Quote:
Originally Posted by Brush Okie
What antibiotic would you recommend?
How do you differentiate between bacterial, viral and fungal? I am guessing the rash.
Would you place everyone or at least some of the troops on prophylactic antibiotics?
|
Treatment of choice for these guys (in light of the newly noted nuchal rigidity) is parenteral ceftriaxone. The purpura and nuchal rigidity is the telltale sign of meningococcemia.
Viral meningitis tends to be more mild in immunocompetent hosts and does not classically present with petechiae/purpura.
Fungal meningiditis would be a red flag of a much more serious problem, such as advanced immunocompromised state (i.e. AIDS), or innoculating the CSF with tainted medications (like the recent outbreak with steroid injections).
Both fungal and viral meningitis tend to be more slowly progressive.
Prophylactic treatment would depend on availability of sufficient antibiotics - I would certainly treat the symptomatic patients and have to determine the need for prophylaxis for close contacts depending on availability of antibiotics and nature of contact with the index cases.
__________________
"The dignity of man is not shattered in a single blow, but slowly softened, bent, and eventually neutered. Men are seldom forced to act, but are constantly restrained from acting. Such power does not destroy outright, but prevents genuine existence. It does not tyrannize immediately, but it dampens, weakens, and ultimately suffocates, until the entire population is reduced to nothing better than a flock of timid, uninspired animals, of which the government is shepherd." - Alexis de Tocqueville
|