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Meningitis DefinitionMeningitis is a serious inflammation of the meninges, the thin, membranous covering of the brain and the spinal cord. The dura is the toughest, outermost layer, and is closely attached to the inside of the skull.
The middle layer, the arachnoid, is important because of its involvement in the normal flow of the cerebrospinal fluid (CSF), a lubricating and nutritive fluid that bathes both the brain and the spinal cord. The space between the arachnoid and the pia contains CSF, which helps insulate the brain from trauma.
CSF, produced within specialized chambers deep inside the brain, flows over the surface of the brain and spinal cord.
All content on this website, including dictionary, thesaurus, literature, geography, and other reference data is for informational purposes only. Meningitis is most commonly caused by infection (by bacteria, viruses, or fungi), although it can also be caused by bleeding into the meninges, cancer, diseases of the immune system, and an inflammatory response to certain types of chemotherapy or other chemical agents. This fluid serves to cushion these relatively delicate structures, as well as supplying important nutrients for brain cells.
Tell a friend about us, add a link to this page, or visit the webmaster's page for free fun content. The most serious and difficult-to-treat types of meningitis tend to be those caused by bacteria. In some cases, meningitis can be a potentially fatal condition.DescriptionMeningitis is a particularly dangerous infection because of the very delicate nature of the brain. A careful balance between CSF production and reabsorption is important to avoid the accumulation of too much CSF.Because the brain is enclosed in the hard, bony case of the skull, any disease that produces swelling will be damaging to the brain. Brain cells are some of the only cells in the body that, once killed, will not regenerate themselves.
The skull cannot expand at all, so when the swollen brain tissue pushes up against the skull's hard bone, the brain tissue becomes damaged and may ultimately die. Therefore, if enough brain tissue is damaged by an infection, serious, life-long handicaps will remain.In order to learn about meningitis, it is important to have a basic understanding of the anatomy of the brain. Furthermore, swelling on the right side of the brain will not only cause pressure and damage to that side of the brain, but by taking up precious space within the tight confines of the skull, the left side of the brain will also be pushed up against the hard surface of the skull, causing damage to the left side of the brain as well.Another way that infections injure the brain involves the way in which the chemical environment of the brain changes in response to the presence of an infection.
Careful balance of oxygen, carbon dioxide, sugar (glucose), sodium, calcium, potassium, and other substances must be maintained in order to avoid damage to brain tissue. The blood-brain barrier prevents various substances that could be poisonous to brain tissue (toxins), as well as many agents of infection, from crossing from the blood stream into the brain tissue. While nonbacterial types of meningitis are more common, bacterial meningitis is the more potentially life-threatening. Certain conditions predispose to this type of meningitis, including alcoholism and chronic upper respiratory tract infections (especially of the middle ear, sinuses, and mastoids).N. Patients with AIDS (acquired immune deficiency syndrome) are more prone to getting meningitis from fungi, as well as from the agent that causes tuberculosis. Patients who have had their spleens removed, or whose spleens are no longer functional (as in the case of patients with sickle cell disease) are more susceptible to other infections, including meningococcal and pneumococcal meningitis.The majority of meningitis infections are acquired by blood-borne spread. A person may have another type of infection (of the lungs, throat, or tissues of the heart) caused by an organism that can also cause meningitis.
If this initial infection is not properly treated, the organism will continue to multiply, find its way into the blood stream, and be delivered in sufficient quantities to invade past the blood brain barrier. Direct spread occurs when an organism spreads to the meninges from infected tissue next to or very near the meninges.
This can occur, for example, with a severe, poorly treated ear or sinus infection.Patients who suffer from skull fractures possess abnormal openings to the sinuses, nasal passages, and middle ears. Organisms that usually live in the human respiratory system without causing disease can pass through openings caused by such fractures, reach the meninges, and cause infection. Similarly, patients who undergo surgical procedures or who have had foreign bodies surgically placed within their skulls (such as tubes to drain abnormal amounts of accumulated CSF) have an increased risk of meningitis.Organisms can also reach the meninges via an uncommon but interesting method called intraneural spread.
This involves an organism invading the body at a considerable distance away from the head, spreading along a nerve, and using that nerve as a kind of ladder into the skull, where the organism can multiply and cause meningitis. Herpes simplex virus is known to use this type of spread, as is the rabies virus.The most classic symptoms of meningitis (particularly of bacterial meningitis) include fever, headache, vomiting, sensitivity to light (photophobia), irritability, severe fatigue (lethargy), stiff neck, and a reddish purple rash on the skin.
Untreated, the disease progresses with seizures, confusion, and eventually coma.A very young infant may not show the classic signs of meningitis. Early in infancy, a baby's immune system is not yet developed enough to mount a fever in response to infection, so fever may be absent. Similarly, debilitated elderly patients may not have fever or other identifiable symptoms of meningitis.Damage due to meningitis occurs from a variety of phenomena. Other types of damage may be due to the mechanical effects of swelling and compression of brain tissue against the bony surface of the skull.
Swelling of the meninges may interfere with the normal absorption of CSF by blood vessels, causing accumulation of CSF and damage from the resulting pressure on the brain. Interference with the brain's carefully regulated chemical environment may cause damaging amounts of normally present substances (carbon dioxide, potassium) to accumulate. Inflammation may cause the blood-brain barrier to become less effective at preventing the passage of toxic substances into brain tissue.DiagnosisA number of techniques are used when examining a patient suspected of having meningitis to verify the diagnosis.
Certain manipulations of the head (lowering the head, chin towards chest, for example) are difficult to perform and painful for a patient with meningitis.The most important test used to diagnose meningitis is the lumbar puncture (commonly called a spinal tap).
Lumbar puncture (LP) involves the insertion of a thin needle into a space between the vertebrae in the lower back and the withdrawal of a small amount of CSF.
Normal CSF should contain no infection-fighting cells (white blood cells), so the presence of white blood cells in CSF is another indication of meningitis. Some of the withdrawn CSF is also put into special lab dishes to allow growth of the infecting organism, which can then be identified more easily.
Special immunologic and serologic tests may also be used to help identify the infectious agent.In rare instances, CSF from a lumbar puncture cannot be examined because the amount of swelling within the skull is so great that the pressure within the skull (intracranial pressure) is extremely high.
If it is found to be very high, no fluid is withdrawn because doing so could cause herniation of the brain stem.
Herniation of the brain stem occurs when the part of the brain connecting to the spinal cord is thrust through the opening at the base of the skull into the spinal canal.
Such herniation will cause compression of those structures within the brain stem that control the most vital functions of the body (breathing, heart beat, consciousness). Death or permanent debilitation follows herniation of the brain stem.TreatmentAntibiotic medications (forms of penicillin and cephalosporins, for example) are the most important element of treatment against bacterial agents of meningitis.

Because of the effectiveness of the blood-brain barrier in preventing the passage of substances into the brain, medications must be delivered directly into the patient's veins (intravenously, or by IV), at very high doses. Patients who develop seizures will require medications to halt the seizures and prevent their return.PrognosisViral meningitis is the least severe type of meningitis, and patients usually recover with no long-term effects from the infection. Without very rapid treatment with the appropriate antibiotic, the infection can swiftly lead to coma and death in less than a day's time. While death rates from meningitis vary depending on the specific infecting organism, the overall death rate is just under 20%.The most frequent long-term effects of meningitis include deafness and blindness, which may be caused by the compression of specific nerves and brain areas responsible for the senses of hearing and sight. Some patients develop permanent seizure disorders, requiring life-long treatment with anti-seizure medications.
Scarring of the meninges may result in obstruction of the normal flow of CSF, causing abnormal accumulation of CSF. This may be a chronic problem for some patients, requiring the installation of shunt tubes to drain the accumulation regularly.PreventionPrevention of meningitis primarily involves the appropriate treatment of other infections an individual may acquire, particularly those that have a track record of seeding to the meninges (such as ear and sinus infections).
Preventive treatment with antibiotics is sometimes recommended for the close contacts of an individual who is ill with meningococcal or H.
A meningococcal vaccine exists, and is sometimes recommended to individuals who are traveling to very high risk areas.
When it affects the dura mater it is termed pachymeningitis; when the arachnoid and pia mater are involved, it is called leptomeningitis.
The term meningitis does not refer to a specific disease entity but rather to the pathologic condition of inflammation of the tissues of the meninges. This form occurs when pathogenic bacteria enter the subarachnoid space and cause a pyogenic inflammatory response. The most common causes are Streptococcus pneumoniae (pneumococcus), Neisseria meningitidis (meningococcus), and Haemophilus influenzae, which are responsible for approximately 70 per cent of all cases. The organisms gain access to the ventriculosubarachnoid spaces and the cerebrospinal fluid where they cause irritation of the tissues bathed by the fluid.Bacterial meningitis typically begins with headache, nausea and vomiting, stiff neck (nuchal rigidity), and chills and fever. Irritability and confusion occur early in the course of the disease, and convulsive seizures occur in about 25 per cent of patients. As the disease progresses the patient becomes less rational, has decreasing levels of consciousness, and lapses into coma.
Inability to straighten the knee when the hip is flexed (a positive kernig's sign) and involuntary flexing of the hip and knee when the neck is flexed forward (a positive brudzinski's sign) are indicative of meningeal irritation.A diagnosis of bacterial meningitis is verified by isolation of the organism from a specimen of cerebrospinal fluid obtained by lumbar puncture. Treatment with the appropriate antibacterial agent is begun at once to reduce the numbers of proliferating bacteria attacking the central nervous system. Supportive measures include rest, maintenance of fluid and electrolyte balance, and prevention or control of convulsions with anticonvulsant drugs.The prognosis is generally good, especially for meningococcal meningitis in which residual neurologic deficits and persistent convulsive seizures are rare. Pneumococcal meningitis and meningitis due to Haemophilus influenzae are more likely to be complicated by these sequelae as well as by septic shock and hydrocephalus.Benign Viral Meningitis.
This term encompasses a group of disorders in which there is some meningeal irritation but no pyogenic organism can be found in the cerebrospinal fluid. It is, therefore, called also aseptic meningitis complex, which is somewhat misleading because the meningeal irritation often follows infection with the mumps virus or with one of the picornaviruses.The patient with this disorder typically complains of headache and signs characteristic of meningeal irritation, intolerance to light, and pain when the eyes are moved from side to side. Assessment of the patient with meningitis includes monitoring vital signs, neurologic status, and fluid and electrolyte status. The plan of care should include provisions for rest and relief from discomfort, a quiet and nonstimulating environment, protection from injury during convulsions, control of elevated body temperature, and isolation precautions as indicated by the specific causative organism. In general, enteric precautions are indicated for patients with aseptic meningitis caused by an enterovirus. Antibiotics must be given precisely as ordered so as to avoid further damage to the central nervous system. Early signs of increased intracranial pressure from brain edema are reported promptly so that measures to reduce pressure can be taken as soon as possible. During the acute phase and convalescence the patient is watched for signs of complications such as septic shock, vascular collapse, and hydrocephalus.
Nutritional status must be maintained throughout the course of illness to reinforce the patient's natural resources for combating infection and recovering from its deleterious effects.Portals of entry resulting in meningitis, meningoencephalitis, and intracranial mass lesions. It usually occurs in epidemics, and symptoms are those of acute cerebral and spinal meningitis. There is also usually an eruption of erythematous, herpetic, or hemorrhagic spots on the skin. It usually has a short uncomplicated course characterized by malaise, fever, headache, stiffness of neck and back, and nausea. Many of these diseases are benign and self-limited, such as meningitis caused by strains of coxsackievirus or echovirus. Others are more severe, such as those involving arboviruses, herpesviruses, or poliomyelitis viruses. Antifungal medications, such as amphotericin B, given intravenously or intrathecally for several weeks, may prevent death from fungal meningitis, but serious neurological sequelae may occur. Except for the first day or two of meningococcal disease, strict isolation procedures are unnecessary. Sedatives and narcotic analgesics should not be used because they may obscure important neurological signs in addition to depressing vital functions.
See Aseptic meningitis, Bacterial meningitis, Cryptococcal meningitis, Eosinophilic meningitis, Gram negative meningitis, H influenzae meningitis, Lymphocytic choriomeningitis, Meningococcal meningitis, Mollaret's meningitis, Neoplastic meningitis, Pneumococcal meningitis, Pseudomeningitis, Purulent meningitis, Staphylococcal meningitis, Tuberculous meningitis. ?400)Inflammation of the membranes of the spinal cord or brain, usually but not always caused by an infectious illness. Bacterial meningitis is a medical emergency that must be treated and diagnosed quickly to obtain the best outcome. It is fatal in 10% to 40% of cases, even with optimal therapy, and may result in persistent neurological injury in about 10% of patients who survive the initial infection. Infectious meningitis now is largely a disease of adults and usually is caused by Streptococcus pneumoniae or Neisseria meningitidis, although other microbes may be responsible. Intravenous steroids (such as dexamethasone) given at the beginning of therapy decreases the risk of death and disability.
It also may result from the spread of blood-borne infection.SymptomsThe symptoms of meningitis include fever, chills, headache, stiff neck, altered mental status, vomiting, and photophobia. Acute bacterial meningitis and meningitis caused by some fungi and amebas may also cause rapid deterioration in mental status, seizures, shock, and death.DiagnosisCerebrospinal fluid (CSF) must be examined. A cell count to assess the level of inflammation, a Gram stain to look for infectious organisms, measurement of spinal fluid pressure, and levels of bacterial antigens, glucose, lactate, and protein are typically obtained.
Meningococcal polysaccharide vaccines are highly effective in preventing the disease during epidemic outbreaks with this organism. Close family contacts of patients with meningococcal meningitis, day care center contacts of infected children, or any persons (including health care workers) with direct contact with the saliva of infected patients are to be treated with antibiotics to prevent disease transmission.TreatmentDefinitive treatment depends on identification of the underlying causes, but empirical therapies for infectious meningitis must be given immediately, hours before the causative agent is identified.

Dexamethasone is administered intravenously before starting antibiotic therapy for best response to reduce the incidence of deafness in children (a common complication) and to help prevent death in adults with pneumococcal meningitis. The evolution of penicillin-resistant strains of pneumococci has altered traditional empirical treatments.
Third-generation cephalosporins, ampicillin and gentamicin, chloramphenicol, or vancomycin plus rifampin have been given, depending on the patient's age, level of immune function, or clinical presentation. Antibiotic therapy is usually administered intravenously for 2 weeks, then orally for a prescribed period for bacterial infections. Viral meningitis treatment is supportive; recovery usually is complete (within 7 to 10 days). Antipyretic analgesics relieve headache and fever.Patient careSpecific measures for coexisting conditions and for shock and other complications (disseminated intravascular coagulation, metabolic acidosis, or seizures) should be initiated when indicated. Neurologic function is closely monitored for changes in level of consciousness, signs of increasing intracranial pressure (ICP), and indications of cranial nerve involvement.
Fluid and electrolyte balance is monitored, and fluids are provided in quantities to prevent or treat dehydration while avoiding fluid overload and resultant cerebral edema. The patient is assessed for adverse effects of antibiotic therapy with peak and trough blood levels assessed to ensure therapeutic levels and avoid toxic overdose. The patient is repositioned carefully and assisted with range-of-motion exercises to prevent skin, muscle, and joint complications. Constipation is prevented by stool softeners or mild laxatives to prevent straining, which could increase ICP.
Basic explanations, realistic reassurance, and support are provided, with reorientation if delirium or confusion is present. Questions from the patient and family should be answered honestly, with reassurance that behavioral changes usually resolve.The patient with infectious meningitis may need monitoring in an ICU.
Patients with neurologic deficits that appear to be continuing should be referred to a rehabilitation program once the acute phase of illness has ended. To help prevent meningitis, patients with chronic sinusitis or other chronic infectious or inflammatory illnesses should be taught the importance of proper hand hygiene and of following through with prescribed treatments. Sterile techniques should be strictly enforced when treating patients with head wounds, skull fractures, or lumbar puncture, ventricular shunting, or other invasive therapies.MENINGITISacute aseptic meningitisA nonpurulent form of meningitis often due to viral infection. It usually runs a short, benign course, marked by fever and headache and ending with recovery.
It typically results from a viral infection (such as coxsackievirus or other enteroviruses) although frequently no causative organism is identified. SymptomsPatients report fever, headache, stiff neck, malaise, and sometimes altered mental status or photophobia.Patient careTreatment is supportive, with antipyretics and pain-relieving medications administered as prescribed. The virus can be spread by direct contact with saliva, sputum, mucus, or stools of an infected person.
Standard precautions apply, with droplet precautions if nasal cultures are positive; contaminated articles are disposed of by double bagging.
Neurological status is monitored for changes in level of consciousness and for increases in intracranial pressure. Personal hygiene is provided, and measures to prevent complications due to immobility are implemented.
A quiet, dark atmosphere is provided, and siderails are padded to reduce the risk of injury. Prescribed analgesics are administered, and cool compresses are applied to the forehead to relieve headache. Intravenous fluids or tube feedings are administered as ordered, and intake and output are monitored. Assessments are made for complications such as shock, respiratory distress, and disseminated intravascular coagulation.Since mosquitoes can spread some viruses that cause meningitis, avoiding mosquito bites during the warm months of the year by wearing insecticides (DEET) and barrier protection, and eliminating standing pools of water, where mosquitoes breed, may help prevent the disease. The public should be made aware of meningitis symptoms (fever, headache, stiff neck, altered levels of consciousness) and the importance of prompt attention for any patient suspected of meningitis.bacterial meningitisMeningitis caused by disease-causing and potentially life-threatening organisms, esp. It may produce symptoms such as headache, backache, confusion, nerve palsies, or seizures and should be suspected when these symptoms arise in patients with known cancers. The diagnosis is confirmed by lumbar puncture with analysis of the cerebrospinal fluid for tumor cells. Syphilis, cryptococcosis, HIV infection, or invasion of the meninges by cancer cells may be responsible.
Occasionally, repeated lumbar punctures reveal a vasculitis of the central nervous system or a partially treated bacterial meningitis.
A rare cause of disease in healthy hosts, cryptococcal meningitis is an opportunistic infection usually seen in patients with advanced AIDS or patients taking high-dose steroids. The diagnosis is established by the results of analysis and culture of cerebral spinal fluid. Mollaret meningitis See: Mollaret meningitispneumococcal meningitisMeningitis due to Streptococcus pneumoniae, a disease predominantly found in adults.
Because of the worldwide emergence of streptococcal resistance to penicillins, chloramphenicol, and cephalosporins, vancomycin, rifampin, and other antibacterial agents are used to treat this infection. Intravenous steroids (such as dexamethasone) given at the beginning of therapy decrease the risk of death and disability caused by this infection.
Lumbar puncture reveals an excessive number of lymphocytes, typically without a decrease in cerebrospinal fluid glucose levels. This can be caused by many different organisms, especially the HERPES SIMPLEX virus, the VARICELLA-ZOSTER virus that causes CHICKEN POX and SHINGLES, the meningococcus, the POLIO virus, the echo virus, the COXSACKIE virus and the MUMPS virus.
Meningitis may also complicate LYME DISEASE, LEPTOSPIROSIS, TYPHUS, TUBERCULOSIS and other infections.
Viral meningitis may be a minor illness but can be acute, with headache, stiff neck, fever and drowsiness progressing rapidly to deep coma. There may be weakness or paralysis of the muscles, speech disturbances, double vision, loss of part of the field of vision and epileptic fits. There is no specific treatment for most virus infections, but herpes meningitis responds to the drug ACYCLOVIR.
Bacterial infection is usually more life-threatening and is indicated by the sudden onset of a stiff neck, headache, fever, and vomiting; may cause stupor, confusion, and convulsions if untreated.

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