Blood cultures
LP for CSF Gram stain and culture
Viral PCRs (eg. HSV); cryptococcal antigen (for HIV pts)
CT or MRI to rule out other diagnoses
Treatment:
< 1 month; suspect GBS, E. coli/GNRs, listeria; ampicillin + cefotaxime or gentamycin
1-3 months; suspect pneumococci, meningococci, H. influenzae; vancomycin IV + ceftriaxone or cefotaxime
3 months-adulthood; suspect pneumococci, meningococci; vancomycin IV + ceftriaxone or cefotaxime
> 60yo; pneumococci, gram neg. bacilli, listeria, meningococci; ampicillin+ vancomycin +cefotaxime or ceftriaxone
Complications:
Cerebral edema
Subdural effusions (occurs in 50% of infants with H. influenzae meningitis)
Ventriculitis/hydrocephalus
Seizures
Hyponatremia Subdural empyema
Sensorneural hearing loss
Death
Notes:
Close contacts of pts with meningococcal meningitis should receive rifampin, ciprofloxacin, or ceftriaxone propylaxis
Dexamthasone may be beneficial in bacterial meningitis, esp S. pneumoniae, if given 15-20 mins before ABx
