Consider this in any patient over 50 or Immunosuppressed, Diabetes, Alcoholics or Pregnant females as need to add Ampicillin
- Not be missed - identify groups at risk
- Causes meningitis and rhomboencephalitis
- Immunosuppressed, Diabetes, Alcoholics
- Pregnant females, neonates
- Brainstem signs may be present
- Confusion, Headaches, Reduced GCS
- Pyrexia, nuchal rigidity and photophobia.
- CT Scan : may show skull fractures or other causes also exclude other pathologies, oedema or hydrocephalus
- LP: CSF: low glucose, raised WCC and Gram positive cocci in pairs.
- ABC and support as required on HDU/ITU
- If Organism is suspected but not confirmed
- Give Cefotaxime 2 g IV 6 hrly or Ceftriaxone 2 g IV 12 hrly
- Add Amipicillin 2 g 4 hrly or Co-trimoxazole 5mg/kg IV daily in 2 doses