Meningitis diagnosis question

[studylol]

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Meningitis is usually diagnosed by lumbar puncture. However, you are not supposed to delay treatment in order to diagnose. So if a question says "how do you manage?" you should pick "give antibiotics" before lumbar puncture.

My question is how is meningitis etiology diagnosed if you are to give treatment before diagnosis?

Thanks!

 

[Bryan Manzana]

You will still do lumbar puncture if possible (no signs of herniation or space-occupying lesions). This will give you confirmation for meningitis depending on the results of cell count, proteins, etc. CSF will be sent for culture. THEN, you'll start on EMPIRIC antibiotics, based on risk factors (such as age group), and hopefully see improvement soon.

A lumbar puncture is done within 30 minutes––it will not significantly delay treatment. It's a very valuable tool in aiding your diagnosis, and culture will be important in determining the organism and antibiotic resistance if your empiric treatment didn't work.

 

[studylol]

That makes sense. I was using SAEMTests for some MCQs and there have been some clear oversights in some questions. This may be one of them because I picked get a LP first.

Thanks

 

[iBS1972]

Please tell me if I'm interpreting or understanding correctly. If a patient presents with meningitis-like picture. The main question is CT first vs. LP first. As far as the standardized tests go, LP always before antibiotics unless if LP must be delayed by CT or other things. What are the indications for LP before CT?

Edit- in neonates, CT can be skipped because fontanelles allow for intracranial volume expansion. In adults: CT before LP if focal neurologic symptoms (could be space-occupying lesion) and signs of ICP (papilledema, irregular respirations, recent seizure). Anything else?

 

[studylol]

Please tell me if I'm interpreting or understanding correctly. If a patient presents with meningitis-like picture. The main question is CT first vs. LP first. As far as the standardized tests go, LP always before antibiotics unless if LP must be delayed by CT or other things. What are the indications for LP before CT?

Edit- in neonates, CT can be skipped because fontanelles allow for intracranial volume expansion. In adults: CT before LP if focal neurologic symptoms (could be space-occupying lesion) and signs of ICP (papilledema, irregular respirations, recent seizure). Anything else?

●Immunocompromised state (eg, HIV infection, immunosuppressive therapy, solid organ or hematopoietic stem cell transplantation)

●History of central nervous system (CNS) disease (mass lesion, stroke, or focal infection)

●New onset seizure (within one week of presentation)

●Papilledema

●Abnormal level of consciousness

●Focal neurologic deficit