Meningitis

Trends in the diagnosis and management of infective meningitis at a tertiary centre over 10 years: a retrospective cohort study providing further evidence for culture-independent diagnostics

Original Articles, Volume 24, Issue 2, Pages 61 – 108 (2025)

Objective: This retrospective study analysed clinical characteristics, diagnosis, and management of infective meningitis patients at a UK-centre, aiming to identify emerging trends in the patient pathway.
Methods: A ten-year review of meningitis patients at a UK tertiary centre was conducted. Inclusion criteria encompassed signs/symptoms of meningitis with CSF WCC ≥4 cells/mm3 or causative pathogen identification.
Results: The study included 298 patients with infective meningitis were included (184 viral, 87 bacterial, 22 tuberculosis, 5 fungal). Key findings indicated underutilisation of culture-independent investigations, delayed administration of antibiotics, and lumbar puncture. Viral meningitis cases with a positively identified causative virus had shorter hospital stays.
Conclusion: Culture-independent investigations are under-utilised in meningitis diagnosis. Patients experience delays in essential interventions. Future advancements in rapid, point-of-care genomic sequencing could enhance diagnostic accuracy and speed.

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Listeria Meningitis, one of your five a day? A case report of Listeria Monocytogenes Meningitis in a fit and well 62-year-old woman

Case Reports, Volume 22, Issue 2, Pages 57 – 108 (2023)

Listeria Monocytogenes is transmitted via ingestion of contaminated food products and can cause invasive disease in susceptible hosts. Risk factors include immunocompromise; pregnancy; being elderly; and new-born.

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CNS infection with a history of recurrent epistaxis: Streptococcal meningitis as a first presentation of juvenile nasopharyngeal angiofibroma

Case Reports, Volume 20, Issue 3, Pages 157-248 (2021)

An adolescent male with a history of recurrent epistaxis presented with headache and vomiting. Investigations revealed concurrent meningitis as well as the presence of a subarachnoid haemorrhage. Subsequent imaging identified a Juvenile Nasopharyngeal Angiofibroma; a rare but important cause of meningitis that should be considered in the young adult population.

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Presentations to An Acute Medical Unit Due to Headache: A Review of 306 Consecutive Cases

Research Audit and Clinical Practice, Volume 11, Issue 3, Pages 129 - 185 (2012)

Abstract

The United Kingdom National Health Service has recently prioritised the need for ambulatory care pathways for acute headache. The present study sought to better characterise patients referred to an Acute Medical Unit so as to inform pathway development. In 2011, York Hospital received 306 referrals due to acute headache, representing 3% of acute medical admissions. Investigations included CT scan (38%), lumbar puncture (38%), and MRI (18%); there were no specialised investigations in 26%, and 18% of patients were discharged on the day of presentation. Subarachnoid haemorrhage occurred in only 4 patients (1%), meningitis in 10 (3%), and intracranial tumour in 5 (2%). The findings indicate that a significant proportion of patients with acute headache could be managed by ambulatory care.

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The Emergency Management of Adult Bacterial Meningitis

Clinical Reviews, Volume 3, Issue 2, Pages 45 - 84 (2004)

Abstract

Over the last decade, new protein-conjugate vaccines against Haemophilus influenzae type b (Hib) and Neisseria meningitidis serogroup C (MenC) have had a dramatic effect on the epidemiology of childhood meningitis in the United Kingdom. Amongst adults, bacterial meningitis remains an important cause of preventable morbidity and mortality. Clinicians need to remain vigilant for the possibility of this infection. The identification of the one patient with meningitis out of many with trivial viral infections remains a difficult task. Even once the diagnosis is made clinically, the subsequent investigation and management of the patient remains controversial, with strong opinions often influenced by one or two adverse experiences. Potential improvements in the way we identify and manage meningitis patients have been identified in recent years. This review will focus on those areas relevant to the emergency care specialist. Meningitis in the immunocompromised patient often has a different clinical and epidemiological pattern and is beyond the scope of this review.

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