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Acute and Chronic Menigitis

Acute and Chronic Menigitis - is tuberculosis Often it must...

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Acute and Chronic Menigitis Diagnosis The diagnosis of meningitis is made by the clinical picture and CSF profile. The identification of the cause is made by gram-stain and culture (for bacteria), viral culture and possibly PCR for viruses. Perhaps the single most important category to be aware of is the lymphocytic low glucose profile: early on, it can be mistaken for the lymphocytic normal glucose profile, attributed to viral infection and not treated. Infections which may be fatal if not treated can thereby be overlooked – including tuberculous, fungal (cryptococcus, histoplasma, coccidioides), and spirochetal (Lyme, syphilis) infections. (See slide for some methods of diagnosis of these infections.) Of the causes of lymphocytic low glucose meningitis, the most difficult to diagnose
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Unformatted text preview: is tuberculosis. Often, it must be treated empirically (while awaiting culture results) after other causes have been ruled out. Treatment For initial empiric treatment in children and adults, a cephalosporin is recommended (aimed at the meningococcus and the small possibility of Staphylococcus aureus, Hemophilus influenzae or a gram-negative enteric organism) together with vancomycin (to cover for penicillin-resistant pneumococci). Based on the results of a recent study, it is recommended that dexamethasone be started at the same time as antibiotic treatment is begun in order to quell the inflammatory reaction and produce a better outcome. Once the results of cultures and sensitivity testing are available, this regimen can be modified....
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