小结
定义
病史和体格检查
关键诊断因素
- presença de fatores de risco
- cefaleia
- fotofobia
- rigidez de nuca
- febre
- náuseas e vômitos
其他诊断因素
- erupção cutânea
- sinal de Kernig
- sinal de Brudzinski
危险因素
- lactentes e crianças pequenas
- adultos jovens
- idosos
- verão e outono
- exposição a vetores mosquito ou carrapato
- não vacinado contra caxumba
- uso de piscinas e lagoas
- imunossupressão
- exposição a roedores
诊断性检查
首要检查
- hemoculturas
- hemograma completo e diferencial
- proteína C-reativa
- procalcitonina sérica
- ureia sérica, creatinina e eletrólitos
- gasometria
- glicose sanguínea
- microscopia do LCR
- coloração de Gram do líquido cefalorraquidiano (LCR)
- cultura bacteriana do LCR
- nível de proteína no LCR
- glicose no LCR
- lactato no LCR
- PCR de LCR, fezes e swab de garganta para patógenos virais
- sorologia para vírus da imunodeficiência humana (HIV)/transcriptase reversa do HIV (RT)-PCR
需考虑的检查
- tomografia computadorizada (TC)/ressonância nuclear magnética (RNM) do crânio
新兴检查
- Procalcitonina no LCR
治疗流程
suspeita de meningite, etiologia desconhecida
Meningite viral confirmada
meningite viral recorrente
撰稿人
专家顾问
John Williams, MRCP, DTM&H
Infectious Diseases Consultant
The James Cook University Hospital
Middlesbrough
UK
利益声明
JW declares that he has no competing interests.
鸣谢
Dr John Williams would like to gratefully acknowledge Dr David Chadwick, a previous contributor to this topic.
利益声明
DC is an author of a reference cited in this topic.
同行评议者
Alex Alexiou, MBBS, BSc, DCH, FRCEM, Dip IMC RCSEd
Consultant in Emergency Medicine
Royal London Hospital
Consultant, Physician Response Unit
Barts Health NHS Trust/London Air Ambulance
London
UK
利益声明
AA declares that he has no competing interests.
Fiona McGill, MRCP, DTMH, DipHIVMed
Clinical Lecturer
Institute of Infection and Global Health
University of Liverpool
Liverpool
UK
利益声明
FM is on the Meningitis Research Foundation’s Medical Advisory Group, has lectured on national and international events on meningitis and has developed a review for ‘clinical medicine’ on viral meningitis and encephalitis.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
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.全文 摘要
McGill F, Griffiths MJ, Bonnett LJ, et al. Incidence, aetiology, and sequelae of viral meningitis in UK adults: a multicentre prospective observational cohort study. Lancet Infect Dis. 2018 Sep;18(9):992-1003.全文 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
- Meningite bacteriana (adultos)
- Meningite bacteriana (crianças)
- Encefalite
更多 鉴别诊断指南
- A guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2018 update by the Infectious Diseases Society of America and the American Society for Microbiology
- The UK joint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults
更多 指南患者教育信息
Punção lombar
更多 患者教育信息
登录或订阅即可浏览 BMJ Best Practice 临床实践完整内容
内容使用需遵循免责声明