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Meningitis – Wikipedia From the free encyclopedia Jump to navigation search Inflammation of membranes around brain and spinal cord MeningitisMeninges central nervous system dura mater arachnoid pia SpecialtyInfectious disease neurologySymptomsFever headache neck stiffness ComplicationsDeafness epilepsy hydrocephalus cognitive deficits CausesViral bacterial other Diagnostic methodLumbar puncture Differential diagnosisEncephalitis tumor lupus Lyme seizures neuroleptic malignant syndrome naegleriasis PreventionVaccination MedicationAntibiotics antivirals steroids Frequency million Deaths is an acute inflammation protective covering known collectively as meninges The most common symptoms are fever Other include confusion or altered consciousness vomiting inability tolerate light loud noises Young children often exhibit only nonspecific such irritability drowsiness poor feeding If a rash present it may indicate particular cause meningitis for instance caused by meningococcal bacteria be accompanied characteristic infection with viruses microorganisms less commonly certain drugs can life-threatening because inflammation’s proximity therefore condition classified medical emergency A lumbar in which needle inserted into canal collect sample cerebrospinal fluid CSF diagnose exclude Some forms preventable immunization mumps pneumococcal Hib vaccines Giving antibiotics people significant exposure types also useful first treatment consists promptly giving sometimes antiviral Corticosteroids used prevent complications from excessive lead serious long-term consequences deafness especially if not treated quickly In occurred about worldwide This resulted deaths down With appropriate risk death than Outbreaks occur between December June each year area sub-Saharan Africa belt Smaller outbreaks areas world word comes Greek meninx membrane suffix -itis Contents Signs Clinical features Early Causes Bacterial Viral Fungal Parasitic Non-infectious Mechanism Diagnosis Lumbar Postmortem Prevention Behavioral Vaccination Antibiotics Management Steroids Prognosis Epidemiology History References External links edit Neck Texas epidemic adults symptom severe occurring almost cases followed flex forward passively due increased muscle tone classic triad diagnostic signs sudden high mental status however all three none extremely unlikely associated photophobia intolerance bright phonophobia Small do aforementioned irritable look unwell fontanelle soft spot on top baby’s head bulge infants aged up months that distinguish illnesses young leg pain cold extremities abnormal skin color Nuchal rigidity occurs presence positive Kernig’s sign Brudzi ski assessed person lying supine hip knee flexed degrees limits passive extension Brudzinski’s when flexion causes involuntary Although both screen sensitivity these tests limited They have very good specificity rarely diseases Another test jolt accentuation maneuver helps determine whether those reporting asked rapidly rotate horizontally this does make worse problems produce similar above but non-meningitic called meningism pseudomeningitis bacterium Neisseria meningitidis differentiated spreading petechial precede numerous small irregular purple red spots petechiae trunk lower mucous conjunctiva occasionally palms hands soles feet typically non-blanching redness disappear pressed finger glass tumbler necessarily relatively specific clues hand foot mouth genital herpes various viral Charlotte Cleverley-Bisman developed child her case progressed gangrene required amputation limbs She survived became poster vaccination campaign New Zealand Additional early stage illness These require prognosis trigger sepsis systemic inflammatory response falling blood pressure fast heart rate abnormally low temperature rapid breathing Very at exclusively insufficient supply organs Disseminated intravascular coagulation activation clotting obstruct flow paradoxically increase bleeding Gangrene Severe infections result hemorrhaging adrenal glands leading Waterhouse-Friderichsen fatal tissue swell inside skull swollen herniate through base noticed decreasing level loss pupillary reflex posturing normal Seizures reasons stages underlying Focal involve one limb part body persistent late-onset difficult control medication poorer outcome abnormalities cranial nerves group arising stem among functions eye movement facial muscles hearing Visual persist after episode encephalitis its vessels cerebral vasculitis well formation clots veins venous thrombosis weakness sensation function supplied affected Most fungi protozoa being next It non-infectious term aseptic refers no demonstrated type usually has already been partially pathogens infect space adjacent e g sinusitis Endocarditis valves spreads clusters bloodstream Aseptic spirochetes includes Treponema pallidum syphilis Borrelia burgdorferi causing encountered malaria infecting amoebic amoebae Naegleria fowleri contracted freshwater sources See Neonatal Streptococcus pneumoniae causative illustration vary according infected individual’s age premature babies newborns old B streptococci subtypes III normally inhabit vagina mainly during week life digestive tract Escherichia coli carrying K antigen Listeria monocytogenes serotype IVb transmitted mother before birth newborn Older more meningococcus serotypes under five Haemophilus influenzae countries offer together Risk persons over years introduction vaccine lowered rates Recent trauma potentially allows nasal cavity enter meningeal Similarly devices shunts extraventricular drains Ommaya reservoirs carry likely Staphylococci Pseudomonas Gram-negative impaired immune An otitis media mastoiditis proportion Recipients cochlear implants Tuberculous Mycobacterium tuberculosis endemic AIDS Recurrent persisting anatomical defects either congenital acquired disorders Anatomical allow continuity external environment recurrent fracture particularly fractures affect extend towards sinuses petrous pyramids Approximately deficiencies complement deficiency predisposes ongoing Viruses enteroviruses simplex virus generally produces sores varicella zoster chickenpox shingles HIV LCMV Arboviruses mosquito insect Influenza Mollaret’s chronic form thought There number factors fungal including use immunosuppressants organ transplantation immunity aging uncommon contamination Symptom onset gradual headaches least couple weeks diagnosis cryptococcal Cryptococcus neoformans now multiple studies accounts AIDS-related Coccidioides immitis Histoplasma capsulatum Blastomyces dermatitidis Candida species parasitic assumed there predominance eosinophils white cell parasites implicated Angiostrongylus cantonensis Gnathostoma spinigerum Schistosoma conditions cysticercosis toxocariasis baylisascariasis paragonimiasis rarer noninfective several spread cancer neoplastic non-steroidal anti-inflammatory intravenous immunoglobulins sarcoidosis then neurosarcoidosis connective erythematosus vessel wall Beh et’s Epidermoid cysts dermoid releasing irritant matter subarachnoid Rarely migraine made eliminated comprise enclose protect delicate impermeable firmly adheres surface following minor contours so named spider-web-like appearance loosely fitting sac separates filled outermost thick durable attached reach two main routes direct contact follows invasion organisms live upon surfaces turn preceded break barrier provided Once entered they places where vulnerable choroid plexus phenomenon Direct arise indwelling nasopharynx formed see identified large-scale rather largely attributed entry When components cells astrocytes microglia respond large amounts cytokines hormone-like mediators recruit stimulate tissues participate becomes permeable vasogenic edema swelling leakage Large numbers interstitial addition walls themselves become inflamed leads decreased third cytotoxic intracranial means harder consequently deprived oxygen undergo apoptosis programmed recognized administration initially worsen process outlined increasing amount products released destruction Particular treatments corticosteroids aimed dampening system’s findings different Type Glucose Protein Cells Acute PMNs gt mm mononuclear lt Malignant Diagnosing possible improve outcomes tap examine recommended contraindicated mass abscess ICP elevated herniation someone raised recent injury problem localizing neurological evidence examination CT MRI scan prior applies adult physical rule out sensitive enough completely suspected having performed markers C-reactive protein complete count cultures LP proves professional guidelines suggest should administered delay longer minutes Often scans later assess monitoring electrolytes important example hyponatremia controversial dehydration inappropriate secretion antidiuretic hormone SIADH overly aggressive Cloudy Gram stain meningococci culture showing negative pink pairs done positioning side applying local anesthetic inserting dural achieved opening measured using manometer cm water cmH O markedly initial prove indication nature cloudy indicates higher levels examined content glucose staining demonstrate absence seen figure reduced further were was taken reliable listeriosis Microbiological identifies organism results take hours available predominantly table neutrophil-predominant lymphocyte-predominant although beginning always indicator Less predominate suggesting etiology others concentration divided serum ratio indicative below considered High lactate likelihood mg dl previously received Various specialized latex agglutination routine encouraged changes limulus lysate unless unhelpful Polymerase chain reaction PCR technique amplify traces DNA order detect highly since trace agent’s identify assist distinguishing enterovirus vaccinated Serology identification antibodies tuberculous processed Ziehl-Neelsen takes long time increasingly cost India ink testing therapeutic difficulty receiving presumptive happens resemble antibiotic need continued until definitive Histopathology autopsy infiltrates consisting neutrophil granulocytes inset magnification diagnosed post mortem widespread layers Neutrophil tend migrated along surrounded pus For some protection short behavioral measures effective contagious neither flu Both droplets respiratory secretions close kissing sneezing coughing cannot air fecal changing behavior led transmission Since s many included against their childhood schemes practically pathogen burden highest still too expensive sharp fall Meningococcus exist groups C W Y introduced substantially quadrivalent exists combines four exception ACW visa requirement taking Hajj Development proved much proteins would elicit weak cross-react human Still Cuba Norway Chile strains shown schedules Two new approved wider range recently approach prevention epidemics based detection reactive at-risk population bivalent trivalent polysaccharide though MenAfriVac effectiveness described model product development partnerships resource-limited settings Routine conjugate PCV active seven significantly reduces incidence covers who had splenectomy surgical removal spleen recipients Childhood Bacillus Calmette-Gu rin reported reduce waning adulthood prompted better Short-term prophylaxis another method preventative contacts rifampicin ciprofloxacin ceftriaxone contracting future Resistance noted recommend considering agents While frequently attempt basilar beneficial harmful without leak mortality untreated Thus wide-spectrum delayed while confirmatory conducted primary care benzylpenicillin transfer hospital Intravenous fluids hypotension shock clear given routinely restricted Given regular review admit intensive unit deemed necessary Mechanical ventilation needed failure monitor optimization perfusion decrease mannitol anticonvulsants Hydrocephalus obstructed insertion temporary drainage device shunt osmotic therapy glycerol unclear effect Structural formula third-generation cefalosporin Empiric exact started immediately even analysis choice depends kind place United Kingdom empirical cefotaxime US resistance cefalosporins found vancomycin Chloramphenicol alone combination ampicillin appears work equally Empirical chosen basis person’s undergone neurosurgery immunocompromised cover broad change deal presumed empiric switched targeted sensitivities must pathogenic adequate quantities inadequate penetrance little tested directly clinical trials Rather relevant knowledge mostly derived laboratory rabbits requires prolonged lungs six dexamethasone benefits reduction adolescents high-income research appear Professional commencement corticosteroid just dose days benefit confined discontinued mechanism suppression overactive role Though low-income supported reason discrepancy Even greatest H dramatically pediatric uses supportive responsible amenable tends run benign course Herpes aciclovir specifically addressed Mild home conservative bedrest analgesics courses antifungals amphotericin flucytosine Raised frequent ideally daily punctures relieve alternatively drain Disability-adjusted per inhabitants data Untreated contrast resolve spontaneously Of die older whose rises again predicted apart cleared severity generalized coliforms S potential disabilities damage sensorineural learning difficulties intelligence survivors reversible emerge disability impairment continues surviving Just survives Demography zones sporadic notifiable unknown estimated excluding annually Western Population-wide summer Brazil Sub-Saharan plagued century labeled Epidemics dry season wave last dying intervening rainy seasons Attack poorly served largest ever recorded history swept across entire region Meningococcal army barracks mobilization college campuses annual pilgrimage pattern cycles understood immunological susceptibility demographic travel displacements socioeconomic overcrowding living climatic drought dust storms concurrent differences distribution N meningitides episodes Europe Asia major accounting documented Hippocrates realized existence seems pre-Renaissance physicians Avicenna description dropsy Edinburgh physician Sir Robert Whytt posthumous report appeared link outbreak Geneva Several States shortly afterward African th starting sweeping Nigeria Ghana Austrian bacteriologist Anton Weichselbaum Mortality reports antiserum produced horses American scientist Simon Flexner penicillin late marked emerged could World Day observed April b c d f h i j CDC Archived original March Retrieved k l m n o p q r t u v w x y z aa ab ez-Llorens X McCracken GH Lancet doi PMID CID van de Beek D Gans J Tunkel AR Wijdicks EF January Community-acquired England Journal Medicine NEJMra Ginsberg L Difficult Neurology Neurosurgery Psychiatry Suppl jnnp PMC Ferri Fred F Ferri’s differential practical guide nd ed Philadelphia Elsevier Mosby Chapter M ISBN Centers Disease Control May Primary amebic meningoencephalitis Arizona Florida MMWR Morbidity Weekly Report November ac Hartman BJ Kaplan SL Kaufman BA Roos KL Scheld WM Whitley RJ Practice management PDF Infectious Diseases GBD Injury Incidence Prevalence Collaborators October Global regional national prevalence lived injuries systematic Burden Study Death expectancy all-cause cause-specific age-sex Fact sheet WHO Mosby’s pocket dictionary medicine nursing amp health professions St Louis traumatic September Liddell HG Scott R Greek-English Lexicon Oxford Clarendon Press Spanjaard Weisfelt Reitsma JB Vermeulen prognostic NEJMoa Attia Hatala Cook DJ Wong JG July rational Does patient JAMA jama Theilen U Wilson G Beattie JO Qureshi Simpson invasive summary SIGN BMJ bmj Scottish Intercollegiate Guidelines Network Thomas KE Hasbun Jekel Quagliarello VJ accuracy nuchal Logan SA MacMahon E AE Varon Chen Sternbach GL Rupert Waterhouse Carl Friderichsen apoplexy Emergency Listeriosis Hsu HE Shutt KA Moore MR Beall BW Bennett NM Craig AS Farley MM Jorgensen JH Lexau CA Petit Reingold Schaffner Whitney CG Harrison LH Effect Wei BP Robins-Browne RM Shepherd RK Clark GM O’Leary SJ Can we implant developing February Thwaites Chau TT Mai NT Drobniewski McAdam Farrar Tebruegge Curtis pathogenesis Microbiology Reviews CMR www cdc gov Shalabi lymphocytic Raman Sharma current perspective controversies International Surgery ijsu Sirven JI Malamut BL neurology Wolters Kluwer Health Lippincott Williams Wilkins Honda Warren DK Central Clinics North America idc Kauffman Pappas PG Patterson TF contaminated methylprednisolone injections Sobel JD Dismukes WE Essentials mycology York Springer Durski KN Kuntz KM Yasukawa Virnig Meya DB Boulware DR Cost-effective checklists Acquired Immune Deficiency Syndromes QAI Park Wannemuehler Marston Govender Chiller TM Estimation global QAD ffac Graeff-Teixeira da Silva AC Yoshimura Update eosinophilic relevance Table Gleissner Chamberlain MC Neoplastic Moris Garcia-Monco JC challenge drug-induced Archives Internal archinte Provan Krentz Handbook Laboratory Investigation University Mount Hillary Boyle Sean Evaluation Treatment Family Physician ISSN Chaudhuri Martinez-Martin P Martin PM Kennedy Andrew Seaton Portegies Bojar Steiner I EFNS guideline community-acquired Task Force European Heyderman RS Lambert HP O’Sullivan Stuart JM Taylor Wall RA septicaemia Infection jinf formal British Society UK Research Trust immunocompetent Iguchi Masahiro Noguchi Yoshinori Yamamoto Shungo Tanaka Yuu Tsujimoto Hiraku setting Cochrane Database Systematic CD pub Maconochie IK Bhaumik Fluid Careful electrolyte balance opinions regarding hyponatraemia inappropriately antidiuresis restriction open question Straus SE Thorpe Holroyd-Leduc How perform analyze Perfect JR Dromer Goldman DL Graybill Hamill TS Larsen Lortholary Nguyen MH Powderly WG Singh Sorrell TC practice update infectious society america Sakushima Hayashino Kawaguchi T Jackson JL Fukuhara differentiating meta-analysis hdl Bicanic Cryptococcal Medical Bulletin bmb ldh Tenforde MW Shapiro Rouse Jarvis JN Li Eshun-Wilson Ford Warrell DA JJ Crook DW Textbook Volume Fourth pp Transmission August Segal Pollard AJ Vaccines Peltola Worldwide st decade advent conjugates Prospects Man Diana MenB Foundation FDA News Release First serogroup Wilder-Smith travelers Current Opinion QCO Detecting highly-endemic Relev pid miologique Hebdomadaire Bishai DM Champion Steele ME Thompson Product hit stride lessons Affairs hlthaff Marc LaForce Ravenscroft Djingarey Viviani Epidemic Group imminent solution Vaccine der Poll Pneumococcal approaches Zalmanovici Trestioreanu Fraser Gafter-Gvili Paul Leibovici preventing Ratilal BO Costa Pappamikail Sampaio Antibiotic patients EC Ajdukiewicz Bergman Garner Osmotic therapies added Prasad Kumar Gupta PK Singhal Third generation cephalosporins versus conventional treating Brouwer McIntyre Assiri AM Alasmari FA Zimmerman VA Baddour LM Erwin PJ Tleyjeh IM Corticosteroid Mayo Clinic Proceedings MB Ryan managing Dexamethasone PB Berkey CS King SM Schaad UB Kilpi Kanra GY Perez CM adjunctive randomized Encephalitis Sheet National Institute Neurological Disorders Stroke NINDS Gottfredsson Seminars s- Estimates Member xls Organization Richardson MP Reid Tarlow MJ Rudd PT Hearing adc Chiang SS Khan Milstein Tolman AW Benedetti Starke Becerra Lozano Naghavi Foreman et al DRO DU Lapeyssonnie Cerebrospinal Greenwood Manson Lecture Transactions Royal Tropical Hygiene edition EMC Walker Laws ER Udvarhelyi GB Infections involvement CNS Genesis Neuroscience Thieme Observations Dropsy Brain Balfour Editorial West anything changed Vieusseux moire sur le Maladie qui regne ve au printemps decine Chirurgie Pharmacologie Bruxelles French Ueber Aetiologie akuten cerebro-spinalis Fortschrift Medizin German thirteen hundred Experimental jem Swartz MN view past NEJMp Rosenberg DH Arling PA Penicillin Association reproduced Landmark article Aug By ClassificationDICD- ICD- -CM MeSH DiseasesDB resourcesMedlinePlus eMedicine med emerg Patient 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