Management of acute community-acquired bacterial meningitis : Leading symptoms of impaired consciousness and fever with/without headache

Abstract

Simultaneous symptoms of impaired consciousness and fever are suspicious for acute bacterial meningitis. This is amedical emergency and prompt action is essential. The clinical workup for suspected bacterial meningitis as well as treatment recommendations and differential diagnosis for the main symptoms of decreased vigilance and fever are described. Evaluation of selective literature using PubMed (U.S. National Library of Medicine®, Bethesda, MD, USA), especially taking into account the AWMF (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften) guideline of community-acquired bacterial meningoencephalitis in adults. Bacterial meningoencephalitis presents with the main symptoms of impaired consciousness, nuchal rigidity, headache and fever, which may, however, be absent in some cases. The diagnosis is confirmed by investigation of the cerebrospinal fluid. Further diagnostics include emergency laboratory tests, blood cultures, microbiological examinations, and cranial computed tomography (CCT). Empirical treatment should be administered promptly. Acute bacterial meningitis must be considered in cases of loss of vigilance and fever, requiring arapid, structured approach in the emergency department.