{"id":10249,"date":"2022-01-24T08:11:45","date_gmt":"2022-01-24T06:11:45","guid":{"rendered":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/infectology\/meningitis-encephalitis\/"},"modified":"2022-02-10T17:58:11","modified_gmt":"2022-02-10T15:58:11","slug":"meningitis-encephalitis","status":"publish","type":"page","link":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/infectology\/meningitis-encephalitis\/","title":{"rendered":"Meningitis, encephalitis"},"content":{"rendered":"<span class=\"block-heading\" id=\"header_1\">\n<h3 class=\"wp-block-heading\" id=\"meningitis\" class=\"wp-block-heading\" id=\"meningitis\" class=\"title_collection title1\">Meningitis<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_1\">\n\n\n<ul class=\"wp-block-list\"><li>Meningitis is the inflammation of the membranous covering of the brain and spinal cord.<\/li><li>It can be classified based on the onset and etiology:<ul><li><strong>Acute<\/strong> (&lt;1 day), <strong>subactue<\/strong> (1 day-4 weeks) or <strong>chronic<\/strong> (\u22654 weeks)<\/li><li><strong>Infectious<\/strong> (most cases), <strong>noninfectious<\/strong> (autoimmune, drug-related, or cardiomatosis)<\/li><\/ul><\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_2\">\n<h4 class=\"wp-block-heading\" id=\"acute-meningitis\" class=\"wp-block-heading\" id=\"acute-meningitis\" class=\"title_collection title2\">Acute meningitis<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_2\">\n\n\n<p class=\"wp-block-paragraph\">Acute meningitis is typically the result of bacterial infection. The most common agents vary based on the age group:<\/p>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"pure-table\"><thead><tr><th>Age group<\/th><th>Agent<\/th><\/tr><\/thead><tbody><tr><td>Neonates <span style=\"font-family: inherit; font-size: inherit; font-weight: inherit; color: initial;\">(&lt;3mo)<\/span><\/td><td>Group B strep<br>E. coli<br>L. monocytogenes<\/td><\/tr><tr><td>Children (3mo-18yo)<\/td><td>N. meningitidis<br>S. pneumoniae<br>H. influenzae<\/td><\/tr><tr><td>Adults (18-50yo)<\/td><td>S. pneumoniae<br>N. meningitidis<br>H. influenzae<\/td><\/tr><tr><td>Older adults (&gt;50yo)<\/td><td>L. monocytogenes <br>Gram negative bacilli<br>S. pneumoniae<\/td><\/tr><\/tbody><\/table><figcaption><strong>Table 1. Most common agents based on the age group.<\/strong><\/figcaption><\/figure>\n\n\n<\/span><span class=\"block-heading\" id=\"header_3\">\n<h4 class=\"wp-block-heading\" id=\"asceptic-meningitis\" class=\"wp-block-heading\" id=\"asceptic-meningitis\" class=\"title_collection title2\">Asceptic meningitis<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_3\">\n\n\n<p class=\"wp-block-paragraph\">Aseptic meningitis usually <\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_4\">\n<h4 class=\"wp-block-heading\" id=\"symptoms\" class=\"wp-block-heading\" id=\"symptoms\" class=\"title_collection title2\">Symptoms<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_4\">\n\n\n<ul class=\"wp-block-list\"><li>Fever<\/li><li>Headache<\/li><li>Rashes<\/li><li>Nausea and vomiting<\/li><li>Photophobia<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_5\">\n<h4 class=\"wp-block-heading\" id=\"meningeal-signs\" class=\"wp-block-heading\" id=\"meningeal-signs\" class=\"title_collection title2\">Meningeal signs<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_5\">\n\n\n<p class=\"wp-block-paragraph\">The patient should be lying on their back. Positive sign = suspected meningitis.<\/p>\n\n\n\n<ol class=\"wp-block-list\"><li><strong>Nuchal rigidity<\/strong><ul><li>Flexing the head so the chin touches the chest.<\/li><li>Not possible and painful = positive.<\/li><\/ul><\/li><li><strong>Brudzinski sign<\/strong><ul><li>The knees and hips will flex during the nuchal rigidity test = positive.<\/li><\/ul><\/li><li><strong>Kerning sign<\/strong><ul><li>Flexing the hip and the knee, and then extending the knee (keeping the hip flexed).<\/li><li>Not possible and painful = positive.<\/li><\/ul><\/li><li><strong>Jolt test<\/strong><ul><li>Rocking the head back and forth produces pain<\/li><\/ul><\/li><\/ol>\n\n\n<\/span><span class=\"block-heading\" id=\"header_6\">\n<h4 class=\"wp-block-heading\" id=\"diagnosis\" class=\"wp-block-heading\" id=\"diagnosis\" class=\"title_collection title2\">Diagnosis<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_6\">\n\n\n<ul class=\"wp-block-list\"><li>Clinical signs<\/li><li>Blood tests<\/li><li>Lumbar puncture<ul><li>Bacterial meningitis presents with elevated WBC and proteins, reduced glucose<\/li><li>Aseptic meningitis presents with lymphocytes, and normal glucose<\/li><\/ul><\/li><li>CT<ul><li>Recommended before LP to exclude space-occupying lesions and ICP<\/li><\/ul><\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_7\">\n<h4 class=\"wp-block-heading\" id=\"treatment\" class=\"wp-block-heading\" id=\"treatment\" class=\"title_collection title2\">Treatment<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_7\">\n\n\n<ul class=\"wp-block-list\"><li>In case of acute bacterial meningitis<ul><li>Emperic treatment (see <strong>Table 2<\/strong>) must be started immediately after the lumbar puncture<\/li><\/ul><ul><li>In case of risk for L. monocytogenes, add ampicillin<\/li><li>Dexamethasone (0.15mg\/kg every 6 hours for 4 days) + rifampin<\/li><\/ul><\/li><li>No treatment in asceptic meningitis<\/li><\/ul>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"pure-table\"><thead><tr><th>Age<\/th><th>Treatment<\/th><\/tr><\/thead><tbody><tr><td>0-1mo<\/td><td>Ampicillin + cefotaxime\/aminoglycoside<\/td><\/tr><tr><td>1mo-50yo<\/td><td>Vancomycin + cefotaxime\/ceftriaxone<\/td><\/tr><tr><td>&gt;50yo<\/td><td>Vancomycin + ampicillin + ceftazidime<\/td><\/tr><\/tbody><\/table><figcaption> <strong>Table 2. Treatment based on the age group.<\/strong> <\/figcaption><\/figure>\n\n\n<\/span><span class=\"block-heading\" id=\"header_8\">\n<h3 class=\"wp-block-heading\" id=\"encephalitis\" class=\"wp-block-heading\" id=\"encephalitis\" class=\"title_collection title1\">Encephalitis<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_8\">\n\n\n<ul class=\"wp-block-list\"><li>Encephalitis is the inflammation of the nervous tissue of the brain, often appearing together with meningitis (meningoencephalitis).<\/li><li>Most cases are viral, due to:<ul><li>Herpesvirus<\/li><li>West Nile virus<\/li><li>Enterovirus<\/li><li>EBV<\/li><li>CMV<\/li><li>VZV<\/li><\/ul><\/li><li>Other causes include parasites (toxoplasmosis), fungai (aspergilus), and tumors.<\/li><li>Cerebral edema is a possible complication.<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_9\">\n<h4 class=\"wp-block-heading\" id=\"presentation\" class=\"wp-block-heading\" id=\"presentation\" class=\"title_collection title2\">Presentation<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_9\">\n\n\n<ul class=\"wp-block-list\"><li>Symptoms of meningitis (see above)<\/li><li>Confusion, altered mental status<\/li><li>Focal neurological deficits (aphasia, hemiparesis, palsies)<\/li><li>Convulsions<\/li><li>Somnolcense and coma<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_10\">\n<h4 class=\"wp-block-heading\" id=\"diagnosis\" class=\"wp-block-heading\" id=\"diagnosis\" class=\"title_collection title2\">Diagnosis<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_10\">\n\n\n<ul class=\"wp-block-list\"><li>Blood tests<\/li><li>CXR<\/li><li>Urinalysis<\/li><li>Lumbar puncture with PCR<ul><li>Typically with high lymphocyte count and normal glucose<\/li><\/ul><\/li><li>MRI<ul><li>For ruling out brain abcess and demonstrating edema<\/li><\/ul><\/li><li>EEG<\/li><li>Biopsy<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_11\">\n<h4 class=\"wp-block-heading\" id=\"treatment\" class=\"wp-block-heading\" id=\"treatment\" class=\"title_collection title2\">Treatment<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_11\">\n\n\n<ul class=\"wp-block-list\"><li>Supportive (including mechanical ventilation)<\/li><li>Antiviral therapy is available against some agents<ul><li>Herpesvirus: acyclovir<\/li><li>CMV: ganciclovir<\/li><\/ul><\/li><li>Anticonvulsants (benzodiazepens)<\/li><li>Osmotic diuretics (arcabose) and steroids for cerebral edema<\/li><\/ul>\n<\/span><div id=\"the_titles\" style=\"display:none;\"><h3 class=\"wp-block-heading\" id=\"meningitis\" class=\"wp-block-heading\" id=\"meningitis\">Meningitis<\/h3><h4 class=\"wp-block-heading\" id=\"acute-meningitis\" class=\"wp-block-heading\" id=\"acute-meningitis\">Acute meningitis<\/h4><h4 class=\"wp-block-heading\" id=\"asceptic-meningitis\" class=\"wp-block-heading\" id=\"asceptic-meningitis\">Asceptic meningitis<\/h4><h4 class=\"wp-block-heading\" id=\"symptoms\" class=\"wp-block-heading\" id=\"symptoms\">Symptoms<\/h4><h4 class=\"wp-block-heading\" id=\"meningeal-signs\" class=\"wp-block-heading\" id=\"meningeal-signs\">Meningeal signs<\/h4><h4 class=\"wp-block-heading\" id=\"diagnosis\" class=\"wp-block-heading\" id=\"diagnosis\">Diagnosis<\/h4><h4 class=\"wp-block-heading\" id=\"treatment\" class=\"wp-block-heading\" id=\"treatment\">Treatment<\/h4><h3 class=\"wp-block-heading\" id=\"encephalitis\" class=\"wp-block-heading\" id=\"encephalitis\">Encephalitis<\/h3><h4 class=\"wp-block-heading\" id=\"presentation\" class=\"wp-block-heading\" id=\"presentation\">Presentation<\/h4><h4 class=\"wp-block-heading\" id=\"diagnosis\" class=\"wp-block-heading\" id=\"diagnosis\">Diagnosis<\/h4><h4 class=\"wp-block-heading\" id=\"treatment\" class=\"wp-block-heading\" id=\"treatment\">Treatment<\/h4><\/div>","protected":false},"excerpt":{"rendered":"<p>Meningitis Meningitis is the inflammation of the membranous covering of the brain and spinal cord. It can be classified based on the onset and etiology: Acute (&lt;1 day), subactue (1 day-4 weeks) or chronic (\u22654 weeks) Infectious (most cases), noninfectious (autoimmune, drug-related, or cardiomatosis) Acute meningitis Acute meningitis is typically the result of bacterial infection. [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":10247,"menu_order":11,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-10249","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Meningitis, encephalitis &#8211; Meddists<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/infectology\/meningitis-encephalitis\/\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/infectology\\\/meningitis-encephalitis\\\/\",\"url\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/infectology\\\/meningitis-encephalitis\\\/\",\"name\":\"Meningitis, encephalitis &#8211; 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