Meningitis - Dr. Winters

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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