0071643192.pdf

TREATMENT

■ Stabilization and supportive therapy, as needed
■ Immediateempiric antibiotic therapy
■ Vancomycin, 1 gm IV,
and
■ Ceftriaxone or cefotaxime, 2 gm IV,
and
■ Ampicillinif neonate, >60 years, debilitated, alcoholic
■ Will not decrease ability to detect organism in CSF fluid if LP per-
formed within 2 hours and antigen assays are utilized
■ Dexamethasone
■ Appears to decrease morbidity in adults with bacterialmeningitis (espe-
cially S. pneumoniae) and children with H. influenzaemeningitis
■ Give 0.15 mg/kg IV 15 minutes before or concurrent with the first dose
of antibiotics, repeat every 4–6 hours.
■ Other antibiotics are indicated if fungal infection is suspected or identified.
■ Viral meningitis (diagnosis of exclusion) requires no specific treatment.
■ Admit all patients with high suspicion for meningitis, regardless of LP
results.

COMPLICATIONS

■ Sepsis
■ DIC
■ Seizures
■ Focal neurologic deficits
■ Hearing loss
■ Cognitive deficits
■ Waterhouse-Friderichsen syndrome
■ Transmission of N. meningitidis orH. influenzae type B
■ Seen in household contacts, day-care centers, schools, barracks, and
mucous membrane contacts
■ Chemoprophylaxis with rifampin (four doses) is required once bacterial
organism is identified.

Encephalitis

Encephalitis is a viral infection of the brain parenchyma itself, often a pro-
gression of viral meningitis.

CAUSES

■ Viruses cause the majority of cases ( = most common).
■ Arboviruses
■ Mosquito and tick-borne viruses
■ Include West Nile virus, St. Louis encephalitis
■ *Herpes simplex virus(HSV)
■ Other herpes viruses (EBV, CMV)
■ Rabies virus
■ Hypersensitivity reaction to MMR vaccination
■ Toxoplasma gondii(immunocompromised)
■ Lyme disease

NEUROLOGY

Donotdelay antibiotics for

CT or LP.

Family members and close

contacts of patients with N.

meningitidisorH. influenzae

meningitis should receive

antibiotic prophylaxis.

Gray matter is predominantly

affected in encephalitis.

Fungal meningitis is difficult to

diagnose: Low-grade fevers,

variable headache, possible

weight loss, lassitude; CSF

with very elevated protein.