The Rational Clinical Examination
David L. Simel, Drummond Rennie
Meningitis, Adult
Rose Hatala, John Attia, Jeffrey G. Wong, Stephen Bent
Make the Diagnosis: Meningitis, Adult
Topics Discussed:
headache, likelihood ratio, make the diagnosis, meningitis, nausea and vomiting, prior probability
Excerpt:
"Meningitis can occur sporadically or in outbreaks. It is impossible
to come up with a single prior probability estimate for all patients with
symptoms compatible with meningitis. Among patients presenting to
the emergency department at a single US hospital with a clinical
suspicion of meningitis who underwent LP, the prevalence of meningitis
(CSF WBC 
6/mL) was 27%.1 Among
the patients in this study,1 the prevalence of
bacterial meningitis as defined by a positive CSF culture result
was 1%. The rates of meningococcal meningitis are low (approximately
1 case/100 000 persons each year; http://www.cdc.gov/meningitis/tech-clinical.htm;
accessed June 3, 2008)...."
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