Bacterial Meningitis (Continued)

In patients with a clinical presentation of meningitis and a CSF lymphocytic pleocytosis with a decreased glucose concentration, fungal infections, Mycobacterium tuberculosis, sarcoidosis, and lymphoma/leptomeningeal metastases are in the differential diagnosis. A subarachnoid hemorrhage manifests with headache and a sudden transient loss of consciousness. Examination of the spinal fluid will reveal red blood cells and xanthochromia, although it may take several hours for xanthochromia to appear.

Treatment. When bacterial meningitis is suspected, dexamethasone and empiric antimicrobial therapy is begun immediately. The choice of empiric antimicrobial therapy depends on the suspected meningeal pathogen, which is determined by the age of the patient and predisposing or associated conditions. Once the organism is identified and the results of antimicrobial sensitivity testing are known, antimicrobial therapy is modified accordingly.

Complications. The major complications of bacterial meningitis are focal and diffuse brain edema, hydrocephalus, arterial cerebrovascular complications (ischemic and/or hemorrhagic stroke), septic sinus thrombosis with thrombophlebitis, hearing loss and vestibulopathy, and seizures. It is the complications of bacterial meningitis that cause the acute and chronic neurologic deficits.

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