Downloaded from the american family physician web site at. Differential diagnosis of tuberculous meningitis from partiallytreated. A differential diagnosis of druginduced aseptic meningitis. Jul 17, 2018 viral meningitis is inflammation of the leptomeninges as a manifestation of central nervous system cns infection. Pdf differential diagnosis of scrub typhus meningitis from. Viral meningitis may mimick other diseases in terms of clinical signs and symptoms. Diagnosis, initial management, and prevention of meningitis. While it usually occurs independently of any primary disease of the ear and the nose, statistical study seems to indicate that, at least in general hospitals, the occurrence of. Pdf differential diagnosis of bacterial and viral meningitis using.
But the patient died after diagnosis of tuberculous meningitis in the last phase. Differential diagnosis differentiating viral meningitis from other diseases. Tuberculous and brucellosis meningitis differential diagnosis. When can the management of meningitis become difficult. Broadly speaking, there are three main potential areas of concern. The aim of this case report is to remind that tm must be considered in the differential diagnosis of intracranial infection in patients from endemic areas and the treatment should be initiated rapidly to prevent delayed diagnosis and lethal complications. Recommended durations of antibiotics and adjunctive treatment including the removal of. Meningitis caused by the bacterium neisseria meningitidis known as meningococcal meningitis can be differentiated from meningitis with other causes by a.
Clinical signs and symptoms are unreliable in distinguishing bacterial. Dec 01, 2015 bacterial meningitis is a severe, lifethreatening infection of the central nervous system that requires immediate medical attention. Diagnosis, initial management, and prevention of meningitis aafp. Tuberculous meningitis in the differential diagnosis of cns. Although the lancet and thwaites diagnostic scoring systems were found to be highly effective in the differential diagnosis of tbm and bacterial meningitis in previous studies,, the agreement between these two scores was not strong. Describe the causes, clinical manifestations, and general approach to the diagnosis, treatment, and prevention of the different types of meningitis. Cryptococcosis differential diagnoses medscape reference. Read more about the differential diagnoses, alternative diagnoses, misdiagnoses, diagnosis methods, hidden. A cerebrospinal fluid csf glucose level less than 1. All ages diabetics, alcoholics, elderly, debilitated, diseased untreated.
Consider other conditions after initial resuscitation. Logistic regression was used to calculate the predicted probabilities of various combinations of cytokines. This infection justifiably elicits strong emotional reactions and, hopefully, immediate medical intervention. The differential diagnosis of meningitis and encephalitis includes bacterial, viral, fungal, and autoimmune etiologies. Meningitis is diagnosed by confirming inflammation or by identifying an infection in the cerebrospinal fluid the fluid that surrounds the brain. Use of 82 br in differential diagnosis of lymphocytic meningitis. The ultimate aim of this study is to infer data to see if bme should be included in the differential diagnosis of tbm when these two systems suggest the presence of tbm. The uk joint specialist societies guideline on the diagnosis and. Pancreatic cancer is an uncontrolled growth in the pancreas, a gland in the digestive system. May 30, 2018 meningitis occurs when the membranes that cover the brain and spinal cord become inflamed.
Viral meningitis is inflammation of the leptomeninges as a manifestation of central nervous system cns infection. Differential diagnosis of eosinophilic meningitis sciencedirect. Paradoxical immune responses in nonhiv cryptococcal meningitis. Dilemmas in the diagnosis of acute communityacquired. Validation of a clinical prediction rule for the differential diagnosis of acute meningitis. A differential diagnosis of druginduced aseptic meningitis clair cascella, md, sara nausheen, md, and burke a. It is essential for clinicians to recognize the clinical signs and symptoms of meningitis and understand its management and prevention. Pdf differential diagnosis of bacterial and viral meningitis remains an important clinical problem, particularly in the. Thus, diagnostic dilemmas are common in patients with suspected acute communityacquired bacterial meningitis.
Previous clinical studies have clearly demonstrated that the timing of tbm treatment is the most critical factor in determining the ultimate outcome. Once the diagnsis of meningitis is confirmed, the next step may be to differentiate. Bme and tbm patients from 35 tertiary hospitals were included in this study. Thus we would not rely on the differential cell count to exclude a diagnosis of bacterial meningitis in this environment. Difficult and recurrent meningitis journal of neurology. This localized infection develops into a bacteremia with a metastatic infection in the leptomeninges. Differential diagnosis of tuberculous meningitis from. These are among the most important problems in medicine today common acute infections of the nervous system include. Because the patients symptoms were concerning for subarachnoid hemorrhage and brain abscess, we performed a ct scan which ruled out these diagnoses. Cases of acute bacterial meningitis bm require prompt diagnosis and treatment due to significant mortality rates. Viral meningitis differential diagnoses medscape reference. The instant invention relates to a qualitative predictive method, to a method, use and kit applied to the early differential diagnosis of the most prevalent forms of bacterial and viral meningitis, enabling to detect and distinguish the different forms of meningitis.
To determine whether the patients symptoms were from a primary headache or were secondary to another neurological illness, we performed a lumbar puncture. Acute bacterial meningitis viral meningitis brain abscess empyema encephalitis each may present with a nonspecific prodrome of fever and headache. Clinicians should use historical clues in patients presenting with signs and. Practice guidelines for the management of bacterial meningitis. Oct 22, 2004 tuberculous meningitis tbm is a major global health problem, and it is sometimes difficult to perform a differential diagnosis of this disease from other diseases, particularly partiallytreated pyogenic meningitis ptpm. By use of a more stringent cutoff of 80%, 21 had fewer than 80% polymorphonuclear cells, with seven 33% proven bacterial cases, and 76 had 80% or more polymorphonuclear cells with 24 32% confirmed cases. Thus, in the clinical assessment for possible bacterial meningitis, older adults who present without fever, neck stiffness, or altered mental function probably do not have this disease. Jul 16, 2019 infections of the central nervous system cns can be divided into 2 broad categories. The 2016 uk meningitis guidelines recommend an lp be performed.
Information about symptoms, diagnosis and treatment. Cryptococcus tetragattii as a major cause of cryptococcal meningitis among hivinfected individuals in harare, zimbabwe. In helminth infections, but rarely in protozoal infections, eosinophilia is a common sign. Our data disclosed that these two prediction systems falsely identified bme patients as tbm.
Which conditions should be included in the differential. Meningococcal disease may be confused with viral syndrome, influenza, upper respiratory infections, and abdominal pain. Multivariate approach to differential diagnosis of acute. We analyzed data from the records of 422 patients with acute bacterial or viral meningitis. Use of 82br in differential diagnosis of lymphocytic meningitis. However, these symptoms can be variable or absent in young children, making meningitis difficult to diagnose. Bacterial meningitis is a severe, lifethreatening infection of the central nervous system that requires immediate medical attention. Meningitis is an inflammation of the membranes that cover the brain and spinal cord. While in some cases they first treat the underlying cause. Rapid diagnosis and treatment of acute communityacquired bacterial meningitis reduces mortality and neurological sequelae, but can be delayed by atypical presentation, assessment of lumbar puncture safety, and poor sensitivity of standard diagnostic microbiology.
Even with appropriate treatment, morbidity and mortality can be substantial. Download fulltext pdf multiplexpcr for diagnosis of bacterial meningitis article pdf available in brazilian journal of microbiology 508 february 2019 with 402 reads. This is because meningitis is an infection or inflammation of the meninges, which are the protective layers that cover, protect, and cushion the brain. Bacterial meningitis in aging adults clinical infectious. Meningitis is usually caused by a viral or bacterial infection. The differential diagnosis of bacterial meningitis includes two step approach. What are the differential diagnoses for viral meningitis.
Cunha, md druginduced aseptic meningitis should be included in the differential diagnosis of viralaseptic meningitis. Watch the video lecture meningitis and encephalitis. This article will address three broad areas of viral encephalitisits causes, differential diagnosis, and management. Oct 15, 2001 this may be a helpful adjunctive finding, but its sensitivity and specificity for the diagnosis of meningitis require further confirmation. Initial diagnostic testing should be directed at excluding lifethreatening, common, and treatable etiologies. Most of the headache treatments are symptomatic so doctors always suggest you the pain medications which include antianalgesics mostly paracetamol. This is exceedingly rapid in acute bacterial meningitis and death may occur in hours. It is important to differentiate viral meningitis from other diseases with similar presentation.
First is differentiating bacterial meningitis from other diseases which have similar clinical presentation as bacterial meningitis such as encephalitis, brain abscess, subarachnoid hemorrage, and brain tumour. It is diagnostic in 7085% of cases prior to antibiotic exposure. The epidemiology, pathogenesis, management, prognosis, and prevention are discussed separately. Differential diagnosis of scrub typhus meningitis from bacterial meningitis using clinical and laboratory features article pdf available in neurology india 611.
Pdf laboratorial diagnosis of lymphocytic meningitis. Differential diagnosis of meningitis and encephalitis. Bacterial meningitis occurs frequently and is one of the most important acute infections of the central nervous system. Meningitis differential diagnoses medscape reference.
However, brucellar meningoencephalitis bme has similar characteristics with tbm. Early diagnosis and prompt initiation of treatment. Bacterial meningitis differential diagnosis wikidoc. The diagnosis of viral meningitis requires negative csf culture for routine viral meningitis. The peripheral white blood cell count alone is not help. Viral names the causative agent, and the term meningitis implies lack of parenchymal and spinal cord involvement otherwise called encephalitis and myelitis, respectively. Differential diagnosis headache made easy with mnemonics. Receiveroperating characteristic roc curves were used to assess the value of cytokines and other laboratory indexes in the differential diagnosis of bacterial meningitis using medcalc 9. Meningitis infection o f the meninges can be attributed to a variety o f agents, including bacteria, protozoa and some helminths. Clinical diagnosisthe classical symptoms and signs of acute meningitis may be absent in the very young, the very old and the very sick.
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