Central nervous system infections
Below are details of the management of bacterial meningitis, meningitis contact prophylaxis, brain abscess, viral encephalitis and viral meningitis.
- Symptoms of acute meningitis include:
- Neck stiffness
Always seek urgent advice from infectious diseases / microbiology. Discuss further management with infectious diseases on call at the Queen Elizabeth University Hospital (see Appendix 6 for contact details).
- Duration of therapy dependent on aetiology:
- N. meningitides 5 days
- S. pneumoniae 10-14 days
- L. monocytogenes 21 days
Meningitis Contact Prophylaxis
- All suspected cases of meningococcal disease are notified to the NHSGGC Board, Public Health Protection Unit (see Appendix 6 for contact details).
- Specialists in Communicable Disease will identify close family and friends of the patient who may require antibiotic prophylaxis.
- This should be given as soon as possible (ideally within 24 hours) after diagnosis of the index case.
- Perform blood cultures.
- Discuss treatment and duration with neurosurgery and microbiology / infectious diseases unit.
- Sinus (Streptococcus milleri, Pneumococcus, Haemophilus influenzae)
- Middle ear (mixed aerobes and anaerobes)
- Post traumatic (Staphylococcus aureus or mixed infections)
- Blood stream, endocarditis (Staph and Strep species)
- Encephalitis is inflammation of the parenchyma of the brain. It is often associated with meningitis (meningoencephalitis).
- Symptoms include fever and headache with signs of cerebral involvement - fits, altered level of consciousness, confusion, personality change, focal neurological changes e.g. cranial nerve deficits.
- Herpes Simplex Virus (HSV) is the commonest cause of sporadic viral encephalitis, however in many cases no aetiological agent is identified.
- Treatment should be started with IV aciclovir.
- Perform CT scan before lumbar puncture (LP).
- Send CSF for viral PCR as well as microbiology and biochemistry.
- In the first 72 hours after the onset of HSV encephalitis, CSF PCR may be negative; repeat LP is advised if the diagnosis is suspected.
Duration of treatment for confirmed HSV encephalitis is at least 14 days with a second CSF sample for PCR advised after 14 days of treatment. If the HSV PCR remains positive continued treatment is recommended. Discuss with infectious diseases unit / virology.
In general no specific antiviral treatment is recommended. Viral meningitis does not require antiviral therapy unless the patient is immunocompromised. Discuss with infectious diseases / virology.
Content last updated December 2018