Episode 68 -- Meningitis and Encephalitis - An Interview with Dr. Andrew Hogan

<p>Episode 68 -- Emergency Department Management of Adults With Infectious Meningitis and Encephalitis – An Interview with Dr. Andrew Hogan</p><p></p><p>EMplify -- April 2022</p><p></p><p>Interview with the Author: Andrew N. Hogan, MD</p><p></p><p>1.Meningitis vs encephalitis</p><ul><li>Why this topic?</li><li>What do the words mean? What's the difference?</li></ul><p>2.Bacterial meningitis</p><ul><li>How common is it in the US? Is it more common in third world countries?</li><li>Mortality rate in the US</li><li>Causes – if Neisseria and H influenzae improved post vaccination, why not S pneumoniae disease ? (Table 1)</li></ul><p>3,Viral meningitis</p><ul><li>How common is it in the US?</li><li>What are the common causes? (Table 2)</li></ul><p>4.Viral encephalitis</p><ul><li>Same prognosis as viral meningitis?</li><li>Same organisms as viral meningitis? (Table 2)</li><li>Does COVID-19 cause this illness?</li></ul><p>5.Fungal infections</p><ul><li>Who gets these?</li><li>60% die? 1 million cases a year, 600K deaths?</li></ul><p>6.Prehospital care:</p><ul><li>What does EMS need to know?</li><li>How do they protect themselves from being exposed?</li><li>How can they help us make the diagnosis?</li><li>EMS is giving antibiotics in some areas?</li><li>PEP</li></ul><p>7.ED evaluation: History</p><p>8.ED evaluation: Physical exam</p><p>9.Diagnostics: CSF</p><ul><li>What's large volume? Is it safe?</li><li>Cell counts on tubes 1+4, all the time or only if traumatic and obviously bloody?</li><li>Is opening pressure helpful?</li><li>CSF lactate level – can this be run in a normal lactic acid analyzer?</li><li>PCR/NAAT testing</li></ul><p>10.Serum labs</p><ul><li>What is helpful?</li><li>Serum PCR</li><li>Serum cryptococcal antigen</li></ul><p>11.Imaging </p><ul><li>Is CT imaging before LP still necessary? Can we be selective?</li><li>Is MRI helpful in the ED, or is there a role in encephalitis?</li></ul><p>12.Treatment</p><ul><li>Antibiotics</li><li>Steroids: Who gets them? When? Are there downsides of giving them?</li></ul