Emergency Department Management of Adults With Infectious Meningitis and Encephalitis (Infectious Disease CME) | Store
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Emergency Department Management of Adults With Infectious Meningitis and Encephalitis (Infectious Disease CME)
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Publication Date: April 2022 (Volume 24, Number 4)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I credits, 4 AAFP Prescribed credits, and 4 AOA Category 2-A or 2-B CME credits. CME expires 04/01/2025.

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Infectious Disease CME credits, subject to your state and institutional approval.

Authors

Andrew N. Hogan, MD
Assistant Professor, Department of Emergency Medicine, Division of EMS, University of Texas Southwestern Medical Center, Dallas, TX
C. Reece Brockman II, MD, FACEP
Assistant Professor, Department of Emergency Medicine, University of Texas Southwestern Medical School, Dallas, TX
Amanda Santa Maria, MD
Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX

Peer Reviewers

Corlin Jewell, MD
Assistant Professor, BerbeeWalsh Department of Emergency Medicine, University of Wisconsin School of Medicine & Public Health, Madison, WI
Benjamin Schnapp, MD, MEd
Associate Residency Program Director, Assistant Professor, BerbeeWalsh Department of Emergency Medicine, University of Wisconsin School of Medicine & Public Health, Madison, WI

Abstract

Infectious meningitis and encephalitis are often life-threatening illnesses, though prompt workup and targeted treatment can greatly reduce morbidity and mortality. Although presentation of central nervous system infection can sometimes be subtle, this issue focuses on evidence-based strategies for identifying combinations of signs and symptoms to narrow the diagnosis. Identifying meningitis versus encephalitis; bacterial versus viral, fungal, or iatrogenic causes; and providing prompt empiric antimicrobials and appropriate diagnostic testing are key to management. Cerebrospinal fluid testing findings are outlined to help determine a potential cause for symptoms, along with blood and serum testing options. International society guidelines and evidence regarding the need for computed tomography prior to lumbar puncture are presented, which can help reduce unnecessary imaging. Disposition criteria are expanded to help determine whether a patient can go home, or the level of hospital care that will be required for those admitted.

Case Presentations

CASE 1
A 24-year-old woman with a history of migraine presents to the ED with a “splitting” headache…
  • The patient says this headache is more severe than any migraine she has had before.
  • She is noted to have a temperature of 38.3°C, a heart rate of 115 beats/min, and a blood pressure of 105/70 mm Hg.
  • You wonder whether this episode is simply another migraine or something else entirely…
CASE 2
A 62-year-old man with a history of heart transplant presents by EMS as a possible code stroke, with facial droop and partial hemiparesis….
  • On arrival, the patient is noted to be febrile to 38.8°C with a heart rate of 112 beats/min and blood pressure of 131/64 mm Hg.
  • His wife informs you by telephone that he has been developing the symptoms over several days and has also been prone to bizarre fits of laughter and angry outbursts.
  • You wonder whether the patient’s change in behavior is related to the fever, and if so, why?…
CASE 3
A 36-year-old man with a history of IV heroin use and HIV presents to your ED with 2 weeks of worsening headache, neck stiffness, and malaise. Your institution’s sepsis alert is triggered…
  • He admits to poor adherence to his antiretroviral medications for “a long time.”
  • His temperature is 38.5°C; his heart rate, 121 beats/min; and his blood pressure, 95/48 mm Hg.
  • Manipulation of his neck elicits guarding.
  • You order broad-spectrum antibiotics according to a sepsis order set, but you wonder whether these antimicrobials are sufficient to cover for potential causative agents…

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

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