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- Bacterial etiology of meningitis varies by patient age, immune status, & history of neurosurgical procedure or head trauma
- Aseptic meningitis: all nonbacterial causes (viruses, fungi, parasites, medications, cochlear implants, malignancies)
- Nasopharyngeal (bacteria) or mucosal surface (viral) colonization → bacteremia or viremia → invasion into CNS → replication → meningeal inflammation → neurological sequelae
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Pertinent Positive Labs
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- Lumbar puncture for cerebrospinal fluid (CSF) analysis
- CSF laboratory values & Gram stain help determine cause of meningitis
- Further work-up of aseptic meningitis: PCR for HSV/enteroviruses; CSF cryptococcal antigen for cryptococcal meningitis in immunosuppressed patients (in HIV, CD4+ <50cells/mm3)
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Treatment goals: ameliorate signs & symptoms, eradicate infection, prevent development of neurological sequelae
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Principles of treatment: high-dose parenteral therapy; agent must penetrate blood-brain barrier, be bactericidal in the CSF, & have antimicrobial activity against infecting pathogen
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Pharmacological Treatment ...