Meningitis

Meningitis is inflammation of the membranes (meninges) covering the brain and the spinal cord. Although the most common causes are infection (bacterial, viral, fungal or parasitic), chemical agents and even tumor cells may cause meningitis. Encephalitis and brain abscess can complicate infective meningitis.

Treatment

Meningitis is a medical emergency, being a condition with a high mortality rate if untreated. All suspected cases, however mild, need emergency medical attention and on the presumption, until otherwise disproven, that all cases are bacterial in nature, broad spectrum antibiotics should be urgently started before the culture results are available. If lumbar puncture can not be performed because of raised intracranial pressure (likely due to edema or concomitant brain abscess), a broad spectrum intravenous antibiotic should be started immediately (this is often a third generation cephalosporin or, in less affluent countries, chloramphenicol). When cerebrospinal fluid gram stain, or blood or CSF culture and sensitivity results, are available and confirm the bacterial nature of the infection, then the empiric treatment can be refined by switching to more specific antibiotics. In children (but not in adults) the administration of steroids helps reduce the incidence of deafness following meningitis.

Related Topics:
Cephalosporin - Gram stain

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Infection of the meninges usually originates through spread from infection of the neighbouring structures (which include the sinuses and mastoid cells of ear). These should be investigated when diagnosis of meningitis is confirmed or suspected.

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If the patient is commonly in contact with many others (e.g. at school or army barracks), people in the surroundings (and usually family members) may be commenced on prophylactic treatment; this is generally done with the antibiotic rifampicin, which is otherwise mainly used in tuberculosis. Alternative drugs used for prophylaxis include ceftriaxone (which is preferred in pregnant women) and ciprofloxacin.

Related Topics:
Prophylactic - Rifampicin - Tuberculosis - Ceftriaxone - Ciprofloxacin

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