Emergency department management of meningitis and encephalitis.
Bacterial meningitis and viral encephalitis are infectious disease emergencies that can cause significant patient morbidity and mortality. Clinicians use epidemiologic, historical, and physical examination findings to identify patients at risk for these infections, and central nervous system (CNS) imaging and lumbar puncture (LP) may be needed to further evaluate for these diagnoses. The diagnosis of bacterial meningitis can be challenging, as patients often lack some of the characteristic findings of this disease with presentations that overlap with more common disorders seen in the emergency department. This article addresses considerations in clinical evaluation, need for CNS imaging before LP, interpretation of cerebrospinal fluid results, standards for and effects of timely antibiotic administration, and recommendations for specific antimicrobial therapy and corticosteroids.
Fitch
Michael T
MT
Department of Emergency Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA. mfitch@wfubmc.edu
Abrahamian
Fredrick M
FM
Moran
Gregory J
GJ
Talan
David A
DA
D000890:Anti-Infective Agents / Q000627:therapeutic use; D004635:Emergency Medicine / Q000379:methods*; D018792:Encephalitis, Viral / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D016920:Meningitis, Bacterial / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D010808:Physical Examination / Q000379:methods
D000890:Anti-Infective Agents