Description
Meningitis is a serious infection that can cause inflammation of the protective membranes covering the brain and spinal cord. Infants less than three months old are at a higher risk for meningitis because their immune system is not fully developed yet. Most common symptoms of meningitis in infants are fever, irritability, poor feeding, vomiting, and a bulging fontanelle, bacterial meningitis is more severe and requires prompt treatment with antibiotics. Treatment typically involves hospitalization and intravenous antibiotics or antiviral medication, depending on the cause of the infection.
Summary Listen
- Meningitis is defined as the inflammation of the meninges, often manifesting as pleocytosis in the cerebrospinal fluid (CSF). It can be categorized as aseptic, viral, or bacterial, with CSF analysis being crucial for differentiation, focusing on white blood cell count, glucose, protein levels, and appearance.
- Viral meningitis, more common in spring, summer, and fall, usually originates from the respiratory or GI tract. Symptoms can include fever, poor feeding, vomiting, diarrhea, irritability, lethargy, nuchal rigidity, and bulging fontanels. Diagnosis relies on CSF PCR, but clinical features alone cannot reliably differentiate viral from bacterial forms.
- Bacterial meningitis has higher mortality if untreated. Common pathogens vary by age. Diagnosis includes blood cultures and lumbar puncture, which is contraindicated in cases of cardiopulmonary compromise, increased intracranial pressure, or skin infection. Antimicrobial therapy should not be delayed and CSF sent for analysis.
- Neurological findings in meningitis can include altered consciousness, increased intracranial pressure (bulging fontanelles, headache, papilledema), and seizures. Neuroimaging via CT scan is necessary before lumbar puncture in certain conditions.
- Complications of meningitis include abscess, subdural effusion, empyema, thrombosis, impaired mental status, hearing loss, developmental disabilities, hydrocephalus, and SIADH. Management involves addressing fever and pain, and repeat CSF analysis may be necessary.
- Empiric antibiotic therapy is crucial. Steroids, like dexamethasone, can reduce inflammation, intracranial pressure, and prevent hearing loss, but are most effective when administered before or simultaneously with antibiotics. Steroids interrupt cytokine-mediated neurotoxic effects of bacterial lysis. Specific antibiotic choices and durations depend on the identified pathogen.
- Prevention includes isolation and droplet precautions. Vaccines and chemoprophylaxis are important for contacts. Antibiotics like ceftriaxone and rifampin are used for chemoprophylaxis. Household contacts, particularly children under four and immunocompromised individuals, are prioritized for prophylaxis.
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About the Speakers
Dr.Vishant Sharma
Emergency Medicine at Max Super Speciality Hospital Gurugram
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