, but it has particularly virulence for babies and children. Bacterial meningitis is relatively common, can progress rapidly, and can result in death or permanent debilitation. Bacterial meningitis is a potentially catastrophic infectious disease associated with substantial mortality and a risk of permanent disability in survivors. Pediatric bacterial meningitis differential diagnoses. Early diagnosis and treatment of bacterial meningitis is critical, and a high index of clinical suspicion is essential. Thecontinuous darkly shaded areas represent the subarachnoid space which surrounds the brain and spinal cord andwhich is filled with csf. It more commonly causes pneumonia or ear or sinus infections. As bacterial meningitis can be very serious, treatment with antibiotics will usually start before the diagnosis is confirmed and will be stopped later on if tests show the condition is being caused by a virus. The clinical signs include bulging fontanelle, fever, drowsiness. Meningitis about bacterial meningitis infection cdc. The earlier the treatment is initiated, the better your childs outcome.
Primary culture and presumptive identification of neisseria meningitidis, streptococcus pneumoniae, and haemophilus influenzae. Meningitis is an inflammation of the tissue that covers the brain and spinal cord that can be caused by several different types of, as well as viruses and fungibacteria. Given the lack of specificity of clinical findings, the key to the diagnosis of meningitis is the evaluation of csf. Majoranatomical features ofthe central nervous system. Meningococcal meningitis is an acute form of bacterial meningitis caused by neisseria meningitidis. Neisseria meningitidis is usually commensal, with 511% of adults and up to 25% of adolescents being asymptomatic carriers. This is because meningitis is an infection or inflammation of the meninges, which are the protective layers that cover, protect, and cushion the brain. The focus of this topic is on bacterial meningitis acquired in the community. Bacterial meningitis is an important cause of death both in the developed and developing world. The diagnostic accuracy of kernigs sign, brudzinskis sign.
It is important that you seek immediate medical assistance if you suspect meningitis. Bacterial meningitis is an inflammation of the meninges, including the pia, arachnoid, and subarachnoid space, that occurs in response to infection with bacteria andor bacterial products. After the diagnosis has been confirmed generally within 1248 hours of admission to the hospital, the patients antibacterial therapy can be modified according to the causative organism and its susceptibilities. The diagnosis of bacterial meningitis is discussed in greater detail viral meningitis. Microbiology laboratories commonly receive cerebrospinal fluid csf or blood specimens from patients with meningitis, pneumonia, or unexplained febrile illness. Definitive diagnosis, however, is almost always made on the basis of lumbar puncture. The treatment, prognosis, and complications of neonatal bacterial meningitis are discussed separately, as is bacterial meningitis in older children. Therefore, meticulous attention must be paid to appropriate treatment and monitoring of patients with this disease. Bacterial meningitis is a lifethreatening disease which requires rapid diagnosis and antimicrobial therapy. Because the primary purpose of this manual is to aid in the identification of n. It can be treated with appropriate antibiotics that also prevents spread. Bacterial meningitis and meningococcal disease are transmitted through close contact via droplets or secretions from the upper respiratory tract. Rapid diagnosis of bacterial meningitis by realtime pcr.
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