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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

Table 30-1 Etiology of Bacterial Meningitis by Age & Predisposing Factors (Clin Infect Dis 2004;39:1267)

Pertinent Positive Labs

  • 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)

Table 30-2 CSF Laboratory Interpretation (Lee M. Basic Skills in Interpreting Laboratory Data, 4th ed., 2009)
Table 30-3 Gram Staining Characteristics of Bacteria (Levinson W. Review of Medical Microbiology & Immunology, 2010)

Treatment goals: ameliorate signs & symptoms, eradicate infection, prevent development of neurological sequelae

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Clinical Pearl 30-1

Start empiric ABX as soon as possible in all patients with suspected meningitis

Principles of treatment: high-dose parenteral therapy; agent must penetrate blood-brain barrier, be bactericidal in the CSF, & have antimicrobial activity against infecting pathogen

Pharmacological Treatment ...

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