Meningitis (Bacterial)ICU / resuscitation

Fever, severe headache, neck stiffness, confusion (GCS 13) for 1 day; petechial rash on the legs

• GCS ≤8 or falling
• Petechial/purpuric rash with shock
• Seizures or focal signs
• Papilloedema

• Viral meningitis / HSV encephalitis
• TB meningitis
• Cryptococcal meningitis (HIV)
• SAH
• Brain abscess
• Cerebral malaria, scrub typhus

• Admit: All suspected bacterial meningitis
• ICU: GCS ≤8, seizures, shock, raised ICP
• Intubate: GCS ≤8, status epilepticus, airway compromise
• Vasopressors: Septic shock after fluids — noradrenaline

• Mortality rises with every hour of delay; empirical antibiotics come first.
• In India, also think of TB meningitis (subacute, basal exudates, low glucose, lymphocytes), cryptococcal meningitis (HIV) and Japanese encephalitis/scrub typhus in season.
• Durations: meningococcus 5–7 days, H. influenzae 7–10, pneumococcus 10–14, Listeria ≥21 days.

• Delay antibiotics for CT or LP
• Do an LP with focal signs, papilloedema or coma before imaging
• Forget Listeria cover in older, pregnant or immunocompromised patients
• Restrict fluids routinely or give glycerol (WHO 2025)

• Delaying antibiotics for imaging
• Missing Listeria cover
• Not considering TB or cryptococcus
• Forgetting contact prophylaxis

ICU if unstable; otherwise HDU/ward with 1–2-hourly neuro obs. Audiology before discharge; public health notified.