What is the diagnosis and treatment for Meningitis (inflammation of the meninges)?

From the Guidelines

Meningitis diagnosis and treatment involve prompt recognition, cerebrospinal fluid analysis, and empiric antibiotic therapy. The diagnosis of meningitis is primarily based on clinical characteristics and laboratory parameters, including cerebrospinal fluid (CSF) analysis, which remains the principal contributor to the final diagnosis 1.

Diagnostic Approach

• Clinical symptoms, such as headache, fever, and stiff neck, are key indicators of meningitis
• Laboratory parameters, including blood cultures and CSF analysis, are essential for diagnosis
• Imaging studies, such as CT scans, may be necessary in certain cases to rule out other conditions

Treatment Approach

• Empiric antibiotic therapy should be started within one hour of arrival in all suspected meningitis cases 1
• The choice of antibiotics needs to be differentiated according to the patient's age, risk factors, and local resistance rates of pneumococci
• Dexamethasone is the only proven adjunctive treatment and should be started together with the antibiotics 1
• Follow-up of surviving patients should include evaluation for hearing loss and pneumococcal vaccination to prevent recurrences

Guideline Recommendations

• The European Society for Clinical Microbiology and Infectious Diseases (ESCMID) guideline provides clear evidence-based guidance for the diagnosis and treatment of bacterial meningitis 1
• The UK Joint Specialist Societies guideline also provides recommendations for the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults 1
• The Infectious Diseases Society of America (IDSA) practice guidelines for the management of bacterial meningitis emphasize the importance of early recognition and prompt treatment 1

Future Perspectives

• Further development and implementation of vaccines is the most important strategy to further reduce the incidence of bacterial meningitis 1
• New treatments, such as further inhibition of the inflammatory response in the brain or treatment of specific complications, may also be necessary to reduce mortality and sequelae 1

From the Research

Diagnosis of Meningitis

• The diagnosis of meningitis is based on clinical presentation, physical examination, and laboratory tests, including lumbar puncture and cerebrospinal fluid analysis 2, 3.
• The classic symptoms of bacterial meningitis are fever, neck stiffness, altered mental status, and headache 3.
• Certain patient populations, such as the young and the immunocompromised, may have a blunted presentation, and for these patients, clinicians must have an especially low threshold for obtaining a lumbar puncture 3.

Treatment of Meningitis

• Antibiotic therapy should be initiated as soon as possible when bacterial meningitis is suspected, as early treatment is associated with a better outcome 2, 3, 4.
• The choice of empirical antimicrobial therapy is based on the patient's age and underlying disease status; once the infecting pathogen is isolated, antimicrobial therapy can be modified for optimal treatment 4.
• Adjunctive dexamethasone therapy is recommended for many patients with suspected or proven bacterial meningitis, as it has been shown to reduce mortality and adverse outcomes in certain cases 3, 4.
• The use of adjunctive dexamethasone should be administered concomitant with or just prior to the first antimicrobial dose for maximal effect on the subarachnoid space inflammatory response 4.

Management Approach

• The management approach to patients with suspected or proven bacterial meningitis includes emergent cerebrospinal fluid analysis and initiation of appropriate antimicrobial and adjunctive therapies 4.
• Distinguishing between acute, chronic, and recurrent meningitis is essential for proper diagnostic testing and treatment approaches 5.
• Emerging antibiotic resistance is an upcoming challenge in the treatment of bacterial meningitis, and current treatment strategies must take this into account 6.