01/06/2022
MENINGITIS ✍
WHAT IS MENINGITIS ?
Meningitis is an inflammation of the fluid and membranes (meninges) surrounding your brain and spinal cord.
Most cases of meningitis are caused by a viral infection, but bacterial, parasitic and fungal infections are other causes. Some cases of meningitis improve without treatment in a few weeks. Others can be life-threatening and require emergency antibiotic treatment.
Seek immediate medical care if you suspect that someone has meningitis. Early treatment of bacterial meningitis can prevent serious complications.
SYMPTOMS OF MENINGITIS
Early meningitis symptoms may mimic the flu (influenza). Symptoms may develop over several hours or over a few days.
Possible signs and symptoms in anyone older than the age of 2 include:
* Sudden high fever
* Stiff neck
* Severe headache that seems different from normal.
* Headache with nausea or vomiting
* Confusion or difficulty concentrating.
* Seizures
* Sleepiness or difficulty waking.
* Sensitivity to light
* No appetite or thirst
* Skin rash (sometimes, such as in meningococcal meningitis).
SIGNS AND SYMPTOMS IN NEWBORNS
Newborns and infants may show these signs and symptoms:
▪️High fever
▪️Constant crying
▪️Excessive sleepiness or irritability
▪️Difficulty waking from sleep
▪️Inactivity or sluggishness
▪️Not waking to eat
▪️Poor feeding
▪️Vomiting
▪️A bulge in the soft spot on top of a baby's head (fontanel).
▪️Stiffness in the body and neck
▪️Infants with meningitis may be difficult to comfort, and may even cry harder when held.
WHEN TO SEE A DOCTOR
Seek immediate medical care if you or someone in your family has meningitis signs or symptoms, such as:
🔸️Fever
🔹️Severe, unrelenting headache
🔸️Confusion
🔹️Vomiting
🔸️Stiff neck etc
Bacterial meningitis is serious and can be fatal within days without prompt antibiotic treatment. Delayed treatment increases the risk of permanent brain damage or death.
If a family member or someone you live or work with has meningitis, you may need to take medications to prevent getting the infection.
CAUSES OF MENINGITIS
Viral infections are the most common cause of meningitis, followed by bacterial infections and, rarely, fungal and parasitic infections. Because bacterial infections can be life-threatening, identifying the cause is essential.
BACTERIAL MENINGITIS
Bacteria that enter the bloodstream and travel to the brain and spinal cord cause acute bacterial meningitis. But it can also occur when bacteria directly invade the meninges or layers of the membranes that cover and protect the brain and spinal cord. This may be caused by an ear or sinus infection, a skull fracture, or rarely, some surgeries.
SEVERAL COMMON BACTERIA THAT CAN CAUSE ACUTE MENINGITIS INCLUDE:
▪️STREPTOCOCCUS PNEUMONIAE (PNEUMOCOCCUS) : this bacterium is the most common cause of bacterial meningitis in infants, young children and adults. It more commonly causes pneumonia or ear or sinus infections. A vaccine can help prevent this infection.
▪️NEISSERIA MENINGITIDIS (MENINGOCOCCUS) : this bacterium is another leading cause of bacterial meningitis. These bacteria commonly cause an upper respiratory infection but can cause meningococcal meningitis when they enter the bloodstream. This is a highly contagious infection that affects mainly teenagers and young adults. A vaccine can help prevent infection. Even if vaccinated, anybody who has been in close contact with a person with meningococcal meningitis should receive an oral antibiotic to prevent the disease.
▪️HAEMOPHILUS INFLUENZAE (HAEMOPHILUS) : haemophilus influenzae type b (Hib) bacterium was once the leading cause of bacterial meningitis in children. But new haemophilus b vaccines have greatly reduced the number of cases of this type of meningitis.
▪️LISTERIA MONOCYTOGENES (LISTERIA) : these bacteria can be found in unpasteurized cheeses, hot dogs and lunchmeats. Pregnant women, newborns, older adults and people with weakened immune systems are most susceptible. Listeria can cross the placental barrier, and infections in late pregnancy may be fatal to the baby.
VIRAL MENINGITIS
Viral meningitis is usually mild and often clears on its own. Most cases are caused by a group of viruses known as enteroviruses, which are most common. Viruses such as herpes simplex virus, HIV, mumps virus, West Nile virus and others also can cause viral meningitis.
CHRONIC MENINGITIS
Slow-growing organisms (such as fungi and Mycobacterium tuberculosis) that invade the membranes and fluid surrounding your brain cause chronic meningitis. Chronic meningitis develops over two weeks or more. The signs and symptoms of chronic meningitis include: headache, fever, vomiting and mental cloudiness which are similar to those of acute meningitis.
FUNGAL MENINGITIS
Fungal meningitis is relatively uncommon. It may mimic acute bacterial meningitis. It is often contracted by breathing in fungal spores that may be found in soil, decaying wood and bird droppings. Fungal meningitis is not contagious from person to person.
✔CRYPTOCOCCAL MENINGITIS : is a common fungal form of the disease that affects people with immune deficiencies, such as AIDS. It is life-threatening if not treated with an antifungal medication. Even with treatment, fungal meningitis may recur.
PARASITIC MENINGITIS
Parasites can cause a rare type of meningitis called EOSINOPHILIC MENINGITIS. Parasitic meningitis can also be caused by a tapeworm infection in the brain (CYSTICERCOSIS) or cerebral malaria. Amoebic meningitis is a rare type that is sometimes contracted through swimming in fresh water and can quickly become life-threatening. The main parasites that cause meningitis typically infect animals. People are usually infected by eating foods contaminated with these parasites. Parasitic meningitis is not spread between people.
OTHER CAUSES MENINGITIS
Meningitis can also result from noninfectious causes, such as chemical reactions, drug allergies, some types of cancer and inflammatory diseases such as sarcoidosis.
RISK FACTORS OF MENINGITIS
Risk factors for meningitis include:
✔SKIPPING VACCINATIONS : Risk rises for anyone who has not completed the recommended childhood or adult vaccination schedule.
✔AGE : Most cases of viral meningitis occur in children younger than five (5) years. Bacterial meningitis is common in those under age 20.
✔LIVING IN A COMMUNITY SETTING : College students living in dormitories, personnel on military bases, and children in boarding schools and child care facilities are at greater risk of meningococcal meningitis. This is probably because the bacterium is spread through the respiratory route, and spreads quickly through large groups.
✔PREGNANCY : Pregnancy increases the risk of listeriosis -- an infection caused by listeria bacteria, which may also cause meningitis. Listeriosis increases the risk of miscarriage, stillbirth and premature delivery.
✔COMPROMISED IMMUNE SYSTEM : AIDS, alcoholism, diabetes, use of immunosuppressant drugs and other factors that affect your immune system also make you more susceptible to meningitis. Having your spleen removed also increases your risk, and anyone without a spleen should get vaccinated to minimize that risk.
COMPLICATIONS OF MENINGITIS
Meningitis complications can be severe. The longer you or your child has the disease without treatment, the greater the risk of seizures and permanent neurological damage, including:
▪️Hearing loss
▪️Memory difficulty
▪️Learning disabilities
▪️Brain damage
▪️Gait problems
▪️Seizures
▪️Kidney failure
▪️Shock and
▪️Death
With prompt treatment, even people with severe meningitis can have good recovery.
PREVENTION OF MENINGITIS
Common bacteria or viruses that can cause meningitis can spread through coughing, sneezing, kissing, or sharing eating utensils, a toothbrush or a cigarette.
These steps can help prevent meningitis:
🔹️WASH YOUR HANDS : Careful hand-washing with soap and clean water helps prevent the spread of germs. If you have children, teach them how to wash their hands often, especially before eating and after using the toilet, and after spending time in a crowded public place or petting animals. Show them how to vigorously and thoroughly wash and rinse their hands.
🔸️PRACTICE GOOD HYGIENE : Do not share drinks, foods, straws, eating utensils, lip balms or toothbrushes with anyone else. Teach your children and teens to avoid sharing these items too.
🔹️STAY HEALTHY : Maintain your immune system by getting enough rest, exercising regularly, and eating a healthy diet with plenty of fresh fruits, vegetables and whole grains.
🔸️COVER YOUR MOUTH : When you need to cough or sneeze, be sure to cover your mouth and nose.
🔹️If you are pregnant, take care with food. Reduce your risk of listeriosis by cooking meat properly. Avoid cheeses made from unpasteurized milk. Choose cheeses that are clearly labeled as being made with pasteurized milk.
VACCINATIONS
Some forms of bacterial meningitis are preventable with the following vaccinations:
✔HAEMOPHILUS INFLUENZAE TYPE b (HIB) VACCINE : The World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) recommend this vaccine for children starting at about 2 months of age. The vaccine is also recommended for some adults, including those who have sickle cell disease or AIDS and those who do not have a spleen.
✔PNEUMOCOCCAL CONJUGATE VACCINE (PCV13) : This vaccine also is part of the WHO and CDC recommended routine vaccination schedule for children younger than 2 years. Additional doses are recommended for children between the ages of 2 and 5 who are at high risk of pneumococcal disease, including children who have chronic heart or lung disease or cancer.
✔PNEUMOCOCCAL POLYSACCHARIDE VACCINE (PPSV23) : Older children and adults who need protection from pneumococcal bacteria may receive this vaccine. The CDC recommends the PPSV23 vaccine for all adults older than 65; for younger adults and children age 2 and older who have weak immune systems or chronic illnesses such as heart disease, diabetes or sickle cell anemia; and for anyone who doesn't have a spleen.
✔MENINGOCOCCAL CONJUGATE VACCINE : The CDC recommends that a single dose be given to children ages 11 to 12, with a booster shot given at age 16. If the vaccine is first given between ages 13 and 15, the booster is recommended between ages 16 and 18. If the first shot is given at age 16 or older, no booster is necessary.
This vaccine can also be given to children between the ages of 2 months and 10 years who are at high risk of bacterial meningitis or who have been exposed to someone with the disease. It is also used to vaccinate healthy but previously unvaccinated people who have been exposed in outbreaks.
DIAGNOSIS OF MENINGITIS
Diagnosis of meningitis is based on a medical history, a physical exam and certain diagnostic tests. Signs of infection around the head, ears, throat and skin along the spine are checked.
The following diagnostic tests are considered :
* BLOOD CULTURES : A blood sample is placed in a special dish to see if it grows microorganisms, particularly bacteria. A sample may also be placed on a slide and stained (Gram's stain), then studied under a microscope to see whether bacteria are present.
* IMAGING : Computerized tomography (CT ) or magnetic resonance imaging (MRI) scans of the head may show swelling or inflammation.
* X-RAYS or CT SCANS of the chest or sinuses also may show infection that may be associated with meningitis.
* SPINAL TAP (LUMBAR PUNCTURE) : For a definitive diagnosis of meningitis, a spinal tap to collect cerebrospinal fluid (CSF) is done. In people with meningitis, the CSF often shows a low sugar (glucose) level along with an increased white blood cell count and increased protein.
Cerebrospinal fluid ( CSF ) analysis may also help to identify which bacterium caused the meningitis. If viral meningitis is suspected, a DNA-based test known as a polymerase chain reaction (PCR) is ordered for amplification or a test to check for antibodies against certain viruses to determine the specific cause and proper treatment.
TREATMENT FOR MENINGITIS
The treatment of meningitis depends on the type. For instance,
BACTERIAL MENINGITIS
Acute bacterial meningitis must be treated immediately with intravenous antibiotics and sometimes corticosteroids. This helps to ensure recovery and reduce the risk of complications, such as brain swelling and seizures.
The antibiotic or combination of antibiotics depends on the type of bacteria causing the infection. A broad-spectrum antibiotic is recommended until the exact cause of the meningitis is determine
Draining of any infected sinuses or mastoids — the bones behind the outer ear that connect to the middle ear Improve the treatment.
VIRAL MENINGITIS
Antibiotics can not cure viral meningitis, and most cases improve on their own in several weeks. Treatment of mild cases of viral meningitis usually includes:
▪️Bed rest
▪️Plenty of fluids
Over-the-counter pain medications to help reduce fever and relieve body aches is recommended.
Corticosteroids to reduce swelling in the brain, and an anticonvulsant medication to control seizures are prescribed. If a herpes virus caused your meningitis, an antiviral medication is available.
OTHER TYPES OF MENINGITIS
If the cause of your meningitis is unknown, a start of antiviral and antibiotic treatment is initiated while the cause is determined.
Treatment for chronic meningitis is based on the underlying cause. Antifungal medications treat fungal meningitis, and a combination of specific antibiotics can treat tuberculous meningitis. However, these medications can have serious side effects, so treatment may be deferred until a laboratory can confirm that the cause is fungal.
NONINFECTIOUS MENINGITIS TREATMENT
Noninfectious meningitis due to allergic reaction or autoimmune disease may be treated with corticosteroids. In some cases, no treatment may be required because the condition can resolve on its own.
NOTE : Cancer-related meningitis requires therapy for the specific cancer.
Meningitis can be life-threatening, depending on the cause. If you've been exposed to bacterial meningitis and you develop symptoms, go to an emergency room and let medical staff know whether you have meningitis. If you have, you can be treated.
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