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Meningitis

German: Meningitis

1 Definition

The spinal cord and brain is covered by a transparent protective fluid called cerebrospinal fluid (CSF) and the spinal cord is covered by a thin sheath called meninges. The infection or inflammation of the meninges and the CSF is known as meningitis. Meningitis can be bacterial, viral and fungal. Depending on the etiology meningitis can be divided into:

  1. Viral meningitis: is less severe and self limiting.
  2. Bacterial Meningitis: is less common but more fatal.
  3. Fungal meningitis: Cryptococcal meningitis is a fatal form in patients with HIV. Other fungi associated with meningitis are Candida and aspergillus.

2 Route of infection

Meningitis can be caused due to direct infection or could be secondary to an ascending infection from other parts of the body. The most common source is the respiratory tract. The infective agents reach meninges from the bloodstream or directly from a nearby infection such as an ear infection or the nasopharynx. The causative agents survive well in the nervous system because of the lack of immune response.

Meningitis is spread by direct contact with the nasal and throat discharges of infected persons

3 Viral meningitis

Also known as aseptic meningitis. Most common etiology of viral meningitis are the viruses belonging to the group, enteroviruses such as coxachievirus and echovirus. Other viruses such as the herpes virus and varicella can also cause the viral meningitis.

3.1 Symptoms

Fever, severe headache, neck stiffness, photophobia, nausea, vomiting, lethargy and confusion are common symptoms. The symptoms might differ from person to person.

3.2 Diagnosis

Laboratory tests of the cerebro spinal fluid.

3.3 Treatment

Viral meningitis is self limiting. The symptoms usually last for 7 to 10 days. So there is not specific treatment. Supportive treatment should be instituted. Viral meningitis does not require treatment unless accompanied by encephalitis.

3.4 Prevention

Maintain good personal hygiene. Frequent hand washing with soap when in contact with persons with viral meningitis.

4 Bacterial Meningitis

Many types of bacteria can cause meningitis. The most common cause of bacterial meningitis in newborns is Escherichia coli, Group B Streptococcus and Listeria monocytogenes. In children older than two months of age Streptococcus pneumoniae and Neisseria meningitides are common.

4.1 Incubation period

The incubation period depends on the causative agent. The incubation period for meningococcal infection is 2-10 days. The usual range of incubation for most organisms causing meningitis is 2 days to 2 weeks.

4.2 Symptoms

  • Common symptoms in patients over the age of 2 years are high fever, headache and neck stiffness. These are the typical symptoms seen in both viral and bacterial meningitis. 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.
  • In advanced stages bruises may develop under the skin and spread rapidly.
  • Patients may present with seizures as the disease progresses further.

4.3 Diagnosis

The cerebro spinal fluid (CSF) is abnormal with elevated white cell count and protein, low glucose and gram staining may show bacteria. Culture and analysis of the CSF is done which is obtained by spinal tap. The CSF analysis determines if the causative organism is a bacteria or virus. The culture helps to identify the organism.

4.4 Treatment

early diagnosis is very important for the treatment and depends on the causative organism. When meningitis is suspected broad spectrum antibiotics should instituted depending on the age of the patient. After the organism has been isolated from the spinal fluid by culture then the organism specific antibiotics should be administered. Effective antibiotic treatment is possible if the diagnosis is made early.

4.5 Complications

advanced infection may lead to severe brain damage, coma and death. The survivors of severe infection may suffer from hearing loss, mental retardation, paralysis and seizures.

4.6 Prevention

  • Vaccines are available against Hib, Neisseria meningitides and Streptococcus pneumoniae.
  • Early identification of the disease and report to the local health authorities in order to treat close contacts with patients and prevent outbreaks.
  • Overseas travelers should take the meningococcal vaccine at least one week before their departure.

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