CL?N?CAL D?AGNOS?S AND TREATMENT OF ACUTE BACTER?AL MEN?NG?T?S: A COMPREHENS?VE L?TERATURE REV?EW

Ozgur Karcioglu* and Banu Arslan

ABSTRACT

Acute bacterial meningitis (ABM) is still a substantial cause of high mortality and severe neurological morbidity during recent decades, despite the advances in diagnosis and antimicrobial therapy.Streptococcus pneumonia (pneumococci), Haemophilus influenzae type b (Hib), and Neisseria meningitidis (meningococci) are the most commonly isolated organisms in the etiology. The entity is often difficult to recognize, for the “classic” constellation of fever, neck stiffness, headache, and obtundation are noted in less than half of the cases diagnosed with ABM. Diagnostic procedures include lumbar puncture, blood cultures, White blood cell count, lactate, glucose and procalcitonin, and CSF analyses (urine reagent strips, glucose, protein, lactate and microscopic examination).Expedient commencement of appropriate antibiotic therapy, airway support, maintenance of proper oxygenation, dexamethasone, seizure control and fluid resuscitation titrated and individualized for each clinical scenario comprise the ideal treatment conditions for the patient. This article reviews the epidemiology, clinical presentation, diagnosis, and treatment of ABM following recent advances and new literature findings to update the primary care and emergency physician in the acute setting.

Keywords: Acute bacterial meningitis, meningitis, central nervous system infection, diagnosis, treatment, lumbar puncture.