acute bacterial meningitis

Definition

• Inflammation of tissue around the brain/spinal cord
• Usually arising from nasopharynx (hematogenous spread), bacteremia, or direct inoculation (surgery, contiguous infection, trauma, foreign body [eg, CSF shunt])

Microbiology in Bacterial Meningitis

Clinical manifestations (Lancet 2016;339:16)

• Headache (84%), fever (74%), stiff neck (74%), photosensitivity, GCS <14 (71%), nausea (62%), seizure (23%); 95% have 2 of 4: HA, fever, stiff neck, ΔMS
• Presentation may be atypical (eg, lethargy w/o fever) in elderly and immunosupp.

Physical exam-acute bacterial meningitis

Sequential management of bacterial meningitis

cerebrospinal fluid lab results

Empiric Treatment of Bacterial Meningitis complications of bacterial meningitis

Early intravenous administration of glucocorticoids in central nervous system infection