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Meningitis

Meningitis. By: Sahar Bannani ID Intern. Practical Guidelines for the Management of Bacterial Meningitis. Developed By: Infectious Diseases Society of America Date Released: November 2004 Date Modified: March 2008. Guideline Category:. Diagnosis Evaluation Management Treatment.

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Meningitis

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  1. Meningitis By: SaharBannani ID Intern

  2. Practical Guidelines for the Management of Bacterial Meningitis • Developed By:Infectious Diseases Society of America • Date Released:November 2004 • Date Modified:March 2008

  3. Guideline Category: • Diagnosis • Evaluation • Management • Treatment

  4. Rating Scheme • Strength of Evidence:I, II, III • Strength of the Recommendations:A, B, C, D, E

  5. Diagnosis

  6. Diagnosis • Hx and P/Ex • Blood Cultures • LP • Serum Procalcitonin • CT • LP: • WBCs, RBCs, Bacteria, Proteins, Glucose • Lactate • CRP • Gram Stain • Latex Agglutination Test • Limulus Lysate Assay • PCR / RT-PCR

  7. Which Patients with Suspected Bacterial Meningitis Should Undergo CT before LP?

  8. B-II • Immunocompromised State • Hx of CNS Disease • New Onset Seizure • Papilledema • Abnormal Level of Consciousness • Focal Neurological Deficit

  9. What Specific CSF Diagnostic Tests Should Be Used to Determine the Bacterial Etiology of Meningitis?

  10. Gram Stain (A-III) • Latex Agglutination (D-II) • G-Stain –ve (C-II) • Pretreated (B-III) • Limulus Lysate Assay (D-II) • PCR (B-II)

  11. What Lab Tests Helps in Distinguishing Bacterial from Viral Meningitis?

  12. Bacterial vs. Viral • Lactate Concerntration (D-III) • Post-op NeuroSurg (B-II) • CRP (B-II) • Procalcitonin (C-II) • PCR (B-II)

  13. Treatment

  14. How Quickly Should Antimicrobial Therapy be Administered in Suspected Bacterial Meningitis? C-III

  15. Empirical Antimicrobial Therapy (A-111)

  16. Specific Antimicrobial Therapy (A-111) • Child + suspected L. Monocytogenes: Ampi + 3G Ceph + Vanco • Child + Suspected G-ve enteric bacteria: Ampi + Aminoglycoside

  17. Duration of Antimicrobial Therapy(A-III) • N. meningitidis, H. influenza  7 days • S. pneumoniae  10 – 14 days • S. agalactiae  14 – 21 days • Aerobic G-ve Bacilli, L. monocytogenes  21 days

  18. Role of Dexa • Neonates (C-I) • Infants and Children: • H. influenza b (A-I) • Post Antimicrobial Rx (A-I) • Pneumococcal (C-I) • Adults: • Pneumococcal (A-I) • Post Antimicrobial Rx (A-I) • All (B-III) • Pneumococcal Meningitis (B-III) • Rifampin + Vanco + 3G Ceph + Dexa (B-III)

  19. Specific Antimicrobial Therapy • Cephalosporins • Vancomycin • Rifampin • Carbapenems • Flouroquinolones

  20. Bacterial Meningitis postCSF-Shunting • Do we administer Antimicrobial Therapy by Intraventricular Route?(A-III) vs. (B-III)

  21. Bacterial Meningitis fromPre-Existing CSF-Shunt • Do we remove the shunt? And when a new one can be implanted? (A-II) (B-II) (C-III)

  22. Indications for Repeated LP (A-III)

  23. Criteria for Out-Patient Rx(A-III) • In-patient Rx ≥ 6 days • Afebrile 24-48 hrs • No neuro dysfunction • Stable • PO intake • Access to home nursing for Rx • Reliable IVL and infusion device (if needed) • Daily availability of a physician • Plan • Compliance • Safe environment

  24. Management Algorithm for Children with Suspected Bacterial Meningitis

  25. Management Algorithm for Adults with Suspected Bacterial Meningitis

  26. Questions ?!

  27. Comments ?!

  28. ThankYou

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