Meningitis Classification and external resources
Meninges of the central nervous system: dura mater, arachnoid, and pia mater.
ICD-10	G00.-G03.
ICD-9	320-322
DiseasesDB	22543
MedlinePlus	000680
eMedicine	med/2613  emerg/309 emerg/390
MeSH	D008581

Meningitis is inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings G00-G99 - Diseases of the Nervous system (G00-G09 Inflammatory diseases of the Central nervous system ( Bacterial meningitis G00-G99 - Diseases of the Nervous system (G00-G09 Inflammatory diseases of the Central nervous system ( Bacterial meningitis The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. The Diseases Database is a free Website that provides information about the relationships between medical conditions Symptoms, and Medications. MedlinePlus, with the MedlinePlus Medical Encyclopedia, is a website network containing Health information from the world's largest medical Library eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors Medical Subject Headings ( MeSH) is a huge Controlled vocabulary (or metadata system for the purpose of indexing journal articles and books Inflammation ( Latin, inflamatio, to set on fire is the complex biological response of vascular tissues to harmful stimuli such as Pathogens The brain is the center of the Nervous system in animals All Vertebrates and the majority of Invertebrates have a brain The spinal cord is a long thin tubular bundle of Nerves that is an extension of the Central nervous system from the brain and is enclosed in and protected The meninges (singular meninx) is the system of membranes which envelops the Central nervous system. Meningitis may develop in response to a number of causes, most prominently bacteria, viruses and other infectious agents, but also physical injury, cancer, or certain drugs. The Bacteria ( singular: bacterium) are a large group of unicellular Microorganisms Typically a few Micrometres in length bacteria have A virus (from the Latin virus meaning Toxin or Poison) is a sub-microscopic infectious agent that is unable Cancer (medical term Malignant Neoplasm) is a class of Diseases in which a group of cells display uncontrolled While some forms of meningitis are mild and resolve on their own, meningitis is a potentially serious condition due to the proximity of the inflammation to the brain and spinal cord. The potential for serious neurological damage or even death necessitates prompt medical attention and evaluation. Infectious meningitis, the most common form, is typically treated with antibiotics and requires close observation. In modern usage an antibiotic is a Chemotherapeutic agent with activity against Microorganisms such as Bacteria, fungi or Protozoa Some forms of meningitis (such as those associated with meningococcus, mumps virus or pneumococcus infections) may be prevented with immunization. Neisseria meningitidis, also simply known as meningococcus, is a heterotrophic Gram-negative diplococcal Bacterium best known for Mumps or epidemic Parotitis is a Viral disease of the Human species Streptococcus pneumoniae, or pneumococcus, is a Gram-positive, alpha-hemolytic diplococcus aerotolerant anaerobe and a member of the Genus Immunization, or immunisation, is the process by which an individual's Immune system becomes fortified against an agent (known as the

Signs and symptoms

Severe headache is the most common symptom of meningitis (87 percent) followed by nuchal rigidity ("neck stiffness", 83 percent). Meningism is the triad of nuchal rigidity Photophobia (intolerance of bright light and Headache. The classic triad of diagnostic signs consists of nuchal rigidity (being unable to flex the neck forward), sudden high fever^[1] and altered mental status. Fever (also known as pyrexia, from the Greek pyretos meaning fire or a febrile response, from the Latin word Febris All three features are present in only 44% of all cases of infectious meningitis. ^[2] Other signs commonly associated with meningitis are photophobia (inability to tolerate bright light), phonophobia (inability to tolerate loud noises), irritability and delirium (in small children) and seizures (in 20-40% of cases). Photophobia is a Symptom of excessive sensitivity to Light and the aversion to Sunlight or well-lit places Phonophobia (also called ligyrophobia) is a fear of loud sounds Irritability is an excessive response to stimuli. Irritability takes many forms from the Contraction of a Unicellular organism when touched to complex Delirium is an acute and relatively sudden (developing over hours to days decline in attention-focus perception and Cognition. An epileptic seizure is caused by excessive and/or hypersynchronous electrical Neuronal activity and is usually self-limiting In infants (0-6 months), swelling of the fontanelle (soft spot) may be present. References in Pop Culture The dragon in John Gardner's 1971 novel Grendel makes reference to the fontanele as a mark of the universe's progress

Nuchal rigidity is typically assessed with the patient lying supine, and both hips and knees flexed. The supine position is a position of the body; lying down with the Face up as opposed to the Prone position, which is face down If pain is elicited when the knees are passively extended (Kernig's sign), this indicates nuchal rigidity and meningitis. In infants, forward flexion of the neck may cause involuntary knee and hip flexion (Brudzinski's sign). Meningism is the triad of nuchal rigidity Photophobia (intolerance of bright light and Headache. Although commonly tested, the sensitivity and specificity of Kernig's and Brudzinski's tests are uncertain. ^[3]

In "meningococcal" meningitis (i. e. meningitis caused by the bacteria Neisseria meningitidis), a rapidly-spreading petechial rash is typical, and may precede other symptoms. Neisseria meningitidis, also simply known as meningococcus, is a heterotrophic Gram-negative diplococcal Bacterium best known for Purpura (from the Latin purpura, meaning "purple" is the appearance of red or purple discolorations on the Skin, caused by Bleeding underneath The rash consists of numerous small, irregular purple or red spots on the trunk, lower extremities, mucous membranes, conjunctiva, and occasionally on the palms of hands and soles of feet. Other clues to the nature of the cause may be the skin signs of hand, foot and mouth disease and genital herpes, both of which may be associated with viral meningitis. Hand foot and mouth disease (HFMD is a human Syndrome caused by intestinal viruses of the Picornaviridae family. Herpes simplex virus 1 and 2 ( HSV-1 and HSV-2) are two species of the herpes virus family Herpesviridae, which cause infections ^[4]

Diagnosis

Investigations

Suspicion of meningitis is generally based on the nature of the symptoms and findings on physical examination. Physical examination or clinical examination is the process by which a Health care provider investigates the body of a Patient for signs Meningitis is a medical emergency, and referral to hospital is indicated. A medical emergency is an Injury or Illness that is acute and poses an immediate risk to a person's life or long term health If meningitis is suspected based on clinical examination, early administration of antibiotics is recommended, as the condition may deteriorate rapidly. In modern usage an antibiotic is a Chemotherapeutic agent with activity against Microorganisms such as Bacteria, fungi or Protozoa In the hospital setting, initial management consists of stabilization (e. g. securing the airway in a depressed level of consciousness, administration of intravenous fluids in hypotension or shock), followed by antibiotics if not already administered. The airways are those parts of the Respiratory system through which air flows to get from the external environment to the Alveoli. Intravenous therapy or IV therapy is the giving of Liquid substances directly into a Vein. In Physiology and Medicine, hypotension refers to an abnormally low Blood pressure.

Investigations include blood tests (electrolytes, liver and kidney function, inflammatory markers and a complete blood count) and usually X-ray examination of the chest. A blood test is a laboratory analysis performed on a Blood sample that is usually extracted from a Vein in the arm using a needle, or via A complete blood count ( CBC) also known as full blood count ( FBC) or full blood exam ( FBE) or blood panel, is X-radiation (composed of X-rays) is a form of Electromagnetic radiation. The most important test in identifying or ruling out meningitis is analysis of the cerebrospinal fluid (fluid that envelops the brain and the spinal cord) through lumbar puncture (LP). Cerebrospinal fluid ( CSF) Liquor cerebrospinalis, is a clear Bodily fluid that occupies the Subarachnoid space and the Ventricular system In Medicine, a lumbar puncture (colloquially known as a spinal tap) is a Diagnostic and at times therapeutic procedure that is performed in order However, if the patient is at risk for a cerebral mass lesion or elevated intracranial pressure (recent head injury, a known immune system problem, localizing neurological signs, or evidence on examination of a raised ICP), a lumbar puncture may be contraindicated because of the possibility of fatal brain herniation. Intracranial pressure, ( ICP) is the pressure exerted by the Cranium on the Brain tissue Cerebrospinal fluid (CSF and the brain's circulating Herniation, a deadly side effect of very high Intracranial pressure, occurs when the Brain shifts across structures within the Skull. In such cases a CT or MRI scan is generally performed prior to the lumbar puncture to exclude this possibility. Computed tomography (CT is a Medical imaging method employing Tomography. Otherwise, the CT or MRI should be performed after the LP, with MRI preferred over CT due to its superiority in demonstrating areas of cerebral edema, ischemia, and meningeal inflammation.

During the lumbar puncture procedure, the opening pressure is measured. A pressure of over 180 mm H₂O is indicative of bacterial meningitis.

The cerebrospinal fluid (CSF) sample is examined for white blood cells (and which subtypes), red blood cells, protein content and glucose level. Cerebrospinal fluid ( CSF) Liquor cerebrospinalis, is a clear Bodily fluid that occupies the Subarachnoid space and the Ventricular system Red blood cells are the most common type of Blood cell and the Vertebrate body's principal means of delivering Oxygen to the body tissues via the Blood Proteins are large Organic compounds made of Amino acids arranged in a linear chain and joined together by Peptide bonds between the Carboxyl Glucose (Glc a Monosaccharide (or simple Sugar) also known as grape sugar, is an important Carbohydrate in Biology. Gram staining of the sample may demonstrate bacteria in bacterial meningitis, but absence of bacteria does not exclude bacterial meningitis; microbiological culture of the sample may still yield a causative organism. Gram staining (or Gram's method) is an empirical method of differentiating bacterial species into two large groups ( Gram-positive and A microbiological culture, AKA microbial culture, is a method of multiplying microbial organisms by letting them reproduce in predetermined culture media under controlled laboratory The type of white blood cell predominantly present predicts whether meningitis is due to bacterial or viral infection. A virus (from the Latin virus meaning Toxin or Poison) is a sub-microscopic infectious agent that is unable Other tests performed on the CSF sample include latex agglutination test, limulus lysates, or polymerase chain reaction (PCR) for bacterial or viral DNA. A latex fixation test (or latex agglutination test) is an agglutination technique used to detect antibodies such as those produced in response to the Rubella If the patient is immunocompromised, testing the CSF for toxoplasmosis, Epstein-Barr virus, cytomegalovirus, JC virus and fungal infection may be performed. In Medicine, immunodeficiency (or immune deficiency) is a state in which the Immune system 's ability to fight Infectious disease is compromised Toxoplasmosis is a Parasitic disease caused by the Protozoan Toxoplasma gondii. The Epstein-Barr Virus ( EBV) also called Human herpesvirus 4 (HHV-4 is a Virus of the herpes family (which includes Herpes Cytomegalovirus (CMV (from the Greek cyto-, "cell" and -megalo-, "large" is a viral The JC virus or John Cunningham virus (JCV is a type of human Polyomavirus (formerly known as papovavirus and is genetically similar to BK virus and SV40 A fungus (ˈfʌŋgəs is a eukaryotic Organism that is a member of the kingdom Fungi (ˈfʌndʒaɪ

An autopsy demonstrating signs of pneumococcal meningitis. A lymphocyte is a type of White blood cell in the Vertebrate Immune system. Pleocytosis is a term used to describe an increased cell count {Gk Red blood cells are the most common type of Blood cell and the Vertebrate body's principal means of delivering Oxygen to the body tissues via the Blood An autopsy, also known as a post-mortem examination, necropsy, or obduction, is a Medical procedure that consists of a thorough Examination Streptococcus pneumoniae, or pneumococcus, is a Gram-positive, alpha-hemolytic diplococcus aerotolerant anaerobe and a member of the Genus The forceps (center) are retracting the dura mater (white). Forceps are a handheld hinged instrument used for grasping and holding objects The dura mater (from the Latin "hard mother" or pachymeninx, is the tough and inflexible outermost of the three layers of the Meninges surrounding the Underneath the dura mater are the leptomeninges, which are edematous and have multiple small hemorrhagic foci (red). In Medicine, leptomeninges (literally thin Meninges) is a term used to refer to the Pia mater and Arachnoid mater. Oedema (or Edema in American English formerly known as dropsy or hydropsy, is the increase of Interstitial fluid in any organ &mdash swelling Bleeding, technically known as hemorrhaging / haemorrhaging (see American and British spelling differences) is the loss of Blood from

In bacterial meningitis, the CSF glucose to serum glucose ratio is < 0. 4. The Gram stain is positive in >60% of cases, and culture in >80%. Latex agglutination may be positive in meningitis due to Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae, Escherichia coli, Group B Streptococci. Streptococcus pneumoniae, or pneumococcus, is a Gram-positive, alpha-hemolytic diplococcus aerotolerant anaerobe and a member of the Genus Neisseria meningitidis, also simply known as meningococcus, is a heterotrophic Gram-negative diplococcal Bacterium best known for Haemophilus influenzae, formerly called Pfeiffer's bacillus or Bacillus influenzae, is a non-motile Gram-negative Coccobacillus Limulus lysates may be positive in Gram-negative meningitis.

Cultures are often negative if CSF is taken after the administration of antibiotics. In these patients, PCR can be helpful in arriving at a diagnosis. It has been suggested that CSF cortisol measurement may be helpful. Cortisol is a Corticosteroid Hormone produced by the Adrenal gland (in the Zona fasciculata of the Adrenal cortex) ^[6]

Aseptic meningitis refers to non-bacterial causes of meningitis and includes infective etiologies such as viruses and fungi, neoplastic etiologies such as carcinomatous and lymphomatous meningitis, inflammatory causes such as sarcoidosis (neurosarcoidosis)) and chemical causes such as meningitis secondary to the intrathecal introduction of contrast media. A virus (from the Latin virus meaning Toxin or Poison) is a sub-microscopic infectious agent that is unable A fungus (ˈfʌŋgəs is a eukaryotic Organism that is a member of the kingdom Fungi (ˈfʌndʒaɪ Sarcoidosis, also called sarcoid (from the Greek sarx, meaning "flesh" or Besnier-Boeck disease, is an immune system disorder characterized Neurosarcoidosis (sometimes shortened to neurosarcoid) refers to Sarcoidosis, a condition of unknown cause featuring Granulomas in various tissues involving Contrast medium Radiocontrast agents (also simply contrast agents or contrast materials) are compounds used to improve the visibility of internal bodily structures

Although the term "viral meningitis" is often used in any patient with a mild meningeal illness with appropriate CSF findings, certain patients will present with clinical and CSF features of viral meningitis, yet ultimately be diagnosed with one of the other conditions categorized as "aseptic meningitis". This may be prevented by performing polymerase chain reaction or serology on CSF or blood for common viral causes of meningitis (enterovirus, herpes simplex virus 2 and mumps in those not vaccinated for this). Serology is the scientific study of blood serum. In practice the term usually refers to the Diagnostic identification of antibodies in the serum The enteroviruses are a genus of (+ssRNA viruses associated with several human and mammalian diseases Herpes simplex virus 1 and 2 ( HSV-1 and HSV-2) are two species of the herpes virus family Herpesviridae, which cause infections Mumps or epidemic Parotitis is a Viral disease of the Human species ^[4]

A related diagnostic and therapeutic conundrum is the "partially treated meningitis", i. e. meningitis symptoms in patients who have already been receiving antibiotics (such as for presumptive sinusitis). Sinusitis is an Inflammation of the Paranasal sinuses which may or may not be as a result of infection from Bacterial fungal, viral In these patients, CSF findings may resemble those of viral meningitis, but antibiotic treatment may need to be continued until there is definitive positive evidence of a viral cause (e. g. a positive enterovirus PCR). The enteroviruses are a genus of (+ssRNA viruses associated with several human and mammalian diseases ^[4]

Prediction rules

The Bacterial Meningitis Score predicts reliably whether a child (older than two months) may have infectious meningitis. In children with at least 1 risk factor (positive CSF Gram stain, CSF absolute neutrophil count ≥ 1000 cell/µL, CSF protein ≥ 80 mg/dL, peripheral blood absolute neutrophil count ≥ 10,000 cell/µL, history of seizure before or at presentation time) it had a sensitivity of 100%, specificity of 63. 5%, and negative predictive value of 100%. ^[7]

Causes

Most cases of meningitis are caused by microorganisms, such as viruses, bacteria, fungi, or parasites, that spread into the blood and into the cerebrospinal fluid (CSF). A microorganism (also spelled micro organism or micro-organism and also called a microbe) is an Organism that is Microscopic (usually A virus (from the Latin virus meaning Toxin or Poison) is a sub-microscopic infectious agent that is unable The Bacteria ( singular: bacterium) are a large group of unicellular Microorganisms Typically a few Micrometres in length bacteria have A fungus (ˈfʌŋgəs is a eukaryotic Organism that is a member of the kingdom Fungi (ˈfʌndʒaɪ Parasitism is a type of symbiotic relationship between Organisms of different Species. Cerebrospinal fluid ( CSF) Liquor cerebrospinalis, is a clear Bodily fluid that occupies the Subarachnoid space and the Ventricular system ^[8] Non-infectious causes include cancers, systemic lupus erythematosus and certain drugs. Cancer (medical term Malignant Neoplasm) is a class of Diseases in which a group of cells display uncontrolled Systemic lupus erythematosus ( SLE or lupus,) is a chronic autoimmune disease that can be fatal though with recent medical advances fatalities are becoming A drug, broadly speaking is any chemical substance that when absorbed into the body The most common cause of meningitis is viral, and often runs its course within a few days. Bacterial meningitis is the second most frequent type and can be serious and life-threatening. Numerous microorganisms may cause bacterial meningitis, but Neisseria meningitidis ("meningococcus") and Streptococcus pneumoniae ("pneumococcus") are the most common pathogens in patients without immune deficiency, with meningococcal disease being more common in children. Neisseria meningitidis, also simply known as meningococcus, is a heterotrophic Gram-negative diplococcal Bacterium best known for Streptococcus pneumoniae, or pneumococcus, is a Gram-positive, alpha-hemolytic diplococcus aerotolerant anaerobe and a member of the Genus Staphylococcus aureus may complicate neurosurgical operations, and Listeria monocytogenes is associated with poor nutritional state and alcoholism. Staphylococcus aureus (ˌstæfɨləˈkɒkəs ˈɔriəs literally "Golden Cluster Seed" and also known as golden staph) is the most common cause of Listeria monocytogenes is a Gram-positive Bacterium, in the division Firmicutes, named for Joseph Lister. Haemophilus influenzae (type B) incidence has been much reduced by immunization in many countries. Haemophilus influenzae, formerly called Pfeiffer's bacillus or Bacillus influenzae, is a non-motile Gram-negative Coccobacillus Mycobacterium tuberculosis (the causative agent of tuberculosis) rarely causes meningitis in Western countries but is common and feared in countries where tuberculosis is endemic. Mycobacterium tuberculosis is the Bacterium that causes most cases of Tuberculosis. Tuberculosis (abbreviated as TB for tubercle bacillus or T u' b' erculosis Bacillus --> is a common

Treatment

Bacterial meningitis

Bacterial meningitis is a medical emergency and has a high mortality rate if untreated. A medical emergency is an Injury or Illness that is acute and poses an immediate risk to a person's life or long term health ^[9] All suspected cases, however mild, need emergency medical attention. Empiric antibiotics must be started immediately, even before the results of the lumbar puncture and CSF analysis are known. Empiric therapy is a medical term referring to the initiation of treatment prior to determination of a firm diagnosis In Medicine, a lumbar puncture (colloquially known as a spinal tap) is a Diagnostic and at times therapeutic procedure that is performed in order Cerebrospinal fluid ( CSF) Liquor cerebrospinalis, is a clear Bodily fluid that occupies the Subarachnoid space and the Ventricular system Antibiotics started within 4 hours of lumbar puncture will not significantly affect lab results. Adjuvant treatment with corticosteroids reduces rates of mortality, severe hearing loss and neurological sequelae in adults, specifically when the causative agent is Pneumococcus. Corticosteroids are a class of Steroid hormones that are produced in the Adrenal cortex. ^[10]

The choice of antibiotic depends on local advice. Mycobacterium is a Genus of Actinobacteria, given its own family the Mycobacteriaceae Cryptococcus (literally "Hidden Seed" is a Genus of Fungus. In most of the developed world, the most common organisms involved are Streptococcus pneumoniae and Neisseria meningitidis: first line treatment in the UK is a third-generation cephalosporin (such as ceftriaxone or cefotaxime). Streptococcus pneumoniae, or pneumococcus, is a Gram-positive, alpha-hemolytic diplococcus aerotolerant anaerobe and a member of the Genus Neisseria meningitidis, also simply known as meningococcus, is a heterotrophic Gram-negative diplococcal Bacterium best known for The cephalosporins (ˌsɛfələˈspɔrən/ /ˌkɛfə- are a class of β-lactam antibiotics. Ceftriaxone ( INN) (ˌsɛftraɪˈæksoʊn/ /ˌkɛf- is a third-generation Cephalosporin Antibiotic. Cefotaxime ( INN) (sɛfəˈtæksiːm/ /kɛfə- is a third-generation Cephalosporin Antibiotic. In those under 3 years of age, over 50 years of age, or immunocompromised, ampicillin should be added to cover Listeria monocytogenes. Ampicillin is a beta-lactam Antibiotic that has been used extensively to treat bacterial Infections since 1961 Listeria monocytogenes is a Gram-positive Bacterium, in the division Firmicutes, named for Joseph Lister. ^[11] In the U. S. and other countries with high levels of penicillin resistance, the first line choice of antibiotics is vancomycin and a carbapenem (such as meropenem). Vancomycin ( INN) (ˌvæŋkoʊˈmaɪsɪn is a Glycopeptide Antibiotic used in the Prophylaxis and treatment of infections caused by Carbapenems are a class of Beta-lactam antibiotics with a broad spectrum of antibacterial activity and have a structure which renders them highly resistant to Beta-lactamases Meropenem is an ultra-broad spectrum injectable Antibiotic used to treat a wide variety of infections including Meningitis and Pneumonia. In sub-Saharan Africa, oily chloramphenicol or ceftriaxone are often used because only a single dose is needed in most cases. Sub-Saharan Africa is a geographical term used to describe the area of the African continent which lies south of the Sahara, or those African countries Chloramphenicol is a Bacteriostatic Antimicrobial originally derived from the Bacterium Streptomyces venezuelae, isolated by Ceftriaxone ( INN) (ˌsɛftraɪˈæksoʊn/ /ˌkɛf- is a third-generation Cephalosporin Antibiotic.

Staphylococci and gram-negative bacilli are common infective agents in patients who have just had a neurosurgical procedure. Again, the choice of antibiotic depends on local patterns of infection: cefotaxime and ceftriaxone remain good choices in many situations, but ceftazidime is used when Pseudomonas aeruginosa is a problem, and intraventricular vancomycin is used for those patients with intraventricular shunts because of high rates of staphylococcal infection. Cefotaxime ( INN) (sɛfəˈtæksiːm/ /kɛfə- is a third-generation Cephalosporin Antibiotic. Ceftriaxone ( INN) (ˌsɛftraɪˈæksoʊn/ /ˌkɛf- is a third-generation Cephalosporin Antibiotic. Ceftazidime ( INN) (sɛfˈtæzɨdiːm/ /kɛf- is a third-generation Cephalosporin Antibiotic. Pseudomonas aeruginosa is a Gram-negative, aerobic, rod-shaped Bacterium with unipolar motility. Vancomycin ( INN) (ˌvæŋkoʊˈmaɪsɪn is a Glycopeptide Antibiotic used in the Prophylaxis and treatment of infections caused by Staphylococcus (in Greek σταφυλη staphyle means bunch of grapes and κοκκος coccos means granule is a genus of Gram-positive In patients with intracerebral prosthetic material (metal plates, electrodes or implants, etc. ) then sometimes chloramphenicol is the only antibiotic that will adequately cover infection by Staphylococcus aureus (cephalosporins and carbapenems are inadequate under these circumstances). Chloramphenicol is a Bacteriostatic Antimicrobial originally derived from the Bacterium Streptomyces venezuelae, isolated by Staphylococcus aureus (ˌstæfɨləˈkɒkəs ˈɔriəs literally "Golden Cluster Seed" and also known as golden staph) is the most common cause of

Once the results of the CSF analysis are known along with the Gram-stain and culture, empiric therapy may be switched to therapy targeted to the specific causative organism and its sensitivities.

• Neisseria meningitidis (Meningococcus) can usually be treated with a 7-day course of IV antibiotics:
  • Penicillin-sensitive -- penicillin G or ampicillin
  • Penicillin-resistant -- ceftriaxone or cefotaxime
  • Prophylaxis for close contacts (contact with oral secretions) -- rifampin 600 mg bid for 2 days (adults) or 10 mg/kg bid (children). Neisseria meningitidis, also simply known as meningococcus, is a heterotrophic Gram-negative diplococcal Bacterium best known for Penicillin (sometimes abbreviated PCN or pen) is a group of Beta-lactam antibiotics used in the treatment of Bacterial Infections Ampicillin is a beta-lactam Antibiotic that has been used extensively to treat bacterial Infections since 1961 Ceftriaxone ( INN) (ˌsɛftraɪˈæksoʊn/ /ˌkɛf- is a third-generation Cephalosporin Antibiotic. Cefotaxime ( INN) (sɛfəˈtæksiːm/ /kɛfə- is a third-generation Cephalosporin Antibiotic. Rifampicin ( INN) (rɪˈfæmpəsɪn or rifampin ( USAN) is a Bactericidal Antibiotic drug of the Rifamycin group Rifampin is not recommended in pregnancy and as such, these patients should be treated with single doses of ciprofloxacin, azithromycin, or ceftriaxone
• Streptococcus pneumoniae (Pneumococcus) can usually be treated with a 2-week course of IV antibiotics:
  • Penicillin-sensitive -- penicillin G
  • Penicillin-intermediate -- ceftriaxone or cefotaxime
  • Penicillin-resistant -- ceftriaxone or cefotaxime + vancomycin
• Listeria monocytogenes is treated with a 3-week course of IV ampicillin + gentamicin. Azithromycin is an Azalide, a subclass of Macrolide Antibiotics. Ceftriaxone ( INN) (ˌsɛftraɪˈæksoʊn/ /ˌkɛf- is a third-generation Cephalosporin Antibiotic. Streptococcus pneumoniae, or pneumococcus, is a Gram-positive, alpha-hemolytic diplococcus aerotolerant anaerobe and a member of the Genus Penicillin (sometimes abbreviated PCN or pen) is a group of Beta-lactam antibiotics used in the treatment of Bacterial Infections Ceftriaxone ( INN) (ˌsɛftraɪˈæksoʊn/ /ˌkɛf- is a third-generation Cephalosporin Antibiotic. Cefotaxime ( INN) (sɛfəˈtæksiːm/ /kɛfə- is a third-generation Cephalosporin Antibiotic. Ceftriaxone ( INN) (ˌsɛftraɪˈæksoʊn/ /ˌkɛf- is a third-generation Cephalosporin Antibiotic. Cefotaxime ( INN) (sɛfəˈtæksiːm/ /kɛfə- is a third-generation Cephalosporin Antibiotic. Vancomycin ( INN) (ˌvæŋkoʊˈmaɪsɪn is a Glycopeptide Antibiotic used in the Prophylaxis and treatment of infections caused by Listeria monocytogenes is a Gram-positive Bacterium, in the division Firmicutes, named for Joseph Lister. Ampicillin is a beta-lactam Antibiotic that has been used extensively to treat bacterial Infections since 1961 Gentamicin is an Aminoglycoside Antibiotic, used to treat many types of bacterial infections particularly those caused by Gram-negative
• Gram negative bacilli -- ceftriaxone or cefotaxime
• Pseudomonas aeruginosa -- ceftazidime
• Staphylococcus aureus
  • Methicillin-sensitive -- nafcillin
  • Methicillin-resistant -- vancomycin
• Streptococcus agalactiae -- penicillin G or ampicillin
• Haemophilus influenzae -- ceftriaxone or cefotaxime

Viral meningitis

Patients diagnosed with mild viral meningitis may improve quickly enough to not require admission to a hospital, while others may be hospitalized for many more days for observation and supportive care. Ceftriaxone ( INN) (ˌsɛftraɪˈæksoʊn/ /ˌkɛf- is a third-generation Cephalosporin Antibiotic. Cefotaxime ( INN) (sɛfəˈtæksiːm/ /kɛfə- is a third-generation Cephalosporin Antibiotic. Pseudomonas aeruginosa is a Gram-negative, aerobic, rod-shaped Bacterium with unipolar motility. Ceftazidime ( INN) (sɛfˈtæzɨdiːm/ /kɛf- is a third-generation Cephalosporin Antibiotic. Staphylococcus aureus (ˌstæfɨləˈkɒkəs ˈɔriəs literally "Golden Cluster Seed" and also known as golden staph) is the most common cause of Nafcillin sodium is a narrow spectrum Beta-lactam antibiotic of the Penicillin class Vancomycin ( INN) (ˌvæŋkoʊˈmaɪsɪn is a Glycopeptide Antibiotic used in the Prophylaxis and treatment of infections caused by Streptococcus agalactiae also known as Group B Streptococcus (GBS and more colloquially as Strep B and group B Strep is a Gram-positive Streptococcus Penicillin (sometimes abbreviated PCN or pen) is a group of Beta-lactam antibiotics used in the treatment of Bacterial Infections Ampicillin is a beta-lactam Antibiotic that has been used extensively to treat bacterial Infections since 1961 Haemophilus influenzae, formerly called Pfeiffer's bacillus or Bacillus influenzae, is a non-motile Gram-negative Coccobacillus Ceftriaxone ( INN) (ˌsɛftraɪˈæksoʊn/ /ˌkɛf- is a third-generation Cephalosporin Antibiotic. Cefotaxime ( INN) (sɛfəˈtæksiːm/ /kɛfə- is a third-generation Cephalosporin Antibiotic. Overall, the illness is usually much less severe than bacterial meningitis.

Unlike bacteria, viruses cannot be killed by antibiotics. Drugs such as acyclovir may be employed if herpes virus infection is either suspected or demonstrated. Aciclovir ( INN ^[4]

Fungal meningitis

This form of meningitis is rare in otherwise healthy people but is a higher risk in those who have AIDS, other forms of immunodeficiency (an immune system that does not respond adequately to infections) and immunosuppression (immune system malfunction as a result of medical treatment). In Medicine, immunodeficiency (or immune deficiency) is a state in which the Immune system 's ability to fight Infectious disease is compromised Immunosuppression involves an act that reduces the activation or Efficacy of the Immune system. In AIDS, Cryptococcus neoformans is the most common cause of fungal meningitis; it requires Indian ink staining of the CSF sample for identification of this capsulated yeast. Cryptococcus neoformans is an encapsulated yeast-like Fungus that can live in both Plants and Animals This species also known by its "Indian ink" redirects here For the play by Tom Stoppard see Indian Ink (play. Fungal meningitis is treated with long courses of highly dosed antifungals. An antifungal drug is Medication used to treat fungal Infections such as Athlete's foot, Ringworm, Candidiasis (thrush ^[12]

Complications

In children there are several potential disabilities which result from damage to the nervous system. These include sensorineural hearing loss, epilepsy, diffuse brain swelling, hydrocephalus, cerebral vein thrombosis, intra cerebral bleeding and cerebral palsy. Sensorineural hearing loss is a type of Hearing loss in which the root cause lies in the Vestibulocochlear nerve ( Cranial nerve VIII the inner Ear Epilepsy is a common chronic Neurological disorder that is characterized by recurrent unprovoked seizures. Cerebral edema (cerebral oedema in British English) is an excess accumulation of water in the intracellular and/or extracellular spaces of the Brain. Hydrocephalus (pronunciation ˌhaɪˌdɹoʊˈsɛfələs is a term derived from the Greek words "hydro" meaning water and "cephalus" meaning head and this condition Cerebral venous sinus thrombosis ( CVST) is a rare form of Stroke that results from Thrombosis (a blood clot of the Dural venous sinuses, which An intracranial hemorrhage is a Hemorrhage, or bleeding within the Skull. Cerebral palsy ( CP) is an Umbrella term encompassing a group of non-progressive, non- contagious conditions that cause Physical disability ^[13] Acute neurological complications may lead to adverse consequences. In childhood acute bacterial meningitis deafness is the most common serious complication. Sensorineural hearing loss often develops during first few days of the illness as a result of inner ear dysfunction, but permanent deafness is rare and can be prevented by prompt treatment of meningitis. Sensorineural hearing loss is a type of Hearing loss in which the root cause lies in the Vestibulocochlear nerve ( Cranial nerve VIII the inner Ear The inner Ear is the bony labyrinth, a system of passages comprising two main functional parts the organ of hearing or Cochlea ^[14]

Those that contract the disease during the neonatal period and those infected by S. pneumoniae and gram negative bacilli are at greater risk of developing neurological, auditory, or intellectual impairments or functionally important behaviour or learning disorders which can manifest as poor school performance. Bacilli specifically refers to a taxonomic class of Bacteria. Developmental disability is a term used to describe life-long disabilities attributable to mental and/or physical or combination of mental and physical impairments In the United States and Canada, the term learning disability (LD refers to a group of disorders that affect a broad range of academic and functional skills including ^[15]

In adults central nervous system complications include brain infarction, brain swelling, hydrocephalus, intracerebral bleeding; systemic complications are dominated by septic shock, adult respiratory distress syndrome and disseminated intravascular coagulation. In Vertebrates the central nervous system ( CNS) is the part of the Nervous system which is enclosed in the Meninges. Hydrocephalus (pronunciation ˌhaɪˌdɹoʊˈsɛfələs is a term derived from the Greek words "hydro" meaning water and "cephalus" meaning head and this condition Disseminated intravascular coagulation ( DIC) also known as consumptive coagulopathy, is a pathological activation of Coagulation (blood clotting mechanisms ^[16] Those who have underlying predisposing conditions e. g. head injury may develop recurrent meningitis. ^[17] Case-fatality ratio is highest for gram-negative etiology and lowest for meningitis caused by H. influenzae (also a gram negative bacilli). In Epidemiology, case fatality (CF or Fatality Rate, is the Ratio of Deaths within a designated Population, over a certain period Gram-negative bacteria are those Bacteria that do not retain Crystal violet dye in the Gram staining protocol Etiology (alternatively aetiology, aitiology) is the study of causation. Haemophilus influenzae, formerly called Pfeiffer's bacillus or Bacillus influenzae, is a non-motile Gram-negative Coccobacillus Fatal outcome in patients over 60 years of age is more likely to be from systemic complications e. g. pneumonia, sepsis, cardio-respiratory failure; however in younger individuals it is usually associated with neurological complications. Pneumonia is an inflammatory illness of the Lung. Frequently it is described as lung Parenchyma / alveolar inflammation and abnormal Sepsis is a serious medical condition characterized by a whole-body inflammatory state (called a Systemic inflammatory response syndrome or SIRS caused ^[17] Age more than 60, low Glasgow coma scale at presentation and seizure within 24 hours increase the risk of death among community acquired meningitis. The Glasgow Coma Scale or GCS, sometimes also known as the Glasgow Coma Score is a neurological scale which aims to give a reliable objective An epileptic seizure is caused by excessive and/or hypersynchronous electrical Neuronal activity and is usually self-limiting ^[18]

Prevention

Immunization

Vaccinations against Haemophilus influenzae (Hib) have decreased early childhood meningitis significantly. Haemophilus influenzae, formerly called Pfeiffer's bacillus or Bacillus influenzae, is a non-motile Gram-negative Coccobacillus Haemophilus influenzae type b vaccine (Hib vaccine or PRP vaccine is a Conjugate vaccine developed for the prevention of invasive disease caused by Haemophilus influenzae ^[19]

Vaccines against type A and C Neisseria meningitidis, the kind that causes most disease in preschool children and teenagers in the United States, have also been around for a while. Neisseria meningitidis, also simply known as meningococcus, is a heterotrophic Gram-negative diplococcal Bacterium best known for The United States of America —commonly referred to as the Type A is also prevalent in sub-Sahara Africa and W135 outbreaks have affected those on the Hajj pilgrimage to Mecca. The Sahara (الصحراء الكبرى aṣ-ṣaḥrā´ al-kubra, "The Great Desert" is the world's largest hot Desert and the world's second largest The Hajj (حج is a pilgrimage to Mecca (Makkah It is the largest annual pilgrimage in the world Mecca ˈmɛkə also spelled Makkah ˈmækə (in full Makkah Al-Mukarramah (Arabic mækːæ(t ælmʊkarˑamæ مكّة المكرمة, literally Honored Immunisation with the ACW135Y vaccine against four strains is now a visa requirement for taking part in the Hajj.

Vaccines against type B Neisseria meningitidis are much harder to produce, as its capsule is very weakly immunogenic masking its antigenic proteins. Immunogenicity is the ability of a particular substance which is called the Antigen, to provoke an Immune response. There is also a risk of autoimmune response, and the porA and porB proteins on Type B resemble neuronal molecules. A vaccine called MeNZB for a specific strain of type B Neisseria meningitidis prevalent in New Zealand has completed trials and is being given to many people in the country under the age of 20 free of charge. MeNZB is a Vaccine against a specific strain of group B Meningococcus, currently being used to control an epidemic of meningococcal disease in New Zealand New Zealand is an Island country in the south-western Pacific Ocean comprising two main landmasses (the North Island and the South Island There is also a vaccine, MenBVac, for the specific strain of type B meningoccocal disease prevalent in Norway, and another specific vaccine for the strain prevalent in Cuba. Norway ( Norwegian: Norge ( Bokmål) or Noreg ( Nynorsk) officially the Kingdom of Norway, is a Constitutional The Republic of Cuba (ˈkjuːbə or) consists of the island of Cuba (the largest and second-most populous island of the Greater Antilles) Isla de la According to reports released in May 2008, Novartis is in the advanced stages of testing a general meningococcus type B vaccine. Novartis International AG is a multinational Pharmaceutical company based in Basel Switzerland that manufactures drugs such as Clozapine ^[20]

Pneumococcal polysaccharide vaccine against Streptococcus pneumoniae is recommended for all people 65 years of age or older. Pneumococcal polysaccharide vaccine (PPV also known as Pneumovax, is a Vaccine used to prevent Streptococcus pneumoniae (pneumococcus infections Streptococcus pneumoniae, or pneumococcus, is a Gram-positive, alpha-hemolytic diplococcus aerotolerant anaerobe and a member of the Genus Pneumococcal conjugate vaccine is recommended for all newborns starting at 6 weeks - 2 months, according to American Association of Pediatrics (AAP) recommendations. Pneumococcal conjugate vaccine or Prevnar is a Vaccine used to protect Infants and young children against disease caused by the Bacterium

Mumps vaccination has led to a sharp decline in mumps virus associated meningitis, which prior to vaccination occurred in 15% of all cases of mumps. Mumps or epidemic Parotitis is a Viral disease of the Human species ^[4]

Prophylaxis

In cases of meningococcal meningitis, prophylactic treatment of close relatives with antibiotics (e. g. rifampicin, ciprofloxacin or ceftriaxone) may reduce the risk of further cases. Rifampicin ( INN) (rɪˈfæmpəsɪn or rifampin ( USAN) is a Bactericidal Antibiotic drug of the Rifamycin group Ceftriaxone ( INN) (ˌsɛftraɪˈæksoʊn/ /ˌkɛf- is a third-generation Cephalosporin Antibiotic. ^[21]

Epidemiology

Demography of meningococcal meningitis. Neisseria meningitidis, also simply known as meningococcus, is a heterotrophic Gram-negative diplococcal Bacterium best known for Red: meningitis belt, orange: epidemic meningitis, grey: sporadic cases

Meningitis can affect anyone in any age group, from the newborn to the elderly.

The "Meningitis Belt" is an area in sub-Saharan Africa which stretches from Senegal in the west to Ethiopia in the east in which large epidemics of meningococcal meningitis occur (this largely coincides with the Sahel region). Sub-Saharan Africa is a geographical term used to describe the area of the African continent which lies south of the Sahara, or those African countries Senegal (le Sénégal officially the Republic of Senegal, is a country south of the Sénégal River in western Africa. NOTE This intro is the result of careful NPOV work Please do not make potentially controversial edits to it without first discussing on the talk page See also Sahel Tunisia, a region of eastern Tunisia. The Sahel or Sahel Belt (from Arabic ساحل sāḥil It contains an estimated total population of 300 million people. The largest epidemic outbreak was in 1996, when over 250,000 cases occurred and 25,000 people died as a consequence of the disease.

History

Meningitis was first described in the 1020s in Avicenna's The Canon of Medicine,^[22] and again more accurately by Avenzoar of al-Andalus in the 12th century. TemplateInfobox Muslim scholars --> ( Persian /ابو علی الحسین ابن عبدالله ابن سینا (born The Canon of Medicine ( Arabic: القانون في الطب Al-Qanun fi al-Tibb " The Law of Medicine " Persian Abū Merwān ’Abdal-Malik ibn Zuhr ( أبو مروان عبد الملك بن زهر) (also known as Ibn Zuhr, Avenzoar, Abumeron or Ibn-Zohr Al-Andalus (الأندلس was the Arabic name given to those parts of the Iberian Peninsula governed by Muslims or ^[23] Symptoms of the disease were also noted in 1805 by the Swiss Gabinetto Vieusseux (a scientific-literary association) during an outbreak in Geneva, Switzerland. The Gabinetto Scientifico Letterario GP Vieusseux, founded in 1819 by Giovan Pietro Vieusseux, a Merchant from Geneva, is a library in Geneva (Genève is the second-most populous city in Switzerland (after Zürich) and is the most populous city of Romandy (the French -speaking Switzerland (English pronunciation; Schweiz Swiss German: Schwyz or Schwiiz Suisse Svizzera Svizra officially the Swiss Confederation In 1887, Dr. Anton Weichselbaum (1845-1920) of Vienna became the first to isolate the specific germ, meningococcus. Anton Weichselbaum ( February 8, 1845 &mdash October 23, 1920) was an Austrian Pathologist and Bacteriologist who was a native Vienna ( in Wien; see also other names) is the Capital of Austria, and is also one of the nine States of Austria. ^[24]

In the 19th century, meningitis was a scourge of the Japanese imperial family, playing the largest role in the horrendous pre-maturity mortality rate the family endured. The Imperial House of Japan (also referred to as the Imperial Family or kōshitsu, 皇室 comprises those members of the extended family of the reigning Emperor of In the mid-1800s, only the Emperor Kōmei and two of his siblings reached maturity out of fifteen total children surviving birth. ( July 22, 1831 - January 30, 1867) was the 121st emperor of Japan, according to the traditional order of succession Kōmei's son, the Emperor Meiji, was one of two survivors out of Kōmei's six children, including an elder brother of Meiji who would have taken the throne had he lived to maturity. The (3 November 1852 — 30 July 1912 or Meiji the Great was the 122nd emperor of Japan according to the traditional order of succession reigning from 3 February Five of Meiji's 15 children survived, including only his third son, Emperor Taishō, who was feeble-minded, perhaps as a result of having contracted meningitis himself. The (31 August 1879 – 25 December 1926 was the 123rd emperor of Japan, according to the traditional order of succession reigning from 30 July 1912 until his death The term feeble-minded was used from the late 19th century through the early 20th century as a loose description of a variety of mental deficiencies including what would now be considered By Emperor Hirohito's generation the family was receiving modern medical attention. also known as, (April 29 1901 – January 7 1989 was the 124th Emperor of Japan according to the traditional order reigning from December 25 1926 until his death As the focal point of tradition in Japan, during the Tokugawa Shogunate the family was denied modern "Dutch" medical treatment then in use among the upper caste; despite extensive modernization during the Meiji Restoration the Emperor insisted on traditional medical care for his children. The Tokugawa shogunate, also known as the, and the, was a feudal regime of Japan established by Tokugawa Ieyasu and ruled by the Shoguns of The, also known as the Meiji Ishin, Revolution, or Renewal, was a chain of events that led to enormous changes in Japan 's political and social structure Kampō (or Kanpō 漢方 medicine is the Japanese study and adaptation of Traditional Chinese medicine.

See also

• Encephalitis
• Maurice Hilleman

References

External links

• Meningitis at the Open Directory Project
• WHO: Meningococcal meningitis
• Merck Manual: Central nervous system infections
• Vaccination information from the NHS, UK
• CDC: Meningococcal disease
• CNN Health Library, Meningitis
• Meningitis Foundation of America
• Information on Meningitis UK and the charity's search for a vaccine
• Information from the Meningitis Trust
• Information from the Meningitis Trust in New Zealand
• Information from the National Meningitis Association - U.S.
• Symptoms & disease information from Meningitis Research Foundation
• Meningitis Research Foundation - symptoms information in 22 languages