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 encephalitisWhy this topic?What do the words mean? What's the difference?2.Bacterial meningitisHow common is it in the US? Is it more common in third world countries?Mortality rate in the USCauses – if Neisseria and H influenzae improved post vaccination, why not S pneumoniae disease ? (Table 1)3.Viral meningitisHow common is it in the US?What are the common causes? (Table 2)4.Viral encephalitisSame prognosis as viral meningitis?Same organisms as viral meningitis? (Table 2)Does COVID-19 cause this illness?5.Fungal infectionsWho 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: CSFWhat'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 labsWhat is helpful?Serum PCRSerum 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.TreatmentAntibioticsSteroids: Who gets them? When? Are there downsides of giving them?13.Special populationsAutoimmune diseaseLacking childhood vaccinesHealthcare associated infections14.Cutting edge15.Disposition