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Previous medical treatment and existing conditions

As many as 40% of patients with acute or subacute bacterial meningitis have previously been treated with oral antibiotics (presumably due to misdiagnosis at the time of initial presentation).

The presence of a ventriculoperitoneal shunt and a history of recent cranial surgery should be elicited. Patients with low-grade ventriculitis associated with a ventriculoperitoneal shunt may have a less dramatic presentation than do patients with acute bacterial meningitis, with headache, nausea, minimal fever, and malaise.

The presence of cochlear implants with a positioner has been associated with a higher risk of bacterial meningitis.

Multiple etiologies of fever and seizures in patients with alcoholism or cirrhosis make meningitis challenging to diagnose.

Location and travel

Geographic location and travel history are important in the evaluation of patients. H capsulatum and B dermatitidis are considered in patients with exposure to endemic areas of the Mississippi and Ohio River valleys; C immitis is considered in regions of the southwestern United States, Mexico, and Central America; and B burgdorferi is considered in regions of the northeastern and northern central United States.

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