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
