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Meningitis - Dr. Winters

9/18/2014

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Picture
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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  • RESIDENCY
    • About CMC
    • Curriculum
    • Benefits
    • Explore Charlotte
    • Official Site
  • FELLOWSHIP
    • Fellowships at CMC
    • Ultrasound
    • EMS
    • Global EM
    • Pediatric EM
    • Toxicology >
      • Tox Faculty
      • Tox Application
  • PEOPLE
    • Program Leadership
    • Current Chiefs
    • PGY-3
    • PGY-2
    • PGY-1
    • Recent Grads >
      • Class of 2023
      • Class of 2022
    • Alumni
  • STUDENTS/APPLICANTS
    • Medical Students at CMC
    • EM Acting Internship
    • Healthcare Disparities Externship
    • Resident Mentorship
  • #FOAMed
    • EM GuideWire
    • CMC Imaging Mastery
    • Pediatric EM Morsels
    • Blogs, etc. >
      • CMC ECG Masters
      • Core Concepts
      • Cardiology Blog
      • Dr. Patel's Coding Blog
      • Global Health Blog
      • Ortho Blog
      • Pediatric Emergency Medicine
      • Tox Blog
  • Chiefs Corner
    • Top 20
    • Current Chiefs
    • Incentive Shifts & Moonlighting >
      • AEC Incentive Shifts
      • STICU Moonlighting
      • MICU X moonlighting
      • Cardiac Rehab >
        • Pineville Cardiac Rehab
        • Union Cardiac Rehab
    • Schedules >
      • Block Schedule
      • ED Shift Schedule
      • Conference and Resident Lectures
      • Journal Club
      • CQR
      • Simulation
    • Resources >
      • Fox Reference Library
      • FlashPoint
      • Airway Lecture
      • Student Resources
      • PGY - 1
      • PGY - 2
      • PGY - 3
      • Simulation Reading
      • Resident Wellness
      • Resident Research
      • Resume Builder
    • Individualized Interactive Instruction
    • Off Service Rotators