2018;36(4):687-703. doi:10.1016/j.ncl.2018.07.004, Salazar L, Hasbun R. Cranial imaging before lumbar puncture in adults with community-acquired meningitis: clinical utility and adherence to the Infectious Diseases Society of America guidelines. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Physical examination findings have shown wide variability in their sensitivity and specificity, and are not reliable to rule out bacterial meningitis.18–20 Examples of Kernig and Brudzinski tests are available at https://www.youtube.com/watch?v=Evx48zcKFDA and https://www.youtube.com/watch?v=rN-R7-hh5x4. If not treated, meningitis can lead to brain swelling and cause permanent disability, coma, and even death. A person should tell a doctor about any recent potential meningitis exposures, and request testing for meningitis immediately. If you appear to have viral meningitis, treatment is usually less aggressive and consists of measures to make you more comfortable. In 20 bis 30 % kommt es frühzeitig zu Hirnnervenschädigungen, in bis zu 50 % zu Krampfanfällen. Can diet and exercise reverse prediabetes? people who have had their spleen removed. Hahné SJ, Charlett A, Purcell B, Samuelsson S, Camaroni I, Ehrhard I, Heuberger S, Santamaria M, Stuart JM (2006) Effectiveness of antibiotics given before admission in reducing mortality from meningococcal disease: systematic review. Get our printable guide for your next doctor's appointment to help you ask the right questions. However, a blood culture cannot definitively diagnose or rule out meningitis. Treatment of tuberculous, cryptococcal, or other fungal meningitides is beyond the scope of this article, but should be considered if risk factors are present (e.g., travel to endemic areas, immunocompromised state, human immunodeficiency virus infection). 10 Things People With Depression Wish You Knew. Die Häufigkeit und das Erregerspektrum der außerhalb des Krankenhauses erworbenen bakteriellen Meningitis sind altersabhängig (Neugeborene: B-Streptokokken, Escherichia coli und Listerien; Kinder: Meningokokken, Pneumokokken und Haemophilus influenzae Typ b; Erwachsene: Pneumokokken, Meningokokken, Listerien, Mycobacterium tuberculosis). Proulx N, Fréchette D, Toye B, Chan J, Kravcik S (2005) Delays in the administration of antibiotics are associated with mortality from adult acute bacterial meningitis. Very rarely, an amoeba called Naegleria fowlerican travel through water, up the nose, and into the brain. Blood test CT scan Spinal tap Home testing Causes Outlook Testing for meningitis can include various tests, including a physical exam, blood tests, bacterial cultures, and cerebrospinal. These patients, as well as those coinfected with human immunodeficiency virus, should be managed in consultation with an infectious disease subspecialist when available. No home tests can conclusively prove that a person does or does not have meningitis. Meningitis is a dangerous inflammation of the brain and/or spinal cord lining. Die angegebenen Dosierungen beziehen sich auf normalgewichtige Erwachsene. Usually, the brain is protected naturally from the body's immune system by the barrier that the meninges create between the bloodstream and the brain itself. Unlike meningitis, it is less likely to cause a fever. A CSF culture can usually detect the specific organisms causing meningitis. Incoming college freshmen who live in close quarters, such as dormitories, may be given a vaccine to prevent this type of bacterial meningitis. Rarely, certain insects, such as mosquitoes and ticks, are thought to spread these viruses. Often, you are placed in an isolation room to protect staff and others from infection. Human metapneumovirus, or hMPV, is an infection that affects the upper and respiratory tract, according to the CDC. Know how you can contact your provider if you have questions. HILLARY R. MOUNT, MD, AND SEAN D. BOYLE, DO. In dieser Zeit tragen Pflegepersonal und Angehörige Mundschutz, Handschuhe und Schutzkittel. This may include those with high pressure inside the skull, certain brain diseases, a history of stroke, and those with weak immune systems because of HIV or certain drugs. Treatment should not be delayed if there is lag time in the evaluation. Eine Verwirrtheit oder Bewusstseinstrübung steht oft im Vordergrund, und eine definitive Klärung eines Verwirrtheitszustands ist nur durch Liquoruntersuchung und zerebrale Bildgebung möglich [5]. The authors thank Thomas Lamarre, MD, for his input and expertise. you How do approach a patient with suspected bacterial meningitis? This examination can show swelling, fluid, redness, or other signs of an underlying ear infection accompanying meningitis, which is more common in children. A doctor may also perform physical tests to assess for inflammation of the meninges. The fluid is sent to a laboratory for examination, where it is analyzed for proteins, white blood cells, blood, and infectious organisms. The major difference between the two is that muscle strain pain is typically centered around a particular muscle and may worsen with its movement. One test looks for what is known as the Brudzinski sign. When the membranes become infected, they swell and press on the spinal cord or brain. 2018;7(6):148. doi:10.3390/jcm7060148. Meningitis is a disease caused by an inflammation of the meninges. The most common is. Meningitis, an inflammation or infection of the meninges that line the brain and spinal cord, is most commonly caused by viral or bacterial infections. The doctor then sends the CSF to the lab to analyze it for signs of infection. A spinal tap is needed to confirm a diagnosis of meningitis and to help identify the type of infection. Spinale Ausfälle einschließlich einer Para- oder Tetraparese sind ebenfalls nicht selten Frühsymptome der Tuberkulose des ZNS. Bacterial meningitis classically has a very high and predominantly neutrophilic pleocytosis, low glucose level, and high protein level. Zu Beginn einer Meningokokken-Erkrankung fehlen sie oft. Etiologies range in severity from benign and self-limited to life-threatening with potentially severe morbidity. That said, it's also possible that you may have meningitis but no apparent physical signs. Lesen Sie, welche Symptome die Hirnhautentzündung verursacht und wie eine Impfung schützt. The other test looks for what is called the Kernig sign. Säuglinge unter einem Jahr, alte Menschen und tief Komatöse entwickeln häufig keinen Meningismus. In 2015, the Advisory Committee on Immunization Practices gave meningococcal serogroup B vaccines a category B recommendation (individual clinical decision making) for healthy patients 16 to 23 years of age (preferred age 16 to 18 years). Bacterial meningitis is caused by only one kind of bacteria. Meningitis tests can tell a doctor which type of meningitis a person has, and guide treatment decisions. 2018;18(1):139. doi:10.1186/s12883-018-1143-z, Soeters HM, McNamara LA, Blain AE, et al. It is more serious and life-threatening than meningitis and requires high-level care to prevent permanent neurological damage. It can be caused by viruses that are commonly contagious in the community, including enterovirus, mumps virus, herpes simplex virus, varicella zoster virus (which normally causes chickenpox), Epstein-Barr virus, and West Nile virus. Nach Erregeranzucht wird die Behandlung ggf. Die pathologischen Veränderungen der Hirnhäute und des angrenzenden Nervengewebes werden einerseits durch die Erreger selbst (), andererseits aber auch . Sometimes, however, meningitis is accompanied by the flu. In certain conditions, your healthcare provider may recommend one of the meningitis vaccines. It is diagnosed by identifying an infection or confirming inflammation in the cerebrospinal fluid (CSF) that surrounds the brain and spinal cord. Priorisierung von Erregern. During an ear examination, your healthcare provider will look in your ear canal. It is usually used to evaluate seizures and changes in consciousness. Lab tests will help figure out which type of meningitis your teen has -- bacterial, viral, or fungal. Crit Care Med 34: 2758-65, 2. Bacterial meningitis can kill a person within a few hours without treatment, while viral meningitis often goes away on its own. It is diagnosed by identifying an infection or confirming inflammation in the cerebrospinal fluid (CSF) that surrounds the brain and spinal cord . Fever, headache, neck stiffness, and altered mental status are classic symptoms of meningitis, and a combination of two of these occurs in 95% of adults presenting with bacterial meningitis.12 However, less than one-half of patients present with all of these symptoms.12,13, Presentation varies with age. The person may require a prolonged period of hospitalization and rehabilitation. The doctor focuses early treatment on a medical opinion of the most likely cause based on your symptoms and physical examination findings. The meninges are the membranes that protect the brain and spinal cord. This is typically done along with a contrast, a substance that gets injected into a vein so tissues stand out more on scans. BMJ 332: 1295-1298, 5. Several vaccines are available to prevent types of bacterial meningitis. All Rights Reserved. A rash with red and purple spots that remain visible when pressed can indicate severe meningitis. If viral meningitis is suspected, you may need a DNA-based test known as a polymerase chain reaction amplification. Determining how many people get viral meningitis is difficult because it often remains undiagnosed and is easily confused with the, The prognosis for viral meningitis is much better than that for bacterial meningitis, with most people recovering completely with simple treatment of the symptoms. Avoid aspirin. Are There Home Remedies for Meningitis in Adults? All rights reserved. Passive neck flexion during Brudzinski's sign causes movement in the spinal cord to stretch the meninges. Because meningitis can be a life-threatening emergency, a person who thinks they may have meningitis should seek immediate medical care. A brain abscess is a type of infection in the brain that is localized to one area. Cochrane Database Syst Rev 2008 Jan 23;(1):CD005437. The most serious form of meningitis is bacterial. However, it is impossible to know which type of meningitis a person has without medical testing. Aseptic meningitis is the most common form. You can find out more about our use, change your default settings, and withdraw your consent at any time with effect for the future by visiting Cookies Settings, which can also be found in the footer of the site. They: Meningitis Research Foundation. Although an estimated 16 million cases of bacterial meningitis occurred worldwide in 2013, only 4100 cases per year occur in the USA [2,19]. https://pubmed.ncbi.nlm.nih.gov/17907046/#:~:text=The%20diagnosis%20of%20bacterial%20meningitis,determined%20by%20blood%20culture%20alone. Instead, anyone with symptoms of meningitis should seek immediate medical care. So ist die Inzidenz der kindlichen Haemophilus-influenzae-Meningitis in Deutschland seit Einführung der Schutzimpfung stark rückläufig. A CT scan uses x-rays to take pictures of the brain and skull. Meningitis is inflammation of the meninges and subarachnoid space. Because of the poor performance of clinical signs to rule out meningitis, all patients who present with symptoms concerning for meningitis should undergo prompt lumbar puncture (LP) and evaluation of cerebrospinal fluid (CSF) for definitive diagnosis. BMJ 305: 141-143. If friends or family members notice a person experiencing confusion or seizures, or the person is difficult to awaken, they should call 911 immediately. In den 90er Jahren wurden v. a. in Großbritannien Studien publiziert, in denen die Sterblichkeit der Meningokokken-Erkrankung (Sepsis, Meningitis, gemischt septisch-meningitische Verläufe) sank, wenn Hausärzte vor Ort bei klinischem Verdacht Penicillin applizierten [2, 9]. A doctor bends the knee toward the chest, then attempts to straighten the leg upward. Although bacterial and fungal meningitis require extended hospitalization, meningitis caused by viruses can often be treated at home and has a much better outcome. What Are the Best PsA Treatments for You? Bacterial meningitis has a much higher fatality rate than viral meningitis. Because the results of the spinal tap can take up to several hours to return, the treatment often begins before the results are available. If this causes the person to flex their knees or hips, this suggests inflammation of the meninges, and may mean a person has meningitis. Go to the emergency room or call a doctor immediately if a person has: There are a number of different tests a doctor can perform to diagnose meningitis, depending on which type of meningitis they think a person may have. Other tests may be performed to look for other sources of infection. When seizures cause fevers, they are generally very brief in duration and resolve on their own. The biggest difference is that meningitis symptoms more often involve the head, neck, and eyes. As with a brain MRI or brain CT, a spine MRI might detect inflammation of the meninges. If the person is vomiting, lay the person on one side to prevent him or her from inhaling vomit. In addition, the Infectious Diseases Society of America, the National Institute for Health and Care Excellence, and the American Academy of Pediatrics guidelines were reviewed. As with meningitis, your symptoms can worsen with changes in body position. Epidemiology. A strained/pulled muscle of the upper shoulders or upper back can cause severe pain that worsens with movement like meningitis. If allowed to progress, you can die from bacterial meningitis. Vaccinations can prevent or minimize the incidence of meningitis. HSV and varicella zoster viral polymerase chain reaction testing should be used in the setting of meningoencephalitis. Brain imaging using magnetic resonance imaging (MRI) or computed tomography (CT) can sometimes detect inflammation of meningitis. National Institute of Neurological Disorders and Stroke. Several tests and diagnostic procedures may follow. Bei ohne erkennbare Ursache Komatösen und Bewusstseinsgetrübten muss deshalb auch an die eitrige Meningitis als mögliche Komaursache gedacht werden. There are 2 types of meningitis, each with different causes: Rarely, a fungus or tuberculosis causes meningitis. Treatment for meningitis depends on the specific cause of the disease. What Is the Prognosis of Meningitis in Adults? Find out how much you know about meningitis, Unpredictable Days With Myasthenia Gravis. C-reaktives Protein (CRP) ≥ 20 mg/l bzw. Door-to-antibiotic time lapse of more than six hours has an adjusted odds ratio for mortality of 8.4.37 If CSF results are more consistent with aseptic meningitis, antibiotics can be discontinued, depending on the severity of the presentation and overall clinical picture. 1). Dr. Moawad regularly writes and edits health and career content for medical books and publications. Most cases of aseptic meningitis are viral and require supportive care. Full recovery is normal, but headaches, fatigue, and depression may persist. Patient information: See related handout on meningitis, written by the authors of this article. As a healthcare provider works toward a diagnosis, they may look to rule out the following. This non-invasive test, known as a funduscopic exam, allows your healthcare provider to see if you have swelling of the optic nerve, a bundle of nerves that carry visual messages. optimiert. Erschienen in: Der Allgemeinarzt, 2012; 34 (9) Seite 18-20, 1. Viral meningitis is often treated at home with acetaminophen (Tylenol) and other pain medications. https://www.youtube.com/watch?v=Evx48zcKFDA, https://www.youtube.com/watch?v=rN-R7-hh5x4, http://reference.medscape.com/calculator/bacterial-meningitis-score-child. What is the meningitis rash? The Advisory Committee on Immunization Practices recently added a category B recommendation (individual clinical decision making) for consideration of vaccination with serogroup B vaccines in healthy patients 16 to 23 years of age (preferred age of 16 to 18 years).60,61 The serogroup B vaccines are not interchangeable, so care should be taken to ensure completion of the series with the same brand that was used for the initial dose. This is not the case for all patients and can vary in older patients and those with partially treated bacterial meningitis, immunosuppression, or meningitis caused by L. monocytogenes.11 It is important to use age-adjusted values for white blood cell counts when interpreting CSF results in neonates and young infants.23 In up to 57% of children with aseptic meningitis, neutrophils predominate the CSF; therefore, cell type alone cannot be used to differentiate between aseptic and bacterial meningitis in children between 30 days and 18 years of age.24. If the diagnosis is uncertain, or if you have recently been on antibiotics, you may be admitted to the hospital for observation and treatment until the diagnosis is certain. In jedem Fall ist eine sofortige ärztliche Behandlung notwendig. This article explores the importance of seeking immediate medical attention to test for meningitis, types of tests and how doctors diagnose meningitis, meningitis causes, and the outlook for a person diagnosed with various types of the disease. Aim Until now, the performance of interferon-γ release assay (IGRA) and Mantoux tests remains unclear in infant tuberculous meningitis (TBM). Kurzinformationen Ursachen Symptome Diagnose Prognose Vorbeugung Behandlung Akute bakterielle Meningitis ist eine sich rapide entwickelnde Entzündung der Gewebsschichten, die das Gehirn und Rückenmark umgeben (Hirnhäute), und des flüssigkeitsgefüllten Raums zwischen den Hirnhäuten (Subarachnoidalraum), die von Bakterien verursacht wird. University-based outbreaks of meningococcal disease caused by serogroup B, United States, 2013–2018. The initial management strategy is outlined in Figure 1.7,9 Stabilization of the patient's cardiopulmonary status takes priority. Bei alten Patienten fehlen nicht selten Fieber und Nackensteifigkeit. 2019;25(3):434-40. doi:10.3201/eid2503.181574, Ramachandran PS, Wilson MR. If you have bacterial or fungal meningitis, you are often admitted to the intensive-care unit, for either a short period of observation or a longer period if you are more ill. Care of bacterial meningitis begins by ensuring that your breathing and blood pressure are adequate. Steroids may be given to try to decrease the severity of the disease. This can be an indicator of a severe form of meningitis that needs emergency treatment. In a few cases, viral meningitis can be helped by special antiviral medicines that target specific viruses. A blood culture may be done if a bacterial infection is suspected. Outcomes for viral meningitis are usually better, and a person may recover on their own without treatment. 11. van de Beek D, de Gans J, Spanjaard L, Weisfelt M, Reitsma JB, Vermeulen M (2004) Clinical features and prognostic factors in adults with bacterial meningitis. Dr. Moawad regularly writes and edits health and career content for medical books and publications. Fever, headache, neck stiffness, and altered mental status are classic symptoms of meningitis, and a combination of two of these occurs in 95% of adults presenting with bacterial meningitis. Learn more about bacterial meningitis through this quiz. In those with less severe cases of bacterial meningitis, the death rate can still approach 25%. This test cannot be used to rule out bacterial meningitis.7. However, injuries, cancer, certain drugs, and other types of infections also can cause meningitis. Sie befällt in Deutschland vorwiegend ältere Erwachsene sowie Migranten, in Entwicklungsländern dagegen auch zahlreiche Kinder. A 2015 Cochrane review found a nonsignificant reduction in overall mortality (relative risk [RR] = 0.90), as well as a significant reduction in severe hearing loss (RR = 0.51), any hearing loss (RR = 0.58), and short-term neurologic sequelae (RR = 0.64) with the use of dexamethasone in high-income countries.41 The number needed to treat to decrease mortality in the S. pneumoniae subgroup was 18 and the number needed to treat to prevent hearing loss was 21.38,41 There was a small increase in recurrent fever in patients given corticosteroids (number needed to harm = 16) with no worse outcome.38,41, The best evidence supports the use of dexamethasone 10 to 20 minutes before or concomitantly with antibiotic administration in the following groups: infants and children with H. influenzae type B, adults with S. pneumoniae, or patients with Mycobacterium tuberculosis without concomitant human immunodeficiency virus infection.7,8,42,45 Some evidence also shows a benefit with corticosteroids in children older than six weeks with pneumococcal meningitis.45, Because the etiology is not known at presentation, dexamethasone should be given before or at the time of initial antibiotics while awaiting the final culture results in all patients older than six weeks with suspected bacterial meningitis. These conditions produce brain lesions that produce neurological symptoms. Benign recurrent lymphocytic meningitis (Mollaret meningitis), Drug-induced meningitis (e.g., non-steroidal anti-inflammatory drugs, trimethoprim/sulfamethoxazole), Alternative: meropenem (Merrem IV) plus vancomycin, Adults older than 50 years or with altered cellular immunity or alcoholism, Vancomycin plus ceftriaxone plus ampicillin, Patients with basilar skull fracture or cochlear implant, Patients with penetrating trauma or post neurosurgery, History of central nervous system disease, Seizure (in the previous 30 minutes to one week), Living in a household with one or more unvaccinated or incompletely vaccinated children younger than 48 months, 20 mg per kg per day, up to 600 mg per day, for four days, Close contact (for more than eight hours) with someone with, Single intramuscular dose of 250 mg (125 mg if younger than 15 years), Contact with oral secretions of someone with, Adults: 600 mg every 12 hours for two days, Not fully effective and rare resistant isolates, Children one month or older: 10 mg per kg every 12 hours for two days, Children younger than one month: 5 mg per kg every 12 hours for two days, Previous birth to an infant with invasive, Initial dose of 5 million units intravenously, then 2.5 to 3 million units every four hours during the intrapartum period, Colonization at 35 to 37 weeks' gestation, High risk because of fever, amniotic fluid rupture for more than 18 hours, or delivery before 37 weeks' gestation, Clindamycin susceptibility must be confirmed by antimicrobial susceptibility test. Clin Infect Dis. 5 % der bakteriellen Meningitiden des Erwachsenenalters aus. Your healthcare provider may look at the structures inside your eyes using a tool call an ophthalmoscope, which contains a light and various lenses. Young children may become very irritable and cry. 2015;35(6):611-620. doi:10.1055/s-0035-1564686, Akamatsu M, Maki F, Akiyama H, Hara D, Hoshino M, Hasegawa Y. Rheumatoid meningitis presenting with a stroke-like attack treated with recombinant tissue plasminogen activator: a case presentation. See permissions for copyright questions and/or permission requests. Lebensjahr sollen Kinder gegen Meningokokken geimpft werden, wobei gegen den häufigsten wenig immunogenen Serotyp B noch keine Impfung verfügbar ist. stiff neck. Usually, the complete blood count is normal in meningitis, but sometimes this test may detect white blood cell count (WBC) changes. Thank you, {{form.email}}, for signing up. Instead, a doctor will look for slightly elevated protein levels and elevated white blood cell counts. By Heidi Moawad, MD Your doctor may carry out the test if you experience other symptoms of meningitis, including: sickness. https://www.ncbi.nlm.nih.gov/books/NBK470365/, https://knowledgeplus.nejm.org/blog/suspected-bacterial-meningitis/, https://www.ncbi.nlm.nih.gov/books/NBK459360/, https://www.cdc.gov/meningitis/index.html, https://www.aafp.org/afp/2017/0901/p314.html, https://www.meningitis.org/meningitis/check-symptoms, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6025317/. Preparedness and Response. In 2010, overall, 14.3% of people with bacterial meningitis died. eMedicineHealth does not provide medical advice, diagnosis or treatment. 4. Repeating the LP can identify resistant pathogens, confirm the diagnosis if initial results were negative, and determine the length of treatment for neonates with a gram-negative bacterial pathogen until CSF sterilization is documented.7,47, Prognosis varies by age and etiology of meningitis. J Clin Med. UpToDate. CSF results can be variable, and decisions about treatment with antibiotics while awaiting culture results can be challenging. Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. The etiologies of meningitis range in severity from benign and self-limited to life-threatening with potentially severe morbidity. When you visit the site, Dotdash Meredith and its partners may store or retrieve information on your browser, mostly in the form of cookies. Mikrobiologische Untersuchungen am RKI von A-Z. Know the reason for your visit and what you want to happen. E. coli can spread through contaminated food, particularly when people . The analysis can also determine the type of meningitis, which can be viral, bacterial, fungal, or aseptic (unrelated to infection). An einer bakteriellen Meningitis bei erwachsenen Patienten verstirbt jeder Vierte. What role do imaging tests play in diagnosing meningitis? 02.04.2020 Meningitis ist eine Entzündung der schützenden Hautschichten, die das Gehirn und auch das Rückenmark umschließen. A spinal tap is the only test that can confirm a diagnosis of meningitis. Also known as a spinal tap, this is an invasive but largely safe procedure that involves removing cerebrospinal fluid and then analyzing it in a lab. Mycobacterium tuberculosis, which causes tuberculosis or TB, is a less common cause of bacterial meningitis (called TB meningitis). Bacterial meningitis is the second most common type. Die typische Symptomatik der bakteriellen Meningitis besteht aus Kopfschmerz, Nackensteifigkeit (Meningismus), Fieber und Bewusstseinstrübung. Labs and Tests Imaging Differential Diagnosis Meningitis is a condition that affects the meninges, which are layers of tissue that cover, protect, and cushion the brain and spinal cord. Because meningitis can be so serious, seeking immediate medical care is essential if one experiences the symptoms described above and think that meningitis could be the cause. They include: The outlook depends on the type of meningitis a person has. Der Allgemein- oder Notarzt sollte nur bei Verzögerung des Transports ins Krankenhaus Antibiotika schon vor der Einweisung verabreichen. Although not normally given to adults, the. It can also be used to help diagnose sepsis. The most common symptoms of meningitis are severe headache, stiff neck, and fever. Factors such as age – being either very young or very old – and having a weak immune system can increase the risk of death. We look at what causes it, the symptoms, and treatment options. Examination maneuvers such as Kernig sign or Brudzinski sign may not be useful to differentiate bacterial from aseptic meningitis because of variable sensitivity and specificity. Also, because the fluid around the skull may become blocked their heads may swell. In meningitis, however, this can become a problem. Die häufigsten neurologischen Spätfolgen einer bakteriellen Meningitis sind Hörstörungen, epileptische Anfälle, kognitive Beeinträchtigungen, Augenmuskel- sowie Extremitätenparesen. Your healthcare provider will ask you about your medical history and your symptoms. If you cannot take the person to the hospital, it is advisable to call an ambulance. Trends Neurosci 25: 38-45, 7. Ungeschützte enge Kontaktpersonen erhalten bis zu zehn Tage nach dem letzten Patientenkontakt eine Antibiotikaprophylaxe, die ohne Zeitverzögerung begonnen werden soll, mit einer einmaligen oralen Gabe von 500 - 750 mg Ciprofloxacin oder vier Dosen von je 600 mg Rifampicin (Kinder 10 mg/kg) alle 12 h über zwei Tage.