Nndifferential diagnosis of meningitis pdf merger

Individuals with encephalitis often show mild flulike symptoms. Clinically she presented with meningitis causing diagnostic and therapeutic delays. However, it should be appreciated that in approxi mately half of cases the cause of viral encephalitis is not found. Druginduced aseptic meningitis diam is a rare but important and often challenging diagnosis for the physician. Additional research focuses on autoimmune causes of encephalitis and optional treatments for them. We analyzed data from the records of 422 patients with acute bacterial or viral meningitis. Meningitis has long been known as a clinical disorder. This article describes the background, clinical presentation, diagnosis, and treatment of selected etiologies of subacute and chronic meningitis. Differential diagnosis of infectious and noninfectious meningitis a patient presenting with fever, headache, nausea, emesis, meningeal irritation, and abnormal csf findings high pressure, increased white cell count, and decreased glucose and chloride levels is easily misdiagnosed as having meningitis. Her past medical history was remarkable for dm type 2, hypertension, and hypothyroidism. Introduction to meningitis brain, spinal cord, and nerve. Clinicians need to remain vigilant and treat suspected bacterial meningitis promptly. While in some cases they first treat the underlying cause.

Usually, noninfectious meningitis causes symptoms that are similar to those of bacterial meningitis but are milder and may develop more slowly. Clinical diagnosis the classical symptoms and signs of acute meningitis may be absent in the very young, the very old and the very sick. Bacterial meningitis genetic and rare diseases information. If one episode of meningitis was caused by a drug, meningitis may recur if people take the drug again. The content of the website and databases of the national organization for rare disorders nord is ed and may not be reproduced, copied, downloaded or disseminated, in any way, for any commercial or public purpose, without prior written authorization and approval from nord. Abdul basit is a final year medical student at bolan university of medical and health. Diagnosis of chronic leptomeningitis by using meningeal. In the remainder, infective, neoplastic and socalled aseptic disorders may be identified. However, with viruses being the most common cause of meningitis, rapid diagnosis via pcr can limit unnecessary antibiotic treatment and expedite hospital discharge. Diagnosis, initial management, and prevention of meningitis. Outcome in patients with bacterial meningitis presenting.

Background before the introduction of the conjugate vaccines, haemophilus influenzae type b was the major cause of bacterial meningitis in the united states, and meningitis was primarily a disease. A cerebrospinal fluid csf glucose level less than 1. Meningitis is an inflammation of the membranes that cover the brain and spinal cord. Cunha, md druginduced aseptic meningitis should be included in the differential diagnosis of viralaseptic meningitis. On imaging, it presents as a localized, multiple, or diffuse enhancing dural thickening commonly forming masslike lesions. We report a case of group b streptococcus meningitis in a 72yearold female patient who was admitted in our hospital with a 21day history of bilateral lower thigh pain and swelling associated with fever, headache, and vomiting. A differential diagnosis of druginduced aseptic meningitis clair cascella, md, sara nausheen, md, and burke a. The sample of cerebrospinal fluid is withdrawn and sent to a laboratory to be examined, analyzed, and cultured. Both bacterial and chemical meningitis have been reported. Tuberculous and brucellosis meningitis differential diagnosis. Laboratory methods for the diagnosis of meningitis caused.

However, in contrast to bacterial meningitis, many patients with aseptic meningitis particularly those who have disease caused by viruses or medications have a selflimited course that will resolve without specific. The presence or absence of classic meningeal signs and symptoms should not be used as the sole criteria for referring patients for further diagnostic testing. Dilemmas in the diagnosis of acute communityacquired. When the neck becomes stiff, lowering the chin to chest becomes painful. Noninfectious meningitis, including medicationinduced meningeal inflammation. Symptoms include headache, a stiff neck, and often fever. Aseptic meningitis as the sole manifestation of behcets disease. Chronic meningitis requires a degree of clinical suspicion, as again signs of meningism may be minimal or absent. Introduction meningitis is an infection of the membranes meninges surrounding the brain and spinal cord. The uveomeningeal syndromes are a group of disorders that share involvement of the uvea, retina, and meninges. A first case of meningitisencephalitis associated with. Presents with acute onset of a febrile illness and altered mental status.

Once the diagnsis of meningitis is confirmed, the next step may be to differentiate. Your family doctor or pediatrician can diagnose meningitis based on a medical history, a physical exam and certain diagnostic tests. Bacterial meningitis research papers paper masters. Pdf tuberculous and brucellosis meningitis differential. During theearlypartofthe studyperiod,most csfcellcountsandsmears andmanyof the blood differential leukocyte counts were made by house staff.

Broadly speaking, there are three main potential areas of concern. Diagnosis of chronic leptomeningitis by using meningeal biopsy. Value of cerebrospinal fluid analysis in the differential. Recurrent meningitis may also be caused by conditions that are not infections see table some causes of noninfectious meningitis, such as use of nonsteroidal antiinflammatory drugs nsaids or another drug.

With the advent of chemotherapy delay in the diagnosis ofpurulent meningitis can no longer be excused, for diagnosis at leisure is condonable only when dealing with an incurable or. If you or someone you know has any concern for this whatsoever with symptoms such as fever headache, confusion, stiff painful neck etc they should go to the er now. Bacterial meningitis is a medical emergency characterised by inflammation of the meninges in response to bacterial infection. A better understand the molecular mechanisms involved in the protection and disruption of the bloodbrain barrier could lead to the development of new treatments for several neuroinflammatory diseases such as meningitis and encephalitis. Bacterial meningitis research papers this research paper on bacterial meningitis will examine the acute inflammation of the protective membrane that covers the brain and spinal cord. Noninfectious meningitis msd manual consumer version. Difficult and recurrent meningitis journal of neurology. Prognosis has not improved in decades, despite the advent of improved antimicrobial therapy and heightened index of suspicion among clinicians caring for affected infants. Meningococcal meningitis may be associated with kidney and adrenal gland failure and shock. Initial diagnostic testing should be directed at excluding lifethreatening, common, and treatable etiologies. Aug 16, 2018 bacterial meningitis is one of the most common types of meningitis and constitutes approximately 85% of cases of meningitis. Leptomeningitis, which is more commonly referred to as meningitis, represents inflammation of the subarachnoid space i.

Meningitis causes symptoms that are very similar to those of a routine viral infection. A number of studies have evaluated the prevalence of different organisms that cause bacterial meningitis. Unequivocal descriptions of meningitis date to the seventeenth century, 1 and tuberculous meningitis and syphilitic meningitis have been known as discreet entities for nearly as long. Differential diagnosis of meningitis and encephalitis. The epidemiology, etiology, clinical features, and diagnosis of bacterial meningitis in the neonate will be discussed here. Doctor answers on symptoms, diagnosis, treatment, and more.

Meningitis is usually caused by a viral or bacterial infection. Viral meningitis may mimick other diseases in terms of clinical signs and symptoms. Meningitis is infection of the membranes that surround the brain and spinal cord meninges the incidence of bacterial meningitis has decreased markedly compared to several decades ago as a result of the widespread use of conjugate vaccines and preventive antimicrobial treatment of pregnant women. An analysis of the predictive value of initial observations. Clinicians should use historical clues in patients presenting with signs and. Medical health research papers on various diseases are custom written by the writers at paper masters.

Combine and completely mix the barium chloride and sulfuric acid. We examined csf characteristics and the differential diagnosis of the main types of meningitis. Chandramuki department of neuromicrobiology, national institute of mental heal th and neurosciences nimhans, bengaluru karnataka, india 1. Often, however, meningitis is accompanied by the flu. It is diagnostic in 7085% of cases prior to antibiotic exposure. Noninfectious meningitis is possible when the fluid contains excess white blood cells indicating inflammation and does not contain any bacteria that could be the cause. We assessed the incidence, clinical characteristics, and outcome of patients with bacterial meningitis presenting with a minimal score on the glasgow coma scale from a nationwide cohort study of adults with communityacquired bacterial meningitis in the netherlands from 2006 to 2012. Hypertrophic pachymeningitis radiology reference article. Differential diagnosis between viral and bacterial. 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. Lifethreatening inflammation of the meninges caused by various bacteria.

In combination with a clinical picture and csf examination consistent with bacterial meningitis, a presumptive diagnosis of bacterial meningitis caused by n. A prospective study to determine the value of cerebrospinal fluid analysis in the differential diagnosis of meningitis was performed in 710 consecutively observed patients, both children and adults, who underwent lumbar puncture due to suspected central nervous system infection. If meningococcal disease is suspected in primary care, guidelines recommend that benzylpenicillin be. Meningitis nord national organization for rare disorders. Meningitis and encephalitis fact sheet national institute. Empiric therapy for meningitis associated with sinusitis, otitis, or mastoiditis should. Pathological state of brain parenchymal dysfunction leading to an altered state of consciousness or focal neurological signs. 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. A case report of tuberculous meningitis likai huang 1,2, chienmin lin 3,4, chijen chen 5,6, chaurjong hu 1,4. Rarely, migraine may cause meningitis, but this diagnosis is usually only made when other causes have been eliminated. A definitive diagnosis of meningitis requires examination of cerebrospinal fluid csf via lumbar puncture. Meningitis symptoms, diagnosis, and treatments precision. Bacterial meningitis is observed more frequently and can present in a hyperacute, acute, subacute, or chronic fashion. Bacterial meningitis diagnosis using clinical signs and csf mr imaging when unclear, non responsive to therapy or when complications occur.

Chqgdl60008 meningitis emergency management in children 2 in the older child, the rates of meningitis are much lower with an estimated incidence of 1 per 5,901 febrile children aged 2 to 24 months. Recurrent meningitis is a rare clinical scenario that can be selflimiting or life threatening depending on the underlying etiology. The differential diagnosis between viral meningitis and bacterial meningitis is often very difficult. The diagnosis of druginduced aseptic meningitis is made by establishing a causal relationship between the use of the drug and the onset of signs and symptoms, supported by negative tests for infectious causes of symptoms and rapidity of resolution after the drug is discontinued. Gram staining of csf can be helpful in the diagnosis of neonatal meningitis, but a. Meningitis charities merge to become meningitis now uk. After using the information in your ebook for 3 weeks, it was down within the normal range. Sarscov2 which emerged in wuhan, china, has spread to multiple countries rapidly. Many meningitis patients in the uk who have a csf pleocytosis never have a pathogen identified.

Bacterial meningitis differentials bmj best practice. Meningitis often appears with flulike symptoms that develop over 12 days. This infection justifiably elicits strong emotional reactions and, hopefully, immediate medical intervention. In meningitis, there occurs swelling and inflammation of the membranes and the characteristic presenting features of the infection are fever, headache and stiff neck. The treatment, prognosis, and complications of neonatal bacterial meningitis are discussed separately, as is bacterial meningitis in older children. Diagnosis and management of bacterial meningitis in the. Chronic and recurrent meningitis practical neurology. Chronic meningitis is defined as the persistence of clinical symptoms and signs of meningitis, with or without abnormal cerebrospinal fluid, for more than four weeks. Pitfalls in clinical diagnosis and treatment of infectious.

Viral meningitis is an important cause of admission to hospital, with an estimated incidence of around 515 cases per 100 000 per year in the uk. The focus of this topic is on bacterial meningitis acquired in the community. Intake of antimicrobials, steroids, analgesics amongst others has been implicated. They include brain abscess and subdural or extradural empyema and are classified according to the anatomical location or the etiologic agent.

We report a 33yearold woman who had aseptic meningitis alone, without any other systemic manifestations, due to behcets disease. Thus, meningitis due to neisseria meningitidis is still a concern in a vaccinated individual. Meningitis about bacterial meningitis infection cdc. Both meningitis and septicaemia can cause an acquired brain injury, this is brain damage that has occurred at any time after birth.

Jan 30, 2019 meningitis is an infection of the membranes meninges that cover the brain and the spinal cord. Bacterial meningitiscausesrisk factorssymptomsdiagnosis. Acute bacterial meningitis viral meningitis brain abscess empyema encephalitis each may present with a nonspecific prodrome of fever and headache. Differential diagnosis between viral and bacterial meningitis. Key diagnostic considerations when evaluating a patient presenting with chronic inflam. Review communityacquired bacterial meningitis in adults. Diagnoses to consider aside from meningitis include the following. Behcets disease should be listed as a differential diagnosis of acute aseptic meningitis because, in acute aseptic meningitis caused by behcets disease, early treatment with corticosteroids could ameliorate this disorder. Intracranial abscesses are uncommon, serious, lifethreatening infections. If a doctor suspects meningitis, they will collect samples of blood or cerebrospinal fluid fluid near the spinal cord. Diagnoses included acute or presumed bacterial meningitis n79, acute or presumed viral. We report the first case of meningitis associated with sarscov2 who was brought in by ambulance due to a convulsion accompanied by unconsciousness. Feverweaknesssyncopealtered mental statusseizuredizziness and vertigoheadachesore throatdyspneachest painabdominal painnausea and vomitinggastrointestinal bleedingacute pelvic painback pain pathophysiology of headache. Department of child health, bristol university increasedpowerentails increased responsibility.

Meningitis differential diagnoses medscape reference. An elderly previously vaccinated female contracted tetanus following foot injury. Depending on the different causes or types of meningitis, the inflammation can clear up on its own. Who fact sheet on meningococcal meningitis provides key facts and. The reported incidence almost certainly underestimates the true level, particularly for enteroviral meningitis, the commonest pathogen identified. Meningitis is inflammation of the thin tissue that surrounds the brain and spinal cord, called the meninges. Differential diagnosis differentiating viral meningitis from other diseases. Jan 17, 2019 meningitis can affect anyone from newborns to adults and is usually caused by an infection from a bacteria, virus or fungus that travels from another part of the body through the blood stream to the brain.

You get it when a virus enters the body through the nose or mouth and travels to the brain. Given the lack of specificity of clinical findings, the key to the diagnosis of meningitis is the evaluation of csf. Upon admission, examination showed bilateral warmth and tender soft tissue. The general diagnostic approach to the differential diagnosis which i shall outline here is straightforward, and consists of the history, examination and then general and neurological investiga tions.

Pneumococcal meningitis is often associated with a very purulent csf and a high mortality, especially in older adults. The differential diagnosis of meningitis and encephalitis includes bacterial, viral, fungal, and autoimmune etiologies. The meninges comprise three membranes that, together with the cerebrospinal fluid, enclose and protect the brain and spinal cord the central nervous system. Jan 05, 2008 viral meningitis is a notifiable disease in england and wales, but many cases undoubtedly go unreported. Important infective causes include partially treated bacterial pyogenic. Nice guideline cg102 did not identify any evidence that examined the diagnostic accuracy of pct for differentiating bacterial meningitis. The charity will fund pioneering research to eradicate the disease, support those affected and raise awareness. The results of peripheral blood and spinal fluid analysis are not 100% accurate. Chapter 6 primary culture and presumptive identification.

Outbreaks of the disease are diagnosed mainly in the springautumn period, which may be due to sudden temperature fluctuations, epidemics of infectious diseases, a decrease in immune protection in the population and seasonal vitamin deficiency. The illness course varies, with progression over hours to several days. Viral names the causative agent, and the term meningitis implies lack of parenchymal and spinal cord involvement otherwise called encephalitis and myelitis, respectively. Pachymeningitis is most often found in infants and in middleaged men. Noninfectious meningitis brain, spinal cord, and nerve. Tests to diagnose meningitis include blood tests, imaging tests, and a spinal tap to test cerebrospinal fluid. Serious, complex, and potentially fatal disorder with noninfectious and infectious causes.

Know the causes, risk factors, symptoms, diagnosis, treatmentantibiotics. Pocket manual of differential diagnosis, 5th ed medical books pocket manual of differential diagnosis, 5th ed. A young survivor of meningitis is now active in a campaign to raise awareness of the meningitis vaccine. Meningitis is an acute inflammation of the protective membranes covering the brain and spinal. Most commonly affects extremes of age aseptic meningitis often has a similar presentation to that of bacterial meningitis ie, fever, headache, altered mental status, stiff neck, photophobia, which can be a lifethreatening illness. This aftereffect may take months or even years to develop and can be subtle, although severe acquired brain injury will be obvious quickly. Differential diagnosis headache made easy with mnemonics. Distinctive rashes are typically seen in some forms of the disease. The biggest difference is that meningitis symptoms more often involve the head, neck, and eyes, while other infections often involve the throat and sinuses and cause nausea, vomiting, and diarrhea.

Neurologists are often called on to rule out bacterial meningitis, which can be difficult with the history and physical examination alone. Oct 21, 20 following their merger in april this year, bristolbased meningitis uk and gloucesterbased meningitis trust have now become meningitis now. Jul 17, 2018 viral meningitis is inflammation of the leptomeninges as a manifestation of central nervous system cns infection. Untreated, its mortality approaches 100%, and even with current antibiotics and advanced paediatric intensive care, the mortality rate of the disease is approximately 510%. Bacterial meningitis in the united states in 1995 nejm.

Then other tests are done to identify infectious organisms other than bacteria, such as viruses and fungi in the cerebrospinal fluid. In as many as one third of cases, no cause is found. A differential diagnosis of druginduced aseptic meningitis. Laboratory findings were obtained fromthe patientscase records. Viral meningitis british medical bulletin oxford academic. For a further discussion related to other etiological agents and other infective processes in the cns, please refer to cns infectious diseases. I couldnt get my blood sugar below 300 with medication. Meningitis can occur as a complication of either transcranial or transsphenoidal surgery for craniopharyngioma. Meningococcal meningitis world health organization. Cardinal presentations this post is part of a series called cardinal presentations, based on rosens emergency medicine 8th edition. Csf examination is essential to establish the diagnosis and to identify the etiological agent of lymphocytic meningitis. Clinical features headache, fever, drowsiness, neck stiffness severe meningitis. Streptococcus agalactiae meningitis in adult patient. The 2016 uk meningitis guidelines recommend an lp be.

These are among the most important problems in medicine today common acute infections of the nervous system include. Most of the headache treatments are symptomatic so doctors always suggest you the pain medications which include antianalgesics mostly paracetamol. It is important to differentiate viral meningitis from other diseases with similar presentation. There are other etiologies of an infectious nature. For all types of meningitis, doctors do a spinal tap lumbar puncture to confirm the diagnosis and identify the cause. Hypertrophic pachymeningitis is a condition where there is localized inflammatory thickening of the dura. Epidemiology, diagnosis, and antimicrobial treatment of acute. The differential diagnosis of viral meningitis includes two step approach. A bacterial meningitis can cause death in a very short period of time, 24 to 48 hrs if untreated.