Meningitis is very literally inflammation of the meninges. Something swollen in a closed space is never good, so it’s important to not miss meningitis when it presents.

Classic triad of meningitis

1. Fever
2. Neck stiffness
   • Brudzinski
   • Kernig
3. Mental status change – in babies this can be an increase in somnolence or irritability (unconsolably crying)

Important organisms:

• Bacterial
  • Listeria*
  • E. coli*
  • GBS (Group B strep)*
  • Neisseria meningitidis
  • Strep pneumoniae
  • Staph aureus
  • Gram neg bacilli
  • Haemophilus influenza
• Viral (“aseptic”)
  • HSV
  • Enterovirus
  • HIV
  • Mumps

* These are the common ones in the neonatal period

Bacterial:

• Positive Gram stain
• CSF white blood cell (WBC) count >1000/uL with a predominance of neutrophils
• Low CSF glucose concentration <40 mg/dL (2.2 mmol/L)
• Empiric treatment: high doses of a 3rd generation cephalosporin (cefotaxime, ceftriaxone) and vancomycin (this covers antibiotic-resistant S. pneumoniae, N. meningitidis, and Hib)