|
 | Presentation
 | New onset fever, rash, seizure. |
|
| History
| Photophobia, headache, mental status changes, recent
infections, |
| N/V, nuchal rigidity |
| Any other family members sick? |
| Immunizations, HIV status |
| SH: living conditions, job |
|
| PE
| Vitals |
| HEENT: fundoscopic exam (papilledema), palpate sinuses
for tenderness, EOM, lymphadenopathy, TMs |
| Skin: rash |
| CV: aucsultation |
| lungs: nothing special |
| Extremities: Kernig's (pain with extension of the
knee with hip in flexion),
 | Brudzinski's (involuntary flexion of the hips
with flexion of the neck), |
| DTRs, Babinski. |
|
| Neuro: focal neurological deficits |
|
| DDx
| Meningitis |
| Brain abscess |
| Hypoglycemia |
| CVA |
| Trauma |
| Bacterial endocarditis with septic emboli |
|
| Laboratory
| CBC w/ diff, blood cultures, BMP, stat blood glucose, UA
with culture |
| CXR |
| LP (indications for LP without prior CT:
worse HA ever, less than 36 hours, fever, no papilledema or
focal neurological signs) |
| Bacterial: ¿ WBCs (mostly PMNs),
↓ glucose,
¿ protein, gram stain. |
| Viral: WBCs 5-500, mostly lymphs,
¿ protein, nl
glucose, nothing on gram stain. |
| Fungal: Like viral, do india ink for cryptococcus, AFB
for TB (adenosine deaminase) |
| Latex agglutination: meningococcus, pneumococcus,
PCR for viral and TB. |
|
| Treatment
| Admit, start empiric IV abx |
| Infants: GBS, E. coli,
listeria: 3rd gen ceph plus ampillicin (for listeria), vancomycin.
|
| Young: N. mening., S. pneumo,
H. flu: 3rd gen ceph plus vancomycin |
| Adult: As above, without H.
flu |
| Elderly: S. pneumo, listeria,
gram negatives: 3rd gen ceph plus ampillicin (for listeria),
vancomycin. |
|
| Miscellaneous
| Most common is viral. |
| Head trauma: staph and gram negatives |
| Sources of infection: nasopharyngeal, hematologic |
|
|
