What Is Meningitis? – How Is Meningitis Diagnosed?

What Is Meningitis?

Meningitis is inflammation of membranes around the brain and spinal cord. It can be bacterial, viral, or fungal.   People of any age can get meningitis, but most adults are older than 60 and most children younger than 15, and half are younger than 4.

People who have greater chances of getting bacterial meningitis include those who had their spleen removed, have poor immune (infection-fighting) systems, have suffered a head injury, or have cancer or diabetes mellitus. Those living in crowded camps or dormitories and alcoholics also have a greater chance of getting meningitis.

What Causes Meningitis?

The many causes include bacteria, viruses, fungi, chemicals, drugs, and tumors. The most common bacteria include Neisseria meningitidisHaemophilus influenzaeStreptococcus pneumoniaeListeria monocytogenesEscherichia coliKlebsiella species, and group B streptococcus. Bacteria spread through passing of respiratory and throat secretions (coughing, kissing).

What Are the Symptoms of Meningitis?

In adults common symptoms include high fever, severe headache, and stiff neck, which start over several hours. Others are nausea, vomiting, light sensitivity, feeling sick, muscle and joint aches, and seizure-like muscle jerks. Poor coordination, confusion, drowsiness, loss of consciousness, and rash also occur. Children have fever, high-pitched moaning or crying, grunting, fretfulness, and tiredness. They don’t eat, are sick, arch their back or neck, and have pale, blotchy skin and rash. Newborns and small babies may seem only slow or inactive, be irritable, vomit, or feed poorly. They may not have the common symptoms.

How Is Meningitis Diagnosed?

The doctor makes a diagnosis by looking for bacteria in a sample of spinal fluid. The doctor gets fluid by doing a spinal tap. A needle is put into a spot in the lower back where fluid in the spinal canal can be reached. The doctor may also order blood tests and x-ray imaging tests of the brain.

How Is Meningitis Treated?

People need a hospital stay for treatment with intravenous antibiotics, plenty of fluids, and rest. Bacterial  meningitis is usually fatal if untreated. Other types of meningitis (viral) aren’t as dangerous, and people don’t usually need a hospital stay. Viral meningitis usually goes away on its own. Antibiotics can’t help it.

A neurologist (specialist in brain diseases) or a doctor who treats infectious diseases may be involved in care. Most people usually recover completely from meningitis. Recovery can take 2 to 3 weeks or longer. A vaccine protects against four types of N. meningitidis. It’s not routinely used in the United States, but is sometimes used for outbreaks. College students, especially those living in dormitories, have more chances of getting meningitis and should consider getting this vaccine.

What is STEVENS-JOHNSON Syndrome ?

Toxic epidermal necrolysis (TEN, Lyell’s syndrome) and Stevens-Johnson syndrome (SJS) are part of a spectrum of potentially life-threatening conditions manifesting with widespread epidermal loss and significant involvement of mucous membranes. They represent severe drug hypersensitivity reactions.

  • Classification of these disorders is based on the extent of detachable skin at the worst stage of illness.
  • In TEN, 30% or more of the skin is involved whereas in SJS less than 10% is affected.
  • An intermediate category, in which 10% to 30% of the skin is involved, has also been recognized.
  • Both disorders are rare (incidence is 0.5 cases/million in the United States.

DEFINITION

Stevens-Johnson syndrome is a severe vesiculobullous form of erythema multiforme.

PHYSICAL FINDINGS AND CLINICAL PRESENTATION

  • The cutaneous eruption is generally preceded by vague, nonspecific symptoms of low-grade fever and fatigue occurring 1 to 14 days before the skin lesions. Cough is often present. Fever may be high during the active stages.
  • Bullae generally occur on the conjunctiva, mucous membranes of the mouth, nares, and genital regions.
  • Corneal ulcerations may result in blindness.
  • Ulcerative stomatitis results in hemorrhagic crusting.
  • Flat, atypical target lesions or purpuric maculae may be distributed on the trunk or be widespread.
  • The pain from oral lesions may compromise fluid intake and result in dehydration.
  • Thick mucopurulent sputum and oral lesions may interfere with breathing.

CAUSE

  • Drugs (e.g., phenytoin, penicillins, phenobarbital, sulfonamides) are the most common cause.
  • Upper respiratory tract infections (e.g., M. pneumoniae) and herpes simplex viral infections have also been implicated in SJS.

 

DIFFERENTIAL DIAGNOSIS

  • Pemphigus
  • Pemphigoid
  • Urticaria
  • Serum sickness
  • Staphylococcal scalded-skin syndrome
  • Behçet’s syndrome

LABORATORY TESTS

  • CBC with differential, cultures in cases of suspected infection
  • Skin biopsy is generally reserved for cases in which classic lesions are absent and diagnosis is uncertain.

IMAGING STUDIES

  • Chest x-ray may show patchy changes in patients with pulmonary involvement.

TREATMENT

  • Withdrawal of any potential drug precipitants
  • Careful skin nursing to prevent secondary infection
  • Treatment of associated conditions, (e.g., acyclovir for herpes simplex virus infection, erythromycin for Mycoplasma infection)
  • Antihistamines for pruritus
  • Treatment of the cutaneous blisters with cool, wet Burow’s compresses
  • Relief of oral symptoms by frequent rinsing with lidocaine (Xylocaine Viscous)
  • Liquid or soft diet with plenty of fluids to ensure proper hydration
  • Treatment of secondary infections with antibiotics
  • Corticosteroids: use remains controversial; when used, prednisone, 20 to 30 mg twice daily, until new lesions no longer appear, then rapidly tapered
  • Topical steroids: may use to treat papules and plaques; however, should not be applied to eroded areas
  • Vitamin A: may be used for lacrimal hyposecretion
  • Prognosis varies with severity of disease. It is generally good in patients with limited disease; however, mortality may approach 10% in patients with extensive involvement.
  • Oral lesions may continue for several months.
  • Scarring and corneal abnormalities may occur in 20% of patients.