Meningitis and meningismus definitions
Meningitis is inflammation of the meninges. [1] Meningitis is associated with meningeal irritation signs such as meningismus. [1] Meningismus is neck flexion limitation when the patient is fully supine. [1]
Clinical differences in presentation
Meningitis typically presents with fever, headache, meningismus, and pain in the head and/or neck. [1] Meningitis can be associated with altered mental status. [1] Meningismus is a physical examination finding that may reflect meningeal irritation rather than inflammation itself. [1]
Initial management for suspected meningitis
Empirical treatment is recommended when bacterial meningitis is suspected. [1] Dexamethasone should be administered immediately for presumptive bacterial meningitis followed by appropriate antibiotics. [1] Empiric antibiotics should be initiated without delay. [1]
Diagnostic workflow for suspected meningitis
Contact and droplet precautions should be applied until the pathogen is classified when meningitis is suspected. [1] Head CT should be obtained if the neurological examination is abnormal. [1] Lumbar puncture should be performed when CT results are available. [1]
Empiric antimicrobial regimens for suspected bacterial meningitis
Empiric treatment for acute bacterial meningitis should include intravenous ceftriaxone or cefotaxime in children and adults. [2] Ampicillin or amoxicillin should be added to initial empiric therapy in people with risk factors for Listeria monocytogenes infection. [2] Vancomycin should be considered in settings with high prevalence of penicillin or third-generation cephalosporin resistance among Streptococcus pneumoniae isolates. [2] Empiric vancomycin should be combined with a third-generation cephalosporin for many immunocompetent adult presentations of suspected bacterial meningitis. [1] Dexamethasone dosing should be given per protocol timing with the first antibiotic dose and should not delay antibiotic administration. [1]
Management for meningismus without confirmed meningitis
Meningismus should trigger evaluation for meningitis because meningitis causes meningismus. [1] If meningitis is not supported by subsequent diagnostic evaluation, management should shift to the identified cause rather than continuing meningitis-directed therapy. [1]
Safety and escalation priorities
Altered mental status is associated with airway risk and close monitoring for intubation needs. [1] Early empiric treatment and supportive care for sepsis physiology should be included when meningitis is suspected. [1]
Public health considerations
If meningococcal meningitis is suspected, exposure prophylaxis for contacts should be considered. [1]