Meningitis clinical presentation

Aseptic meningitis is a rare adverse effect of non-selective NSAIDs in patients with or without connective tissue disease or rheumatological disease. Rofecoxib has been implicated in five patients (four women and one man), in each case occurring within 12 days of the start of rofecoxib therapy (1). The clinical presentations and cerebrospinal fluid findings were typical of aseptic meningitis. One patient had rheumatoid arthritis. After drug withdrawal and recovery, two consecutive rechallenges in one patient led to relapses. 

Kaplan SL. Clinical presentations, diagnosis, and prognostic factors of bacterial meningitis. Infect Dis Clin North Am 1999 13 579-593. 

C. neoformans is strongly neurotropic and readily disseminates from the lung to the CNS, specifically the lep-tomeninges, and occasionally the parenchyma of the brain. The clinical characteristics of cryptococcal meningitis differ somewhat, however, between patients with and without underlying AIDS. In patients without AIDS, disease presentation is more insidious and symptoms such as dizziness,... 

A four-year-old male presents to an emergency room at a small community hospital in the southeastern United States with history of fever to 103 F, vomiting, and increasing irritability. The emergency room physician notes meningismus and makes a clinical diagnosis of acute bacterial meningitis. 

Drug concentrations in pleural fluid, peritoneal fluid, synovial fluid, aqueous humor, and vitreous humor approach two-thirds of the serum concentration when local inflammation is present. Meningeal and am-niotic fluid penetration, with or without local inflammation, is uniformly poor. Measurement of serum, urine, or cerebrospinal fluid drug levels has not been used clinically. 

The spectrum of activity of flucytosine is restricted to Cryptococcus neoformans, some Candida species, and the dematiaceous molds that cause chromoblastomycosis. Flucytosine is not used as a single agent because of its demonstrated synergy with other agents and to avoid the development of secondary resistance. Clinical use at present is confined to combination therapy, either with amphotericin B for cryptococcal meningitis or with itraconazole for chromoblastomycosis. 

The clinical signs of meningitis include the classical triad of fever, stiff neck and impaired consciousness found together in around 44% of cases (van de Beek et ah, 2006). Over 90% of patients with community-acquired bacterial meningitis present with at least two of four symptoms ... 

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