The term meninges literally means “membrane”. These are the layers that surround the brain and the spinal cord. This includes the most outer dura mater (inner to the skull), middle arachnoid mater, and innermost pia mater. The fluid that flows between these meninges is called the Cerebrospinal Fluid.
Meningitis is the inflammation of meninges. This may most commonly be due to viral or bacterial infection.
Causes and types of Meningitis:
The infection-causing agents enter the bloodstream and reach the patient’s brain or spinal cord. Non-infectious causes are physical and disease-related causes that may turn into meningitis.
- Viral Meningitis – Enterovirus family of viruses, coxsackievirus A, coxsackievirus B, and echoviruses
- Most commonly found
- Uncommon Viral causative breeds
- West Nile virus
- Influenza
- Mumps
- HIV
- Measles
- Herpesviruses
- Colt virus
Viral meningitis usually cures on its own.
- Bacterial Meningitis – Streptococcus pneumoniae cause pneumococcal meningitis
- Neisseria meningitidis cause meningococcal meningitis
- Listeria monocytogenes
- Staphylococcus aureus
- Fungal Meningitis – Cryptococcuus which is found in dirt or soil that is contaminated with bird droppings
- Blastomyces
- Histoplasma found in places contaminated with bat and bird droppings
- Coccidioides
- Other parasites existing in the dirt, feces, and other seafood may cause meningitis. Angiostrongylus cantonensis, Baylisascaris procyonis, and Gnathostoma spinigerum are some common parasitic species.
- Non-Infectious Meningitis causes:
- Cancer
- SLE
- Chemical irritation
- Head Injury
- Fungi
- Drug allergies
- Immune-compromised conditions like pregnancy, AIDS, alcoholism, after an organ transplant, diabetes, splenectomy and the like
Symptoms vary in case of:
- Viral Meningitis
- Diminished appetite
- Irritability
- Sleepiness
- Tiredness
- Fever
- Headaches
- Stiff neck
- Seizures
- Person act sensitive to bright light
- Nausea and vomiting
- Bacterial Meningitis
- Changed mental status
- Nausea
- Vomiting
- Sensitivity to light
- Irritability
- Headache
- Fever
- Chills
- Stiff neck
- Purple bruised areas of skin
- Sleepiness
- Laziness
- Fungal Meningitis
- Nausea
- Vomiting
- Sensitivity to light
- Fever
- Headache
- Confusion or disorientation
A typical rash is produced by bacterial meningitis due to the involvement of capillaries and resultant blood leaks. It gets severe as the infection spreads.
Prevention:
Prophylactic meningococcal conjugate vaccines are available for bacterial meningitis. It may have a series of side-effects at the time of vaccination but it provides a more widespread and longer protection against meningitis. This vaccine is recommended for a risk population:
- People mass living together like that in dorms, camps and the like
- Adolescents around eleven years
- People travelling to African or middle eastern countries
- Toddlers who are immune-compromised or has no spleen
Diagnosis:
- Physical Exam
- Presenting complaints
- Spinal Tap or Lumbar Puncture – to prescribe the best antibiotic
- Blood Culture
- CBC
- Chest X-Ray to differentiate pneumonia, TB
- CT Scan to differentiate sinusitis or brain abscess
Treatment is based on a causative organism or underlying cause:
- Immediate medical attention for bacterial meningitis
- Antibiotics
- Anti-fungal drugs
- Pain meds
- Symptomatic Management for parasitic meningitis
- Anti-convulsants as required
- Anti-viral medication for viral meningitis
- Lots of rest
- Plenty of fluids
Complications:
- Convulsions or seizures
- Loss of hearing
- Loss of vision
- Abnormal gait
- Memory issues
- Migraine
- Kidney failure
- Arthritis
- Brain tissue impairment
- Hydrocephalus
- A subdural empyema or fluid between the brain and the skull
- Sepsis
- Gangrene
- Shock
- Death
Meningitis is covered from all aspects of management, preventive, involving intervention and treatment, however, it is good to keep good hygienic practices at a place and make growing children a part of it. This includes hand washing, covering face while coughing, sneezing, and eating from their own plates. Small hygiene practices may take you a long healthy way.
Dr. Amit Shrivastava | Senior Consultant – Neurology | Dharamshila Narayana Superspeciality Hospital, Delhi