Lumbar Puncture Performed Promptly or After Neuroimaging in Acute Bacterial Meningitis in Adults: A Prospective National Cohort Study Evaluating Different Guidelines

Acute bacterial meningitis is a life-threatening infection. By definition, meningitis is an infection of the meninges and the subarachnoid space. Bacterial meningitis is associated with an inflammatory response that involves the meninges, the subarachnoid space, the brain parenchyma, and the cerebral arteries and veins. As such, bacterial meningoencephalitis is the more accurate descriptive term. This chapter discusses the epidemiology, etiology, pathophysiology and pathogenesis, diagnosis, differential diagnosis, treatment, complications, and prognosis of the disease. The discussion of diagnosis covers clinical manifestations, physical examination findings, laboratory tests, and imaging studies. The discussion of treatment covers empirical therapy, specific antimicrobial therapy, and dexamethasone therapy. Graphs compare causative organisms and clinical manifestations of community-acquired meningitis. Illustrations depict proper patient positioning for detecting nuchal rigidity, Kernig sign, Brudzinski sign, and lumbar puncture, as well as a sagittal view of a lumbar puncture needle as it is advanced into the subarachnoid space. An algorithm delineates the approach to the patient with symptoms and signs of bacterial meningitis. Tables outline bacterial pathogens based on predisposing and associated conditions, cerebrospinal fluid diagnostic studies for meningitis, the appearance of the organism on a Gram stain, empirical antimicrobial therapy based on predisposing and associated conditions, recommendations for specific antibiotic therapy in bacterial meningitis, and recommended doses for antibiotics commonly used in the treatment of bacterial meningitis. This review contains 8 highly rendered figures, 6 tables, and 75 references.

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Acute Bacterial Meningitis

10.2310/im.6270 ◽

2015 ◽

Author(s):

Karen L. Roos

Keyword(s):

Bacterial Meningitis ◽

Lumbar Puncture ◽

Antimicrobial Therapy ◽

Subarachnoid Space ◽

Cerebral Arteries ◽

Clinical Manifestations ◽

Empirical Therapy ◽

Patient Positioning ◽

Acute Bacterial Meningitis ◽

Associated Conditions

Acute bacterial meningitis is a life-threatening infection. By definition, meningitis is an infection of the meninges and the subarachnoid space. Bacterial meningitis is associated with an inflammatory response that involves the meninges, the subarachnoid space, the brain parenchyma, and the cerebral arteries and veins. As such, bacterial meningoencephalitis is the more accurate descriptive term. This chapter discusses the epidemiology, etiology, pathophysiology and pathogenesis, diagnosis, differential diagnosis, treatment, complications, and prognosis of the disease. The discussion of diagnosis covers clinical manifestations, physical examination findings, laboratory tests, and imaging studies. The discussion of treatment covers empirical therapy, specific antimicrobial therapy, and dexamethasone therapy. Graphs compare causative organisms and clinical manifestations of community-acquired meningitis. Illustrations depict proper patient positioning for detecting nuchal rigidity, Kernig sign, Brudzinski sign, and lumbar puncture, as well as a sagittal view of a lumbar puncture needle as it is advanced into the subarachnoid space. An algorithm delineates the approach to the patient with symptoms and signs of bacterial meningitis. Tables outline bacterial pathogens based on predisposing and associated conditions, cerebrospinal fluid diagnostic studies for meningitis, the appearance of the organism on a Gram stain, empirical antimicrobial therapy based on predisposing and associated conditions, recommendations for specific antibiotic therapy in bacterial meningitis, and recommended doses for antibiotics commonly used in the treatment of bacterial meningitis. This review contains 8 highly rendered figures, 6 tables, and 75 references.

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Effect of Antibiotic Pretreatment on Cerebrospinal Fluid Profiles of Children with Acute Bacterial Meningitis

Nepal Journal of Medical Sciences ◽

10.3126/njms.v2i2.8963 ◽

2013 ◽

Vol 2 (2) ◽

pp. 135-139 ◽

Cited By ~ 4

Author(s):

S Adhikari ◽

E Gauchan ◽

G BK ◽

KS Rao

Keyword(s):

Cerebrospinal Fluid ◽

Bacterial Meningitis ◽

Antibiotic Therapy ◽

Lumbar Puncture ◽

Laboratory Finding ◽

Clinical Findings ◽

Acute Bacterial Meningitis ◽

Antibiotic Administration ◽

Intravenous Antibiotic ◽

Considerable Difficulty

Background: Analysis of cerebrospinal fluid is gold standard for diagnosis of meningitis. There is considerable difficulty in interpreting laboratory finding after prior antibiotic therapy. This study was conducted to evaluate the effect of intravenous antibiotic administration before lumbar puncture on cerebrospinal fluid profiles in children with bacterial meningitis. Methods: A hospital based retrospective study carried out using the data retrieved from the medical record department of Manipal Teaching Hospital Pokhara, Nepal; from 1st July 2006 to 31st July 2011. Clinical findings and relevant investigations were entered in a predesigned proforma. Patients were divided in two different groups as bacterial meningitis with and without prior intravenous antibiotic therapy. Various laboratory parameters including CSF were compared between these two groups using the statistical software, SPSS version 18.0. Results: A total of 114 children were included in this study among which 49(43%) children had received intravenous antibiotics before lumbar puncture. Mean CSF WBC count was(267.6± 211 vs. 208.1±125.3.3) and protein level (114.1±65.9 vs. 98.3±37.7mg/dl) in untreated vs. pretreated groups respectively. Neutrophil percentage was decreased (57.1±28.1vs.72.9±18.9) with higher CSF sugar level (43.3±11.8 vs. 51.2±13.2) after prior antibiotics therapy (p<0.001). Conclusion: Antibiotic pretreatment was associated with higher cerebrospinal fluid glucose levels with decreased neutrophils and increased lymphocytes. Pretreatment did not modify total cerebrospinal fluid white blood cell count and cerebrospinal fluid protein levels. Nepal Journal of Medical Sciences | Volume 02 | Number 02 | July-December 2013 | Page 135-139 DOI: http://dx.doi.org/10.3126/njms.v2i2.8963

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Acute Bacterial Meningitis

10.2310/im.1270 ◽

2014 ◽

Author(s):

Karen L. Roos

Keyword(s):

Bacterial Meningitis ◽

Lumbar Puncture ◽

Antimicrobial Therapy ◽

Subarachnoid Space ◽

Cerebral Arteries ◽

Clinical Manifestations ◽

Empirical Therapy ◽

Patient Positioning ◽

Acute Bacterial Meningitis ◽

Associated Conditions

Acute bacterial meningitis is a life-threatening infection. By definition, meningitis is an infection of the meninges and the subarachnoid space. Bacterial meningitis is associated with an inflammatory response that involves the meninges, the subarachnoid space, the brain parenchyma, and the cerebral arteries and veins. As such, bacterial meningoencephalitis is the more accurate descriptive term. This chapter discusses the epidemiology, etiology, pathophysiology and pathogenesis, diagnosis, differential diagnosis, treatment, complications, and prognosis of the disease. The discussion of diagnosis covers clinical manifestations, physical examination findings, laboratory tests, and imaging studies. The discussion of treatment covers empirical therapy, specific antimicrobial therapy, and dexamethasone therapy. Graphs compare causative organisms and clinical manifestations of community-acquired meningitis. Illustrations depict proper patient positioning for detecting nuchal rigidity, Kernig sign, Brudzinski sign, and lumbar puncture, as well as a sagittal view of a lumbar puncture needle as it is advanced into the subarachnoid space. An algorithm delineates the approach to the patient with symptoms and signs of bacterial meningitis. Tables outline bacterial pathogens based on predisposing and associated conditions, cerebrospinal fluid diagnostic studies for meningitis, the appearance of the organism on a Gram stain, empirical antimicrobial therapy based on predisposing and associated conditions, recommendations for specific antibiotic therapy in bacterial meningitis, and recommended doses for antibiotics commonly used in the treatment of bacterial meningitis. This review contains 8 highly rendered figures, 6 tables, and 75 references.

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Acute Bacterial Meningitis Complicated by Brain Herniation Shortly after Lumbar Puncture: A Case Report

Global Journal of Health Science ◽

10.5539/gjhs.v10n3p121 ◽

2018 ◽

Vol 10 (3) ◽

pp. 121

Author(s):

Khalid Ibrahim Al Noaim

Keyword(s):

Bacterial Meningitis ◽

Lumbar Puncture ◽

Skull Fracture ◽

Acute Bacterial Meningitis ◽

Normal Brain ◽

Antibiotic Administration ◽

Brain Herniation ◽

Brain Ct ◽

Neuroprotective Strategy ◽

History Of

INTRODUCTION: Brain herniation is a known complication of acute bacterial meningitis. Brain CT is requested before the lumbar puncture to rule out increased intracranial pressure. Delay antibiotic administration, secondary to brain CT leads to a poor clinical outcome.CASE PROFILE: 10 year old boy had previous history of skull fracture and pneumococcal meningitis, presented to ER with history of fever, headache and vomiting for 2 days. Clinically, he was fully conscious and vitally stables with positive meningeal signs and normal other examinations. Brain CT was normal before the lumbar puncture. The lumbar puncture came suggestive of meningitis in the form of leukocytosis with low glucose and high protein. Antibiotics were given after the lumbar puncture. Two hours after the lumbar puncture, the patient had deteriorations in the level of consciousness and respiratory arrest followed by a coma. Brain CT was repeated which showed cerebellar herniation and subarachnoid hemorrhage. Neuroprotective strategy was performed without improvements. Blood and CSF cultures showed pneumococcal growth. After onne week, brain death was confirmed.CONCLUSION: Brain herniation is a severe complication of bacterial meningitis. Clinical findings are the best indicators to delay the LP and to predict the risk of herniation. Normal brain CT doesn’t necessarily mean LP is safe. Early antibiotics administrations improve the mortality and morbidity. Unnecessary CT before the LP lead to a delay of antibiotic administration and poor outcome.

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