Episode 68 — Meningitis and Encephalitis – An Interview with Dr. Andrew Hogan

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 May 2, 2022

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