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 HoganEMplify -- April 2022Interview with the Author: Andrew N. Hogan, MD1.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?* PEP7.ED evaluation: History8.ED evaluation: Physical exam9.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 testing10.Serum labs* What is helpful?* Serum PCR* Serum cryptococcal antigen11.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 infections14.Cutting edge15.Disposition