Meningitis and Encephalitis Management and Prevention Challenges PDF
Meningitis and encephalitis continue to be associated with high rates of mortality and neurological sequelae, and despite the availability of molecular diagnostic techniques, the majority of patients have unknown causes. The differential diagnosis is broad and includes a wide spectrum of infectious and noninfectious etiologies, some requiring urgent therapy for survival. Some of the most common challenges clinicians face include the low sensitivity of meningeal signs, overutilization of unnecessary screening cranial imaging in suspected meningitis, delays in the diagnosis of urgent treatable causes, emerging causes of meningitis and encephalitis, large proportion of unknown etiologies, low sensitivity of current microbiological techniques especially in the setting of previous antibiotic therapy, underutilization of available molecular diagnostic tests, and empiric antibiotic therapy and hospitalization for viral meningitis cases. Even though there are published guidelines, compliance with them is not optimal and physicians do not follow standardized algorithms in their empirical approach. Due to the high rate of adverse clinical outcomes, prevention when feasible is of utmost importance.
The use of conjugate vaccines for the three most common meningeal pathogens has dramatically changed the current epidemiology of bacterial meningitis, prenatal screening for Group B streptococcus in pregnancy has decreased early-onset neonatal meningitis, and vaccination for Japanese encephalitis has had a dramatic impact in the countries where it has been implemented. Adherence to protocols to prevent health-care associated meningitis and ventriculitis is effective, but compliance with them is not uniformly performed. Finally, this book will serve to guide current and future researchers in the field to address the gaps in knowledge that currently exist in the diagnosis, management, and prevention of the most important causes of meningitis and encephalitis in the world with the ultimate goal to improve the outcomes of these devastating clinical syndromes.