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Meningitis

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What is Meningitis? 

Meningitis

Meningitis is an acute infection of the meninges. Meninges is the protective outer layer of the brain and spinal cord which consists of the pia mater, arachnoid mater, and dura mater.

Meningitis is characterized by Kernig’s sign (extension at the knee with the hip joint flexed causes spasms in the hamstring muscles) and Brudzinski’s sign (passive flexion of the neck causes flexion of the hips and knees). 

Cause of Meningitis 

Meningitis is an infectious disease which is caused by micro-organisms such as bacteria or viruses. 

Bacteria involved in meningitis are Gram-negative bacilli (Escherichia coli, Proteus) Group B streptococci,  Hemophilus influenza, Streptococcus pneumonia, Neisseria meningitidis (subtypes B, C, Y, W). 

Viruses involved in meningitis are herpes simplex virus, mumps virus, HIV, and Varicella virus. etc. 

Fungi causing Fungal meningitis are cryptococcosis.

Stages of Meningitis 

• Stage I (early): non-specific symptoms and signs without the alteration of consciousness.
• Stage II (intermediate): altered consciousness without coma or delirium plus minor focal neurological signs
• Stage III (advanced): stupor or coma, severe neurological deficits, seizures or Involuntary movements.

Sign And Symptoms Of Meningitis

The person suffering from meningitis initially has some major symptoms such as : 

  • The patient will have severe headaches which get worse over time. 
  • Pyrexia( Fever ) or hyperpyrexia (high fever) 
  • They can have a chilled along with cold hands and feet.
  • Tiny red or purple rashes on arms, hands, legs.
  • Discoloration of skin.
  • Some patients do have a few episodes of Nausea /Vomiting.
  • Weakness
  • High body temperature 
  • High heart rate 
  • Blur visions 
  • Meningism 
  • Glasgow coma scale (GCS) less than 11
  • Altered mental status
  • Lethargy

Meningism consists of headache, photophobia(sensitivity to light), and neck stiffness, often accompanied by other signs of meningeal irritation. General observation of Kernig’s and Brudzinski’s signs can also help identify meningitis. 

The severity of clinical features varies with causative organism. such as 

  • The patient suffering from viral meningitis may have headaches and irritability, along with high pyrexia during the acute phase of infection. 
  • Headache, drowsiness, fever, and neck stiffness are the usual presenting features in bacterial meningitis but in severe bacterial meningitis, the patient may develop focal neurological signs such as weakness or paralysis in the left arm, and the right leg. The patient might suffer from seizures (Myoclonic contraction ) leading to claw hands.
  • Patient with Tuberculous meningitis shows severe symptoms such as Headache, Vomiting, Low graded fever. The onset is much slower than in other bacterial meningitis :- over 2–8 weeks.

How to diagnose meningitis?

Any person with similar signs and symptoms which are mentioned above indicates that might the person have meningitis. A person can perform Meningitis glass test right at that spot to know the severity of the condition and whether he /she needs emergency care or not.

What is Meningitis Glass test? 

Meningitis Glass test is a method used to check whether a rash fades under pressure or not. Someone with a fever and a rash that does not fade under pressure needs urgent medical attention. This is life-threatening in 80% cases. 

How to perform the Meningitis Glass test?
  • Press any side of clear glass firmly against your skin. 
  • Spots/rash may fade at first.  
  • Keep checking 
  •  Get medical help immediately If the rashes does not fade with pressure then. 
  • Some people’s darker skin tone makes it difficult to observe the rashes and check lighter areas such as the palms of the hands, soles of the feet, inside the eyelids, and the roof of the mouth. 
Physical Examination of Meningitis.

The physical examination involves overall sensory and motor examination along with cranial nerve examination. Kernig’s sign (extension at the knee with the hip joint flexed causes spasms in the hamstring muscles) and Brudzinski’s sign (passive neck flexion causes hip and knee flexion). 

lumbar puncture

The diagnosis is made by lumbar puncture. CSF usually contains an excess of lymphocytes. While glucose and protein levels are commonly normal, latter may be raised. It is important to verify that patient has not received antibiotics (for whatever cause) prior to lumbar puncture, as CSF lymphocytosis can also be found in partially treated bacterial meningitis.

CSF analysis 

The CSF is under increased pressure.  The fluid contains up to 500 × 106 cells/L, predominantly lymphocytes, but can contain neutrophils protein and a marked fall in glucose.

Brain Imaging 

 Brain imaging may show hydrocephalus, brisk meningeal enhancement on enhanced CT or MRI, or an intracranial tuberculoma. 

Blood test 

Our body’s defense mechanism during any infection produces a large amount of WBCs similar to meningitis shows high WBCs. 

How to treat Meningitis? 

Treatment of Viral meningitis 

The patient suffering from meningitis may also occur as a complication of a systemic viral infection such as mumps, measles, infectious mononucleosis, herpes zoster, and hepatitis. Whatever the virus, complete recovery without specific therapy is the rule.

Treatment of Bacterial meningitis

The mortality rate of untreated patients is 80 %. In bacterial meningitis, patient should be treated as early as possible. In suspected bacterial meningitis patient should be given parenteral benzylpenicillin immediately (intravenous is preferable) and prompt hospital admission should be arranged.

1. Adults aged 18–50 years with or without a typical meningococcal rash
• Cefotaxime 2 g IV 4 times daily or
• Ceftriaxone 2 g IV twice daily
2.  The Patients in whom penicillin-resistant pneumococcal infection is suspected, or in areas with a significant incidence of penicillins
resistance in the community.
• Vancomycin 1 g IV twice daily or
• Rifampicin 600 mg IV twice daily
3. Adults aged > 50 years and those in whom Listeria monocytogenes infection is suspected (brainstem signs, immunosuppression, diabetic, alcoholic).
• Ampicillins 2 g IV 6 times daily or
• Co-trimoxazole 5 mg/kg IV daily in two divided doses
4. The Patients with a clear history of anaphylaxis to β-lactams
• Chloramphenicol 25 mg/kg IV 4 times daily plus.
• Vancomycin 1 g IV twice daily
5. Adjunctive treatment 
• Dexamethasone 0.15 mg/kg 4 times daily for 2–4 days

Precaution from meningococcal exposure

Meningitis occurs due to exposure to meningococcal bacteria spread by sharing respiratory and throat secretions (saliva or spit). If an infected person comes in contact with a normal person in various ways such as

  • Household contacts (including persons who ate or slept in the same dwelling as the patient during the 7 days prior to disease onset)
  • Child-care and nursery-school contacts
  • Persons having contact with patient’s oral secretions during the 7 days before disease onset: Kissing, Sharing of toothbrushes, Sharing of eating utensils, Mouth-to-mouth. resuscitation, Unprotected contact during endotracheal intubation
  • Healthcare worker without direct exposure to patient’s oral secretions.

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