Episode 68 — Emergency Department Management of Adults With Infectious Meningitis and Encephalitis – An Interview with Dr. Andrew Hogan
EMplify — April 2022
Interview with the Author: Andrew N. Hogan, MD
1.Meningitis vs encephalitis
- Why this topic?
- What do the words mean? What’s the difference?
2.Bacterial meningitis
- How common is it in the US? Is it more common in third world countries?
- Mortality rate in the US
- Causes – if Neisseria and H influenzae improved post vaccination, why not S pneumoniae disease ? (Table 1)
3.Viral meningitis
- How common is it in the US?
- What are the common causes? (Table 2)
4.Viral encephalitis
- Same prognosis as viral meningitis?
- Same organisms as viral meningitis? (Table 2)
- Does COVID-19 cause this illness?
5.Fungal infections
- Who gets these?
- 60% die? 1 million cases a year, 600K deaths?
6.Prehospital care:
- What does EMS need to know?
- How do they protect themselves from being exposed?
- How can they help us make the diagnosis?
- EMS is giving antibiotics in some areas?
- PEP
7.ED evaluation: History
8.ED evaluation: Physical exam
9.Diagnostics: CSF
- What’s large volume? Is it safe?
- Cell counts on tubes 1+4, all the time or only if traumatic and obviously bloody?
- Is opening pressure helpful?
- CSF lactate level – can this be run in a normal lactic acid analyzer?
- PCR/NAAT testing
10.Serum labs
- What is helpful?
- Serum PCR
- Serum cryptococcal antigen
11.Imaging
- Is CT imaging before LP still necessary? Can we be selective?
- Is MRI helpful in the ED, or is there a role in encephalitis?
12.Treatment
- Antibiotics
- Steroids: Who gets them? When? Are there downsides of giving them?
13.Special populations
- Autoimmune disease
- Lacking childhood vaccines
- Healthcare associated infections
14.Cutting edge
15.Disposition
Last Updated on January 25, 2023
Sam Ashoo, MD, FACEP, is board certified in emergency medicine and clinical informatics. He serves as EB Medicine’s editor-in-chief of interactive clinical pathways and FOAMEd blog, and host of EB Medicine’s EMplify podcast. Follow him below for more…
