Transmission-Based Precautions for Suspected or Confirmed Meningitis
Transmission-based precautions for meningitis are based on the likely or confirmed organism and expected route of transmission, in addition to standard precautions. [1]
General Precaution Framework
Standard precautions are recommended for all patients with suspected or confirmed meningitis. [1]
Viral (Aseptic/Nonbacterial) Meningitis Precautions
Aseptic meningitis (nonbacterial or viral) is managed with standard precautions. [1] Contact precautions are recommended for infants and young children with aseptic meningitis. [1] Enteroviral meningitis is managed with contact precautions for infants and children. [1]
Bacterial Meningitis Precautions
Bacterial meningitis from gram-negative enteric organisms in neonates is managed with standard precautions. [1] Fungal meningitis is managed with standard precautions. [1] Meningitis due to Streptococcus pneumoniae is managed with standard precautions. [1] Meningitis due to Listeria monocytogenes is managed with standard precautions. [1] Meningitis due to Haemophilus influenzae type b (known or suspected) is managed with droplet precautions plus standard precautions until 24 hours after initiation of effective therapy. [1] Meningitis due to Neisseria meningitidis (meningococcal) (known or suspected) is managed with droplet precautions plus standard precautions until 24 hours after initiation of effective therapy. [1] Meningococcal disease (sepsis, pneumonia, meningitis) is managed with droplet precautions plus standard precautions until 24 hours after initiation of effective therapy. [2]
Tuberculous Meningitis Precautions
Meningitis due to Mycobacterium tuberculosis is managed with standard precautions when pulmonary disease is not present. [1] Airborne precautions are recommended for tuberculous meningitis when pulmonary infiltrate is present. [1] Airborne plus contact precautions are recommended for tuberculous meningitis when potentially infectious draining body fluid is present. [1] For tuberculosis meningitis, concurrent active pulmonary disease or draining cutaneous lesions may necessitate addition of contact and/or airborne precautions. [1]
Duration of Precautions for Droplet-Precaution Meningitis
For Haemophilus influenzae type b meningitis, droplet precautions are used until 24 hours after initiation of effective therapy. [1] For meningococcal meningitis, droplet precautions are used until 24 hours after initiation of effective therapy. [1]
Common Isolation-Decision Triggers
When meningitis is suspected to be meningococcal, empiric droplet precautions are recommended for the first 24 hours of antimicrobial therapy. [2] When meningitis is suspected to be due to H. influenzae type b, droplet precautions are recommended for known or suspected cases until 24 hours after initiation of effective therapy. [1]
Key Laboratory/Clinical Reassessment Principle
Precautions should be reassessed as diagnostic results and antimicrobial-response information become available, including determination of whether effective therapy has been initiated for droplet-precaution pathogens. [1]