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lnfectious Disease Bacterial Meningitis Diagnosis Symptoms and signs of bacterial meningitis include fever, nuchal rigidity, photophobia, and altered mental status. Testing CT of the head is indicated before proceeding with LP if signs or symptoms of increased intracranial pressure (papilledema, focal neurologic deficits, altered mental status, immunocompromise), history of CNS disease (stroke, mass), or new-onset seizures are present. STUDY TABLE: Typical CSF Findings in Patients With Viral and Bacterial Meningitis CSF Parameter Viral Meningitis Bacteriat Meningitis Opening pressure <250 mm H2O 200-500 mm H2O Leukocyte count 50-1 000/pL 1 000-5000/pL Leukocyte differential Lymphocytes Neutrophils Glucose >45 mg/dL <40 mg/dL Protein <200 mg/dL 100-500 mg/dL Gram stain Negative Positive in 600/o-907o Culture Negative Positive in707"-85"/" CSF Gram stain and cultures should be obtained, and Streptococcus pneumonioe antigen detection and multiplex PCR assay should be performed, before antibiotic initiation. The two most common organisms causing bacterial meningitis are S. pneumonioe and Neisserio meningitidis, accounting for >80% of cases.

Culture Negative Positive in707"-85"/" CSF Gram stain and cultures should be obtained, and Streptococcus pneumonioe antigen detection and multiplex PCR assay should be performed, before antibiotic initiation. The two most common organisms causing bacterial meningitis are S. pneumonioe and Neisserio meningitidis, accounting for >80% of cases. Treatment STUDY fABLE: Empiric Antibiotic Management of Bacterial Meningitis Clinical Characteristics Empiric Antibiotic Regimen I m m u nocom petent host with com m u nity-acquired lV ceftriaxone or cefotaxime plus lV vancomycin bacterial meningitis Patients >50 years or those with altered cell-mediated lV a mpicillin (Listeria coverage) plus lV ceftriaxone or cefotaxime immunity plus lVvancomycin Allergies to p-lactams lV moxifloxacin instead of cephalosporin lV tri m eth o pri m-su lf a m eth oxazole instead of a m p i ci I I i n Hospital-acquired bacterial meningitis (head trauma, lV vancomycin plus lV ceftazidime, cefepime, or meropenem neu rosurgery, ventricular drains) In patients treated empirically or with confirmed pneumococcal meningitis, adjunctive dexamethasone should be given with or before administration of antimicrobial agents and continued for 4 days. Treatment of viral meningitis is symptomatic and supportive. Empiric antimicrobial agents may be initiated in viral meningitis until bacterial meningitis is excluded. 221