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