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Acute Bacterial Meningitis In Adults

Signs & Symptoms

 Neck stiffness
Note: The classic clinical triad
Ref: Uptodate [ Clinical features and diagnosis of acute bacterial meningitis in adult] Harrison [ 999] Cecil [ 854]
Headache
Note: The classic clinical triad, severe, generalized, due to Increase in ICP
Ref: Uptodate [ Neurologic complications of bacterial meningitis in adults] Harrison [ 999] Cecil [ 854]
Severe generalized Headache
Note: The classic clinical triad, severe, generalized, due to Increase in ICP
Ref: Uptodate [ Neurologic complications of bacterial meningitis in adults] Harrison [ 999] Cecil [ 854]
Meningismus
Note: The classic clinical triad
Ref: Uptodate [ Clinical features and diagnosis of acute bacterial meningitis in adult] Harrison [ 999] Cecil [ 854]

Physical Examination

 Neck stiffness
Note: The classic clinical triad
Ref: Uptodate [ Clinical features and diagnosis of acute bacterial meningitis in adult] Harrison [ 999] Cecil [ 854]
Meningismus
Note: The classic clinical triad
Ref: Uptodate [ Clinical features and diagnosis of acute bacterial meningitis in adult] Harrison [ 999] Cecil [ 854]
Nuchal rigidity
Note: The classic clinical triad
Ref: Uptodate [ Clinical features and diagnosis of acute bacterial meningitis in adult] Harrison [ 999] Cecil [ 854]

Lab / Serology

 Polymorphonuclear leukocytosis
Note: (>100 cells/μL)
Ref: Uptodate [ Clinical features and diagnosis of acute bacterial meningitis in adults] Harrison [ 1000]
Increased CSF opening pressure
Note: >180 mmH2O
Ref: Harrison [ 1000]
Positive CSF bacterial culture
Note: Gold standard
Ref: Uptodate [ Clinical features and diagnosis of acute bacterial meningitis in adults] Harrison [ 1000] Cecil [ 856]

Imagin Study

 Diffuse meningeal enhancement
Note: Not diagnostic, due to Increased blood-brain barrier permeability
Ref: Harrison [ 1001]
Aneurysm formation of focal intracranial vessels
Ref: Uptodate [ Neurologic complications of bacterial meningitis in adults]
Brain Mass lesion
Ref: Uptodate [ Neurologic complications of bacterial meningitis in adults]

Complication

 Unresponsive to stimuli
Note: Time of presentation
Ref: Uptodate [ Neurologic complications of bacterial meningitis in adults] Harrison [ 999] Cecil [ 854]
Responsive to pain
Note: Time of presentation
Ref: Uptodate [ Neurologic complications of bacterial meningitis in adults] Harrison [ 999] Cecil [ 854]
Decreased level of consciousness
Note: Time of presentation
Ref: Uptodate [ Neurologic complications of bacterial meningitis in adults] Harrison [ 999] Cecil [ 854]

Risk Factors

 Elder
Ref: Epocrates [ Https://online.epocrates.com/diseases/53932/Bacterial-meningitis]
Smoking
Ref: Epocrates [ Https://online.epocrates.com/diseases/53932/Bacterial-meningitis]
Alcohol
Ref: Harrison [ 998]

Cause

 S pneumoniae
Note: Most common cause in adults >20
Ref: Uptodate [ Epidemiology of bacterial meningitis in adults] Harrison [ 998] Cecil [ 853]
Neisseria meningitidis
Ref: Uptodate [ Epidemiology of bacterial meningitis in adults] Harrison [ 998] Cecil [ 853]
Streptococcus agalactiae
Note: Common in neonates
Ref: Uptodate [ Epidemiology of bacterial meningitis in adults] Harrison [ 998] Cecil [ 853]

Other