La Revue du praticien
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Bacterial meningitis is a medical emergency requiring early diagnosis and therapy in order to reduce mortality and morbidity. Although fever is the most sensitive sign, occuring in a majority of patients, it may be absent, especially in oldest patients. Most patients have alterations in mental status but coma is more frequent in meningitis caused by S. pneumoniae. ⋯ In adults with suspected meningitis, mass effect on CT-scan is unfrequent and as a consequence, the risk of lumbar punction is negligible. Very early administration of antibiotics, even before hospital admission in case of suspected meningococcal infection may result in a decreased abilty to identify the etiologic agent by cultures. The use of new techniques for detection of bacterial antigens and the development of rapid PCR assays may be particularly helpful in patients who had received antibiotics before lumbar puncture.
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La Revue du praticien · May 2004
[Corticosteroid treatment in bacterial meningitis of adults and children].
The neurologic deleterious effect of bacterial meningitis are the consequences of an inflammatory local response suggesting that an adjunctive anti-inflammatory therapy is able to favoured a better prognostic. Many clinical trials indicate that dexamethasone significantly reduce auditive sequella in children with meningitis due to Haemophilus influenzae, reduce mortality and morbidity of meningitis due to S. pneumoniae in adults but has few effect on Neisseria meningitidis. Corticotherapy should be initiated just before or at the time of first antibiotherapy and prolonged during 2 to 4 days. Major concern is a potential decrease of antibiotics concentration in cerebrospinal fluid that may be detrimental in patients with meningitis caused by S. pneumoniae strains that are highly resistant to penicillin or cephalosporins.