Overview
What are the signs and symptoms of bacterial and viral meningitis?
What should be the medical history focus when meningitis is suspected?
Which symptoms suggest enteroviral infection when meningitis is suspected?
What are signs of meningitis in infants?
What should a physical exam for meningitis include?
Which exams should be performed in chronic meningitis?
What are the signs of aseptic meningitis syndrome?
What are the diagnostic challenges in suspected meningitis?
Which blood studies are useful in the diagnosis of meningitis?
Which lab tests should be ordered in suspected meningitis?
What are the initial treatment measures that should be taken in suspected meningitis?
What are the treatment options for bacterial meningitis?
Which complications of acute bacterial meningitis must be treated initially?
In which types of meningitis is therapy dictated by the etiologic pathogen (infectious agent)?
What are the categories of infections of the central nervous system (CNS)?
Which areas of the brain and spinal cord are affected by meningitis?
What are risk factors for meningitis?
What is the clinical presentation of meningitis?
Which anatomical regions does meningitis affect?
What is the mortality rate associated with bacterial meningitis?
How has the emergence of antibiotic-resistant bacteria changed treatment approaches for meningitis?
Which conditions may evolve from bacterial meningitis?
What are the common noninfectious causes of meningitis?
What are the subtypes of acute bacterial meningitis?
How is acute meningitis differentiated from subacute or chronic meningitis?
How are fungal and parasitic meningitis classified?
Is aseptic meningitis reclassified once a cause is identified?
What is the most likely pathogenesis of meningitis?
How are meningitis infectious agents transmitted to a newborn?
How do meningitis pathogens travel from the middle ear to the meninges?
What is the role of the blood-brain barrier in the pathogenesis of meningitis?
What is the disease course of untreated bacterial meningitis?
What perpetuates the infectious process in bacterial meningitis?
What is the pathophysiology of increased intracranial pressure (ICP) in meningitis?
What is the disease course if cerebral edema due to meningitis is left untreated?
Which proinflammatory molecules (proteins) have a role in the pathogenesis of meningitis?
What is the role of cytokines in the pathogenesis of meningitis?
What is the role of secondary proinflammatory mediators in the pathogenesis of meningitis?
What is the cause of profound neutrophilic pleocytosis in meningitis?
What is the role of pattern recognition receptors in the pathogenesis of meningitis?
What is the role of bacterial seeding in the pathogenesis of meningitis?
How do infectious agents gain access to the subarachnoid space in meningitis?
What causes aseptic meningitis?
What are causes of meningitis?
Does HIV infection increase the risk of meningitis?
What are viral causes of meningitis?
What causes pachymeningitis (perimeningitis)?
What does the presence of Haemophilus influenza (H influenza) in adults with meningitis suggest?
What is the role of Streptococcus pneumoniae (S pneumoniae) in the development of meningitis?
What are risk factors for developing meningococcal meningitis?
What is the role of Listeria monocytogenes (L monocytogenes) in the development of meningitis?
Which groups are at risk for Listeria monocytogenes (L monocytogenes) meningitis?
Which aerobic gram-negative bacilli (Enterobacteriaceae) are etiologic agents of meningitis?
What are risk factors for developing staphylococcal meningitis?
What is the most common cause of aseptic meningitis in children and adults?
How are enteroviruses classified?
How common are nonpolio enteroviruses (NPEVs) as a cause of viral meningitis?
What is the incidence of aseptic meningitis due to echovirus 30 (EV30)?
Which Herpesviridae (herpesviruses) cause meningitis?
Which arthropod-borne viruses cause meningitis?
Which virus causes California encephalitis?
How is lymphocytic choriomeningitis virus (LCMV) transmitted?
How common is aseptic meningitis caused by the mumps virus?
When should HIV infection be suspected as the cause of aseptic meningitis?
Which adenovirus serotypes are etiologic agents of meningoencephalitis?
When should Toscana virus (TOSV) meningitis or encephalitis be suspected?
What causes chronic meningitis?
What is the role of Brucellae in the development of meningitis?
What are the risk factors for developing brucellosis (Brucella meningitis)?
What is the role of Mycobacterium tuberculosis (M tuberculosis) in the development of meningitis?
When should tuberculous meningitis be suspected?
How is Treponema pallidum (T pallidum) transmitted?
What is the role of Cryptococcus neoformans (C neoformans) in the development of meningitis?
What are the risk factors for developing coccidioidal meningitis?
What is the role of Histoplasma capsulatum (H capsulatum) in the development of meningitis?
What are the risk factors for developing Candida meningitis?
What are the risk factors for developing Sporothrix schenckii (S schenckii) meningitis?
How is primary amebic meningoencephalitis (PAM) transmitted?
What are the forms of primary amebic meningoencephalitis (PAM) and what are their presentations?
What are Acanthamoeba and Balamuthia granulomatous amebic encephalitis?
Why is the incidence of meningitis higher in developing countries than in the US?
What is the incidence of bacterial meningitis in the US?
In what parts of the world is meningococcal meningitis endemic?
What is the incidence of neonatal bacterial meningitis?
Which preventive measures have decreased the incidence of bacterial meningitis in the US?
Which preventive measures have decreased the incidence of pediatric bacterial meningitis in the US?
What age groups are at highest risk for developing acute bacterial meningitis?
How does age affect risk of meningitis from specific etiologic agents?
Is bacterial meningitis more common in females or males?
What is the mortality rate associated with pneumococcal meningitis?
What is the incidence of aseptic meningitis?
What factors influence the infection rates of aseptic meningitis?
In addition to aseptic meningitis, what other disorders are caused by West Nile virus infection?
Which less-common arboviruses have caused aseptic meningitis in the US?
What is the epidemiology of lymphocytic choriomeningitis (LCM) virus infections?
What is the global distribution of fungal pathogens that cause meningitis?
What is the global distribution of parasites that cause meningitis?
What is the global distribution of Brucella chronic meningitis?
What is the global incidence of Mycobacterium tuberculosis (M tuberculosis) infection?
What is the global distribution of Borrelia burgdorferi (B burgdorferi) (Lyme disease)?
What is the global distribution of Cryptococcus neoformans (C neoformans)?
What is the global distribution of Coccidioides immitis (C immitis)?
What is the global distribution of Sporothrix schenckii (S schenckii)?
Which presentations of meningitis increase the risk for neurologic sequelae or death?
What are negative prognostic factors in adults with bacterial meningitis?
What are the serious complications of bacterial meningitis?
What are the delayed complications of pneumococcal meningitis?
How common are seizures in meningitis?
What is the incidence of neurologic complications of bacterial meningitis?
What is mortality rate associated with bacterial meningitis?
What is the prognosis of meningitis caused by opportunistic pathogens?
Which pathogens cause the highest mortality and morbidity in bacterial meningitis?
What is the prognosis for meningococcal meningitis versus pneumococcal meningitis?
What is the prognosis for viral meningitis?
Presentation
Which atypical symptoms of meningitis may develop in infants?
What are symptoms of meningitis?
How soon do symptoms of bacterial meningitis develop?
What symptoms may precede viral meningitis?
How common are seizures in bacterial meningitis?
Which patient groups are more likely to present with atypical symptoms of meningitis?
Which factors should be assessed in cases of meningitis to help determine etiology?
What should be the focus of the medical history in suspected meningitis?
How common is bacterial meningitis following antibiotic use?
Are alcoholism and cirrhosis risk factors for meningitis?
What roles do season and temperature have in the identification of meningitis etiology?
What is the classic presentation of meningitis?
What are possible systemic findings of meningitis?
What are expected physical findings in viral meningitis?
Which etiologies of meningitis may present with nonblanching petechiae and cutaneous hemorrhages?
What is the typical presentation of meningitis in infants?
What are the focal neurologic signs of meningitis?
When is lumbar puncture (LP) indicated in suspected meningitis?
Which systemic findings on physical exam provide clues to the etiology of meningitis?
Which physical exam findings suggest chronic meningitis?
What are the presentation and clinical stages of chronic tuberculous meningitis?
What is the presentation of syphilitic meningitis?
What is the presentation of Lyme meningitis?
What is the presentation of Cryptococcus neoformans (C neoformans) meningitis?
What is the presentation of coccidioidal meningitis?
What is the presentation of helminthic eosinophilic meningitis?
What is the presentation of aseptic meningitis?
What are immediate complications of meningitis?
What disorders are caused by brain parenchymal damage in bacterial meningitis?
What are the delayed complications of meningitis?
Is cerebral edema a common complication of meningitis?
What causes cranial nerve palsy and cerebral infarction in meningitis?
How does cerebritis develop in meningitis?
What are the risk factors for development of subdural effusion in meningitis?
How does ventriculitis develop in meningitis and how common is it?
How does ventriculomegaly develop in meningitis?
DDX
Which disorders should be considered in differential diagnoses of meningitis?
What are the differential diagnoses for Meningitis?
Workup
What are the diagnostic challenges of meningitis?
Why should lumbar puncture be performed whenever meningitis is suspected?
When is a CT scan of the head indicated in suspected meningitis?
What lab tests should be performed in suspected meningitis?
What does evidence of pneumonia on initial chest X-ray indicate in suspected meningitis?
Which blood tests are useful in suspected bacterial meningitis?
When are cultures most useful for diagnosing meningitis?
What is the role of polymerase chain reaction (PCR) testing in the diagnosis of meningitis?
Which syphilis screening tests should be performed in the evaluation of suspected meningitis?
What is the role of serum procalcitonin (PCT) testing in the diagnosis of meningitis?
What does cerebrospinal fluid (CSF) cell count indicate in meningitis?
What are the cerebrospinal fluid (CSF) characteristics in acute bacterial meningitis?
What are cerebrospinal fluid (CSF) characteristics in viral meningitis?
What are cerebrospinal fluid (CSF) characteristics in fungal meningitis?
Can fungal infection in the blood be used to diagnose fungal meningitis?
What are the cerebrospinal fluid (CSF) characteristics of primary amebic meningoencephalitis (PAM)?
What are the cerebrospinal fluid (CSF) characteristics of Lyme meningitis?
What are the cerebrospinal fluid (CSF) characteristics of tuberculous meningitis?
What is the cerebrospinal fluid (CSF) glucose level in bacterial meningitis?
What is the cerebrospinal fluid (CSF) protein level in bacterial meningitis?
What is the role of acid-fast bacillus (AFB) stain in the diagnosis of meningitis?
What is the role of culture from cerebrospinal fluid (CSF) in viral meningitis?
Is neuroimaging (CT scanning, MRI) used in the diagnosis of meningitis?
When is cerebral herniation most likely to occur following lumbar puncture (LP) for meningitis?
What neuroimaging findings suggest bacterial meningitis?
Treatment
How is meningitis managed after initial treatment?
Which tests should be performed first for acute meningitis?
When should antimicrobial therapy be initiated for meningitis?
Which systemic complications of acute bacterial meningitis should be immediately treated?
How are patients monitored for systemic complications of acute bacterial meningitis?
How is hyperventilation managed in intubated patients with meningitis?
When is an intracranial pressure (ICP) monitor indicated in meningitis?
How are seizures managed in meningitis?
How is subacute meningitis treated?
How is bacterial meningitis treated?
Does treatment reduce the risk of mortality in meningitis?
How should patients with bacterial meningitis be monitored during antibiotic treatment?
What is the treatment for bacterial meningitis in the first month of life?
What is the treatment for bacterial meningitis in infants aged 1-3 months?
What is the treatment for bacterial meningitis in children aged 3 months to 7 years?
What is the treatment for bacterial meningitis in children and adults aged 7-50 years?
What is the role of dexamethasone in the treatment of bacterial meningitis?
What is the antibiotic treatment of choice for patients aged 50 years or older with meningitis?
What are the IDSA guidelines for adjunctive dexamethasone in meningitis?
What is the treatment for bacterial meningitis in the setting of HIV infection?
Is the use of steroid therapy (dexamethasone) effective in the treatment of bacterial meningitis?
What are the benefits of steroid therapy for bacterial meningitis?
Is intrathecal administration of antibiotics FDA approved for the treatment of bacterial meningitis?
How are intrathecal antibiotic dosages determined for bacterial meningitis?
How is viral meningitis treated?
How is herpes simplex (HSV) meningitis treated?
How is cytomegalovirus (CMV) meningitis treated?
What are the causes of fungal meningitis?
How is cryptococcal meningitis treated?
How is intracranial pressure (ICP) reduced in cases of cryptococcal meningitis?
How is HIV-related acute cryptococcal meningitis treated?
What is induction and consolidation therapy for cryptococcal meningitis?
What is the treatment for solid-organ transplant recipients with cryptococcal meningitis?
What is the treatment for meningitis caused by Coccidioides immitis (C immitis)?
What is the treatment for Histoplasma capsulatum (H capsulatum) meningitis?
What is treatment for candidal meningitis?
What is the treatment for Sporothrix schenckii (S schenckii) meningitis?
What is the treatment for tuberculous meningitis?
When is corticosteroid therapy indicated for treatment of tuberculous meningitis?
What is the treatment for syphilitic meningitis?
How is parasitic meningitis treated?
How is Lyme meningitis treated?
Which patients should receive the H influenzae type B (Hib) or S pneumoniae vaccines?
What vaccinations are recommended for patients with functional or structural asplenia?
Who should be offered the quadrivalent meningococcal polysaccharide vaccine?
Which meningococcal vaccines for serogroup B are approved by the FDA?
When is chemoprophylaxis for meningitis recommended?
When are consultations with specialists indicated in the treatment of meningitis?
How should meningitis be monitored?
Guidelines
What are the IDSA guidelines on the diagnosis of healthcare-associated ventriculitis and meningitis?
What are the IDSA guidelines on the treatment of healthcare-associated ventriculitis and meningitis?
Medications
When should empiric antibiotic medications be given to treat meningitis?
Which medications in the drug class Sulfonamides are used in the treatment of Meningitis?
Which medications in the drug class Tetracyclines are used in the treatment of Meningitis?
Which medications in the drug class Carbapenems are used in the treatment of Meningitis?
Which medications in the drug class Fluoroquinolones are used in the treatment of Meningitis?
Which medications in the drug class Glycopeptides are used in the treatment of Meningitis?
Which medications in the drug class Aminoglycosides are used in the treatment of Meningitis?
Which medications in the drug class Penicillins, Amino are used in the treatment of Meningitis?
Which medications in the drug class Penicillins, Natural are used in the treatment of Meningitis?
Which medications in the drug class Antivirals, CMV are used in the treatment of Meningitis?
Which medications in the drug class Antivirals, Other are used in the treatment of Meningitis?
Which medications in the drug class Antifungals, Systemic are used in the treatment of Meningitis?
Which medications in the drug class Antituberculous Agents are used in the treatment of Meningitis?
Which medications in the drug class Corticosteroids are used in the treatment of Meningitis?
Which medications in the drug class Diuretics, Loop are used in the treatment of Meningitis?
Which medications in the drug class Anticonvulsants, Other are used in the treatment of Meningitis?
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Pneumococcal meningitis in a patient with alcoholism. Courtesy of the CDC/Dr. Edwin P. Ewing, Jr.
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Acute bacterial meningitis. This axial nonenhanced computed tomography scan shows mild ventriculomegaly and sulcal effacement.
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Acute bacterial meningitis. This axial T2-weighted magnetic resonance image shows only mild ventriculomegaly.
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Acute bacterial meningitis. This contrast-enhanced, axial T1-weighted magnetic resonance image shows leptomeningeal enhancement (arrows).
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Chronic mastoiditis and epidural empyema in a patient with bacterial meningitis. This axial computed tomography scan shows sclerosis of the temporal bone (chronic mastoiditis), an adjacent epidural empyema with marked dural enhancement (arrow), and the absence of left mastoid air.
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Subdural empyema and arterial infarct in a patient with bacterial meningitis. This contrast-enhanced axial computed tomography scan shows left-sided parenchymal hypoattenuation in the middle cerebral artery territory, with marked herniation and a prominent subdural empyema.
Tables
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- Overview
- Presentation
- DDx
- Workup
- Treatment
- Approach Considerations
- Treatment of Subacute Meningitis
- Treatment of Bacterial Meningitis
- Treatment of Viral Meningitis
- Treatment of Fungal Meningitis
- Treatment of Tuberculous Meningitis
- Treatment of Syphilitic Meningitis
- Treatment of Parasitic Meningitis
- Treatment of Lyme Meningitis
- Prevention
- Consultations
- Long-Term Monitoring
- Show All
- Guidelines
- Medication
- Medication Summary
- Sulfonamides
- Tetracyclines
- Carbapenems
- Fluoroquinolones
- Antibiotics, Miscellaneous
- Glycopeptides
- Aminoglycosides
- Penicillins, Amino
- Penicillins, Natural
- Cephalosporins, 3rd Generation
- Antivirals, CMV
- Antivirals, Other
- Antifungals, Systemic
- Antituberculous Agents
- Vaccines, Inactivated, Bacterial
- Corticosteroids
- Diuretics, Osmotic Agents
- Diuretics, Loop
- Anticonvulsants, Hydantoins
- Anticonvulsants, Barbiturates
- Anticonvulsants, Other
- Show All
- Questions & Answers
- Media Gallery
- Tables
- References