Which conditions should be included in the differential diagnoses of viral meningitis. Differential diagnosis between viral and bacterial. This article describes the background, clinical presentation, diagnosis, and treatment of selected etiologies of subacute and chronic meningitis. 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. Wbc differential may be misleading early in the course of meningitis, as in small. Meningitis is an important differential diagnosis in a febrile child with altered mental status or with. There are a number of predisposing conditions that increase the risk of pneumococcal meningitis, the most important of which is pneumococcal pneumonia.
Laboratory diagnosis of meningitis an overview in relation. Comparative proteomics of cerebrospinal fluid reveals a. Initial diagnostic testing should be directed at excluding lifethreatening, common, and treatable etiologies. To find out if your teenager has meningitis, his doctor may ask him to get a procedure called a lumbar puncture, or spinal tap. The differential diagnosis of bacterial meningitis includes two step approach. Updates on diagnosis of meningitis and encephalitis. It is critical for the clinician to distinguish bacterial and nonbacterial causes of meningitis. Therefore, meticulous attention must be paid to appropriate treatment and monitoring of patients with this disease. An overview in relation tothesudan, mustafa abdallah salih, mb,bs, mpch,md department of paediatrics and child health, faculty of medicine, university of khartoum introduction sudan lies within the meningitis belt and merringococcal disease has been one of its major problems throughout the twentieth century. The basic approach to lp is the same whether or not bacterial meningitis is the most likely diagnosis. The differential diagnosis for chronic meningitis is long and can be divided into 3 categories. A differential diagnosis of druginduced aseptic meningitis clair cascella, md, sara nausheen, md, and burke a.
Differential diagnosis of tuberculous meningitis from. A cerebrospinal fluid csf glucose level less than 1. Pdf differential diagnosis of scrub typhus meningitis. Echovirus type united states, 2001 echoviruses constitute one of the major groups of the genus enterovirus and are associated with illnesses including aseptic meningitis, nonspecific rashes, encephalitis, and myositis 1. Building a therapeutic alliance in a collaborative manner with the primary patient team by. The results of peripheral blood and spinal fluid analysis are not 100% accurate. Meningitis is an inflammation of the tissue that covers the brain and spinal cord that can be caused by several different types of, as well as viruses and fungibacteria. Cunha, md druginduced aseptic meningitis should be included in the differential diagnosis of viralaseptic meningitis. Introduction bacterial meningitis is a severe, lifethreatening infection of the central nervous. Clinical features alone cannot confirm the diagnosis of meningitis. In general, meningitis caused by a virus is less serious than meningitis caused by bacteria. The classic triad of fever, headache, and neck stiffness occurs in about 85% of patients diagnosed with acute bacterial meningitis, but in only about 10% of patients with chronic meningitis. Laboratory methods for the diagnosis of meningitis caused by neisseria meningitidis, streptococcus pneumoniae, and haemophilus influenzae. Pdf differential diagnosis of bacterial and viral meningitis remains an important clinical problem, particularly in the initial hours of.
The epidemiology, pathogenesis, management, prognosis, and prevention are discussed separately. Csf remains the corner stone for the diagnosis of different types of meningitis and encephalitis. Up until today, however, there is no international consensus or gold standard method for the clinical diagnosis of meningitis, encephalitis, myelitis or adem 16,1824. The differential diagnosis of meningitis and encephalitis includes bacterial, viral, fungal, and autoimmune etiologies. Adverse events headache can occur in up to 60% of patients who undergo lp, and backache can occur in up to 40% of patients. Updates on diagnosis of meningitis and encephalitis mary greeley medical center grand round feb 22, 2017 michihiko goto md msci clinical assistant professor division of infectious diseases department of internal medicine university of iowa carver college of. First is differentiating bacterial meningitis from other diseases which have similar clinical presentation as bacterial meningitis such as encephalitis, brain abscess, subarachnoid hemorrage, and brain tumour. Diagnosis and management in resource limited settings a. Tariro makadzange, md dphil research fellow, mgh visiting lecturer, university of zimbabwe. We analyzed data from the records of 422 patients with acute bacterial or viral meningitis. Bacterial meningitis differential diagnosis wikidoc. Epa title management of previously healthy patients with a pediatric. The differential diagnosis of viral meningitis is critical because the signs and symptoms can be very similar to other forms of meningitis that are lifethreatening if not treated promptly. The differential diagnosis of viral meningitis includes two step approach.
Sometimes funguses, cancers, head injuries or other factors can cause meningitis, but cases from these sources are rare. Neoplastic meningitis is an event in the course of cancer with a variable clinical presentation and a wide differential diagnosis. Diagnosis and treatment now that we have gone through history and physical exam, we can narrow down our differential diagnosis and order investigations accordingly. Echovirus is an enterovirus that rarely has been detected in the. Druginduced aseptic meningitis is rare but proba bly more common than the literature would suggest. A differential diagnosis of druginduced aseptic meningitis. It is not known why one person gets meningitis when others exposed to the same germs do not get as sick, or dont get sick at all. This information does not change the differential diagnosis significantly. Meningitis is the inflammation of the meninges in response to infection or chemical agents.
Clinical presentation, diagnosis, and radiological. Differential diagnosis of scrub typhus meningitis from bacterial meningitis using clinical and laboratory features article pdf available in neurology india 611. Pediatric bacterial meningitis is a lifethreatening illness that results from bacterial infection of the meninges and leaves some survivors with significant sequelae. The differential diagnosis between viral meningitis and bacterial meningitis is often very difficult. Which conditions should be included in the differential.
For meningitis in resourcelimited settings, with high patient loads and limited financial resources, cns diagnostic algorithms may be useful to guide diagnosis and treatment. Causes of trismus several conditions may cause or predispose an individual to develop trismus. Pediatric bacterial meningitis differential diagnoses. Diagnosis and differential diagnosis of meningitis at patients bed. Meningitis meningitis is a severe illness characterized by serous inflammation of the linings of the brain and spinal cord meninges. Diagnosis of chronic leptomeningitis by using meningeal. Checklists can standardize patient care, reduce errors, and improve health outcomes.
Meningitis renaissance school of medicine at stony brook. Case 1 tn is a 42yom who is admitted with severe headache, fatigue and weight loss over the last 2 months. These are among the most important problems in medicine today common acute infections of the nervous system include. Dilemmas in the diagnosis of acute communityacquired bacterial. Introduction meningitis is an infection of the membranes meninges surrounding the brain and spinal cord. Diagnosis, initial management, and prevention of meningitis. The peripheral white blood cell count alone is not help.
Viral meningitis is usually selflimited and resolves without treatment, although case reports suggest that treatment is indicated and beneficial in certain clinical. In an earlier study, we demonstrated the presence of a 30kd protein antigen in cerebrospinal fluid csf of tbm patients. Curricular components for infectious diseases epa 1. Evaluating the brighton collaboration case definitions. Key diagnostic considerations when evaluating a patient presenting with chronic inflam. Laboratory diagnosis particularly biochemical analysis of cerebrospinal fluid csf plays a prominent role in the differential diagnosis of various disorders caused to central nervous system cns by varieties of bacterial and viruses. While aseptic meningitis, most frequently caused by enteroviruses, is usually benign with a selflimiting course, bacterial meningitis remains associated with high morbidity and mortality rates, despite advances in antimicrobial therapy and intensive care.
When meningitis is caused by an infection, tests may be able to identify the specific virus or bacteria causing it. Di lemmas exist in the diagnosis of patients with bacterial meningitis, because clinical findings do not always. However, the costeffectiveness of such algorithms is unknown. Six non aetiologyspecific spots belonging to the intersection subsets of pneumococcal, andor meningococcal, andor enteroviral meningitis corresponding to complement c3, creactive protein, and apolipoprotein ai proved to be informative to the predictive model. Pdf differential diagnosis of bacterial and viral meningitis using. Bacterial meningitis is an inflammation of the meninges, including the pia, arachnoid, and subarachnoid space, that occurs in response to infection with bacteria andor bacterial products. Meningitis differential diagnoses medscape reference. Clinicians should use historical clues in patients presenting with signs and.
Recognize the complications and sequelae of bacterial meningitis in children. Laboratory methods for the diagnosis of meningitis caused by. Some of the most common causes of bacterial meningitis include neisseria meningitidis, streptococcus. Several tests can confirm the diagnosis of meningitis.
Is the classic triad of fever, headache, and stiff neck reliable for bacterial meningitis. Infections of the central nervous system cns can be divided into 2 broad categories. Viral names the causative agent, and the term meningitis implies lack of parenchymal and spinal cord involvement otherwise called encephalitis and myelitis, respectively. Depending on the availability of laboratory and neuroimaging. Diagnosis clinical features and clues to the responsible pathogen. Treatment for bacterial meningitis is antibiotics, with or without steroids. Costeffective diagnostic checklists for meningitis in. Acute bacterial meningitis viral meningitis brain abscess empyema encephalitis each may present with a nonspecific prodrome of fever and headache. This being said, the classification of headaches as primary vs secondary and new vs old provides not only a memorable framework for the differential diagnosis but also a clinically useful structure by which the differential can be organized by pivotal points. Laboratory methods for the diagnosis of meningitis caused by neisseria meningitidis, streptococcus pneumoniae, and haemophilus influenzae w h o m a n ua l, 2n d e d i t ion1 1 the first edition has the who reference whocdscsredc99. Viral meningitis is inflammation of the leptomeninges as a manifestation of central nervous system cns infection. What would your differential diagnosis of this problem have been. Chronic meningitis is commonly defined as inflammation in the csf persisting for at least 1 month without spontaneous resolution.
Tuberculous meningitis tbm is a major global health problem, and it is sometimes difficult to perform a differential diagnosis of this disease from other diseases, particularly partiallytreated pyogenic meningitis ptpm. Chandramuki department of neuromicrobiology, national institute of mental heal th and neurosciences nimhans, bengaluru karnataka, india 1. Differential diagnosis seizures meningitis tumors and other space occupying lesions such as brain abscess hypoglycemia hypertensive encephalopathy complicated or hemiplegic migraine focal encephalitis including cerebellitis traumatic extradural or subdural hemorrhage demyelinating conditions e. 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.
Diagnosis of chronic leptomeningitis by using meningeal biopsy. A case report of tuberculous meningitis likai huang 1,2, chienmin lin 3,4, chijen chen 5,6, chaurjong hu 1,4. The analysis of cerebrospinal fluid after a bacterial meningitis if exudative and features facilitates the clinical differential diagnosis, unlike the analysis of samples after viral and fungal infections, which show less changes with transudate characteristics depending on clinical associations and more specific analyses as the microbiological. Key questions were formulated in a pico format population. Azithromycin is as effective as beta lactams for the treatment of gas pharyngitis if the gas is susceptible to macrolides.
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