Meningitis

Definition

Meningitis is a condition characterized by high fever, stiffness of neck, altered consciousness, confusion due to inflammatory changes of the protective membrane, meninges, surrounding the brain and spinal cord. Inflammation of the meninges occurs due to an infection by bacteria, virus, fungi or other microorganisms. Immunocompromised patients due to HIV/AIDS are at a greater risk of developing meningitis.

Meningitis may lead to permanent hearing loss, blindness, poor mental development even death. Treatment depends upon the cause of meningitis. Usually viral infection resolves on its own within a short period and no specific treatment is necessary. Antibiotics and antifungals are prescribed depending upon the other infecting organisms, which without treatment can be deadly.

Symptoms

Early symptoms of meningitis are often confused with that of flu (seasonal influenza). Symptoms in patients above 2 years age include :

  • High fever
  • Severe headache
  • Confusion
  • Drowsiness
  • Stiffness of neck
  • Increased sensitivity to sound and light
  • Nausea and vomiting
  • Convulsions
  • Rapidly spreading rashes to limbs, trunk, conjunctiva and mucosal membrane may sometimes be associated with meningitis, caused by Neisseria meningitides.

Children less than 2 years of age may not present with specific symptoms mentioned above and cannot report symptoms.  Instead parents and caregivers need to take note of :

  • Inconsolable crying with high fever.
  • Irritability and drowsiness.
  • Lack of interest in surroundings or toys.
  • Difficulty in feeding.
  • Bulging of the soft spots on the scalp with stiff neck.

Meningitis may lead to complications like :

  • Sepsis characterized by rapidly falling blood pressure, rapid pulse rate and rapid shallow breathing.
  • Disseminated intravascular coagulation characterized by widespread coagulation of blood leading to increased bleeding tendency.
  • The rashes seen especially in meningococcal meningitis may become infected.
  • Bleeding in adrenal gland.
  • Swelling of brain tissue and causing loss of consciousness, abnormal posture, convulsion or coma.
  • Nerves may be suppressed causing permanent hearing, visual loss, muscle weakness and even paralysis.
  • Kidney failure.
  • Long term behavioral, developmental and learning defects.
  • Death.

Causes

The meninges consist of three membranes which sits between the brain or spinal cord and surrounding bone. Infective microorganisms reach the meninges either directly through nasal cavity or via the blood stream. The immune system releases large amount of toxic chemicals and recruits immune cells against the infective organisms which lead to the inflammatory changes of the meninges and swelling of the brain.

Infective organisms responsible includes :

  • Bacteria: type of bacteria usually depends upon the age of the patient, like :
    – In premature babies and babies less than 3 months: group B streptococcus, E.coli and Listeria.
    – In older children and adults, Neissseria, Streptococcus pneumonia and H. influenzae.
    – Tubercular meningitis is common in HIV patients.
  • Virus: enterovirus, HSV-2, varicella zoster, mumps and HIV virus.
  • Fungus: commonly affects immunocompromised persons.

Meningitis does not only arise due to infectious agents. Some drugs may lead to meningitis like NSAIDs and the use of certain antibiotics.

Risk factors

  • HIV/AIDS
  • Chemotherapy
  • Medication for organ transplantation
  • Crowded living conditions
  • Pregnancy
  • Animal handlers
  • Devices in brain or meninges like cerebral shunts

Treatment

Treatment depends upon the cause of the meningitis. A lumbar puncture may be conducted where a sample of the cerebrospinal fluid is collected and sent for laboratory testing.

  • Bacteria. Quick treatment with single or combination of antibiotics.
  • Virus: Usually resolve in two weeks on its own.
  • Symptomatic treatment: Required in all cases which includes steroids, fluid replacement, anticonvulsants, rest and antipyretics to reduce fever.
  • Vaccines against some bacteria like Meningococcus, H. influenzae and Pneumococci preventi infection and therefore meningitis.

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