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The Immune SystemMeningitis Synonyms : Clinical features, Diagnosis, Management, Prognosis, Nutrition, Herbs, Meningitis refers to infection and inflammation of the meninges of the brain and may be bacterial, viral and fungal (rare, e.g., cryptococcal meningitis in AIDS). 1.
Viral
infection
is the commonest cause of meningitis, and usually results in a benign and
self-limiting illness, requiring no specific therapy. Viral (aseptic)
meningitis is usually a much less serious illness than bacterial meningitis
unless there is associated encephalitis which is rare. A number of viruses can
cause meningitis, the commonest being enteroviruses
(echo viruses, coxsackie viruses) and the mumps
virus. In the majority of patients no specific virus is isolated. 2. Many bacteria can cause meningitis, but Neisseria meningitidis (meningococcus) and Streptococcus pneumoniae (pneumococcus) are the most common. Until recently Haemophilus influenzae type b (Hib) was the most common cause of meningitis in infants, but vaccination has dramatically reduced its incidence. Meningococci exist in the nasopharynx of about 5% of the population and spread by respiratory droplets and close contact. For unknown reasons, only a small fraction of carriers develop meningitis. Meningococcal meningitis occurs most often in the first year of life, and in epidemics among closed populations (e.g., in military barracks or boarding schools). In adults, pneumococcus is the most common cause of meningitis. Especially at risk are alcoholics and persons with chronic otitis, sinusitis, pneumococcal pneumonia, sickle cell disease, or asplenia (removed spleen). Clinical features: < BACK TO TOP >
Viral
meningitis occurs mainly in children or young adults, with the acute onset of
headache, irritability, and variable fever; older children describe also
photophobia (sensitivity to light) and myalgia. Abdominal pain, diarrhoea and
vomiting may occur.
In
bacterial meningitis these symptoms are more pronounced and progress to
changes in consciousness such as irritability, confusion, drowsiness or coma;
seizures may also occur. The condition, especially if caused by meningococcus
can progress to septicaemia and endotoxic shock. Neck stiffness due to meningeal irritation (‘meningism? is common and can be elicited by passive flexion of the neck which is resisted as a result of muscle spasm. Diagnosis: < BACK TO TOP >
Clinical
picture is usually very suggestive, especially if meningeal
signs are present. Abrupt neck flexion in a supine patient results
in involuntary flexion of the hips and knees (Brudzinski’s
sign). Attempts to extend the knee from the flexed-thigh position are met
with strong passive resistance (Kernig’s
sign). Both signs are thought to be caused by irritation of motor nerve
roots passing through inflamed meninges as they are put under tension.
Lumbar
puncture
should be performed promptly and a sample of CSF has to be taken for
laboratory analysis. In viral meningitis the CSF contains an excess of
lymphocytes, but normal glucose and protein levels and its culture is always
negative for bacteria. Enteroviruses can be isolated from CSF in few days but
only in 50% of patients. Viral nucleic acid can be demonstrated in CSF using
special polymerase chain reaction. In bacterial disease CSF is cloudy, thicker, with many leukocytes, elevated proteins but decreased glucose (used by bacteria). CSF culture will definitely identify the bacteria involved, but rapid serologic agglutination latex tests for bacterial antigens are commercially available and can be done on CSF in few minutes (their sensitivity and accuracy vary). Management < BACK TO TOP >
There
is no specific treatment for viral meningitis and the condition is usually
benign and self-limiting. The patient should be treated symptomatically in a
quiet environment. Bacterial meningitis requires vigorous treatment with antibiotics active against the causative bacteria (e.g., semisynthetic penicillins, cephalosporins, vancomycin). Prognosis < BACK TO TOP >
Nutrition < BACK TO TOP > Nutrition that alleviate or prevent Meningitis :- Herbs < BACK TO TOP > Herbs that alleviate or prevent Meningitis :- (source : -) |
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