What are the diagnostic criteria and treatment options for suspected meningitis?

From the Guidelines

Suspected meningitis requires prompt diagnosis and treatment, and the most recent evidence suggests that cerebrospinal fluid (CSF) analysis remains the principal contributor to the final diagnosis 1. The diagnostic criteria include clinical symptoms such as fever, headache, neck stiffness, altered mental status, and photophobia, as well as physical examination findings like positive Kernig's and Brudzinski's signs. Some key points to consider in the diagnosis and treatment of meningitis include:

• The European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guideline advises starting empiric treatment within one hour of arrival in all suspected meningitis cases, with the choice of antibiotics differentiated according to the patient's age, risk factors, and local resistance rates of pneumococci 1.
• Dexamethasone is the only proven adjunctive treatment and should be started together with the antibiotics, with a recommended dose of 10 mg IV every 6 hours for 2-4 days 1.
• The ESCMID guideline also recommends evaluating for hearing loss and pneumococcal vaccination to prevent recurrences in surviving patients 1.
• Lumbar puncture is a crucial diagnostic tool, but cranial imaging may be considered before the procedure in selected patients to evaluate for signs of brain shift, such as severely altered mental status, focal neurologic deficits, new-onset seizures, or a severe immunocompromised state 1.
• Empiric therapy in adults with community-acquired bacterial meningitis should include ceftriaxone and vancomycin, with the addition of ampicillin for patients over 50 years or immunocompromised to cover Listeria 1. Some of the key considerations in the treatment of meningitis include:
• The duration of therapy, which typically ranges from 7-21 days depending on the causative organism 1.
• The need for isolation precautions and prophylaxis for close contacts if meningococcal meningitis is suspected 1.
• The importance of supportive care for viral meningitis and specific antifungal therapy for fungal meningitis 1.

From the Research

Diagnostic Criteria for Meningitis

• The diagnostic criteria for meningitis include a combination of clinical presentation, laboratory tests, and imaging studies 2, 3, 4, 5, 6
• Clinical presentation may include symptoms such as headache, fever, stiff neck, altered mental status, and nausea 2, 3, 4, 5, 6
• Laboratory tests, such as cerebrospinal fluid (CSF) analysis, may show elevated leukocytes, protein, and decreased glucose levels 2, 5
• Imaging studies, such as brain imaging, may be performed to rule out other conditions and to assess for complications 2, 3

Treatment Options for Meningitis

• Treatment for meningitis typically involves prompt empirical intravenous antibiotic therapy and adjunctive dexamethasone 2, 4
• The choice of antibiotics depends on the suspected causative organism and the patient's age, immune status, and other factors 2, 3, 4
• Supportive care, such as fluid management and nursing care, is also important in the treatment of meningitis 4

Risk Factors and Complications

• Risk factors for meningitis include older age, immunosuppressive conditions, and exposure to certain pathogens 2, 3, 6
• Complications of meningitis may include hearing loss, focal neurological deficits, and death 2, 3, 5
• Patients with meningitis may also experience long-term sequelae, such as fatigue, headaches, and emotional problems 3

Diagnostic Challenges

• The diagnosis of meningitis can be challenging, as the symptoms may be non-specific and the disease can present in different ways in different patients 3, 5, 6
• A high index of suspicion is necessary to diagnose meningitis, especially in adults 3, 5
• Further research is needed to improve the diagnosis and treatment of meningitis 5