a. 60505, E31.22 b. 60505, E31.21 c. 60500, E31.21 d. 60502, E31.22 How is Streptococcal A Meningitis reported in ICD-10-CM? a. Only Streptococcal, group A, as the cause of diseases classified elsewhere is reported. b. Only one code is reported for streptococcal meningitis.
Streptococcal meningitis is reported first; Streptococcal, group A, as the cause of diseases classified elsewhere is reported second. d. Streptococcal meningitis is reported first; Streptococcal, group A, as the cause of diseases classified elsewhere is reported second.
Streptococcal meningitis is a severe, life-threatening infection. It may pose a diagnostic challenge, especially in infants, because these patients may exhibit non-specific signs. The most vital for a patient outcome is fast diagnosis and treatment.
The pivotal test for the diagnosis of meningitis (including streptococcal) is cerebrospinal fluid (CSF) examination. It is required to confirm the diagnosis, identify the causative bacterial pathogen, and, therefore, to implement de-escalated treatment later on.
In most cases the manifestation codes will have in the code title, "in diseases classified elsewhere.". Codes with this title are a component of the etiology/manifestation convention. The code title indicates that it is a manifestation code.
The 2022 edition of ICD-10-CM G00.2 became effective on October 1, 2021.
Streptococcal meningitis is an acute, purulent inflammation of the membranes surrounding the brain and spinal cord caused by bacteria from the Streptococci species. This condition requires prompt diagnosis and treatment to avoid the high morbidity and morbidity associated with its complications. This activity reviews the evaluation and treatment of Streptococcal mening itis and highlights the role of the interprofessional team in managing patients with this condition.
In neonates, S . agalactiaeis one of the leading pathogens responsible for meningitis. In the U.S., from 2006 to 2015, early-onset disease (onset at 0 to 6 days of life, EOD) incidence decreased from 0.37 to 0.23 per 1000 live births, mainly due to intrapartum antibiotic prophylaxis. Late-onset disease (LOD) rates were stable in those years.[4] The global incidence of invasive GBS disease in infants is 0.49 per 1000 live births, with the highest numbers in Africa.[5] Other groups of streptococci rarely cause meningitis. S. viridansaccounts for 0.3% to 3.0% of cases of bacterial meningitis in adults and 1% in children.[6] Group A streptococcal meningitis was diagnosed in 2% of the cases of community-acquired bacterial meningitis. [7]
The pivotal test for the diagnosis of meningitis (including streptococcal) is cerebrospinal fluid (CSF) examination. It is required to confirm the diagnosis, identify the causative bacterial pathogen, and, therefore, to implement de-escalated treatment later on. CSF should be obtained as soon as bacterial meningitis is suspected unless contraindications for urgent lumbar puncture (LP) are present. Contraindications for immediate LP include risk of herniation, uncorrected coagulopathy, or critical condition of the patient. According to the Infectious Diseases Society of America guidelines, head CT before LP is warranted in the case of focal neurologic deficit, abnormal level of consciousness, papilledema, seizure within one week of presentation, history of central nervous system disease, and an immunocompromised state. During LP, samples of CSF are taken and sent for physical and chemical characteristics, cell count, Gram stain, latex agglutination test (LAT), culture, and, if available, polymerase chain reaction (PCR). CSF examination in patients with streptococcal meningitis usually shows neutrophilic pleocytosis (white blood count of 500/ microL or higher), elevated lactate level, and lowered CSF/serum glucose ratio. CSF leukocyte count less than 50/mm^3 and elevated CSF protein level (at least 660 mg/dL) were poor prognostic factors in children with pneumococcal meningitis.[15] CSF Gram staining results in the initial identification of bacteria. LAT detects antigens of few pathogens, among them S. pneumoniae. Results are provided in a short time. The causative pathogen is confirmed by positive culture from the CSF sample; however, in a study comparing traditional culture and antigen detection methods, less than half of the cases of bacterial meningitis were culture positive.[16] Another option was PCR, especially valid when previously using antibiotics. The use of the PCR test in determining the etiology of bacterial meningitis is increasing. However, it recognizes only several types of bacteria – the ones included in the primer mix. In the previously mentioned study, LAT proved to be more sensitive compared to conventional Gram stain and culture technique in identifying the specific organisms like H. influenzae, S. pneumoniae, and Group B Streptococcus. Nevertheless, the combination of culture, Gram stain, and LAT was more effective than any single method alone. [16]
Clinical signs of neonatal and infant meningitis are usually non-specific, including irritability or lethargy, fever or hypothermia, poor feeding, and vomiting with diarrhea. More specific signs on the physical examination like bulging fontanel, nuchal rigidity, and seizures in neonates are usually late findings.[12] In the study of Amarilyo et al., half of the enrolled patients with meningitis with open fontanel had bulging fontanel.[13] This study enrolled children aged two months to 16 years with suspected meningitis - Kernig's and Brudzinski's signs had a sensitivity of 27% and 51%, respectively, with a high positive predictive value of 77% and 81%, respectively. Classic meningeal signs are often absent in infants less than six months. Weber et al. proved that reduced feeding, the appearance of being very sick, being lethargic or unconscious, neck stiffness, and a bulging fontanel are the variables associated independently with meningitis in children aged two months to 3 years. [14]
Symptoms of bacterial meningitis, including Streptococcal, can develop either suddenly or over a few days. Typically they are present 3 to 7 days after exposure. There are no specific symptoms that allow recognition of causative agents of bacterial meningitis based solely on history taking and examination.
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Supportive care, including fluid management, reduction of intracranial pressure, antipyretics, and analgesics, are valid parts of the therapy.