Meningitis
Inflammation of the meninges of the brain or spinal cord.
Bacterial meningitis:
More common in infants and young children; most commonly Neisseria meningitidis, Strep. pneumoniae, Listeria monocytogenes, Haemophilus infuenzae. Infection reaches meninges by haematogenous spread from close infection or via communication with CSF.
Clinical features:
Acute – prodromal respiratory infection or sore throat, presents with severe headache, photophobia, fever, vomiting – feel very unwell – may be confused and drowsy. Have neck stiffness, neck retraction, positive Kernig’s sign
Antibiotics may modify clinical features – need to assess carefully for meningeal irritation
Can be fatal in as little as a few hours.
Diagnosis confirmed by lumber puncture for examination of CSF identify organism
Treatment – parental antibiotics (usually benzylpenicillin prior to hospitalisation, then cefotaxime as it effective against the 3 most common causes may change after identification of organism); IV fluids for hydration
Complications – septic shock, disseminated intravascular coagulation (DIC), respiratory distress syndrome, increased intracranial pressure, seizures, hydrocephalus, subdural effusion.
Viral meningitis:
Milder than bacterial – slower onset; most commonly echoviruses and Coxsackie virus; usually benign and self-limiting. Treatment is symptomatic.
Chronic meningitis:
May be due to tubercle bacillus, syphilis or fungal. Clinical features are non-specific. Insidious onset (develop over period of weeks rather than days).
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