The symptoms are similar to viral and bacterial meningitis. As with many opportunistic fungal infections of immune compromised patients, it can be quite serious, and treatment is difficult or impossible. Diagnosis and Treatment

The biggest question for physicians treating patients with suspected meningitis is: "is it viral or is it bacterial?" Rapid tests for Neisseria meningitidis (meningococcus) and Haemophilus influenzae Type B have made it relatively easy to determine within a short period of time whether these are the causative agents. These tests are on CSF, however, which can be difficult and painful to extract from the patient. Since they are antibody tests, there can be a delay from onset of infection to production of antibodies; therefore, there can be a false negative early in the course of the disease.

Another indication is the presence of white blood cells in CSF. While the presence of white cells is indicative of a CSF infection, such as meningitis, an absence does not rule out the disease.

Treatment protocols vary depending on the type of meningitis. Viral meningitis treatment is generally palliative only -- pain relief and bed rest. In some cases where the patient is particularly sick, there may be some antiviral drugs given, although they are usually not effective unless given early in the course of the disease.

Other than rapid antibody tests, there are no techniques which allow for rapid bacterial CSF isolation and differentiation. In some cases, the low number of CFU's in the CSF requires multiplication through PCR or enriched media used for septicemia testing. An isolation step is then required, and after 24-48 hours one can take one or more CFU's and run an antimicrobial susceptibility...

Alternatively, one can prescribe Vancomycin along with a carbapenem, as the resistance to penicillin is quite high in the United States. If the patients are young or old, one might add a -cillin drug, such as ampicillin, to counter a possible infection by Listeria monocytogenes.
Conclusion

Bacterial meningitis is a serious infection which requires rapid treatment in the presence of relatively little information. The treatments can cause a number of side effects, and require several days of hospitalization to administer IV drugs. For these reasons, the physician confronted with a potential of bacterial meningitis must make informed guesses, and hope that he/she does not subject too many patients needlessly to heavy antibiotic therapy while not missing any true cases of bacterial meningitis.

Bibliography

Bashir, HE, Laundy, M and Booy, R. "Diagnosis and treatment of bacterial meningitis." Archives of Disease in Childhood (2003): 615-620.

Mayhall CG, Archer NH, Lamb VA, Spadora AC, Baggett JW, Ward JD, Narayan RK. "Ventriculostomy-related infections. A prospective epidemiologic study." NEJM (1984): 553-559.

Radetsky, M. "Duration of symptoms and outcome in bacterial meningitis: an analysis of causation and the implications of a delay in diagnosis." Pediatr Infect Dis J (1992): 698-701.

Schuchat, a, Robinson, K, Wenger, JD, Harrison, LH, Farley, M, Reingold, AL, Lefkowitz, L and Perkins, BA. "Bacterial Meningitis in the United States in 1995." JAMA (1997): 970-976.

Meningitis