What is meningitis and how is it treated?

 

What is meningitis and how is it treated?

Meningitis means infection or innflammation of brain coverings that separates brain from skull bone. There are so many causes of meningitis.

According to cause we classified meningitis as

Bacterial/pyogenic meningitis

Bacterial meningitis has another classification according to age of onset-

#Neonatal meningitis- Most commonly caused by a bacteria Escherichia coli

# School going childrens- by Haaemophillus influenzae

#Adults-may be bacterial (Streptococcus pneumoniae), Viral or tubercular.

Viral meningitis (viruses of herpes group and others)

Tubercular meningitis (Mycobacterium tuberculosis)

Dianosis usually we made from History, Clinical examinations and investigations.

From history,

Bacterial meningitis has short history of high grade fever (usually 3–7 days) with or without unconciousness. Viral has also same history. But tubercular meningitis has long history of low grade evening rising fever with h/o significant weight loss (loss of >10% within last 3 months). Unconciousness may or may not present when patient come to the doctor.

Physical examination,

We look for neck ridgidity, kernig's sign and brudzinski's sign.

Investigations,

CSF examination frequently done by lumber puncture to identify the cause of meningitis either bacterial or viral or tubercular.

Treatment:

We treat according to cause. At first we give priority to give drug by injective form usually intravenously.

Bacterial meningitis - by sensitive antibiotic.

Viral meningitis - by antiviral drugs.

Tubercular meningitis - by anti-tubercular medications according to WHO guidelines

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Which are the tests to confirm bacterial meningitis?

To investigate possible meningitis or encephalitis, healthcare practitioners start with a physical examination and a medical history. This examination may occur in the emergency room as symptoms may suddenly appear and rapidly worsen over several hours to a couple of days.

The healthcare practitioner will ask about recent illnesses, exposure to animals, mosquitoes, or ticks, contact with other people who have becomeill, recent travel – especially outside of the United States, and recent activities. The healthcare practitioner will note the presence or absence of signs and symptoms frequently associated with meningitis and encephalitis. Neurological examinations may be performed to assess the status of the patient's nervous system, sensory and motor function, coordination, vision, hearing,strength, and mental status.

Laboratory Tests-Laboratory tests are performed to detect, identify, evaluate, and monitor meningitis and encephalitis. These tests are performed in order to:*.Distinguish these infections from other conditions with similar symptoms*.Determine the cause, whetherbacteria,viruses,fungi, orparasites, as rapidly as possible to start and guide treatment*.Evaluate the affected person's general state of health,immune systemstatus, current signs andsymptoms, and current complications to guide symptom relief and to minimize inflammationand neurological or brain damage*.Where possible, determine the infection's source; this is especially important when the microbe causing the infection may be spread to others and may be a public health concern.

Depending on the suspected cause, samples may be sent to local or state public health laboratories for testing.

Tests include:Cerebrospinal fluid (CSF) analysis. This is a primary diagnostic tool for encephalitis and meningitis. CSF analysis is a group of common tests, and a wide variety of other tests, that can beordered and performed on a sample of CSF. It is collected using a procedure called a lumbar puncture or spinal tap.Initial CSF tests—The initial basic set of CSF tests that are often performed with suspected infections of thecentral nervous systeminclude:

Physical characteristics: normal CSF appears clear and colorless. The appearance of the sample of CSF is usually compared to a sample of water. In infections, the initial pressure of CSF during collection may be increased and the sample may appear cloudy due to the presence of white blood cells (WBCs) or microorganisms.

CSF protein: only a small amount is normally present in CSF because proteins are large molecules and do not cross the blood/brain barrier easily. Increases in protein are commonly seen with meningitis, brainabscess, and neurosyphilis.*.CSF glucose: normal is about 2/3 the concentration of blood glucose. Glucose levels may decrease when cells that are not normally present use up (metabolize) the glucose. These may include bacteria or cells present due to inflammation (WBCs).

CSF total cell counts: WBCs may be increased with central nervous system infections.*.CSF WBC differential: small numbers oflymphocytes,monocytes(and in neonates,neutrophils) are normal in a sample of CSF. There may be:*.An increase in neutrophils with a bacterial infection*.An increase in lymphocytes with a viral infection*.Sometimes an increase in eosinophils with a parasitic infection*.CSF Gram stain for direct observation of microbes*.CSF culture and sensitivity for bacteria, fungi, and viruses.

Additional or follow-up CSF tests—If any of the initial tests are abnormal, then additional infectious testing may be ordered. This may include one or more of the following:*.Detection of viruses by molecular tests (polymerase chain reactions, PCR) – detection of viral genetic material (DNA,RNA) such asWest Nile virus,herpes, and enteroviruses.

CSF Cryptococcal antigen – to detect a specific fungal infection*.Other CSF antigen tests – depending on which organism(s) are suspected*.Specific CSF antibody tests – depending on which organism(s) are suspectedLess commonly ordered CSF infectious diseases testsinclude:*.CSF AFB smear and culture(whentuberculosisis suspected) – positive with tuberculosis and withother mycobacteria*.CSF Molecular tests to detectMycobacteria tuberculosis*.CSF syphilis testing (VDRL)– positive withsyphilisthat has infected the brain (neurosyphilis); negative does not rule out conditionSeveral other types of CSF testingmay occasionallybe ordered to help distinguish between viral and bacterial meningitis:

CSF lactic acid – often used to distinguish between viral and bacterial meningitis; the level will usually be increased with bacterial and fungal meningitis while it will remain normal oronly slightly elevated with viral meningitis.*.CSF lactate dehydrogenase (LD) – used to differentiate between bacterial and viral meningitis*.CSF C-reactive protein (CRP) is anacute phase reactantand is elevated with inflammation; it is markedly increased with bacterial meningitis. Since it is verysensitiveeven with early bacterialmeningitis, it is often used to distinguish between bacterial and viral meningitis.Laboratory tests on samples other than CSF—may be ordered along with or following CSF testing and may include:*.Blood glucose,protein,CBC (complete blood count)– to evaluate and to compare with CSF levels.

Procalcitonin– growing evidence suggests that measuring blood levels of procalcitonin is usefulin distinguishing bacterial from viral meningitis;a high blood level is a strong indication of bacterial meningitis.*.Tests forantibodiesin blood for a variety of viruses, such asarboviruses, in particular West Nile virus, if there is a four-fold rise in thetiterof the antibody between two samples collected about a month apart, then it indicates a recent infection by that microorganism.*.Molecular tests that directly detect viruses in blood*.Blood culturesmay be ordered to detect and identify bacteria in the blood.*.Culturesof other parts of the body may be performed to detect the source of the infection that led to meningitis or encephalitis.

CMP (comprehensive metabolic panel)– tests that evaluate organ functionNon-Laboratory TestsImaging tests may be performed to look for signs of brain inflammation or abnormalities but may be unremarkable with encephalitis. Brain damage, tumors, bleeding, andabscessesmay be detected. 

Tests may include:CT (computed tomography)*.MRI (magnetic resonance imaging)*.Ultrasound*.EEG (electroencephalography) – to detect abnormal brain waves.