Curricular components for infectious diseases epa 1. The differential diagnosis of viral meningitis is critical because the signs and symptoms can be very similar to other forms of meningitis that are lifethreatening if not treated promptly. It is not known why one person gets meningitis when others exposed to the same germs do not get as sick, or dont get sick at all. A differential diagnosis of druginduced aseptic meningitis. Costeffective diagnostic checklists for meningitis in. Checklists can standardize patient care, reduce errors, and improve health outcomes.
Viral meningitis is usually selflimited and resolves without treatment, although case reports suggest that treatment is indicated and beneficial in certain clinical. Laboratory methods for the diagnosis of meningitis caused by neisseria meningitidis, streptococcus pneumoniae, and haemophilus influenzae. First is differentiating bacterial meningitis from other diseases which have similar clinical presentation as bacterial meningitis such as encephalitis, brain abscess, subarachnoid hemorrage, and brain tumour. Laboratory methods for the diagnosis of meningitis caused by. The classic triad of fever, headache, and neck stiffness occurs in about 85% of patients diagnosed with acute bacterial meningitis, but in only about 10% of patients with chronic meningitis. We analyzed data from the records of 422 patients with acute bacterial or viral meningitis. The analysis of cerebrospinal fluid after a bacterial meningitis if exudative and features facilitates the clinical differential diagnosis, unlike the analysis of samples after viral and fungal infections, which show less changes with transudate characteristics depending on clinical associations and more specific analyses as the microbiological. Clinical presentation, diagnosis, and radiological. Differential diagnosis of tuberculous meningitis from. This information does not change the differential diagnosis significantly. Causes of trismus several conditions may cause or predispose an individual to develop trismus. Several tests can confirm the diagnosis of meningitis.
These are among the most important problems in medicine today common acute infections of the nervous system include. Some of the most common causes of bacterial meningitis include neisseria meningitidis, streptococcus. Meningitis is an inflammation of the tissue that covers the brain and spinal cord that can be caused by several different types of, as well as viruses and fungibacteria. Wbc differential may be misleading early in the course of meningitis, as in small. Epa title management of previously healthy patients with a pediatric. Clinical features alone cannot confirm the diagnosis of meningitis. Acute bacterial meningitis viral meningitis brain abscess empyema encephalitis each may present with a nonspecific prodrome of fever and headache.
The differential diagnosis of viral meningitis includes two step approach. Viral names the causative agent, and the term meningitis implies lack of parenchymal and spinal cord involvement otherwise called encephalitis and myelitis, respectively. It is critical for the clinician to distinguish bacterial and nonbacterial causes of meningitis. Di lemmas exist in the diagnosis of patients with bacterial meningitis, because clinical findings do not always. Key questions were formulated in a pico format population. The peripheral white blood cell count alone is not help. Differential diagnosis seizures meningitis tumors and other space occupying lesions such as brain abscess hypoglycemia hypertensive encephalopathy complicated or hemiplegic migraine focal encephalitis including cerebellitis traumatic extradural or subdural hemorrhage demyelinating conditions e. A cerebrospinal fluid csf glucose level less than 1. Laboratory diagnosis of meningitis an overview in relation.
Pdf differential diagnosis of bacterial and viral meningitis remains an important clinical problem, particularly in the initial hours of. Recognize the complications and sequelae of bacterial meningitis in children. Evaluating the brighton collaboration case definitions. Updates on diagnosis of meningitis and encephalitis mary greeley medical center grand round feb 22, 2017 michihiko goto md msci clinical assistant professor division of infectious diseases department of internal medicine university of iowa carver college of. What would your differential diagnosis of this problem have been. While aseptic meningitis, most frequently caused by enteroviruses, is usually benign with a selflimiting course, bacterial meningitis remains associated with high morbidity and mortality rates, despite advances in antimicrobial therapy and intensive care. Clinicians should use historical clues in patients presenting with signs and. Csf remains the corner stone for the diagnosis of different types of meningitis and encephalitis. For meningitis in resourcelimited settings, with high patient loads and limited financial resources, cns diagnostic algorithms may be useful to guide diagnosis and treatment. Diagnosis, initial management, and prevention of meningitis. Differential diagnosis of scrub typhus meningitis from bacterial meningitis using clinical and laboratory features article pdf available in neurology india 611. Six non aetiologyspecific spots belonging to the intersection subsets of pneumococcal, andor meningococcal, andor enteroviral meningitis corresponding to complement c3, creactive protein, and apolipoprotein ai proved to be informative to the predictive model. Azithromycin is as effective as beta lactams for the treatment of gas pharyngitis if the gas is susceptible to macrolides.
When meningitis is caused by an infection, tests may be able to identify the specific virus or bacteria causing it. Chandramuki department of neuromicrobiology, national institute of mental heal th and neurosciences nimhans, bengaluru karnataka, india 1. There are a number of predisposing conditions that increase the risk of pneumococcal meningitis, the most important of which is pneumococcal pneumonia. The results of peripheral blood and spinal fluid analysis are not 100% accurate. Clinical symptoms include headache, stiff neck, high fever, nauseavomiting and rash. Depending on the availability of laboratory and neuroimaging. Key diagnostic considerations when evaluating a patient presenting with chronic inflam.
Pediatric bacterial meningitis differential diagnoses. Meningitis is the inflammation of the meninges in response to infection or chemical agents. Diagnosis and differential diagnosis of meningitis at patients bed. In an earlier study, we demonstrated the presence of a 30kd protein antigen in cerebrospinal fluid csf of tbm patients. A case report of tuberculous meningitis likai huang 1,2, chienmin lin 3,4, chijen chen 5,6, chaurjong hu 1,4. Meningitis differential diagnoses medscape reference. Introduction meningitis is an infection of the membranes meninges surrounding the brain and spinal cord.
Pediatric bacterial meningitis is a lifethreatening illness that results from bacterial infection of the meninges and leaves some survivors with significant sequelae. Diagnosis of chronic leptomeningitis by using meningeal biopsy. The differential diagnosis between viral meningitis and bacterial meningitis is often very difficult. Updates on diagnosis of meningitis and encephalitis. Treatment for bacterial meningitis is antibiotics, with or without steroids. The pathogenesis, epidemiology, treatment, prognosis, and prevention of acute bacterial meningitis in adults and issues related to acute bacterial meningitis in children and to chronic, recurrent, and aseptic meningitis are discussed separately. Meningitis meningitis is a severe illness characterized by serous inflammation of the linings of the brain and spinal cord meninges. Differential diagnosis between viral and bacterial. This article describes the background, clinical presentation, diagnosis, and treatment of selected etiologies of subacute and chronic meningitis.
However, the costeffectiveness of such algorithms is unknown. Tariro makadzange, md dphil research fellow, mgh visiting lecturer, university of zimbabwe. Echovirus is an enterovirus that rarely has been detected in the. Meningitis is an important differential diagnosis in a febrile child with altered mental status or with. Pdf differential diagnosis of bacterial and viral meningitis using. A differential diagnosis of druginduced aseptic meningitis clair cascella, md, sara nausheen, md, and burke a. Laboratory diagnosis particularly biochemical analysis of cerebrospinal fluid csf plays a prominent role in the differential diagnosis of various disorders caused to central nervous system cns by varieties of bacterial and viruses. Comparative proteomics of cerebrospinal fluid reveals a. Which conditions should be included in the differential diagnoses of viral meningitis. Cunha, md druginduced aseptic meningitis should be included in the differential diagnosis of viralaseptic meningitis. Is the classic triad of fever, headache, and stiff neck reliable for bacterial meningitis. The basic approach to lp is the same whether or not bacterial meningitis is the most likely diagnosis. Bacterial meningitis is an inflammation of the meninges, including the pia, arachnoid, and subarachnoid space, that occurs in response to infection with bacteria andor bacterial products. Neoplastic meningitis is an event in the course of cancer with a variable clinical presentation and a wide differential diagnosis.
An overview in relation tothesudan, mustafa abdallah salih, mb,bs, mpch,md department of paediatrics and child health, faculty of medicine, university of khartoum introduction sudan lies within the meningitis belt and merringococcal disease has been one of its major problems throughout the twentieth century. This being said, the classification of headaches as primary vs secondary and new vs old provides not only a memorable framework for the differential diagnosis but also a clinically useful structure by which the differential can be organized by pivotal points. To find out if your teenager has meningitis, his doctor may ask him to get a procedure called a lumbar puncture, or spinal tap. The differential diagnosis of bacterial meningitis includes two step approach. Tuberculous meningitis tbm is a major global health problem, and it is sometimes difficult to perform a differential diagnosis of this disease from other diseases, particularly partiallytreated pyogenic meningitis ptpm.
Pdf differential diagnosis of scrub typhus meningitis. Chronic meningitis is commonly defined as inflammation in the csf persisting for at least 1 month without spontaneous resolution. The differential diagnosis of meningitis and encephalitis includes bacterial, viral, fungal, and autoimmune etiologies. Infections of the central nervous system cns can be divided into 2 broad categories. Which conditions should be included in the differential. Laboratory methods for the diagnosis of meningitis caused by neisseria meningitidis, streptococcus pneumoniae, and haemophilus influenzae w h o m a n ua l, 2n d e d i t ion1 1 the first edition has the who reference whocdscsredc99.
Up until today, however, there is no international consensus or gold standard method for the clinical diagnosis of meningitis, encephalitis, myelitis or adem 16,1824. Introduction bacterial meningitis is a severe, lifethreatening infection of the central nervous. First is differentiating viral meningitis from other diseases which have similar clinical presentation as viral meningitis such as encephalitis, brain abscess, subarachnoid hemorrage, and brain tumour. Case 1 tn is a 42yom who is admitted with severe headache, fatigue and weight loss over the last 2 months. Diagnosis and management in resource limited settings a. Diagnosis clinical features and clues to the responsible pathogen. Adverse events headache can occur in up to 60% of patients who undergo lp, and backache can occur in up to 40% of patients. Sometimes funguses, cancers, head injuries or other factors can cause meningitis, but cases from these sources are rare. Diagnosis and treatment now that we have gone through history and physical exam, we can narrow down our differential diagnosis and order investigations accordingly. Therefore, meticulous attention must be paid to appropriate treatment and monitoring of patients with this disease. In general, meningitis caused by a virus is less serious than meningitis caused by bacteria.
Meningitis renaissance school of medicine at stony brook. Differential diagnosis of meningitis and encephalitis. Echovirus type united states, 2001 echoviruses constitute one of the major groups of the genus enterovirus and are associated with illnesses including aseptic meningitis, nonspecific rashes, encephalitis, and myositis 1. Building a therapeutic alliance in a collaborative manner with the primary patient team by. Druginduced aseptic meningitis is rare but proba bly more common than the literature would suggest. Diagnosis of chronic leptomeningitis by using meningeal. Viral meningitis is inflammation of the leptomeninges as a manifestation of central nervous system cns infection. The epidemiology, pathogenesis, management, prognosis, and prevention are discussed separately. The differential diagnosis for chronic meningitis is long and can be divided into 3 categories.
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