Meningitis (suspected)

# Meningitis (Suspected)
Patients presents with altered mental status, nuchal rigidity, and fever, concerning for meningitis. Ddx also includes alternative infectious encephalopathy, substance/tox, respiratory/metabolic derangement, endocrinopathy or intracranial mass effect. NCHCT and antibiotics prior to Lumbar Puncture if abnormal consciousness, focal neuro deficits, over 60 y.o., immunocompromised host, history of CNS disease, new onset seizures within 1 week, or papilledema.
Dx
- CXR, UA/UCx
- Serum: CBC, CMP, VBG, Lactate, BCx x2, INR, Utox, TSH, HIV, RPR,
- CSF: Protein, Glucose, Bacterial Gram Stain+Cx, Cell count + diff, HSV DNA. Consider VZV IgM+IgG, CrAg, Cocci, Histo, VDRL
- Opening pressure: ***
- CPO/Tele
- NCHCT as above PRN
Tx
- Droplet precautions if concerned for Neisseria meningitidis
- Vanc Ceftriaxone (meningeal dosing)
- Add Acyclovir if concern for HSV or encephalitis
- Add Ampicillin if >50 y.o.
- Dexamethasone 10q4 if suspected Streptococcus pneumoniae