Emergency Department Management of Adults With Infectious Meningitis and Encephalitis

Show Notes

• Meningitis vs encephalitis
  • Why this topic?
  • What do the words mean? What's the difference?
• Bacterial meningitis
  • How common is it in the US? Is it more common in third world countries?
  • Mortality rate in the US
  • Causes – if Neisseria and H influenzae improved post vaccination, why not S pneumoniae disease ? (Table 1)
• Viral meningitis
  • How common is it in the US?
  • What are the common causes? (Table 2)
• Viral encephalitis
  • Same prognosis as viral meningitis?
  • Same organisms as viral meningitis? (Table 2)
  • Does COVID-19 cause this illness?
• Fungal infections
  • Who gets these?
  • 60% die? 1 million cases a year, 600K deaths?
• Prehospital care:
  • What does EMS need to know?
  • How do they protect themselves from being exposed?
  • How can they help us make the diagnosis?
  • EMS is giving antibiotics in some areas?
  • PEP
• ED evaluation: History
• ED evaluation: Physical exam
• Diagnostics: CSF
  • What's large volume? Is it safe?
  • Cell counts on tubes 1+4, all the time or only if traumatic and obviously bloody?
  • Is opening pressure helpful?
  • CSF lactate level – can this be run in a normal lactic acid analyzer?
  • PCR/NAAT testing
• Serum labs
  • What is helpful?
  • Serum PCR
  • Serum cryptococcal antigen
• Imaging
  • Is CT imaging before LP still necessary? Can we be selective?
  • Is MRI helpful in the ED, or is there a role in encephalitis?
• Treatment
  • Antibiotics
  • Steroids: Who gets them? When? Are there downsides of giving them?
• Special populations
  • Autoimmune disease
  • Lacking childhood vaccines
  • Healthcare associated infections
• Cutting edge
• Disposition