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High risk and low prevalence diseases: Adult bacterial meningitis

Michael J Pajor1, Brit Long2, Alex Koyfman3

  • 1Department of Emergency Medicine, Washington University School of Medicine, St Louis, MO, USA.

The American Journal of Emergency Medicine
|January 2, 2023
PubMed
Abstract

Insights

Acute bacterial meningitis in adults is serious but manageable. Prompt diagnosis and treatment in the emergency department are crucial for reducing severe outcomes and improving patient prognosis.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Emergency Medicine

Background:

  • Acute bacterial meningitis in adults is a rare condition with significant morbidity.
  • Meningitis involves inflammation of the meninges and subarachnoid space.

Purpose of the Study:

  • To review key aspects of acute bacterial meningitis in adults.
  • To highlight diagnostic and management strategies for emergency department (ED) clinicians.

Main Methods:

  • Review of current evidence on the presentation, diagnosis, and management of acute bacterial meningitis.
  • Focus on emergency department (ED) clinical practice.

Main Results:

  • Classic meningitis symptoms (fever, nuchal rigidity, altered mental status) are not always present; up to 95% exhibit at least two of four cardinal symptoms.
  • Streptococcus pneumoniae and Neisseria meningitidis are the most common bacterial causes.
  • Cerebrospinal fluid analysis via lumbar puncture is the gold standard for diagnosis.
  • Head CT before lumbar puncture is often unnecessary.
  • Empiric treatment includes vancomycin, ceftriaxone, and dexamethasone.
  • Elevated intracranial pressure requires neurocritical care management.

Conclusions:

  • Understanding the nuances of acute bacterial meningitis aids emergency clinicians.
  • Timely diagnosis and management are essential for better patient outcomes.
Keywords:
Infectious diseaseMeningitisNeurology

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