髄膜炎疑い

パス全体像

1. 【判断】Is CT needed before LP?
   Are there indications for a head CT before lumbar puncture?（Suspected bacterial meningitis is a neurological emergency — start treatment within 1 h and do not delay for imaging/LP; draw blood cultures immediately. Indications for CT before LP (any): immunocompromise, seizure within the past week, focal neurological signs, altered consciousness/coma, papilledema, known CNS disease.）
   • CT-before-LP indication present → CT then LP (treat first)
   • None (LP can be done first) → LP then treat immediately
2. 【終点】CT then LP (treat first)
   細菌性髄膜炎を疑う：血培後、可能な施設では腰椎穿刺前または直後に抗菌＋デキサメタゾン（肺炎球菌を想定）を遅滞なく。禁忌があれば先にCT。 isolationと感染対策。（補足：Empiric antibiotics (adults): ceftriaxone 2 g IV q12h (or cefotaxime) + vancomycin 15–20 mg/kg q8–12h; add ampicillin if >50 years or immunocompromised (cover Listeria); add acyclovir if HSV encephalitis is suspected. Dexamethasone 0.15 mg/kg q6h × 2–4 days, given 10–20 min before or with the first antibiotic dose; continue 4 days if pneumococcus confirmed, otherwise stop.）
3. 【終点】LP then treat immediately
   ウイルス性/低可能性：支持療法、必要時アシクロビル（HSV脳炎除外が必要なら）。再評価を継続。（補足：Empiric antibiotics (adults): ceftriaxone 2 g IV q12h (or cefotaxime) + vancomycin 15–20 mg/kg q8–12h; add ampicillin if >50 years or immunocompromised (cover Listeria); add acyclovir if HSV encephalitis is suspected. Dexamethasone 0.15 mg/kg q6h × 2–4 days, 10–20 min before or with the first antibiotic dose.）