Management of a patient with bacterial meningitis at the emergency department: case report and literature review
Abstract
Bacterial meningitis is a severe infectious disease of the brain protective membranes occurring worldwide and threatening the lives of people of all age groups. The most frequent pathogens of the disease are Streptococcus pneumoniae, Neisseria meningitidis and Listeria monocytogenes.
The classic triad of symptoms composes of, in adult patients, a fever, nuchal rigidity and alteration of mental status. In children, we may observe headaches, fever, vomiting and positive meningeal phenomena.
In new-borns, only non-specific symptoms predominantly occur. To determine the diagnosis of bacterial meningitis, it is essential to examine the cerebrospinal fluid.
In bacterial meningitis, a classic finding in liquor is represented by leucocytosis with a predominance of polynuclear, low concentration of glucoses and high protein levels. An early initiation of empirical antibiotic treatment is very important as for the development of the condition, followed by, afterthe diagnosis of the pathogen, the targeted therapy.
The time from admission to the hospital to the administration of the first dose of antibiotics should not exceed 1 hour. Administration of dexamethasone is a routine part of the treatment.
The article introduces a čase report of a typical example of bacterial meningitis with primary management of a patient at the emergency department.