Acute bacterial meningitis

Investigations

1. If patient is in coma or has papilledema or focal neurological signs -* exclude an intracranial mass with a CT scan. If the patient is deteriorating rapidly, or has a bleeding disorder that cannot be rapidly corrected, take off blood cultures and commence antibiotics (see below) prior to scanning.

2. If above signs are absent or CT scan excludes a mass lesion -* confirm diagnosis with a lumbar puncture and identify the organism.

CSF examination - moderate increase in pressure < 300 mm CSF.

Gram + ve paired cocci Gram - ve bacilli Gram-ve intra and extracellular cocci = pneumococcus - haemophilus = meningococcus

- cell count is elevated, 100-10 000 cells/mm3(80-90% polymorphonuclear leucocytes).

- glucose is depressed.

- enzyme lactic dehydrogenase is elevated.

- culture CSF

Serological!immunological tests

- countercurrent Immunoelectrophoresis detects capsular antigen in CSF; leads to rapid diagnosis if CSF microscopy is unhelpful, especially if patient has already started antibiotics.

Blood cultures

- Organism isolated in 80% of cases of Haemophilus meningitis.

- Pneumococcus and meningococcus in less than 50% of patients.

3. Check serum electrolytes.

- important in view of the frequency of inappropriate antidiuretic hormone secretion in meningitis.

4. Detect the source of infection.

- Chest X-ray - pneumonia

- Sinus X-ray - sinusitis

- Skull X-ray - fracture

- Petrous views - mastoiditis

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