Delayed Meningitis Diagnosis Leaves Patient Ventilator-Dependent

Case Overview

The case involves a female author who began feeling neck pain while traveling to promote her new book. After experiencing the neck pain for a week, she presented to the hospital with severe pain, low-grade fever, and altered mental state. The author was prescribed a muscle relaxant and a steroid for pain relief and was discharged from the hospital. The author’s condition continued to worsen over the next few days. She checked back into the hospital three days later and was immediately diagnosed with meningitis. This resulted in a prolonged and complicated ICU course for the author. She remains ventilator dependent. An infectious disease expert was sought to opine on the causality between a delay in treating meningitis and a patient’s difficult clinical course.

Questions to the Infectious Disease and Communicable Disease expert and their responses

How often do you treat patients with meningitis?

Community-acquired bacterial meningitis is a relatively rare occurrence, with an incidence of 1-2 per 100,000 population. Because I work for a referral center, I have experience with about one case /month of confirmed bacterial meningitis.

What is the standard of care in regards to starting time sensitive antibiotic prophylaxis for suspected cases of meningitis?

If a provider even considers bacterial meningitis in their differential diagnosis, antibiotics should be started within 30 minutes of that clinical suspicion, whether or not a spinal tap is done before antibiotics. Steroids are also usually given.

How would a delay in initiating antibiotics impact a patient's clinical course?

Delays in diagnosis and proper management are usually directly proportional to adverse outcomes, including morbidity and mortality.

About the expert

This expert has over 30 years of experience in infectious diseases, hospital epidemiology, and antibiotic stewardship. He received his BS in molecular biophysics and biochemistry from Yale University and his MD from the Vanderbilt University School of Medicine. He then completed a residency in internal medicine and a research fellowship in infectious diseases at the University of Wisconsin, followed by a clinical fellowship in infectious diseases at the University of Maryland Medical Center. Today, this expert is double board-certified in internal medicine and infectious diseases and is a member of several professional organizations, including the American Society for Microbiology, the Infectious Disease Society of America, and the Society for Health Care Epidemiology of America. He also stays active in academia with 61 peer-reviewed publications and 4 book chapters. Previously, he was the medical director of quality assurance, infectious diseases, and hospital epidemiology at the Carle Foundation Hospital. Additionally, he was a clinical assistant professor of internal medicine at Yale University, the director of infectious disease clinical research at Bristol-Myers Squibb, and the head of infection control and hospital epidemiology at The Ohio State University. More recently, this expert worked as an attending epidemiologist, as the director of the antimicrobial stewardship program at the University of Wisconsin Hospital, as an adjunct clinical professor of infectious diseases at the University of Wisconsin, and as the director of antibiotic stewardship for the state of Wisconsin. Currently, he serves as a professor emeritus of infectious disease at a top-ranked university in Wisconsin.

E-004446

Specialties:

Infectious Disease and Communicable Disease