MENINGITIS

Types of meningitis include:

• Acute bacterial meningitis occurs suddenly due to a bacterial infection and is generally the most serious type of meningitis.
• Aseptic meningitis is similar to other forms of meningitis, but the cause is not a bacterial infection of the meninges or CSF. Aseptic meningitis can be caused by viruses, some drug reactions, and certain conditions, such as tuberculosis, brain surgery, head injury, cancer, or Lyme disease.
• Chronic meningitis is a long-term disease and develops over weeks or months.
• Viral meningitis can occur suddenly (acute) or develop slowly over a two-week period or longer (chronic).

Meningitis can also be caused by other organisms and some medicines, but this is rare.

Meningitis is contagious. The germs that cause it can be passed from one person to another through coughing and sneezing and through close contact.

The signs and symptoms that may occur in anyone older than age of 2 include:

• Sudden high fever
• Severe headache that isn’t easily confused with other types of headache
• Stiff neck
• Vomiting or nausea with headache
• Confusion or difficulty concentrating
• Seizures
• Sleepiness or difficulty waking up
• Sensitivity to light
• Lack of interest in drinking and eating
• Skin rash in some cases, such as in meningococcal meningitis

 Signs in newborns

Newborns and infants may not have the classic signs and symptoms of headache and stiff neck. Instead, signs of meningitis in this age group may include:

• High fever
• Constant crying
• Excessive sleepiness or irritability
• Inactivity or sluggishness
• Poor feeding
• A bulge in the soft spot on top of a baby’s head (fontanel)
• Stiffness in a baby’s body and neck

Infants with meningitis may be difficult to comfort, and may even cry harder when picked up.

DIAGNOSIS

Diagnosis of meningitis is based on a medical history, a physical exam, and tests.

Your doctor will almost always do a lumbar puncture. This is done by inserting a long, thin needle into the spinal canal. The doctor uses the needle to collect samples of spinal fluid to check for bacteria and viruses.

Other tests that may be done include:

• Complete blood count, to check for signs of infection.
• Blood culture, to check for infections.
• Urine test, to check for infection in the urinary tract.
• Chest X-ray, to check for lung infections.
• Biopsy of a skin rash.
• CT scan or MRI, to look for swelling of brain tissue or for complications such as brain damage.

RECOMMENDED MEDICATIONS

The decision about what medicine to use depends on the organism causing the infection, the extent of the infection, and the person’s age and general health.

Medicine choices

Medicines used for treating meningitis include:

• Antibiotics to treat bacterial infection. Often two antibiotics are given together. Antibiotics aren’t given for viral meningitis.
• Medicines to treat seizures.
• Medicines to treat pressure on the brain.
• Medicines to treat fever and muscle aches. The most common ones are nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen (Tylenol).

The treatment depends on the type of meningitis you or your child has.

Bacterial meningitis

Acute bacterial meningitis requires prompt treatment with intravenous antibiotics and, more recently, cortisone medications, to ensure recovery and reduce the risk of complications, such as brain swelling and seizures. The antibiotic or combination of antibiotics that your doctor may choose depends on the type of bacteria causing the infection.

Viral meningitis

Antibiotics can’t 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

If the cause of your meningitis is a herpes virus, an antiviral medication is available.

Other types of meningitis

Fungal meningitis is treated with antifungal medications. However, these medications can have serious side effects, so treatment may be deferred until a laboratory can confirm that the cause is fungal. Chronic meningitis is treated based on the underlying cause, which is often fungal.

Noninfectious meningitis due to allergic reaction or autoimmune disease may be treated with cortisone medications. In some cases, no treatment may be required, because the condition can resolve on its own. Cancer-related meningitis requires therapy for the individual cancer.