If there is bacterial meningitis — the normally clear or champagne color cerebral spinal fluid is cloudy and turbid (pus is present) it can be an eye ball diagnosis.
From the lab — a gram stain takes about 15 minutes. This disease can go from presentation to deadly within six hours. It also has a pretty classic rash.
My father contracted bacterial meningitis in 1993. For some reason when he was first admitted from the ER, they thought he had an intestinal blockage as he had severe abdominal pain and nausea and a bad headache, a low-grade fever. They were going to do tests the next day.
However, early the next morning when my mother and I went to the hospital we found him to be confused and delusional, seeing things that were not there, crazy things like a model train running around the ceiling and WWII planes flying outside his hospital room window, a fire in a trashcan in the corner of the room that was not there, asking me to hand him his cigarettes and an ash tray on the end table that were not there.
And other crazing things like claiming his eldest granddaughter was on the TV right now doing porn and reliving his WWII experiences saying “I’m here because I just got shot in the ass. And my best friend was shot in the ass. Everybody in my unit got shot in the ass”. OK, that last one made us laugh a bit. (FWIW like Forrest Gump, he did take a shrapnel wound to the buttocks and his right leg during the war).
I immediately went to the nurse’s station and asked what was going on? The RN in charge asked, “isn’t he always like this?” I guess she thought since he was 71, he had dementia or something.
I said, “no, he’s not like this at all, this no is not normal” and told her in no uncertain terms, rather forcefully that I wanted to see the doctor in charge, “not later or when he’s available but RIGHT NOW!!! RIGHT DAMN NOW!!!”
An LPN/Nursing Assistant who had been caring for him overnight, pulled me aside and said something like, “When you talk to the doctor, ask him to do a spinal tap because I think your dad has Meningitis. I noticed his neck is stiff and he’s light sensitive, has a high fever and he wasn’t seeing things and acting strange until a few hours ago.”
She also begged me not to say that she spoke to me because she said she could be fired for it. Sadly, I never got the chance to thank her as I never saw her again, as she may have helped save my father’s life.
Long story short the NA was right. When I mentioned my dad’s symptoms to the doctor and he more closely examined him, a spinal tap was ordered ASAP which confirmed meningitis, got the results within less than a few hours and a culture that was put through as a rush that confirmed it was bacterial.
The hospital called in an infectious disease specialist and a doctor specializing in allergies from Johns Hopkins. The allergy specialist was called in because according to my dad’s medical records he was allergic to penicillin, the very antibiotic they wanted to give him and the infectious disease specialist because my dad’s case seemed unusual.
Skin tests were done, and it was determined he had a mild to moderate allergic reaction to penicillin but the risks of him dying from meningitis were greater than the risk of him dying from the penicillin so with my mother’s permission, being advised of the risks, he was given penicillin. He was immediately transferred to the ICU where he stayed for the next 5 days, given penicillin and I think other antibiotics and very closely monitored.
My mother and I were advised not to touch him, but surprisingly were not given antibiotics prophylactically as a precaution but when visiting him in the ICU had to don gowns and masks and gloves.
After getting out of the ICU he spent another month and a half in the hospital. After being out of danger however, his recovery was slow, and he still occasionally had bouts of hallucinations and mental confusion for several weeks.
And he was never the same after that and while he was a diabetic which was under control and had pernicious anemia for which he was being treated, he had been very healthy. But after the meningitis it was one thing after another, a triple heart bypass, prostate surgery, numerous other health issues too many to list and a bit of a personality change – he had always been a difficult sort of person but his bouts of anger, especially toward my mother, his verbal abuse toward her were disturbing, enough that at one point she considered leaving him. The one good thing to come of this was he quit smoking.
He died in 2003 from an anti-bacterial resistant bacterial pneumonia after 6 weeks in the ICU at Hopkins.
I remember numerous doctors asking questions as to how he may have contracted bacterial meningitis. The only thing we could come up with was about a week before he got sick, he was doing a side job renovating a bathroom and was removing a toilet and cut his hand while doing so.