Meningitis is an inflammation of the meninges. The most common causes in adults are bacterial infections with Streptococcus pneumoniae, Neisseria meningitidis or Haemophilus influenzae. Aseptic meningitis may be caused by drugs (eg. NSAIDs, metronidazole and IV immunoglobulin), neoplasms or viruses. Typical signs and symptoms include severe headache, nuchal rigidity, fever, altered mental status, photophobia, phonophobia or vomiting.
Presentation
Most patients present with multiple symptoms. The most common symptoms of meningitis are fever, headache, neck stiffness and altered mental status. Other symptoms include nausea, vomiting, photophobia, confusion and irritability (exhibited by uncontrolled cry in children).
Signs elicited include bulging anterior fontanelle in children less than 18 months. Signs of meningeal irritation, focal neurological signs and some systemic findings are also present.
Entire Body System
- Fever
The most common symptoms of meningitis are fever, headache, vomiting, loss of appetite, tiredness, drowsiness or altered consciousness, irritability, stiff neck and sensitivity to light. Some people with meningitis can have seizures. [healthdirect.gov.au]
fever, neck stiffness, and altered mental status. [ncbi.nlm.nih.gov]
Article continues below Common Symptoms Meningitis can start suddenly, and early symptoms may include one or more of the following: Fever. Running a fever is a common part of the immune system’s defense against infections. [spine-health.com]
Older adults and people with other medical problems may have only a slight headache and fever. Treatment depends on the cause. Bacterial meningitis can be deadly if not treated right away. [vch.ca]
- High Fever
An infant presented to our hospital with high fever and irritability, as well as refusal to walk. Cerebrospinal fluid collected through lumbar puncture showed increased eosinophil count and third-stage Angiostrongylus cantonensis larvae. [ncbi.nlm.nih.gov]
He had a chesty cough and runny nose for a week and developed a high fever two days before he was rushed to the hospital. He became cranky and less active, cried a lot and refused to drink milk. [thestar.com.my]
[…] are symptoms to look for in children: Irritability Vomiting from a high fever Frequent crying Swelling of the head Lack of appetite Seizures (sometimes also seen in adults if the meningitis is advanced) Symptoms typically come on quickly, in as little [columbianeurology.org]
You should get medical care right away if you have A sudden high fever A severe headache A stiff neck Nausea or vomiting Early treatment can help prevent serious problems, including death. [medlineplus.gov]
- Fatigue
[…] left with one of more permanent problems and suffer physical, neurological and physiological after-effects Viral meningitis is usually less serious than bacterial meningitis but can still leave people with long-lasting after-effects, such as headaches, fatigue [meningitisnow.org]
The symptoms may include fever, headache, stiff neck and fatigue. Rash, sore throat and intestinal symptoms may also occur. How soon do symptoms appear? Symptoms generally appear within one week of exposure. [health.ny.gov]
Symptoms may include: Headache Sensitivity to light ( photophobia ) Slight fever Upset stomach and diarrhea Fatigue Bacterial meningitis is an emergency. You will need immediate treatment in a hospital. [nlm.nih.gov]
Symptoms may include: Headache Sensitivity to light (photophobia) Slight fever Upset stomach and diarrhea Fatigue Bacterial meningitis is an emergency. You will need immediate treatment in a hospital. [medlineplus.gov]
- Malaise
Coxsackieviruses) or a more severe usually life-threatening illness caused by a bacterium (especially the meningococcus, Neisseria meningitides, or the serotype designated B of Haemophilus influenzae) Note: Meningitis is often marked by fever, headache, vomiting, malaise [merriam-webster.com]
The initial presenting complaints for patients with the WFS usually include a diversity of nonspecific, vague symptoms such as cough, dizziness, headache, sore throat, chills, rigors, weakness, malaise, restlessness, apprehension, myalgias, arthralgias [ncbi.nlm.nih.gov]
Common side-effects are minor and include fever; pain or redness around the injection site; fatigue and malaise; irritability. Very rarely, an allergic response to the vaccine may occur, leading to anaphylaxis or a rash. [victoria.ac.nz]
Incubation period The average incubation period is 4 days, ranging between 2 and 10 days Signs and Symptoms High fever Severe headache, Vomiting or Nausea with Headache Generalised malaise, Confusion Seizures Sleepiness or Difficulty waking up Stiff neck [kznhealth.gov.za]
- Unconsciousness
Older children may also: have a stiff neck have a headache have joint pain and aching muscles not like bright lights be drowsy, confused, delirious or unconscious. All children may have fits or convulsions. [plunket.org.nz]
The man in his 20s was found positive for the coronavirus on March 7 and is unconscious with a fever, pneumonia and meningitis, Yamanashi Prefecture and public broadcaster NHK said. [japantoday.com]
The man in his 20s was found positive for the coronavirus on March 7 and is unconscious with a fever, pneumonia and meningitis, Yamanashi prefecture and public broadcaster NHK said. [straitstimes.com]
Image copyright Matthew Griffin Image caption Matthew said he was supported by girlfriend Xiola Johnson, who sat for hours with him in intensive care while he was unconscious He advised students look into the MenACWY vaccine, which can protect against [bbc.com]
Severe life threatening situations should be managed first by rehydrating patients who are in shock and are hypovolemic, managing seizures and securing the airway if unconscious. [symptoma.com]
Gastrointestinal
- Vomiting
The most common symptoms of meningitis are fever, headache, vomiting, loss of appetite, tiredness, drowsiness or altered consciousness, irritability, stiff neck and sensitivity to light. Some people with meningitis can have seizures. [healthdirect.gov.au]
After 2 months of the illness, he was admitted to our hospital with a persistent headache, vomiting and altered sensorium. CSF for cytospin confirmed myeloid blasts. He was still in haematological remission. [ncbi.nlm.nih.gov]
The main symptoms to look out for are fever, vomiting, headache, stiff neck, sensitivity to light, and drowsiness or altered consciousness. The signs and symptoms do not appear in a definite order and some may not appear at all. [meningitis.com.au]
Other symptoms include photophobia, nausea, vomiting, lethargy and confusion. In newborns the typical symptoms are hard to detect. They usually present with inactivity, irritability, vomiting and poor feeding. [flexikon.doccheck.com]
Common signs & symptoms of meningitis and septicaemia Fever, cold hands and feet Vomiting Drowsy, difficult to wake Confusion and irritability Severe muscle pain Pale, blotchy skin. [meningitisnow.org]
- Nausea
Other symptoms include photophobia, nausea, vomiting, lethargy and confusion. In newborns the typical symptoms are hard to detect. They usually present with inactivity, irritability, vomiting and poor feeding. [flexikon.doccheck.com]
Other symptoms are nausea, vomiting, inability to look bright lights, confusion, irritability and confusion. In babies, there will be a characteristic high-pitched cry. [symptoma.com]
Symptoms can include fatigue, nausea, loss of appetite, and yellowing of the skin. [carthage.edu]
A stiff neck Headache Sensitivity to light Vomiting or nausea In addition, babies with meningitis can have a bulging soft spot in their skull Bacterial meningitis is a medical emergency. [rush.edu]
- Loss of Appetite
[…] of appetite, refusing food (infants) Muscle, leg or joint pain Neck retraction with arching of the back (infants) Pale or blotchy skin Rash or spots that don’t fade with pressure (also called purpure or petechiae )* Rapid breathing Seizures, fits or [meningitis.com.au]
The most common symptoms of meningitis are fever, headache, vomiting, loss of appetite, tiredness, drowsiness or altered consciousness, irritability, stiff neck and sensitivity to light. Some people with meningitis can have seizures. [healthdirect.gov.au]
Symptoms can include fatigue, nausea, loss of appetite, and yellowing of the skin. [carthage.edu]
Common symptoms are: High fever Irritability Lethargy and drowsiness Vomiting and loss of appetite Headache. [schn.health.nsw.gov.au]
Cardiovascular
- Tachycardia
Some factors have however been identified that could worsen the prognosis and they include: Advanced age Low Glasgow Coma Scale Tachycardia Reduced CSF leucocyte count Presence of gram-positive cocci on gram staining Late intervention in bacterial meningitis [symptoma.com]
However, in children with MD and severe tachycardia (possibly requiring further fluid resuscitation) the chronotropic effect of dobutamine can lead to unacceptable tachycardia and further hemodynamic instability. [scielo.br]
Immediate resuscitation if required Clinical signs of shock or hypovolaemia are hypotension, poor peripheral perfusion, cool pale extremities, tachycardia with low volume pulses, high blood lactate or large base deficit. [rch.org.au]
Examination Reduction in lung capacity may produce tachypnoea and tachycardia. Examination of the chest will reveal dullness to percussion over the effusion. There will be decreased breath sounds and decreased tactile vocal fremitus. [patient.info]
Eyes
- Photophobia
Neck stiffness and photophobia are often absent in infants and young children who may manifest nonspecific signs such as irritability, inconsolable crying, poor feeding, and a bulging fontanel. [orpha.net]
Other symptoms include photophobia, nausea, vomiting, lethargy and confusion. In newborns the typical symptoms are hard to detect. They usually present with inactivity, irritability, vomiting and poor feeding. [flexikon.doccheck.com]
Regardless of the particular type of bacteria causing the meningitis, the classical features of the disease include headache, neck stiffness, photophobia (aversion to light), vomiting and fever. Joint pain and drowsiness may also occur. [irishtimes.com]
Clinical manifestations include fever; nuchal rigidity; photophobia; seizures; hearing loss, sensorineural; coma; and cerebrovascular thrombosis. [icd9data.com]
Typical signs and symptoms include severe headache, nuchal rigidity, fever, altered mental status, photophobia, phonophobia or vomiting. Most patients present with multiple symptoms. [symptoma.com]
- Diplopia
659-669, Case 5-2018, 2018 Antibody-Mediated Encephalitis NEJM 378:840-851, Dalmau, J.,et al, 2018 Varicella-Zoster Virus-Related Hemorrhagic Encephalomyelitis Neurol 90:e1360-e1361, Ganesh, A.,et al, 2018 A 56-year-old woman with acute vertigo and diplopia [neudle.com]
These episodes resolve spontaneously and are followed by symptom-free periods of weeks to months Transient neurological abnormalities, including seizures, diplopia, pathologic reflexes, cranial nerve pareses, hallucinations, and coma, occur in as many [emedicine.medscape.com]
Approximately one-half of patients have transient neurological manifestations, including seizures, hallucinations, diplopia, cranial nerve palsies, or altered levels of consciousness. [web.archive.org]
Four months later, he complained of headache, diplopia and severe hearing impairment in the left ear. There was no evidence for bacterial, fungal, tuberculous infection or neoplastic infiltration. [science.gov]
Diplopia With Dural Fibrotic Thickening. Seminars in Pediatric Neurology, Vol. 26, Issue., p. 83. [cambridge.org]
- Eye Pain
Symptoms of meningitis Meningitis is commonly manifested by: severe headache vomiting high fever stiffness of the neck sensitivity and eye pain on exposure to light skin rash Symptoms can differ in young children and babies. [news-medical.net]
Symptoms may include: a very bad headache that won't go away neck stiffness back stiffness eye pain when exposed to light nausea, or being sick to the stomach vomiting, or throwing up body aches fever feeling very sleepy or unable to fully wake up feeling [brennerchildrens.org]
Eye sensitivity and eye pain from bright lights. Dark purple and blotchy skin rash. Dizzy spells. Babies, young children, older adults, and people with other medical conditions may not have the usual symptoms of meningitis. [healthy.kaiserpermanente.org]
[…] around one eye and are accompanied by autonomic symptoms (tearing, runny nose and red eye).[6] Temporomandibular jaw pain (chronic pain in the jaw joint), and cervicogenic headache (headache caused by pain in muscles of the neck) are also possible diagnoses [en.wikipedia.org]
Musculoskeletal
- Myalgia
The initial presenting complaints for patients with the WFS usually include a diversity of nonspecific, vague symptoms such as cough, dizziness, headache, sore throat, chills, rigors, weakness, malaise, restlessness, apprehension, myalgias, arthralgias [ncbi.nlm.nih.gov]
In the acute form, brucellosis takes the form of a flulike illness, with fever, sweats, malaise, anorexia, headache, myalgia, and back pain. [emedicine.medscape.com]
[…] neck is flexed) Difficulty touching the chin to the chest with the mouth closed Difficulty touching the forehead or chin to the knee Nuchal rigidity can be distinguished from neck stiffness due to cervical spine osteoarthritis or influenza with severe myalgia [merckmanuals.com]
- Neck Pain
See How Neck Pain and Headache Can Occur Together Stiff neck. This symptom most commonly involves a reduced ability to flex the neck forward, also called nuchal rigidity. [spine-health.com]
Neck pain and stiffness – this does NOT apply to sore throat pain in the front of the neck. It refers to severe pain in back of the neck. Looking down at your stomach (stretching the back of your neck) will cause severe pain. [askdrsears.com]
See also[edit] Neck pain Acquired torticollis References[edit] ^ "Neck pain". MedlinePlus. National Institutes of Health. 5 March 2015. Retrieved 27 October 2015. ^ "Neck pain and stiff neck". NHS Choices. National Health Service. 10 December 2014. [en.wikipedia.org]
METHODS :A 43-year-old male patient presented with 'neck pain for 15 days, exacerbated accompanying motor and sensory dysfunction of lower limbs with bowel and bladder dysfunction for 4 days' was admitted to our department. [paper.medlive.cn]
Neck pain and stiffness are common symptoms of meningitis. It can sometimes cause the head, neck, and spine to become rigid and arch backwards (opisthotonos). This is more likely to happen to infants and young children. [healthline.com]
- Low Back Pain
In 2012, fungal meningitis was linked to a contamination in a specific steroid product, methylprednisolone, manufactured in a single pharmacy and injected in the spine of people suffering from low back pain. [emedicinehealth.com]
Herein, we report a 62-year-old man with a 4-wk history of progressive low back pain with radiation to bilateral lower legs, dysphagia and body weight loss. [science.gov]
Ears
- Hearing Impairment
Our findings suggest that S. suis infection should be considered when hearing impairment is present in a patient with bacterial infection and that MRI can help detect ventriculitis, which can necessitate a prolonged treatment duration. [ncbi.nlm.nih.gov]
Twenty one children (17%) had hearing impairments detected at the time of their first OAE recordings. No children developed hearing loss at a later stage. [doi.org]
- Hearing Problem
They may need a hearing test, as a small number of children who have had meningitis develop problems with their hearing. Some children may be left with permanent damage and disability following meningitis. [rch.org.au]
However, long-term complications can include: headaches learning problems memory loss hearing problems speech problems vision problems weakness or paralysis seizures scarring or skin damage kidney damage Some types of meningitis can pass from person to [medicalnewstoday.com]
These include: Hearing loss. This is the most common complication. It is common to have a hearing test after you have recovered from meningitis. Learning problems. [patient.info]
Skin
- Skin Rash
The symptoms of meningococcal disease in babies and young children include: fever, food refusal, fretfulness, drowsiness, purple-red skin rash or bruising skin rash that does not turn skin-coloured when you press on it with a finger or the side of a clear [healthdirect.gov.au]
The symptoms of meningitis in babies and young children include: fever, food refusal, fretfulness, drowsiness, purple-red skin rash or bruising, high moaning cry, light sensitivity and pale or blotchy skin. [brainfoundation.org.au]
The classical rash of meningitis is actually caused by the infection spreading to the bloodstream. This condition is called septicaemia and leads to the appearance of a purple pinprick rash on the skin. [irishtimes.com]
[…] will get a rash. [meningitis.com.au]
- Petechiae
When a patient presents with fever and petechiae, WFS must be considered, even when the patient has a non-toxic appearance. [ncbi.nlm.nih.gov]
Fever Irritability Listless, less responsive Loss of appetite, refusing food (infants) Muscle, leg or joint pain Neck retraction with arching of the back (infants) Pale or blotchy skin Rash or spots that don’t fade with pressure (also called purpure or petechiae [meningitis.com.au]
In babies and adults, a meningitis rash may look like the following: tiny red, pink, brown, or purple pinprick marks (petechiae) on the skin purple bruise-like marks blotchy-appearing areas of skin pale or mottled areas of skin The meningitis rash may [medicalnewstoday.com]
Next, they invade the blood, introducing toxic substances into the circulation and causing fever; if the infection is caused by N. meningitidis, a rash may appear and develop into hemorrhagic spots (petechiae and purpura) in severe cases. [britannica.com]
- Blister
Septicaemia Rash - starts as tiny red pin prick marks and develops into purple bruises or blood blisters Fever Throwing up repeatedly Very cold hands and feet Rapid breathing Pains in limbs, joints, muscles Stomach pain - sometimes diarrhoea Difficulty [services.su.nuigalway.ie]
These marks can later change into larger red or purple blotches and into blood blisters. The rash can be harder to see on darker skin, so check on the palms of the hands or the soles of the feet. [independent.ie]
Look out for tiny red or brown pin-prick marks which can change into larger red or purple blotches and blood blisters. [meningitis.org]
Lesions or blood blisters may form. The infection can spread quickly. Seek medical attention if your infant has fever with a rash. Another sign of meningitis concerns the soft spot on top of a baby’s head (fontanel). [healthline.com]
Meningococcal septicaemia: Rash that develops into a bruise-like rash or blood blisters - marks do not fade in the ‘tumbler test' Fever Abdominal pain/diarrhoea Rapid breathing Muscle pain Severe drowsiness Vomiting Cold hands and feet Confusion. [irishhealth.com]
- Eruptions
/or headaches anorexia nuchal rigidity (often not present, especially in young children and infants) positive Kernig’s or Brudzinski’s sign altered mental status shock seizures focal neurological deficit petechial rash (an erythematous maculopapular eruption [childrens.health.qld.gov.au]
Migration in subcutaneous tissues induces a linear dermatitis with light to moderate pruritus, usually localized to the abdomen and later in multiple skin areas, known as creeping eruption or CLM. [dx.doi.org]
Neurologic
- Meningism
These infections are known as bacterial meningitis and viral meningitis, respectively. [meningitis.emedtv.com]
Viral (Aseptic) Meningitis Provides frequently asked questions about viral meningitis, several viruses cause Meningitis. [health.state.mn.us]
Meningitis Meninges of the central nervous system: dura mater, arachnoid mater, and pia mater. [en.wikipedia.org]
Meningitis is an inflammation of the meninges. The meninges are the membranes surrounding the brain and spinal cord. [healthdirect.gov.au]
Treatment of bacterial meningitis is with intravenous antibiotics, given immediately on suspicion of meningitis and preferably before hospital admission. [irishtimes.com]
- Headache
[…] the first description of post-LP headache. 6 Headache and backache are the most frequently reported adverse events associated with LP. [doi.org]
There is no treatment for viral meningitis other than controlling symptoms such as headache, which can be severe, and most people make a rapid and full recovery with rest and extra fluids. [healthdirect.gov.au]
Reinsertion of the stylet before needle removal decreased the risk of headache (ARR, 11.3%; 95% CI, 6.50%-16.2%). [ncbi.nlm.nih.gov]
- Seizure
We report a rare case of large frontal sinus osteoma with intracranial extension, associated with meningitis and the development of seizures. [ncbi.nlm.nih.gov]
Clinical manifestations include fever; nuchal rigidity; photophobia; seizures; hearing loss, sensorineural; coma; and cerebrovascular thrombosis. [icd9data.com]
Less frequent presentations of CNS tuberculosis include atypical febrile seizures in children, isolated cranial nerve palsies, bilateral papilledema, and acute confusional states. [emedicine.medscape.com]
Seizures along with a fever may be the first signs of meningitis, although most brief, generalized (so-called tonic-clonic) convulsions turn out to be simple febrile seizures, not meningitis. A rash also may be a symptom of this condition. [healthychildren.org]
- Confusion
Symptoms: Severe headache Stiff neck Dislike of bright lights Fever Throwing up repeatedly Severe sleepiness or confusion Rash Remember: Not everyone gets all these symptoms. They can occur in any order. [services.su.nuigalway.ie]
Other symptoms are nausea, vomiting, inability to look bright lights, confusion, irritability and confusion. In babies, there will be a characteristic high-pitched cry. [symptoma.com]
[…] especially the meningococcus, Neisseria meningitides, or the serotype designated B of Haemophilus influenzae) Note: Meningitis is often marked by fever, headache, vomiting, malaise, and stiff neck, and if left untreated in bacterial forms, may progress to confusion [merriam-webster.com]
Other symptoms include photophobia, nausea, vomiting, lethargy and confusion. In newborns the typical symptoms are hard to detect. They usually present with inactivity, irritability, vomiting and poor feeding. [flexikon.doccheck.com]
Just over one-third associates confusion/irritability with meningitis. Awareness of other symptoms is higher: 84% of parents know about rash, 73% about stiff neck and 66% about dislike of bright light or headache. [irishexaminer.com]
- Irritability
An infant presented to our hospital with high fever and irritability, as well as refusal to walk. Cerebrospinal fluid collected through lumbar puncture showed increased eosinophil count and third-stage Angiostrongylus cantonensis larvae. [ncbi.nlm.nih.gov]
Signs are those of sepsis, CNS irritation (eg, lethargy, seizures, vomiting, irritability [particularly paradoxical irritability], nuchal rigidity, a bulging or full fontanelle), and cranial nerve abnormalities. Diagnosis is by lumbar puncture. [msdmanuals.com]
Other symptoms are nausea, vomiting, inability to look bright lights, confusion, irritability and confusion. In babies, there will be a characteristic high-pitched cry. [symptoma.com]
These primary symptoms can be accompanied by nausea, vomiting, photophobia, confusion and irritability. Some of these classic signs and symptoms cannot be detected in an infant in whom lethargy and irritability are important signs. [ehagroup.com]
Trust your instincts,” he urges, citing signs that can occur in some patients: slight fever, sore throat, general aches/pains, irritability and appetite loss. [irishexaminer.com]
Workup
Laboratory tests
- Blood studies like serum electrolytes, serum glucose and blood urea nitrogen.
- Cultures like blood and urine culture.
- Lumbar puncture for CSF analysis [5] – Intracranial pressure should be checked before this procedure to avoid cerebral herniation. Focal neurological signs might suggest herniation.
- Syphilis testing
- HIV screening
Imaging
CT scan is not routinely done but may be required when then are signs of focal neurological deficit.
Treatment
This involves treating the active infection and managing complications. The medication used is dependent on the type of meningitis. Severe life threatening situations should be managed first by rehydrating patients who are in shock and are hypovolemic, managing seizures and securing the airway if unconscious. Medications that are used are dependent on a wide range of variable like causative organism, age of patient and complications. Such medication may include:
- Antibiotics: Sulfonamides, tetracyclines, carbapenems, fluoroquinolones, penicilins, cephalosporins.
- Antivirals
- Antifungals
- Antituberculosis agents
- Corticosteroids [6]
- Diuretics like osmotic and loop diuretics
- Anticonvulsants like hydantoins and barbiturates
Prognosis
Meningitis is a medical emergency and if treated early, some patients can attain full remission. Some factors have however been identified that could worsen the prognosis and they include:
- Advanced age
- Low Glasgow Coma Scale
- Tachycardia
- Reduced CSF leucocyte count
- Presence of gram-positive cocci on gram staining
Late intervention in bacterial meningitis could lead to permanent brain damage or death. 50% of survivors develop complications like deafness [3], blindness, cranial nerve palsy and hydrocephalus amongst others.
Etiology
Meningitis is caused by a number of agents including:
- Bacteria: This is the commonest cause and agents include H. influenza, S. pneumonia and N. meningitidis.
- Viruses: Some viruses that can cause meningitis are enterovirus and West Nile virus.
- Parasites: This is a very rare cause of meningitis and is fatal in most cases [4].
- Fungi: This is usually as a result of background immunosuppression and some of the organisms implicated are C. neoformans
- Drugs: NSAIDs, IV immunoglobulin and metronidazole.
There are some risk factors that make an individual more susceptible to some particular pathogens, like age and immune status.
Epidemiology
The incidence of meningitis is higher in developing countries because of the poor health sectors which is highlighted by the limited availability of preventive measures like vaccination. The incidence is also dependent on the type of meningitis.
Most meningitis forms affects the extremes of age. Children are particular susceptible to many forms of meningitis [2]. Neonates have the highest risk. Individuals older than 60 years are also at increased risk for meningitis infection.
Sex distribution is equal for most forms of meningitis, although overall, it is slightly more common in males. Meningitis is more common in blacks than in Caucasians and Asians. A particular form, meningococcal meningitis, is endemic in tropical regions alike sub-Saharan Africa and India, and there have been recorded periodic outbreak of epidemics.
Pathophysiology
Pathogens that cause meningitis can get to the meninges in three major ways:
- Through the blood stream which is the most common route of spread for most pathogens.
- Through a retrograde neuronal pathway.
- Through local contiguous spread.
The first event is invasion of the meninges by the pathogens. The exact method of how they cross the blood-brain barrier is poorly documented but it is usually preceded by an overwhelming sepsis. This triggers an inflammatory response and inflammatory cells cross the now porous blood-brain barrier to enter the brain. There is then predominance of lymphocytes or neutrophils based on the pathogen responsible. This process further worsens the condition as it leads to brain swelling and then ischemia of parts of the brain [1]. The inflammatory cells increased the membrane permeability and alter normal chemical contents of the cerebrospinal fluid like glucose and protein.
Prevention
The mainstay of prevention of meningitis is vaccination [7]. Vaccination should be given to individuals who are susceptible to H. influenza and S. pneumonia. Also, individuals who live in and those who travel to endemic areas should be vaccinated against N. meningitidis. Researchers who work with the bacteria should also be vaccinated against it.
Chemoprophylaxis is a second form of prevention and is usually reserved for individuals who have had prior exposure to H. influenza, S. pneumonia and N. meningitidis. Rifampin is the drug of choice. Ceftriaxone can also be used.
Summary
Meningitis is defined as inflammation of the meninges. The meninges are the three layers of membrane that enclose the brain and spinal cord. Meningitis is a disease of the membranes covering the brain. It is often an infectious disease with bacteria being the commonest cause. It manifests via a myriad of CNS symptoms and could result in permanent disability or death. Meningitis is a medical emergency.
Patient Information
Definition
Meningitis is an infection of the layers covering the brain.
Cause
The cause of meningitis are mainly microorganisms although some people at higher risk of meningitis, like very young children and people who are old. People who have an infection is areas close to the brain, like the ear and throat are also at increased risk of getting this disease.
Signs and symptoms
The common symptoms are fever, headache and neck stiffness. Other symptoms are nausea, vomiting, inability to look bright lights, confusion, irritability and confusion. In babies, there will be a characteristic high-pitched cry. Meningitis is an emergency and if any of this symptoms are noted, the individual should be taken to the hospital immediately.
Diagnosis
Diagnosis involves a series of blood tests to check the level of sugar and protein and also to check for infection of the blood. Part of the fluid surrounding the brain, the cerebrospinal fluid is also checked to know the cause of the meningitis. CT scan may also be required.
Treatment
Treatment of meningitis involves mainly, to treating the underlying cause of the disease. Other supportive therapies are instituted as well as treatment of complications that may arise.
References
- Berkhout B. Infectious diseases of the nervous system: pathogenesis and worldwide impact. IDrugs. Nov 2008;11(11):791-5.
- Thigpen, M, Rosenstein, NE, Whitney, CG. Bacterial meningitis in the United States--1998-2003. Presented at the 43rd Annual Meeting of the Infectious Diseases Society of America, San Francisco, CA. October 2005;65.
- Worsøe L, Cayé-Thomasen P, Brandt CT, Thomsen J, Østergaard C. Factors associated with the occurrence of hearing loss after pneumococcal meningitis. Clin Infect Dis. Oct 15 2010;51(8):917-24.
- Ramirez-Avila L, Slome S, Schuster FL, Gavali S, Schantz PM, Sejvar J, et al. Eosinophilic meningitis due to Angiostrongylus and Gnathostoma species. Clin Infect Dis. Feb 1 2009;48(3):322-7.
- Seupaul RA. Evidence-based emergency medicine/rational clinical examination abstract. How do I perform a lumbar puncture and analyze the results to diagnose bacterial meningitis?. Ann Emerg Med. Jul 2007;50(1):85-7.
- Brouwer MC, Heckenberg SG, de Gans J, Spanjaard L, Reitsma JB, van de Beek D. Nationwide implementation of adjunctive dexamethasone therapy for pneumococcal meningitis. Neurology. Oct 26 2010;75(17):1533-9.
- Advisory Committee on Immunization Practices (ACIP). Updated recommendations for use of meningococcal conjugate vaccines. MMWR Morb Mortal Wkly Rep. Jan 28 2011;60(3):72-6.