Meningitis symptoms, cause and meningitis treatment
Meningitis
Definition of meningitis: Inflammation of the meninges over-lying the brain and spinal cord.
We have described in article :
Causes of meningitis
Symptoms of meningitis
Investigations of meningitis
Treatment of meningitis
Complication of meningitis
Irritation of meningitis
Symptoms of meningitis:
New born:
- Vacant stare
- Fever/Hypothermia
- Vomiting
- Reluctance to feed
- Poor tone and poor cry.
- Convulsion
- Fontanelle may bulge
- Kernig’s sign-may present.
- Neck rigidity-absent.
Older children & adult:
- Headache
- Drowsiness
- Fever
- Vomiting
- Restlessness.
- Irritability
- Coma, convulsion
- Cranial nerve palsies
- Neck rigidity.
- Kernig’s sign and Brudzinski’s sign-may be positive.
Investigations of Meningitis:
- CSF examination : Physical, cytological, biochemical and bacteriological (Gm staining and AFB).
- Blood culture may be positive
- CT brain to exclude a mass lesion (eg cerebral abscess).
Treatment of Meningitis :
- Fluid and electrolyte balance.
- Convulsion is controlled by I/V Diazepam or Phenobarbitone
- Good nursing care
- Drug treatment:
For unknown cause:
Neonate: Ampicillin 300-400 mg/kg/day in 4 divided doses
- Gentamycin 5 mg kg/day in 2 divided doses or
- Cefotaxime (third generation cephalosporin).
Pre-school children: Cefotaxime 60-75 mg kg day
Older children and adult: Cefotaxime 2g 1/V 6-hourly or Ceftriaxone 2g IV 12-hourly
Causes of meningitis:
Infective:
- Bacteria:
- Neisseria meningitidis.
- Streptococcus pneumoniae.
- Haemophilus influenza.
- Mycobacterium tuberculosis
- Brucella.
- Viruses:
- Enteroviruses (Echo, Coxackie, polio).
- Mumps, influenza.
- Varicella zoster.
- HIV (Human immunodeficiency virus).
- Protozoa and parasites:
- Toxoplasma.
- Amoeba.
- Cysticercus.
- Fungi:
- Cryptococcus neoformans
- Candida
- Histoplasma
- Blastomyces.
Non-infective:
- Malignant disease:
- Breast cancer.
- Bronchial cancer.
- Leukaemia, Lymphoma.
2. Inflammatory disease:
- Sarcoidosis, SLE.
- Behcet’s disease.
- Mollaret’s meningitis.
Complications of meningitis:
1) Hydrocephalus.
2) Cranial nerve palsy.
3) Focal neurological deficit.
4) Mental deficit.
5) Epilepsy.
6) Death.
Signs of meningeal irritation:
1) Neck rigidity/stiffness.
2) Kernig’s sign.
3) Brudzinski’s sign.
Causes of meningeal irritation:
1) Meningitis.
2) Sub-arachnoid haemorrhage.
3) Encephalitis.
4) Intracerebral haemorrhage.
5) Cerebral malaria.
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