Bacterial meningitis: Causes, Symptoms, Diagnosis & Treatments
Meningitis is largely divided into viral meningitis (most common) and bacterial meningitis. If it is bacterial, it is a medical emergency, so rapid diagnosis and treatment are needed. Without treatment, mortality is close to 100%. Neurological sequelae may also remain. Because bacterial meningitis is more severe than viral meningitis and has a poor prognosis, it is very important to differentiate between these two. First, let's look at bacterial meningitis.
Causes
Streptococcus pneumonia, Neisseria meningitidis, and Haemophilus influenza (decreased by preventive vaccine) are the main causative agents. Group B streptococcus is the most common causative organism in infants 1 month to 3 months of age. Neisseria meningitidis is the most common cause among children and adolescents aged 10 to 19 years.
Symptoms
Symptoms include fever, nausea, vomiting, anorexia and meningeal signs (headache, back pain, neck stiffness). However, because of nonspecific symptoms, all of these symptoms may appear, or only one or two symptoms may appear. Nuchal rigidity can be confirmed with Kernig sign and Brudzinski sign. In infants who can not talk, symptoms such as fever, lethargy, poor feeding, vomiting, seizure, irritability, and bulging fontanelle appear. In cases of infection by Neisseria meningitidis, abnormal rashes in the body often appear in the form of petechiae and purpura.
Diagnosis
CSF testing and culture results are necessary for diagnosis. Cerebrospinal fluid is collected through a lumbar puncture. In patients with an intracranial pressure elevated sign, CT can be performed before lumbar puncture, because brain herniation may occur due to the procedure. Acute bacterial meningitis is predominantly white blood cell (CSF)> 1000 / μL and neutrophil polymorphonuclear cell. CSF glucose is often as low as <40 mg / dL and CSF protein is between 100 and 500 mg / dL. However, because it is not necessarily so, accurate etiology can not be diagnosed on the basis of this. CSF gram stain, CSF culture, or bacterial meningitis when CSF is negative and isolated in blood culture.
Treatments
If bacterial meningitis is suspected, empirical antibiotic therapy should be initiated immediately after lumbar puncture. Bactericidal agents are used for the treatment and concomitant therapies such as fluid supply. (Cefotaxime 300 mg / kg / day or ceftriaxone 100 mg / kg / day) and vancomycin (60 mg / kg / day) that can cover both penicillin-resistant S. pneumoniae and N. meningitidis and H. influenzae b / Kg / day) is administered IV. If necessary, dexamethasone may also be used to minimize neurological sequelae (15-25% of patients have hearing loss or intellectual disability, stiffness, paralysis, etc.). Once the causative organism has been identified through testing, specific antibiotic therapy begins.
Causes
Streptococcus pneumonia, Neisseria meningitidis, and Haemophilus influenza (decreased by preventive vaccine) are the main causative agents. Group B streptococcus is the most common causative organism in infants 1 month to 3 months of age. Neisseria meningitidis is the most common cause among children and adolescents aged 10 to 19 years.
Symptoms
Symptoms include fever, nausea, vomiting, anorexia and meningeal signs (headache, back pain, neck stiffness). However, because of nonspecific symptoms, all of these symptoms may appear, or only one or two symptoms may appear. Nuchal rigidity can be confirmed with Kernig sign and Brudzinski sign. In infants who can not talk, symptoms such as fever, lethargy, poor feeding, vomiting, seizure, irritability, and bulging fontanelle appear. In cases of infection by Neisseria meningitidis, abnormal rashes in the body often appear in the form of petechiae and purpura.
Diagnosis
CSF testing and culture results are necessary for diagnosis. Cerebrospinal fluid is collected through a lumbar puncture. In patients with an intracranial pressure elevated sign, CT can be performed before lumbar puncture, because brain herniation may occur due to the procedure. Acute bacterial meningitis is predominantly white blood cell (CSF)> 1000 / μL and neutrophil polymorphonuclear cell. CSF glucose is often as low as <40 mg / dL and CSF protein is between 100 and 500 mg / dL. However, because it is not necessarily so, accurate etiology can not be diagnosed on the basis of this. CSF gram stain, CSF culture, or bacterial meningitis when CSF is negative and isolated in blood culture.
Treatments
If bacterial meningitis is suspected, empirical antibiotic therapy should be initiated immediately after lumbar puncture. Bactericidal agents are used for the treatment and concomitant therapies such as fluid supply. (Cefotaxime 300 mg / kg / day or ceftriaxone 100 mg / kg / day) and vancomycin (60 mg / kg / day) that can cover both penicillin-resistant S. pneumoniae and N. meningitidis and H. influenzae b / Kg / day) is administered IV. If necessary, dexamethasone may also be used to minimize neurological sequelae (15-25% of patients have hearing loss or intellectual disability, stiffness, paralysis, etc.). Once the causative organism has been identified through testing, specific antibiotic therapy begins.
