Meningitis is an infection of the meninges, the membranes that cover and protect the brain and spinal cord, and also the cerebrospinal fluid (CSF) that cushions the brain. The meninges also prevent the CSF from leaking. Most instances of meningitis are caused by viruses and are generally mild; meningitis brought on by bacteria, however, is really a severe disease and can be fatal. Meningitis happens when illness organisms that have entered the physique and multiplied in the nose, mouth, and throat get into the bloodstream and are carried to the meninges.
In a few cases meningitis can create when the bacteria gain entrance to the physique through a surgical incision or an injury to the head or neck. Doctors sometimes divide instances of meningitis into 3 categories according towards the speed of symptom development. Acute meningitis develops in less than twenty-four hours and is usually brought on by one of several species of bacteria; it is considered a medical emergency. Subacute meningitis requires in between one and seven days for signs and symptoms to appear; it might be brought on by bacteria or viruses. Chronic meningitis develops over a period of more than a week and might outcome from an infection or a noninfectious trigger.
The central symptoms of meningitis are a high fever, headache, and stiff neck, resulting from the swelling brought on by the inflammation of the meninges. Most patients also have nausea and vomiting, mental confusion, extreme sensitivity to light, chills, and rapid breathing. Viral meningitis, which is also known as aseptic meningitis, is a much less severe infection than bacterial meningitis and may not need any particular treatment.
It is brought on by one or more enteroviruses, that are viruses that normally reside in the digestive tract. Viral meningitis generally develops in the late summer time and early fall, and is probably to impact children and adults under the age of thirty. Most viral infections happen in children under the age of five.
Enteroviruses are present in saliva, throat mucus, and feces; they can be transmitted via direct get in touch with with an infected individual or an infected object or surface. Viral meningitis can also be caused by the viruses that trigger chickenpox, mumps, HIV infection, West Nile virus infection, and genital herpes. Bacterial meningitis is really a medical emergency and has a high mortality rate if untreated. It's spread by coughing, kissing, and contact with an infected person’s saliva.
There are a number of different kinds of bacteria that can cause meningitis including Streptococcus pneumoniae, the pneumococcus that is most common in adults, and Neisseria meningitides, the meningococcus that is more typical in kids and teenagers. Persons who have had pneumococcal meningitis might be left with lifelong damage to their nervous system that includes deafness and brain damage. Much less typical types of bacterial meningitis are caused by Listeria, a bacterium that can trigger the death of a baby before birth as well as meningitis; and meningitis brought on by Mycobacterium tuberculosis, the bacterium responsible for tuberculosis.
Haemophilus influenzae, a bacterium that was at one time thought to be the trigger of flu, utilized to be the most common trigger of bacterial meningitis in the United States; however, the introduction of a vaccine against this organism in 1990 has greatly lowered the quantity of instances. Meningitis brought on by fungi is rare in the general population but is a fairly typical opportunistic infection in patients with AIDS.
Most instances of meningitis are caused by disease organisms-viruses, bacteria, or fungi-that enter the bloodstream and are carried to the brain and the meninges. A few instances of meningitis result from inflammatory diseases like lupus or certain cancers. Probably the most essential signs and symptoms used to diagnose meningitis are a high fever, stiff neck, and severe headache, which might come on in much less than each day after infection. Other symptoms in adults may include:
Infants and little children may have somewhat different signs and symptoms:
Diagnosis of meningitis is essential to proper treatment, as the antibiotics utilized to treat bacterial meningitis are not useful in treating viral meningitis. A patient who has acute bacterial meningitis will generally have treatment started as soon as the doctor obtains a sample of cerebrospinal fluid for testing. The CSF is obtained by performing a spinal tap, a procedure in which a needle is inserted into an region in the lower back where the physician can easily obtain a sample of fluid.
A patient with subacute meningitis might be given a physical examination to check for an ear, throat, or sinus infection. The doctor may also perform two maneuvers to see whether the patient’s meninges are inflamed. In one test, the physician raises the patient’s leg at the hip to a correct angle from the examining table and tries to straighten the lower leg. If the leg cannot be straightened or the patient experiences neck pain, he or she most likely has meningitis. The other maneuver involves bending the patient’s neck forward as they lie on the table. If the knees and hips flex upward, the patient probably has meningitis.
The physician may also order an x ray or computed tomography (CT) scan of the head and neck to search for swelling and inflammation. The sample of CSF is sent to a laboratory for analysis. Identification of the particular bacterium can take several days, meanwhile, the doctor can begin to treat the patient with a broad-spectrum antibiotic till the test results come back. In 2007 the Food and Drug Administration (FDA) approved a rapid CSF test that identifies virus particles in CSF in about 3 hours. This test permits doctors to distinguish fairly quickly in between viral and bacterial meningitis and avoid giving unnecessary antibiotics to patients with viral meningitis.
It is important to get a patient with the signs and symptoms of meningitis to a hospital as rapidly as possible, particularly if the signs and symptoms appeared in much less than a day. Patients who're acutely ill and are taken to a hospital are generally treated within thirty minutes of their arrival, as emergency room doctors assume that the patient has bacterial meningitis and don't wish to delay treatment until the specific organism is identified.
A sample of cerebrospinal fluid is taken by a spinal tap for analysis; then the patient is given intravenous penicillin or another broad-spectrum antibiotic, intravenous fluids, and pure oxygen to assist breathing. The patient may also need to be treated for seizures, or to have fluid drained from the sinuses or from the space in between the meninges and also the brain.
After the specific bacterium has been identified, the doctor can adjust the type and dosage of the antibiotics given to the patient. Viral meningitis can't be treated with antibiotics. Patients are generally advised to remain house and rest in bed for a few weeks. They can take over-the-counter pain relievers for muscle aches and pains and to bring down fever. If the viral meningitis is caused by the herpes virus, the doctor might also prescribe acyclovir, an antiviral drug utilized to treat herpes.
Acute bacterial meningitis has a mortality rate of 10-15 percent even with treatment. Pneumococcal meningitis might have a mortality rate as high as 21 percent. Of the patients who survive, between 10 and 20 percent will suffer such complications as blindness, hydrocephalus, hearing loss, learning disorders, or even paralysis. Viral meningitis is generally a much milder illness. Some patients may need to be hospitalized for supportive care for a week or so, but most can recover at home within two weeks. Complications are uncommon with viral meningitis.
You will find a number of vaccines that can be used to stop meningitis. As has already been mentioned, the rates of Haemophilus influenzae meningitis among young children dropped dramatically after a vaccine against this bacterium was added to childhood immunization schedules in the 1990s. There are also vaccines that have been developed to protect adults as well as kids from pneumococcal and meningococcal meningitis.
There is one kind of pneumococcal vaccine known as PCV7, recommended for kids in between two and 5 years of age who're at high risk of infection. A different vaccine recognized as PPV is suggested for adults at risk of pneumococcal meningitis: those over sixty-five, those with weakened immune systems, those with diabetes or heart illness, and those whose spleen was eliminated. The vaccine that protects against the meningococcus is recognized as MCV4. It is suggested for all kids at eleven and twelve and for college students who were not vaccinated at that age. MCV4 may also be used to protect individuals exposed to meningitis during an outbreak or who should travel to countries with high rates of meningococcal meningitis.
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