Cada año se informan unos 6,000 casos de meningitis neumocócica en los Estados Unidos.

A single copy of these materials may be reprinted for noncommercial personal use only. Some cases of meningitis improve without treatment in a few weeks. I have read and accept the Wiley Online Library Terms and Conditions of UseAdult bacterial meningitis: earlier treatment and improved outcome following guideline revision promoting prompt lumbar punctureAdult bacterial meningitis‐a quality registry study: earlier treatment and favourable outcome if initial management by infectious diseases physiciansDelays in the administration of antibiotics are associated with mortality from adult acute bacterial meningitisClinical features and prognostic factors in adults with bacterial meningitisPathogenesis and pathophysiology of pneumococcal meningitisEffect of delayed lumbar punctures on the diagnosis of acute bacterial meningitis in adultsComputed tomography of the head before lumbar puncture in adults with suspected meningitisPractice guidelines for the management of bacterial meningitisESCMID guideline: diagnosis and treatment of acute bacterial meningitisEarly lumbar puncture in adult bacterial meningitis‐‐rationale for revised guidelinesUse of intracranial pressure monitoring in bacterial meningitis: a 10‐year follow up on outcome and intracranial pressure versus head CT scansLumbar puncture performed promptly or after neuroimaging in acute bacterial meningitis in adults: a prospective national cohort study evaluating different guidelinesThe UKjoint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adultsCryptococcosis in human immunodeficiency virus‐negative patients in the era of effective azole therapyCerebrospinal fluid/blood glucose ratio as an indicator for bacterial meningitisBacterial meningitis in the absence of cerebrospinal fluid pleocytosis: a case report and review of the literatureValue of repeat lumbar puncture in the differential diagnosis of meningitisHerpes simplex and varicella zoster CNS infections: clinical presentations, treatments and outcomesDiagnosis of tuberculous meningitis: challenges and promisesSerum glucose adjusted cut‐off values for normal cerebrospinal fluid/serum glucose ratio: implications for clinical practiceDifferential diagnosis of acute meningitis. HSV meningitis is also self‐limiting in immunocompetent patients; symptomatic treatment alone is reasonable, although 7–10 days of antiviral treatment (with acyclovir, valacyclovir or famciclovir) has been shown to improve neurological outcomes in immunocompromised hosts.Neuroimaging is indicated in patients who fail to improve or in whom neurological abnormalities or seizures develop, to evaluate for hydrocephalus, venous sinus thrombosis, subdural empyema or intracerebral abscess.

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This may include airway support with mechanical ventilation, circulatory support with inotropes, medical or surgical reduction of raised ICP and medical management of coagulopathy, hyponatraemia and seizures.

These include obtaining blood cultures, performing lumbar puncture and initiating appropriate therapy, while avoiding harmful delays such as those that result from not administering treatment until neuroimaging has been performed. A meta‐analysis reported that a CSF lactate of ≥35 mg/dL (3.9 mmol/L) had 93% sensitivity and 99% specificity for bacterial meningitis.Viral meningitis is most commonly caused by the enteroviruses and is self‐limiting, although HSV or VZV meningitis may warrant antiviral therapy in some circumstances.Not all patients with aseptic meningitis have viral meningitis, and it is important to consider other causes if a viral aetiology is not confirmed by PCR.Cryptococcal meningitis should be considered in patients with a subacute presentation. However, guidelines differ as to which clinical features constitute an indication to perform CT prior to LP (Table CSF analysis is of vital importance in suspected meningitis as clinical characteristics alone are unable to distinguish meningitis from other diagnoses, and bacterial from non‐bacterial aetiologies.Appearance of the CSF should be noted; cloudy or turbid fluid suggests a significant concentration of leukocytes in the sample (although xanthochromia, elevated protein concentration or a high number of bacterial colony‐forming units may also cause this appearance).Once CSF is delivered to the laboratory, a Gram stain should be rapidly performed. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. La meningitis neumocócica es la forma más común de meningitis y la forma más seria de meningitis bacteriana.

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