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  • Image not available. The three most likely pathogens of bacterial meningitis in the United States are Streptococcus pneumoniae, Neisseria meningitidis, and Hemophilus influenzae, although routine vaccination is having a dramatic effect on the incidence of these pathogens causing infection.
  • Image not available. In cases of meningitis, initial findings can include (a) presenting signs and symptoms: fever, headache, nuchal rigidity (the classic triad), Brudzinski's or Kernig's sign, and altered mental status; and (b) abnormal cerebrospinal fluid (CSF) chemistries: elevated white blood cell (WBC) count (>100 cells/mm3), elevated protein (>50 mg/dL), and decreased glucose levels (<40 mg/dL).
  • Image not available. Two main microbiologic tests that should be obtained include a Gram stain and culture of the CSF.
  • Image not available. Three primary goals of treatment in meningitis include (a) eradication of infection, (b) amelioration of signs and symptoms, and (c) prevention of the development of neurologic sequelae, such as seizures, deafness, coma, and death.
  • Image not available. When selecting antibiotics, the clinician must consider the antibiotic concentration at the site of infection, as well as the spectrum of antibacterial activity. Empirical choices should be based on age, predisposing conditions, and comorbidities. (a) Ceftriaxone or cefotaxime and vancomycin are reasonable initial choices for empirical coverage of community-acquired meningitis in adult patients. (b) Listeria monocytogenes is a common pathogen in infants and elderly; therefore, ampicillin should be added empirically to antimicrobial coverage.
  • Image not available. Empirical coverage with an appropriate antibiotic should be started as soon as possible when clinical suspicion of meningitis exists. If there is a delay in doing a lumbar puncture (even 30–60 minutes), or if the patient is to undergo neuroimaging, the first dose of an antibiotic should not be withheld. Changes in the CSF after initiation of antibiotics usually take 12 to 24 hours.
  • Image not available. In contrast to the treatment of other infectious diseases, antibiotic dosages in the treatment of meningitis should be maximized to optimize CNS penetration.
  • Image not available. The duration of antibiotic treatment for meningitis has not been standardized; however, the duration generally is based on the causative organism and the individual case and may range from 7 to 21 days.
  • Image not available. Close contacts and relatives of the index case should be assessed for appropriate prophylaxis, particularly with N. meningitidis and H. influenzae meningitis.
  • Image not available. Steroid treatment includes dexamethasone 0.15 mg/kg per dose to be given 4 times daily for 4 days in infants and children older than 2 months of age with proven or strongly suspected bacterial meningitis. Steroids should be given prior to antibiotics.

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Upon completion of the chapter, the reader will be able to:

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  • 1. Define meningitis and encephalitis.
  • 2. List the most common bacterial causes of meningitis.
  • 3. Analyze laboratory values of cerebrospinal fluid components and describe the values as normal or as indicative of a specific infective condition.
  • 4. Identify the common signs and symptoms of bacterial meningitis.
  • 5. Select appropriate empiric therapy directed against suspected bacterial meningitis according to age group.
  • 6. List the antibiotic of first choice and alternatives to treat meningitis secondary to Streptococcus pneumoniae, Neisseria meningitidis...

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