mening
Diagnosis, Initial Management, and Prevention of Meningitis
DAVID M. BAMBERGER, MD, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri
Although the annual incidence of bacterial meningitis in the United States is declining, it remains a medical emergency with a potential for high morbidity and mortality. Clinical signs and symptoms are unreliable in distinguishing bacterial meningitis from the more common forms of aseptic meningitis; therefore, a lumbar puncture with cerebrospinal fluid analysis is recommended. Empiric antimicrobial therapy based on age and risk factors must be started promptly in patients with bacterial meningitis. Empiric therapy should not be delayed, even if a lumbar puncture cannot be performed because results of a computed tomography scan are pending or because the patient is awaiting transfer. Concomitant therapy with dexamethasone initiated before or at the time of antimicrobial therapy has been demonstrated to improve morbidity and mortality in adults with Streptococcus pneumoniae infection. Within the
United States, almost 30 percent of strains of pneumococci, the most common etiologic agent of bacterial meningitis, are not susceptible to penicillin. Among adults in developed countries, the mortality rate from bacterial meningitis is
21 percent. However, the use of conjugate vaccines has reduced the incidence of bacterial meningitis in children and adults. (Am Fam Physician. 2010;82(12):1491-1498. Copyright © 2010 American Academy of Family Physicians.)
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Patient Information:
A handout on the pneumococcal conjugate vaccine is available at http://family doctor.org/691.xml. A
cute meningitis is a medical emergency with a potential for high morbidity and mortality. Bacterial meningitis is life threatening, and must be distinguished from the more common aseptic (viral) meningitis. With increased use of conjugate vaccines, the annual incidence of bacterial meningitis in the United
DAVID M. BAMBERGER, MD, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri
Although the annual incidence of bacterial meningitis in the United States is declining, it remains a medical emergency with a potential for high morbidity and mortality. Clinical signs and symptoms are unreliable in distinguishing bacterial meningitis from the more common forms of aseptic meningitis; therefore, a lumbar puncture with cerebrospinal fluid analysis is recommended. Empiric antimicrobial therapy based on age and risk factors must be started promptly in patients with bacterial meningitis. Empiric therapy should not be delayed, even if a lumbar puncture cannot be performed because results of a computed tomography scan are pending or because the patient is awaiting transfer. Concomitant therapy with dexamethasone initiated before or at the time of antimicrobial therapy has been demonstrated to improve morbidity and mortality in adults with Streptococcus pneumoniae infection. Within the
United States, almost 30 percent of strains of pneumococci, the most common etiologic agent of bacterial meningitis, are not susceptible to penicillin. Among adults in developed countries, the mortality rate from bacterial meningitis is
21 percent. However, the use of conjugate vaccines has reduced the incidence of bacterial meningitis in children and adults. (Am Fam Physician. 2010;82(12):1491-1498. Copyright © 2010 American Academy of Family Physicians.)
▲
Patient Information:
A handout on the pneumococcal conjugate vaccine is available at http://family doctor.org/691.xml. A
cute meningitis is a medical emergency with a potential for high morbidity and mortality. Bacterial meningitis is life threatening, and must be distinguished from the more common aseptic (viral) meningitis. With increased use of conjugate vaccines, the annual incidence of bacterial meningitis in the United