Steroids in meningitis - All cause meningitis - reduction in hearing loss and neuro sequelae ; nonstatistical reduction in mortality *** Pediatric - reduction in hearing loss and neurologic seuelae in Hflu; no recs in neonates *** Adult - decrease in mortality in strep pneumo - Steroids are thought to reduce CSF penetration of antibiotics *** Can be bad in resistant bugs - Don't give steroids after you give antibiotics Not everyone needs CT before LP IDSA rec CT - Age > 60, history of CNS disease (stroke, focal infection, mass lesion), immunocompromise, papilledema, altered level of consciousness, focal neuro deficit, new onset seizure within one week of presentation - may be too sensitive Newer data - documented normal CT that herniated after LP > newer recommendations - no LP if evidence of impending herniation Chemoprophylaxis for meningitis - Household contacts, school or daycare contacts, direct exposure to patients secretions - first line is rifampin, second line is cipro HSV meningitis - affects limbic structures of temporal and frontal lobes - 70% mortality untreated > 20% if treated with acyclovir - New psych symptoms or behavioral symptoms, cognitive deficits are more common - Seizures - CSF findings - pleocytosis with lymphocytic predominance, elevated RBC, elevated protein, > Beware that the CSF - can be normal in early disease process, can have neutrophil predominance, can have normal RBC, and glucose can be reduced Tuberculosis - Common in HIV patients - Indolent course then rapid progression - Suggestive CSF - clear appearance, lower pressure, < 50 PMN in kids, >30% lymphocytes in adults - Def give steroids in these patients
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