Materiały źródłowe

• #1 Microbiological diagnosis of meningitis. Clínica Universidad de Navarra

  https://www.cun.es/en/diseases-treatments/diagnosis-procedures/microbiological-diagnosis-meningitis

  „If the germ can be determined by the study of spinal fluid, specific antibiotic treatment should be instituted. If not, an empirical treatment begins that must be directed at the most frequent microbes according to the patient’s characteristics.” […] „To make the diagnosis and to know which microorganism has caused the meningitis, it is necessary to collect a sample of cerebrospinal fluid (CSF) by lumbar puncture.” […] „Although the test that confirms the presumptive diagnosis is the microbiolobic culture, after which an antibiogram (for bacteria) or antifungigram (for fungi) must be carried out, which will give us information on the degree of sensitivity of the microorganism to the various antibiotics or antifungals and thus put the most appropriate treatment in place.” […] „The cerebrospinal fluid (CSF) from a patient with suspected meningitis is the highest priority clinical specimen in a clinical microbiology laboratory and must be processed immediately in all cases.”

• #1 Meningitis – Diagnosis : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/meningitis-diagnosis/

  Meningitis is caused by bacterial, viral, or fungal pathogens. […] Bacterial meningitis has a mortality rate of 15% even with early diagnosis and treatment. […] In adults with community-acquired acute bacterial meningitis, the sensitivity of the classic triad of fever, neck stiffness, and altered mental status is low (44%), but almost all (95%) present with at least two of the four symptoms of headache, fever, neck stiffness, and altered mental status. […] Absence of all of these symptoms essentially rules out the diagnosis. […] Definitive diagnosis cerebrospinal fluid (CSF) analysis, culture, and PCR. […] Current guidelines recommend empiric antibiotics, supportive care, and obtaining neurological opinion while forgoing the LP if there is clinical suspicion of increased intracranial pressure or impending brain herniation.

• #1 Meningitis: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/14600-meningitis

  Symptoms of meningitis include fever, headache, neck stiffness, sensitivity to light, nausea, vomiting and confusion. […] Only your healthcare provider can diagnose meningitis. If you think you have meningitis, talk to your provider or go to the nearest ER. […] Your healthcare provider will diagnose meningitis by doing a physical exam, asking you about your symptoms and testing your cerebrospinal fluid (CSF). […] Some tests your healthcare provider may use to diagnose meningitis include: Nasal or throat swab, Lumbar puncture/spinal tap, Blood tests. […] Meningitis treatment depends on the cause. Antibiotics are used to treat bacterial meningitis and antifungals are used to treat fungal meningitis. […] How is meningitis diagnosed? […] How is meningitis treated? […] You may start to feel better within a few days to a week after starting treatment for meningitis. Full recovery can take weeks to months.

• #1 Bacterial Meningitis: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/11039-bacterial-meningitis

  Bacterial meningitis is a very serious type of meningitis. If you have symptoms of bacterial meningitis, you should seek immediate treatment. Early diagnosis and treatment with antibiotics can often lead to a full recovery. […] Anyone experiencing symptoms of meningitis should seek medical care immediately. Bacterial meningitis can cause death within hours. […] If you or your child has any of these symptoms, go to your nearest emergency room or call 911 right away. Bacterial meningitis can worsen quickly, leading to coma and even death within hours. […] If you suspect you have meningitis, it’s important that you seek immediate medical assistance. A healthcare provider will ask you about your symptoms and perform a physical exam. […] If your provider suspects meningitis, they’ll begin treatment right away, before the test results come back.

• #1 Bacterial meningitis – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/539

  Bacterial meningitis represents a life-threatening inflammation of the meninges. A lumbar puncture to obtain cerebrospinal fluid is the most important investigation when a diagnosis of bacterial meningitis is considered. […] Diagnostic tests include cerebrospinal fluid (CSF) cell count and differential, CSF protein, CSF glucose, CSF Gram stain, CSF culture, antigen detection in CSF, blood culture, CBC and differential, CRP, electrolytes, calcium (Ca), magnesium (Mg), glucose, coagulation profile, CT head, and polymerase chain reaction (PCR).

• #1 Meningitis: Tests and Diagnosis

  https://www.verywellhealth.com/how-meningitis-is-diagnosed-4163534

  Healthcare professionals can test for meningitis using different types of exams, lab tests, and imaging. First, a physical examination is done to look for signs of meningitis and determine if more testing is needed. […] While a variety of tests may be done as part of the diagnostic process, only a lumbar puncture (LP) can confirm meningitis. Also known as a spinal tap, this is an invasive but largely safe procedure that involves removing cerebrospinal fluid and then analyzing it in a lab. […] Immediate diagnosis and treatment for meningitis is important, but that process can only be started if you recognize the signs and symptoms and seek an evaluation promptly. […] A spinal tap is the only test that can confirm a diagnosis of meningitis. The analysis can also determine the type of meningitis, which can be viral, bacterial, fungal, or aseptic (unrelated to infection). […] While certain signs and symptoms may strongly suggest meningitis, only a spinal tap can confirm the diagnosis. This involves taking a sample of cerebrospinal fluid from the lower back to examine it.

• #1 Meningitis in Children | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions—pediatrics/m/meningitis-in-children.html

  Meningitis is a swelling (inflammation) of the thin membranes that cover the brain and the spinal cord. These membranes are called the meninges. […] Meningitis is most often caused by a bacterial or viral infection that moves into the cerebral spinal fluid (CSF). […] The healthcare provider will ask about your child’s symptoms and health history. They may also ask about your family’s health history. They will give your child a physical exam. Your child may also have tests, such as: […] A lumbar puncture (spinal tap) is the only test that diagnoses meningitis. A needle is placed into the lower back, into the spinal canal. […] Several vaccines are available to prevent some of the bacterial and viral infections that can cause meningitis.

• #1 Meningitis – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/meningitis/

  Meningitis is an infection of the meninges in the brain or spinal cord. […] Diagnosis is confirmed with CSF analysis and microbiological studies (e.g., PCR, culture). […] If increased ICP is suspected, a CT of the head is recommended prior to lumbar puncture (LP). […] Do not delay empiric antibiotic therapy in patients suspected of having bacterial meningitis. […] Confirm the diagnosis with LP and CSF analysis (if no LP contraindications are present). […] Start empiric antibiotics immediately after obtaining blood cultures and CSF samples. […] Imaging is not necessary to establish the diagnosis of meningitis in most patients and should only be considered in patients with significant risk factors for complications. […] Lumbar puncture is indicated in all patients with suspected meningitis.

• #1 Overview of Meningitis – Neurologic Disorders – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/neurologic-disorders/meningitis/overview-of-meningitis

  Meningitis is inflammation of the meninges and subarachnoid space. […] Diagnosis is by cerebrospinal fluid (CSF) analysis. […] Meningitis is diagnosed mainly by CSF analysis. Because meningitis can be serious and lumbar puncture is a safe procedure, lumbar puncture should usually be done if there is any suspicion of meningitis. […] CSF findings differ by the type of meningitis but can overlap. […] If patients have signs suggesting increased intracranial pressure or a mass effect (eg, focal neurologic deficits, papilledema, deterioration in consciousness, seizures, especially if patients have HIV infection or are immunocompromised), neuroimaging typically, contrast-enhanced CT or MRI is done before lumbar puncture. […] When lumbar puncture is deferred, blood cultures should be obtained at the time of empiric treatment with antibiotics. […] After intracranial pressure has been lowered and if no mass is detected, lumbar puncture can be done.

• #1 Diagnosis, Initial Management, and Prevention of Meningitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2010/1215/p1491.html

  Although the annual incidence of bacterial meningitis in the United States is declining, it remains a medical emergency with a potential for high morbidity and mortality. Clinical signs and symptoms are unreliable in distinguishing bacterial meningitis from the more common forms of aseptic meningitis; therefore, a lumbar puncture with cerebrospinal fluid analysis is recommended. […] Empiric antimicrobial therapy based on age and risk factors must be started promptly in patients with bacterial meningitis. Empiric therapy should not be delayed, even if a lumbar puncture cannot be performed because results of a computed tomography scan are pending or because the patient is awaiting transfer. […] Evaluation of cerebrospinal fluid is key to the diagnosis of meningitis. […] If bacterial meningitis is suspected, empiric therapy with antimicrobials should not be delayed for more than one hour in patients awaiting diagnostic testing or transfers.

• #1 Meningitis Workup: Approach Considerations, Blood Studies, Cultures and Bacterial Antigen Testing

  https://emedicine.medscape.com/article/232915-workup

  If bacterial meningitis is suspected and the patient’s condition is critical, immediate administration of antibiotics and corticosteroids is warranted, even before lumbar puncture. In cases where bacterial meningitis is suspected but lumbar puncture is delayed due to pending CT or MRI scans, antibiotics and corticosteroids should be initiated after blood cultures, preceding neuroimaging. Prompt treatment should not be hindered by the need for confirmation. […] Measure the opening pressure, and send CSF for cell count (and differential count), chemistry (ie, CSF glucose and protein), and microbiology (ie, Gram stain and cultures). […] Other laboratory tests, which may include blood cultures, are needed to complement the CSF culture. These bacterial cultures are used for identification of the offending bacteria and occasionally its serogroup, as well as for determination of the organisms susceptibility to antibiotics.

• #1 Methods for rapid diagnosis of meningitis etiology in adults

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7248681/

  Infectious meningitis can be caused by viral, bacterial or fungal pathogens. […] Delay in diagnosis contributes to poor outcomes. […] More rapid techniques such as the cryptococcal lateral flow assay (IMMY), GeneXpert MTB/Rif Ultra (Cepheid) and FilmArray multiplex-PCR (Biofire) are three examples that have drastically changed meningitis diagnostics. […] This review will focus on the diagnosis of bacterial, mycobacterial, fungal meningitis due to their worse prognosis and need for accurate diagnosis as well as the various diagnostic tests used in these conditions. […] Due to the high mortality and morbidity of many types of meningitis, it is critical to obtain a diagnosis or initiate empiric treatment rapidly as soon as possible. […] CSF analysis is key to determining the etiology of meningitis.

• #1

  https://www.saem.org/about-saem/academies-interest-groups-affiliates2/cdem/for-students/online-education/m4-curriculum/group-m4-neurology/meningitis-encephalitis

  Patients diagnosed with meningitis or encephalitis have a broad differential diagnosis for the specific underlying causes of the inflammatory responses within the CNS. […] A prompt lumbar puncture (LP) is the preferred diagnostic procedure in patients with suspected bacterial meningitis or encephalitis. […] When performing an LP to assess for possible CNS infection, clinicians typically collect four tubes each containing about 1mL of CSF. Common initial CSF laboratory studies include: Cell count and differential, Protein, Glucose, Grams stain and bacterial culture. […] An LP result revealing an elevated number of white blood cells in the CSF is diagnostic for meningitis or encephalitis. […] CSF results suggestive of bacterial meningitis include the following: Positive Grams stain, Glucose less than 40 mg/dL or ratio of CSF/blood glucose less than 0.40, Protein greater than 200 mg/dL, WBC greater than 1000/mL, Greater than 80% polymorphonuclear neutrophils, Elevated opening pressure during LP.

• #1 Meningitis diagnosis – LevelUpRN

  https://leveluprn.com/blogs/nursing-tips/meningitis-diagnosis?srsltid=AfmBOopv3_WWtFhsCXLypQCemW3M3bPps2gvEVXI1xbgcI3hWPCXWa2L

  Diagnosis of meningitis is done by analyzing the patient’s CSF (cerebrospinal fluid). […] With bacterial meningitis, the CSF will be cloudy and will have decreased glucose content. […] With viral meningitis, CSF will be clear and glucose levels will typically be normal.

• #1 Meningitis Workup: Approach Considerations, Blood Studies, Cultures and Bacterial Antigen Testing

  https://emedicine.medscape.com/article/232915-workup

  The utility of cultures is most evident when LP is delayed until head imaging can rule out the risk for brain herniation, in which cases adjunctive dexamethasone and antimicrobial therapy is rightfully initiated before CSF samples can be obtained. […] The measurement of IgM levels in CSF is particularly effective in diagnosing conditions like West Nile virus. Identifying enlarged mononuclear cells (Mollaret cells) in CSF is a hallmark of HSV-2 meningitis, known for its recurrent nature (Mollaret meningitis). […] The CSF cell count varies according to the offending pathogen. It usually is in the few hundreds (100-1000/L) with a predominance of lymphocytes in patients with viral meningitis. Some cases of echovirus, mumps, and HSV meningitis may produce a neutrophilic picture early in the course of disease.

• #1 Methods for rapid diagnosis of meningitis etiology in adults

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7248681/

  Testing the CSF for inflammatory markers, such as C-reactive protein (CRP), procalcitonin, lactic acid and ferritin may aid in the differentiation of bacterial from viral meningitis but are not commonly used and have been more frequently studied as blood tests. […] The mainstay of diagnosis for bacterial meningitis remains CSF culture. […] PCR testing, especially in the form of assays that test for multiple pathogens has the potential to reduce the time to diagnosis and thus allow for more rapid narrowing of antibiotics. […] Xpert MTB/Rif Ultra is more sensitive than Xpert or culture and is now recommended as the first test to be used to detect tuberculosis meningitis (TBM). […] Diagnosis of cryptococcal meningitis centers around detection of cryptococcal antigen (CrAg) via lateral flow assay, though culture is often helpful as well. […] Despite the existence of numerous diagnostic techniques, determining the etiology of infectious meningitis remains difficult and cumbersome in many cases.

• #1 Meningitis Workup: Approach Considerations, Blood Studies, Cultures and Bacterial Antigen Testing

  https://emedicine.medscape.com/article/232915-workup

  In bacterial meningitis, elevated opening pressure (reference range, 80-200 mm H2O) suggests increased intracranial pressure (ICP) from cerebral edema. In viral meningitis, the opening pressure usually is within the reference range. […] The CSF glucose level (reference range, 40-70 mg/dL) is less than 40 mg/dL in 60% of patients. A simultaneous blood glucose determination should be obtained for the purposes of comparison. […] Gram staining of the CSF permits rapid identification of the bacterial cause in 60-90% of patients with bacterial meningitis. The presence of bacteria is 100% specific, but the sensitivity of this test for detection is variable. […] CSF bacterial cultures yield the bacterial cause in 70-85% of cases. The yield diminishes by 20% in patients who have received antimicrobial therapy. […] In patients with tuberculous meningitis, the CSF is characterized by a predominantly lymphocytic pleocytosis; an elevated protein level, especially if a CSF block is present; and a low glucose level ( 40 mg/dL).

• #1 Clinical features and diagnosis of acute bacterial meningitis in adults – UpToDate

  https://www.uptodate.com/contents/clinical-features-and-diagnosis-of-acute-bacterial-meningitis-in-adults

  Clinical features and diagnosis of acute bacterial meningitis in adults […] The clinical and laboratory features of acute bacterial meningitis in adults will be reviewed here. […] Bacterial meningitis reflects infection of the arachnoid mater and the CSF in both the subarachnoid space and the cerebral ventricles. […] The major causes of community-acquired bacterial meningitis in adults in developed countries are Streptococcus pneumoniae, Neisseria meningitidis, and, primarily in patients over 50 years of age or those who have deficiencies in cell-mediated immunity, Listeria monocytogenes. […] The major causes of health care-associated ventriculitis and meningitis are different (usually staphylococci and aerobic gram-negative bacilli) and occur more commonly after neurosurgical procedures.

• #1 Diagnosis, Initial Management, and Prevention of Meningitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2010/1215/p1491.html

  Given the lack of specificity of clinical findings, the key to the diagnosis of meningitis is the evaluation of CSF. […] Lumbar puncture is a safe procedure, although postprocedure headache occurs in about one third of patients. […] After CSF is obtained, the Gram stain results, white and red blood cell counts, glucose levels, and protein levels should be evaluated immediately. Although no single measure is diagnostic, a combination of abnormal CSF findings is highly suggestive of meningitis and helpful in determining the likely etiology. […] In patients with suspected bacterial meningitis, empiric therapy should not be delayed for more than one hour while awaiting diagnostic testing or transfers. […] After the results of the Gram stain, culture, and susceptibility tests are available, specific therapy targeting the pathogen should be administered. […] Polymerase chain reaction testing of CSF is more sensitive than CSF culture, particularly in patients who received previous antimicrobials.

• #1 Meningitis: Fast Diagnostics for a Deadly Disease

  https://www.biofiredx.com/blog/meningitis-fast-diagnostics-for-deadly-disease/

  Meningitis is a deadly disease that can kill in hours. […] It is important to know the specific cause of meningitis because the treatment differs depending on the cause. […] Meningitis diagnostics are relatively recent in our history. […] Distinguishing bacterial from viral meningitis based on clinical presentation alone is challenging. Getting fast, pathogen-specific answers can help save lives and guide appropriate therapy. […] Bacterial meningitis can be fatal in healthy people in 24 to 48 hours. The right treatment depends on quick identification of the pathogen as bacterial, viral, or yeast. […] The BIOFIRE ME Panel is a syndromic test that targets 14 of the most common bacterial, viral, and yeast causes of central nervous system infections. […] The BIOFIRE ME Panel provides comprehensive results in a clinically actionable timeframe. Getting answers fast can be lifesaving and can help guide appropriate therapy.

• #1 Viral Meningitis – Brain, Spinal Cord, and Nerve Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/brain-spinal-cord-and-nerve-disorders/meningitis/viral-meningitis

  Viral meningitis usually begins with symptoms of a viral infection such as fever, a general feeling of illness, headache, and muscle aches. […] Doctors suspect viral meningitis based on symptoms and do a spinal tap (lumbar puncture) to confirm the diagnosis. […] A spinal tap (lumbar puncture) is done to obtain a sample of cerebrospinal fluid. […] The sample of cerebrospinal fluid is sent to a laboratory to be examined and analyzed. […] Doctors suspect meningitis when people have a headache, fever, and stiff neck. They then try to determine whether meningitis is present and whether it is caused by bacteria (requiring immediate treatment) or a virus. Viral meningitis is more likely when the symptoms are less severe. […] The polymerase chain reaction (PCR) technique, which produces many copies of a gene, is used to identify enteroviruses, herpesviruses (such as HSV and varicella-zoster virus), and some other viruses.

• #1 Diagnosis and Treatment of Viral Meningitis | Journal of Ethics | American Medical Association

  https://journalofethics.ama-assn.org/article/diagnosis-and-treatment-viral-meningitis/2007-07

  CSF analysis should include a gram stain, acid-fast stain, and culture to further aid in diagnosis. […] A positive PCR test for enterovirus in the emergency room can save a patient with mild symptoms from an unnecessary hospital admission, assuming proper support and provisions at home. […] Treatment for viral meningitis is primarily supportive, especially in the case of enterovirus. Some patients require hospitalization for fluid administration and pain relief, while others can be safely treated at home.

• #1 Bacterial Meningitis Imaging: Practice Essentials, Computed Tomography, Magnetic Resonance Imaging

  https://emedicine.medscape.com/article/341971-overview

  In uncomplicated cases of purulent meningitis, early CT scans and MRIs usually demonstrate normal findings or small ventricles and effacement of sulci. The value of CT scanning in the early diagnosis of subdural empyema is limited because of the presence of bone artifact. […] Enhancement of the meninges is seen on contrast-enhanced CT scans and MRIs in cases of bacterial meningitis. However, meningeal enhancement is nonspecific and may also be caused by the following 5 different etiologic subgroups: Infectious, Carcinomatous meningitis, Reactive (eg, surgery, shunt, trauma), Chemical (eg, ruptured dermoid and cysticercoid cysts, intrathecal chemotherapy), Inflammatory (eg, sarcoidosis, collagen vascular disease). […] The European Society for Clinical Microbiology and Infectious Diseases (ESCMID) guidelines for diagnosis and management of acute bacterial meningitis strongly recommended cranial imaging before lumbar puncture in patients with focal neurologic deficits (excluding cranial nerve palsies); new-onset seizures; severely altered mental status (Glasgow Coma Scale score 10), and severely immunocompromised state. However, cranial imaging before lumbar puncture is not recommended in patients who do not have these characteristics.

• #1 Bacterial Meningitis Imaging: Practice Essentials, Computed Tomography, Magnetic Resonance Imaging

  https://emedicine.medscape.com/article/341971-overview

  The Infectious Diseases Society of America (IDSA) guidelines recommend neuroimaging in patients with suspected acute bacterial infection with a GCS 15, arm or leg drift, abnormal ocular motility, visual field defect, dilated pupil, new-onset seizures, immunocompromise, suspected mass lesion, stroke, focal infection, or increased intracranial pressure with papilledema. […] The most important role of CT scanning in imaging patients with meningitis is to identify contraindications to lumbar puncture and complications that require prompt neurosurgical intervention, such as symptomatic hydrocephalus, subdural empyema, and cerebral abscess. Contrast-enhanced CT scans may also help detect complications such as venous thrombosis, infarction, and ventriculitis. […] The value of CT scanning in the early diagnosis of subdural empyema and effusion has been controversial, as this modality may not detect meningitis, especially nonenhanced CT scans in the early stage of the disease. Normal results on CT imaging do not exclude the presence of acute meningitis. […] MRI findings of pyogenic brain abscesses are characteristic.

• #1 Bacterial Meningitis Imaging: Practice Essentials, Computed Tomography, Magnetic Resonance Imaging

  https://emedicine.medscape.com/article/341971-overview

  Meningitis is a clinical syndrome characterized by inflammation of the meninges. The most common cause of meningeal inflammation is bacterial or viral infection. Bacterial meningitis must be the first and foremost consideration in the differential diagnosis of patients with headache, neck stiffness, fever, and altered mental status. Acute bacterial meningitis is a medical emergency, and delays in instituting effective antimicrobial therapy result in increased morbidity and mortality. The decision to obtain a brain CT scan before LP should not delay the institution of antibiotic therapy; such delay can increase mortality. […] Neuroimaging can identify conditions that may predispose to bacterial meningitis; thus, it is indicated in patients who have evidence of head trauma, sinus or mastoid infection, skull fracture, and congenital anomalies. In addition, neuroimaging studies are typically used to identify and monitor complications of meningitis, such as hydrocephalus, subdural effusion, empyema, and infarction and to exclude parenchymal abscess and ventriculitis. Identifying cerebral complications early is important, as some complications, such as symptomatic hydrocephalus, subdural empyema, and cerebral abscess, require prompt neurosurgical intervention.

• #1 Bacterial Meningitis Imaging: Practice Essentials, Computed Tomography, Magnetic Resonance Imaging

  https://emedicine.medscape.com/article/341971-overview

  Computed tomography (CT) scanning is often performed first to exclude contraindications for lumbar puncture. Unfortunately, while increased intracranial pressure is considered a contraindication to lumbar puncture, normal CT scan findings may not be sufficient evidence of normal intracranial pressure in patients with bacterial meningitis. Nonenhanced CT scans and magnetic resonance images (MRIs) of patients with uncomplicated acute bacterial meningitis may be unremarkable. […] MRI is the most sensitive imaging modality, because the presence and extent of inflammatory changes in the meninges, as well as complications, can be detected. MRI is superior to CT scanning in the evaluation of patients with suspected meningitis, as well as in demonstrating leptomeningeal enhancement and distention of the subarachnoid space with widening of the interhemispheric fissure, which is reported to be an early finding in severe meningitis.

• #1

  https://www.meningitis.org/blogs/difference-bacterial-viral-meningitis

  Meningitis means inflammation of the meninges (meninges is the medical term for lining of the brain). Inflammation of the meninges, or meningitis, is most often caused by an infection, but can be caused by other things such as medications or other medical conditions. […] To determine whether a person is suffering from viral or bacterial meningitis, doctors will have to perform a lumbar puncture. This involves collecting a sample of the cerebrospinal fluid (CSF) that surrounds the brain and spinal cord to find out what is causing the meningitis. If the results of the lumbar puncture identify a specific virus or bacteria then the diagnosis is clear. […] It is important to know whether the cause is viral or bacterial as this will determine how to treat the patient. In bacterial meningitis antibiotics are essential but in viral meningitis antibiotics will not have any effect. […] Bacterial meningitis on the other hand can be rapidly fatal or cause devastating after effects, so it is important to treat these cases with antibiotics as soon as possible.

• #1 Aseptic and Bacterial Meningitis: Evaluation, Treatment, and Prevention | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0901/p314.html

  Bacterial meningitis classically has a very high and predominantly neutrophilic pleocytosis, low glucose level, and high protein level. […] CSF results can be variable, and decisions about treatment with antibiotics while awaiting culture results can be challenging. […] The Bacterial Meningitis Score has a sensitivity of 99% to 100% and a specificity of 52% to 62%, and appears to be the most specific tool available currently, although it is not widely used. […] Because CSF enterovirus polymerase chain reaction testing is more rapid than bacterial cultures, a positive test result can prompt discontinuation of antibiotic treatment, thus reducing antibiotic exposure and cost in patients admitted for suspected meningitis. […] Prompt recognition of a potential case of meningitis is essential so that empiric treatment may begin as soon as possible.

• #1 Meningitis in Adults Symptoms, Diagnosis, Causes & Treatment

  https://www.emedicinehealth.com/meningitis_in_adults/article_em.htm

  How Do Health Care Professionals Diagnose Meningitis in Adults? […] Rapid evaluation and entry into the emergency department begin upon arrival when you are identified as possibly having meningitis. […] Examination: The doctor performs an early examination to determine if help is needed with breathing or blood pressure. The doctor then checks your blood pressure, pulse, and temperature. […] Testing: Once the doctor examines you and learns of your symptoms, further evaluation depends on the doctor’s assessment of the likelihood of meningitis. If the doctor suspects bacterial meningitis, he or she may order the following: […] A spinal tap, or lumbar puncture, is necessary to diagnose meningitis. The results of the spinal tap are essential to help the doctor determine both the presence and then the type of meningitis. […] The test results can also indicate if the meningitis is due to a bacterial infection, fungal infection, or a virus.

• #1 Meningitis in Kids (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/meningitis.html

  Meningitis is an inflammation of the meninges (meh-NIN-jeez), the membranes that cover the brain and spinal cord. Some types of meningitis (meh-nen-JYE-tis) can be dangerous and even life-threatening. Routine vaccinations can help prevent it. […] Quick treatment of meningitis usually is successful. So it’s important to know what symptoms it can cause and to get medical care right away if your child might have the illness. […] If the doctor thinks it might be meningitis, they’ll likely order a lumbar puncture (spinal tap) to collect a sample of spinal fluid. This test will show any signs of inflammation and whether the infection is due to a virus or bacteria. The doctor will also order blood tests and other tests to try to find the source of the infection. […] Bacterial meningitis can cause serious problems that might need extra treatment, possibly in the hospital ICU.

• #1 Bacterial Meningitis: Delayed or Missed Diagnosis | Passen Powell Jenkins I Trial Lawyers

  https://www.passenpowell.com/bacterial-meningitis-delayed-missed-diagnosis/

  Meningitis can be misdiagnosed, especially in young children and babies. Many of the symptoms of bacterial meningitis are overlooked in children and babies. In people of all ages, bacterial meningitis can be misdiagnosed as viral meningitis or even strep throat, which causes a delay in the appropriate treatment. Diagnosis might be delayed due to a failure to recognize symptoms or order the appropriate diagnostic tests. […] People suspected of having meningitis need a lumbar puncture performed. Delaying a lumbar puncture often results in a worse prognosis. […] Bacterial meningitis can progress so rapidly that even if a diagnosis is delayed a few hours it can affect survival rates. In a study published in the Journal of Clinical Infectious Diseases, the mortality rate from bacterial meningitis increased by 12 percent for every hour the diagnosis was delayed.

• #1 Cutting-Edge Meningitis Test Provides Faster Diagnosis, More Accurate Treatment | Froedtert & MCW

  https://www.froedtert.com/stories/cutting-edge-meningitis-test-provides-faster-diagnosis-more-accurate-treatment

  The test to pinpoint if meningitis is viral, bacterial or fungal can now be completed in less than two hours. […] Patients suspected of contracting meningitis a potentially fatal disease that demands quick detection are getting diagnosed significantly faster, with treatments tailored to the specific infecting organism. […] In less than two hours, the test pinpoints whether the meningitis is viral, bacterial or fungal. […] Meningitis is a life-and-death infection. Every hour counts. […] The test gives patients a faster route to appropriate therapy, he said. […] Its very beneficial to quickly determine the type with certainty. […] The new test detects all types of meningitis a medical one-stop shop. […] An advantage is that it looks for things we may not have considered. […] Our research capabilities reflect our commitment to quality and groundbreaking diagnostics. […] I am grateful for this rapid testing. Its a game changer in diagnosing bacterial meningitis.

• #1

  https://www.who.int/news/item/10-04-2025-who-launches-first-ever-guidelines-on-meningitis-diagnosis–treatment-and-care

  The World Health Organization (WHO) has today published its first-ever global guidelines for meningitis diagnosis, treatment and care, aiming to speed up detection, ensure timely treatment, and improve long-term care for those affected. […] The new guidelines provide evidence-based recommendations for the clinical management of children over one month of age, adolescents, and adults with acute community-acquired meningitis. […] They address all aspects of clinical care, including diagnosis, antibiotic therapy, adjunctive treatment, supportive care, and management of long-term effects. […] The guidelines provide recommendations for both non-epidemic and epidemic settings, the latter superseding previous 2014 WHO guidelines, which covered meningitis outbreak response. […] With these guidelines, WHO provides countries with a critical tool to close gaps in meningitis diagnosis, treatment and care, ensuring that more people receive timely treatment and long-term support.

• #1 Bacterial Meningitis: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/11039-bacterial-meningitis

  Healthcare providers treat bacterial meningitis with antibiotics. They’ll give you an IV (intravenous) antibiotic with a corticosteroid to bring down the inflammation even before all the test results are in. […] Bacterial meningitis is a serious condition. Between 10% and 15% of people who get the disease will die. Early diagnosis and treatment with antibiotics lead to a better chance of recovery. […] Bacterial meningitis is a very serious, life-threatening disease. If you have symptoms of the condition, it’s important to seek medical attention right away. Early diagnosis and treatment with antibiotics can often lead to a full recovery. But delayed treatment can lead to long-term complications and even death.

• #2 Meningitis: Symptoms, diagnosis and treatment. Clínica Universidad de Navarra

  https://www.cun.es/en/diseases-treatments/diseases/meningitis

  „In the case of an acute bacterial meningitis, a delay in the diagnosis and in the establishment of the antibiotic treatment may imply serious sequels and even death.” […] „For the diagnosis of meningitis, it is necessary to study the cerebrospinal fluid, which is extracted by means of a lumbar puncture. It should be done as soon as possible if there are no contraindications.” […] „The examination of the cerebrospinal fluid allows the identification of the agent causing the meningitis in most patients.” […] „In the case of acute bacterial meningitis, a delay in the diagnosis and in the establishment of the antibiotic treatment may imply permanent brain damage with severe sequelae and even death.” […] „That is why, in case of suspicion of an acute bacterial meningitis, we must start urgent intravenous antibiotic treatment, even before performing the diagnostic lumbar puncture.” […] „With appropriate treatment, administered in time, even patients with potentially serious meningitis can have a good recovery without sequelae.”

• #2 Meningitis – Diagnosis : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/meningitis-diagnosis/

  Meningitis is caused by bacterial, viral, or fungal pathogens. […] Bacterial meningitis has a mortality rate of 15% even with early diagnosis and treatment. […] In adults with community-acquired acute bacterial meningitis, the sensitivity of the classic triad of fever, neck stiffness, and altered mental status is low (44%), but almost all (95%) present with at least two of the four symptoms of headache, fever, neck stiffness, and altered mental status. […] Absence of all of these symptoms essentially rules out the diagnosis. […] Definitive diagnosis cerebrospinal fluid (CSF) analysis, culture, and PCR. […] Current guidelines recommend empiric antibiotics, supportive care, and obtaining neurological opinion while forgoing the LP if there is clinical suspicion of increased intracranial pressure or impending brain herniation.

• #2 Bacterial Meningitis: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/11039-bacterial-meningitis

  Healthcare providers treat bacterial meningitis with antibiotics. They’ll give you an IV (intravenous) antibiotic with a corticosteroid to bring down the inflammation even before all the test results are in. […] Bacterial meningitis is a serious condition. Between 10% and 15% of people who get the disease will die. Early diagnosis and treatment with antibiotics lead to a better chance of recovery. […] Bacterial meningitis is a very serious, life-threatening disease. If you have symptoms of the condition, it’s important to seek medical attention right away. Early diagnosis and treatment with antibiotics can often lead to a full recovery. But delayed treatment can lead to long-term complications and even death.

• #2 Diagnosis, Initial Management, and Prevention of Meningitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2010/1215/p1491.html

  Given the lack of specificity of clinical findings, the key to the diagnosis of meningitis is the evaluation of CSF. […] Lumbar puncture is a safe procedure, although postprocedure headache occurs in about one third of patients. […] After CSF is obtained, the Gram stain results, white and red blood cell counts, glucose levels, and protein levels should be evaluated immediately. Although no single measure is diagnostic, a combination of abnormal CSF findings is highly suggestive of meningitis and helpful in determining the likely etiology. […] In patients with suspected bacterial meningitis, empiric therapy should not be delayed for more than one hour while awaiting diagnostic testing or transfers. […] After the results of the Gram stain, culture, and susceptibility tests are available, specific therapy targeting the pathogen should be administered. […] Polymerase chain reaction testing of CSF is more sensitive than CSF culture, particularly in patients who received previous antimicrobials.

• #2

  https://www.saem.org/about-saem/academies-interest-groups-affiliates2/cdem/for-students/online-education/m4-curriculum/group-m4-neurology/meningitis-encephalitis

  Patients diagnosed with meningitis or encephalitis have a broad differential diagnosis for the specific underlying causes of the inflammatory responses within the CNS. […] A prompt lumbar puncture (LP) is the preferred diagnostic procedure in patients with suspected bacterial meningitis or encephalitis. […] When performing an LP to assess for possible CNS infection, clinicians typically collect four tubes each containing about 1mL of CSF. Common initial CSF laboratory studies include: Cell count and differential, Protein, Glucose, Grams stain and bacterial culture. […] An LP result revealing an elevated number of white blood cells in the CSF is diagnostic for meningitis or encephalitis. […] CSF results suggestive of bacterial meningitis include the following: Positive Grams stain, Glucose less than 40 mg/dL or ratio of CSF/blood glucose less than 0.40, Protein greater than 200 mg/dL, WBC greater than 1000/mL, Greater than 80% polymorphonuclear neutrophils, Elevated opening pressure during LP.

• #2 Aseptic and Bacterial Meningitis: Evaluation, Treatment, and Prevention | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0901/p314.html

  Bacterial meningitis classically has a very high and predominantly neutrophilic pleocytosis, low glucose level, and high protein level. […] CSF results can be variable, and decisions about treatment with antibiotics while awaiting culture results can be challenging. […] The Bacterial Meningitis Score has a sensitivity of 99% to 100% and a specificity of 52% to 62%, and appears to be the most specific tool available currently, although it is not widely used. […] Because CSF enterovirus polymerase chain reaction testing is more rapid than bacterial cultures, a positive test result can prompt discontinuation of antibiotic treatment, thus reducing antibiotic exposure and cost in patients admitted for suspected meningitis. […] Prompt recognition of a potential case of meningitis is essential so that empiric treatment may begin as soon as possible.

• #2 Diagnosis and Treatment of Viral Meningitis | Journal of Ethics | American Medical Association

  https://journalofethics.ama-assn.org/article/diagnosis-and-treatment-viral-meningitis/2007-07

  Viral meningitis is inflammation of the leptomeniges due to a viral agent. It is the most common cause of meningitis, with an annual incidence of 10 to 11 people per 100,000. […] The disease is usually self-limiting, rarely requires hospitalization, and symptoms typically resolve in 7-10 days. Enterovirus is the most common etiologic agent and is responsible for 85 percent of viral meningitis cases. […] The symptoms of viral meningitis are indistinguishable from those of bacterial meningitis or aseptic causes of meningitis. Classic symptoms are fever, headache, and neck stiffness (nuchal rigidity). […] It is critical to distinguish between bacterial and viral etiologies because the course of bacterial meningitis is rapid and potentially deadly. […] Meningitis is definitively diagnosed with a lumbar puncture, which in viral meningitis typically reveals clear cerebral spinal fluid (CSF) with elevated white blood cell counts predominated by lymphocytes, in contrast to the PMNs (polymorphonuclear leukocytes) that typify bacterial etiologies.

• #2 Meningitis Workup: Approach Considerations, Blood Studies, Cultures and Bacterial Antigen Testing

  https://emedicine.medscape.com/article/232915-workup

  In bacterial meningitis, elevated opening pressure (reference range, 80-200 mm H2O) suggests increased intracranial pressure (ICP) from cerebral edema. In viral meningitis, the opening pressure usually is within the reference range. […] The CSF glucose level (reference range, 40-70 mg/dL) is less than 40 mg/dL in 60% of patients. A simultaneous blood glucose determination should be obtained for the purposes of comparison. […] Gram staining of the CSF permits rapid identification of the bacterial cause in 60-90% of patients with bacterial meningitis. The presence of bacteria is 100% specific, but the sensitivity of this test for detection is variable. […] CSF bacterial cultures yield the bacterial cause in 70-85% of cases. The yield diminishes by 20% in patients who have received antimicrobial therapy. […] In patients with tuberculous meningitis, the CSF is characterized by a predominantly lymphocytic pleocytosis; an elevated protein level, especially if a CSF block is present; and a low glucose level ( 40 mg/dL).

• #2 Methods for rapid diagnosis of meningitis etiology in adults

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7248681/

  Testing the CSF for inflammatory markers, such as C-reactive protein (CRP), procalcitonin, lactic acid and ferritin may aid in the differentiation of bacterial from viral meningitis but are not commonly used and have been more frequently studied as blood tests. […] The mainstay of diagnosis for bacterial meningitis remains CSF culture. […] PCR testing, especially in the form of assays that test for multiple pathogens has the potential to reduce the time to diagnosis and thus allow for more rapid narrowing of antibiotics. […] Xpert MTB/Rif Ultra is more sensitive than Xpert or culture and is now recommended as the first test to be used to detect tuberculosis meningitis (TBM). […] Diagnosis of cryptococcal meningitis centers around detection of cryptococcal antigen (CrAg) via lateral flow assay, though culture is often helpful as well. […] Despite the existence of numerous diagnostic techniques, determining the etiology of infectious meningitis remains difficult and cumbersome in many cases.

• #2 Meningitis: Fast Diagnostics for a Deadly Disease

  https://www.biofiredx.com/blog/meningitis-fast-diagnostics-for-deadly-disease/

  Meningitis is a deadly disease that can kill in hours. […] It is important to know the specific cause of meningitis because the treatment differs depending on the cause. […] Meningitis diagnostics are relatively recent in our history. […] Distinguishing bacterial from viral meningitis based on clinical presentation alone is challenging. Getting fast, pathogen-specific answers can help save lives and guide appropriate therapy. […] Bacterial meningitis can be fatal in healthy people in 24 to 48 hours. The right treatment depends on quick identification of the pathogen as bacterial, viral, or yeast. […] The BIOFIRE ME Panel is a syndromic test that targets 14 of the most common bacterial, viral, and yeast causes of central nervous system infections. […] The BIOFIRE ME Panel provides comprehensive results in a clinically actionable timeframe. Getting answers fast can be lifesaving and can help guide appropriate therapy.

• #2

  https://www.meningitis.org/blogs/difference-bacterial-viral-meningitis

  Meningitis means inflammation of the meninges (meninges is the medical term for lining of the brain). Inflammation of the meninges, or meningitis, is most often caused by an infection, but can be caused by other things such as medications or other medical conditions. […] To determine whether a person is suffering from viral or bacterial meningitis, doctors will have to perform a lumbar puncture. This involves collecting a sample of the cerebrospinal fluid (CSF) that surrounds the brain and spinal cord to find out what is causing the meningitis. If the results of the lumbar puncture identify a specific virus or bacteria then the diagnosis is clear. […] It is important to know whether the cause is viral or bacterial as this will determine how to treat the patient. In bacterial meningitis antibiotics are essential but in viral meningitis antibiotics will not have any effect. […] Bacterial meningitis on the other hand can be rapidly fatal or cause devastating after effects, so it is important to treat these cases with antibiotics as soon as possible.

• #2 Bacterial Meningitis: Delayed or Missed Diagnosis | Passen Powell Jenkins I Trial Lawyers

  https://www.passenpowell.com/bacterial-meningitis-delayed-missed-diagnosis/

  Meningitis can be misdiagnosed, especially in young children and babies. Many of the symptoms of bacterial meningitis are overlooked in children and babies. In people of all ages, bacterial meningitis can be misdiagnosed as viral meningitis or even strep throat, which causes a delay in the appropriate treatment. Diagnosis might be delayed due to a failure to recognize symptoms or order the appropriate diagnostic tests. […] People suspected of having meningitis need a lumbar puncture performed. Delaying a lumbar puncture often results in a worse prognosis. […] Bacterial meningitis can progress so rapidly that even if a diagnosis is delayed a few hours it can affect survival rates. In a study published in the Journal of Clinical Infectious Diseases, the mortality rate from bacterial meningitis increased by 12 percent for every hour the diagnosis was delayed.

• #2 Cutting-Edge Meningitis Test Provides Faster Diagnosis, More Accurate Treatment | Froedtert & MCW

  https://www.froedtert.com/stories/cutting-edge-meningitis-test-provides-faster-diagnosis-more-accurate-treatment

  The test to pinpoint if meningitis is viral, bacterial or fungal can now be completed in less than two hours. […] Patients suspected of contracting meningitis a potentially fatal disease that demands quick detection are getting diagnosed significantly faster, with treatments tailored to the specific infecting organism. […] In less than two hours, the test pinpoints whether the meningitis is viral, bacterial or fungal. […] Meningitis is a life-and-death infection. Every hour counts. […] The test gives patients a faster route to appropriate therapy, he said. […] Its very beneficial to quickly determine the type with certainty. […] The new test detects all types of meningitis a medical one-stop shop. […] An advantage is that it looks for things we may not have considered. […] Our research capabilities reflect our commitment to quality and groundbreaking diagnostics. […] I am grateful for this rapid testing. Its a game changer in diagnosing bacterial meningitis.

• #3 Meningitis | Definition, Symptoms, Treatment, & Facts | Britannica

  https://www.britannica.com/science/meningitis

  Meningitis is the inflammation of the meninges, the membranes that cover the brain and spinal cord. […] Diagnosis of meningitis is made by examination and confirmed by the performance of a test called a spinal tap (or lumbar puncture). In this test a needle is inserted into the lower part of the patients back between two vertebrae (bones of the spinal column) and a small sample of cerebrospinal fluid is removed. […] The early diagnosis and prompt treatment of meningitis are particularly important in preventing possible permanent damage to the brain, especially in affected children. […] Meningococcal meningitis is best treated with penicillin. Cases caused by H. influenzae are treated with ampicillin or chloramphenicol. […] The mortality and morbidity of the bacterial disease are substantial, even with the prompt use of appropriate antibiotic therapy.

• #3 Meningitis – Diagnosis : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/meningitis-diagnosis/

  Meningitis is caused by bacterial, viral, or fungal pathogens. […] Bacterial meningitis has a mortality rate of 15% even with early diagnosis and treatment. […] In adults with community-acquired acute bacterial meningitis, the sensitivity of the classic triad of fever, neck stiffness, and altered mental status is low (44%), but almost all (95%) present with at least two of the four symptoms of headache, fever, neck stiffness, and altered mental status. […] Absence of all of these symptoms essentially rules out the diagnosis. […] Definitive diagnosis cerebrospinal fluid (CSF) analysis, culture, and PCR. […] Current guidelines recommend empiric antibiotics, supportive care, and obtaining neurological opinion while forgoing the LP if there is clinical suspicion of increased intracranial pressure or impending brain herniation.

• #3 Meningitis Workup: Approach Considerations, Blood Studies, Cultures and Bacterial Antigen Testing

  https://emedicine.medscape.com/article/232915-workup

  In bacterial meningitis, elevated opening pressure (reference range, 80-200 mm H2O) suggests increased intracranial pressure (ICP) from cerebral edema. In viral meningitis, the opening pressure usually is within the reference range. […] The CSF glucose level (reference range, 40-70 mg/dL) is less than 40 mg/dL in 60% of patients. A simultaneous blood glucose determination should be obtained for the purposes of comparison. […] Gram staining of the CSF permits rapid identification of the bacterial cause in 60-90% of patients with bacterial meningitis. The presence of bacteria is 100% specific, but the sensitivity of this test for detection is variable. […] CSF bacterial cultures yield the bacterial cause in 70-85% of cases. The yield diminishes by 20% in patients who have received antimicrobial therapy. […] In patients with tuberculous meningitis, the CSF is characterized by a predominantly lymphocytic pleocytosis; an elevated protein level, especially if a CSF block is present; and a low glucose level ( 40 mg/dL).

• #3 Meningitis Workup: Approach Considerations, Blood Studies, Cultures and Bacterial Antigen Testing

  https://emedicine.medscape.com/article/232915-workup

  The utility of cultures is most evident when LP is delayed until head imaging can rule out the risk for brain herniation, in which cases adjunctive dexamethasone and antimicrobial therapy is rightfully initiated before CSF samples can be obtained. […] The measurement of IgM levels in CSF is particularly effective in diagnosing conditions like West Nile virus. Identifying enlarged mononuclear cells (Mollaret cells) in CSF is a hallmark of HSV-2 meningitis, known for its recurrent nature (Mollaret meningitis). […] The CSF cell count varies according to the offending pathogen. It usually is in the few hundreds (100-1000/L) with a predominance of lymphocytes in patients with viral meningitis. Some cases of echovirus, mumps, and HSV meningitis may produce a neutrophilic picture early in the course of disease.

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