The first step is to ensure no bacterial meningitis is present, which would require certain antibiotics to be quickly started. Ultimately, the best way to diagnose meningitis is with a lumbar puncture . In this procedure, a needle is slipped between the bones of the back into a sac of cerebrospinal fluid (CSF) well below where the spinal cord actually ends. Doctors then look for signs of inflammation, such as more white blood cells in the CSF than expected. A gram stain is used to look for bacteria. Glucose and protein are measured as well. If glucose is too low, it may be because additional cells are gobbling up that sugar.
In an accompanying editorial (Dtsch Arztebl Int 2017; 114: 463-4), Peter Bischoff and Petra Gastmeier of the institute for hygiene and environmental medicine [Institut für Hygiene und Umweltmedizin], Charité—Universitätsmedizin Berlin, take a clear position: "After almost 40 years of ongoing discussion, it is time to abandon completely the requirement for septic and aseptic surgical areas to be separated and thus make it possible to act more flexibly and cost-efficiently in everyday surgical practice." Routinely cleaning and disinfecting surfaces and devices after each procedure and implementing confirmed evidence-based measures minimizes the risk of postoperative wound infection in surgical patients.