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Meningitis

Dr Swapnil Pawar May 31, 2021 21


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    Meningitis
    Dr Swapnil Pawar

Post written by – Dr Andrew Lam

Meningitis

Organisms Implicated in Meningitis

Bacteria

Age Likely Organisms
< 1 Month
  • E. Coli
  • Group B Streptococcus
  • Listeria Monocytogenes
1 – 3 Months
  • S. Pneumoniae
  • N. Meningitidis
  • Group B Streptococcus
  • H. Influenzae
3 Months – 18 Years
  • S. Pneumoniae
  • N. Meningitidis
  • H. Influenzae
18 – 50 Years
  • S. Pneumoniae
  • N. Meningitidis
> 50 Years
  • S. Pneumoniae
  • N. Meningitidis
  • Listeria Monocytogenes

Viruses

  • Enteroviruses
  • Herpes Simplex Virus
  • Varicella Zoster Virus
  • HIV
  • Mumps

Other

  • Tuberculosis (in immunocompromised)
  • Cryptococcus (in immunocompromised)
  • Syphilis (Treponema Pallidum)

CSF Findings

Bacterial Viral TB/Fungal
Glucose Decreased Normal Decreased
Protein ++ Mildly elevated or normal ++
WCC ++, neutrophil predominant +, lymphocyte predominant +, lymphocyte predominant

Antibiotics Choice in Meningitis

Empirical Therapy: 

Ceftriaxone 2g IV q12h + Dexamethasone 10mg IV (before or with first dose of antibiotic) and then q6h for 4 days

If > 50 y/o, immunocompromised, pregnant or history of ETOH use, add: 

Benzypenicillin 2.4g q4h for Listeria cover

If Gram Positive Cocci identified on gram stain, add: 

Vancomycin (25-30mg/kg) as loading dose

References

Farkas, J. (2017). Meningitis and Encephalitis. The Internet Book of Critical Care. Retrieved May 26th, 2021 from https://emcrit.org/ibcc/meningitis/

Tunkel, A.R. (2018). Aseptic Meningits. UpToDate, Retrieved May 26th, 2021 from https://www.uptodate.com.acs.hcn.com.au/contents/aseptic-meningitis-in-adults

Hasbun, R. (2021). Treatment of bacterial meningitis caused by specific pathogens in adults. Retrieved May 26th, 2021 from https://www.uptodate.com.acs.hcn.com.au/contents/treatment-of-bacterial-meningitis-caused-by-specific-pathogens-in-adults.

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