Bacterial meningitis in adults
Summary
Definition
History and exam
Key diagnostic factors
- headache
- neck stiffness
- fever
- altered mental status
- vomiting
- confusion
- photophobia
- seizures
- presence of risk factors
Other diagnostic factors
- focal neurological signs
- abnormal eye movement
- facial palsy
- balance problems/hearing impairment
- rash
- papilloedema
Risk factors
- advanced age
- crowding
- exposure to pathogens
- immunocompromising conditions
- cranial anatomical defects/ventriculoperitoneal shunt
- cochlear implants
- sickle cell disease
- contiguous infection
- genetic predisposition
Diagnostic investigations
1st investigations to order
- blood culture
- serum pneumococcal and meningococcal PCR
- blood glucose
- FBC and differential
- serum urea, creatinine, and electrolytes
- venous blood gas
- LFTs
- coagulation screen (prothrombin time, INR, activated PTT, fibrinogen, fibrin degradation products)
- serum HIV
- serum procalcitonin (PCT)
- serum CRP
- cerebrospinal fluid (CSF) protein
- CSF lactate
- CSF glucose
- CSF microscopy, Gram stain, culture, and sensitivities
- CSF red and white cell count
- CSF polymerase chain reaction (PCR) for pneumococcus
Investigations to consider
- neuroimaging
- CSF PCR for tuberculosis
- CSF PCR for herpes simplex virus (HSV) 1 and 2 and varicella zoster virus
- CSF, stool, and throat swab PCR for enterovirus
Treatment algorithm
suspected bacterial meningitis: presenting in hospital
suspected bacterial meningitis: presenting in the community
confirmed bacterial meningitis: Haemophilus influenzae
confirmed bacterial meningitis: Enterobacteriaceae
confirmed bacterial meningitis: Streptococcus pneumoniae
confirmed bacterial meningitis: Group B Streptococcus
confirmed bacterial meningitis: Listeria monocytogenes
confirmed bacterial meningitis: Staphylococcus aureus
confirmed bacterial meningitis: Neisseria meningitidis
confirmed bacterial meningitis: Mycobacterium tuberculosis
unconfirmed but clinically suspected bacterial meningitis
Contributors
Expert advisers
Jamie Scott, MB BCh BAO MSc FRCEM
Consultant in Emergency Medicine
Barts Health NHS Trust
Newham University Hospital
Royal London Hospital
Physician Response Unit Senior Fellow
London’s Air Ambulance
London
UK
Declarações
JS declares that he has no competing interests.
Annie Chapman, MBChB, BSc
ST4 Emergency Medicine Doctor
Royal London Hospital
Physician Response Unit Clinical Fellow
London
UK
Declarações
AC declares that she has no competing interests.
Agradecimentos
BMJ Best Practice would like to gratefully acknowledge the previous expert contributors, whose work is retained in parts of the content:
Alexander Alexiou MBBS, BSc, DCH, FRCEM, Dip IMC RCSEd
Emergency Medicine Consultant
Barts Health NHS Trust
Physician Response Unit Consultant
London’s Air Ambulance
Royal London Hospital
London
UK
Disclosures: AA declares that he has no competing interests.
A. Marceline Tutu van Furth, MD, PhD, MBA
Professor in Pediatric Infectious Diseases
Vrije Universiteit Medical Center
Amsterdam
The Netherlands
Disclosures: AMTvF declares that she has no competing interests.
Omaima El Tahir, MD
PhD Candidate
Pediatric Infectious Diseases and Immunogenetics
Vrije Universiteit Medical Center
Amsterdam
The Netherlands
Disclosures: OET declares that she has no competing interests.
Revisores
Robert Taylor, MBChB, MRCP(UK), MRCP(London), DipMedTox, DipTher PGDME, FHEA FRCEM
Acute Hospital Sub Dean (Cornwall)
Honorary Clinical Senior Lecturer
Consultant Emergency Physician
The Knowledge Spa
Royal Cornwall Hospital
Truro
UK
Declarações
RT declares that he has no competing interests.
Créditos aos pareceristas
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Declarações
As afiliações e declarações dos pareceristas referem--se ao momento da revisão.
Referências
Principais artigos
McGill F, Heyderman RS, Michael BD, et al. The UK joint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults. J Infect. 2016 Apr;72(4):405-38.Texto completo Resumo
van de Beek D, Cabellos C, Dzupova O, et al. ESCMID guideline: diagnosis and treatment of acute bacterial meningitis. Clin Microbiol Infect. 2016 May;22 (Suppl 3):S37-62.Texto completo Resumo
Brouwer MC, McIntyre P, Prasad K, et al. Corticosteroids for acute bacterial meningitis. Cochrane Database Syst Rev. 2015 Sep 12;(9):CD004405.Texto completo Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
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