Emergency diagnosis and treatment of adult meningitis
Abstract
Despite the existence of antibiotic therapies against acute bacterial meningitis, patients with the disease continue to suffer significant morbidity and mortality in both high and low-income countries. Dilemmas exist for emergency medicine and primary-care providers who need to accurately diagnose patients with bacterial meningitis and then rapidly administer antibiotics and adjunctive therapies for this life-threatening disease. Physical examination may not perform well enough to accurately identify patients with meningitis, and traditionally described lumbar puncture results for viral and bacterial disease cannot always predict bacterial meningitis. Results from recent studies have implications for current treatment guidelines for adults with suspected bacterial meningitis, and it is important that physicians who prescribe the initial doses of antibiotics in an emergency setting are aware of guidelines for antibiotics and adjunctive steroids. We present an overview and discussion of key diagnostic and therapeutic decisions in the emergency evaluation and treatment of adults with suspected bacterial meningitis.
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Gram staining for bacteria in CSF has high specificity up to 100%, but sensitivity varies between 30% and 90% depending on the bacterial species.
“While specificity for the detection of bacteria is high—up to 100%— sensitivity varies between 30%–90% depending on the bacterial species (1–5).”
From Molecular diagnostics in cerebrospinal fluid for the diagnosis of central nervous system infections (2024) · cites this paper as [1]
Gram stain has been assessed in cases of suspected meningitis and reported to have sensitivity ranging from 10 to 93%, depending on the organism and population being tested, and a near 100% specificity.
“Gram stain has been assessed in cases of suspected meningitis and reported to have sensitivity ranging from 10 to 93%, depending on the organism and population being tested (1), and a near 100% specificity (21).”
From Multicenter Evaluation of BioFire FilmArray Meningitis/Encephalitis Panel for Detection of Bacteria, Viruses, and Yeast in Cerebrospinal Fluid Specimens (2016) · cites this paper as [21]
While pleocytosis in the CSF is a sensitive marker of inflammation, several studies have shown cell counts may be normal in both adult and pediatric patients despite a diagnosis of bacterial meningitis.
“While pleocytosis in the CSF is a sensitive marker of inflammation, several studies have shown cell counts may be normal in both adult and pediatric patients despite a diagnosis of bacterial meningitis (21, 22).”
From Multicenter Evaluation of BioFire FilmArray Meningitis/Encephalitis Panel for Detection of Bacteria, Viruses, and Yeast in Cerebrospinal Fluid Specimens (2016) · cites this paper as [21]
In bacterial meningitis, patient outcome can be optimized through immediate antibiotic treatment, and fast and reliable diagnostic can be crucial.
“In bacterial meningitis, patient outcome can be optimized through immediate antibiotic treatment, thus fast and reliable diagnostic can be crucial [2, 5].”
From Implementation of the FilmArray ME panel in laboratory routine using a simple sample selection strategy for diagnosis of meningitis and encephalitis (2020) · cites this paper as [5]
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Stephenson, T. J., Winrow, A. P., Cartwright, K. A. V., STUART, J. M., Wylie, P., Stevens, D., Drake, W. B., Wood, A. L., Gill, M. J., Sørensen, H. T., et al. (1998) · BMJ · doi:10.1136/bmj.316.7136.1015 · Cited by 10 · see citing works
Clinical management of meningococcal disease. Laboratory confirmation is important.
Sorensen, H. M., Fh, S., Hc, S., et al. (1998) · PubMed · Cited by 8 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Epidemiology, Diagnosis, and Antimicrobial Treatment of Acute Bacterial Meningitis
Brouwer, M. C., Tunkel, A. R., & van de Beek, D. (2010) · Clinical Microbiology Reviews · doi:10.1128/cmr.00070-09 · Cited by 930 · see citing works
Self-citationLeber, A. L., Everhart, K., Balada-Llasat, J.-M., Cullison, J., Daly, J., Holt, S., Lephart, P., Salimnia, H., Schreckenberger, P. C., DesJarlais, S., et al. (2016) · Journal of Clinical Microbiology · doi:10.1128/jcm.00730-16 · Cited by 609 · see citing works
Dilemmas in the diagnosis of acute community-acquired bacterial meningitis
Brouwer, M. C., Thwaites, G. E., Tunkel, A. R., & van de Beek, D. (2012) · The Lancet · doi:10.1016/s0140-6736(12)61185-4 · Cited by 302 · see citing works
Community-acquired bacterial meningitis.
van de Beek, D., Brouwer, M. C., Koedel, U., & Wall, E. C. (2021) · The Lancet · doi:10.1016/s0140-6736(21)00883-7 · Cited by 292 · see citing works
Self-citationEffect of delayed lumbar punctures on the diagnosis of acute bacterial meningitis in adults
Michael, B., Menezes, B. F., Cunniffe, J., Miller, A., Kneen, R., Francis, G., Beeching, N. J., & Solomon, T. (2010) · Emergency Medicine Journal · doi:10.1136/emj.2009.075598 · Cited by 116 · see citing works
Karageorgopoulos, D. E., Valkimadi, P. E., Kapaskelis, A., Rafailidis, P. I., & Falagas, M. E. (2009) · Archives of Disease in Childhood · doi:10.1136/adc.2008.151563 · Cited by 68 · see citing works
Michael, B. D., Sidhu, M., Stoeter, D., Roberts, M., Beeching, N. J., Bonington, A., Hart, I. J., Kneen, R., Miller, A., Solomon, T., et al. (2010) · QJM · doi:10.1093/qjmed/hcq121 · Cited by 62 · see citing works
Costerus, J. M., Brouwer, M. C., Sprengers, M. E. S., Roosendaal, S. D., van der Ende, A., & van de Beek, D. (2018) · Clinical Infectious Diseases · doi:10.1093/cid/ciy200 · Cited by 49 · see citing works
Self-citationTarai, B., & Das, P. (2019) · Neurological Sciences · doi:10.1007/s10072-018-3584-y · Cited by 41 · see citing works
Precit, M. R., Yee, R., Pandey, U., Fahit, M., Pool, C., Naccache, S. N., & Dien Bard, J. (2020) · Journal of Clinical Microbiology · doi:10.1128/jcm.01592-19 · Cited by 39 · see citing works
Molecular diagnostics in cerebrospinal fluid for the diagnosis of central nervous system infections
Olie, S. E., Andersen, C. Ø., van de Beek, D., & Brouwer, M. C. (2024) · Clinical Microbiology Reviews · doi:10.1128/cmr.00021-24 · Cited by 38 · see citing works
“While specificity for the detection of bacteria is high—up to 100%— sensitivity varies between 30%–90% depending on the bacterial species (1–5).”
Self-citationPfefferle, S., Christner, M., Aepfelbacher, M., Lütgehetmann, M., & Rohde, H. (2020) · BMC Infectious Diseases · doi:10.1186/s12879-020-4904-4 · Cited by 36 · see citing works
Viruses Causing Aseptic Meningitis: A Tertiary Medical Center Experience With a Multiplex PCR Assay
Aldriweesh, M. A., Shafaay, E. A., Alwatban, S. M., Alkethami, O. M., Aljuraisi, F. N., Bosaeed, M., & Alharbi, N. K. (2020) · Frontiers in Neurology · doi:10.3389/fneur.2020.602267 · Cited by 30 · see citing works
Rapid Diagnostic Tests for Meningitis and Encephalitis—BioFire
Fleischer, E., & Aronson, P. L. (2020) · Pediatric Emergency Care · doi:10.1097/pec.0000000000002180 · Cited by 28 · see citing works
Iguchi, M., Noguchi, Y., Yamamoto, S., Tanaka, Y., & Tsujimoto, H. (2017) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd012824 · Cited by 17 · see citing works
- Authors
- Fitch, M. T., & van de Beek, D.
- Affiliations
- Wake Forest University Health Sciences (US)
- Corresponding author
- Fitch, Michael T
- Venue
- The Lancet Infectious Diseases
- Publisher
- Elsevier BV
- Published
- 2007-03
- Volume
- 7
- Issue
- 3
- Pages
- 191-200
- ISSN
- 1473-3099 (ISSN-L)
- OpenAlex
- W2085474800
- Cited by
- 189
- References
- 104
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 2 · 2023: 3 · 2022: 9 · 2021: 1 · 2020: 10 · 2019: 7 · 2018: 10 · 2017: 10 · 2016: 15 · 2015: 5 · 2014: 8 · 2013: 13 · 2012: 12
- FWCI
- 2.89
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet Infectious Diseases (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Topics
- Life Sciences › Immunology and Microbiology › Microbiology › Bacterial Infections and Vaccines
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Bacterial Identification and Susceptibility Testing
- Health Sciences › Medicine › Surgery › Infectious Diseases and Tuberculosis
- Keywords
- bacterial meningitis, adult meningitis, emergency diagnosis, antibiotic therapy, adjunctive corticosteroid therapy, lumbar puncture, diagnosis, treatment guidelines, morbidity and mortality
- MeSH terms
- Adult, Anti-Inflammatory Agents, Anti-Bacterial Agents, Dexamethasone, Emergency Medical Services, Humans, Primary Health Care, Spinal Puncture, Steroids, Meningitis, Bacterial
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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