Meningitis

Meningitis
Meninges of the central nervous system: dura mater, arachnoid mater, and pia mater.
SpecialtyInfectious disease, neurology
SymptomsFever, headache, neck stiffness[1]
ComplicationsDeafness, epilepsy, hydrocephalus, cognitive deficits[2][3]
CausesBacterial, viral, fungal, parasitic, non-infectious, and other[4]
Diagnostic methodLumbar puncture[1]
Differential diagnosisEncephalitis, brain tumor, lupus, Lyme disease, seizures, neuroleptic malignant syndrome,[5] naegleriasis[6]
PreventionVaccination[2]
MedicationAntibiotics, antivirals, steroids[1][7][8]
Frequency7.7 million (2019)[9]
Deaths236,000 (2019)[9]

Meningitis is acute or chronic inflammation of the protective membranes covering the brain and spinal cord, collectively called the meninges.[10] The most common symptoms are fever, intense headache, vomiting and neck stiffness and occasionally photophobia.[1]

Other symptoms include confusion or altered consciousness, nausea, and an inability to tolerate light or loud noises.[1] Young children often exhibit only nonspecific symptoms, such as irritability, drowsiness, or poor feeding.[1] A non-blanching rash (a rash that does not fade when a glass is rolled over it) may also be present.[11]

The inflammation may be caused by infection with viruses, bacteria, fungi or parasites.[12] Non-infectious causes include malignancy (cancer), subarachnoid hemorrhage, chronic inflammatory disease (sarcoidosis) and certain drugs.[4] Meningitis can be life-threatening because of the inflammation's proximity to the brain and spinal cord; therefore, the condition is classified as a medical emergency.[2][8] A lumbar puncture, in which a needle is inserted into the spinal canal to collect a sample of cerebrospinal fluid (CSF), can diagnose or exclude meningitis.[1][8]

Some forms of meningitis are preventable by immunization with the meningococcal, mumps, pneumococcal, and Hib vaccines.[2] Giving antibiotics to people with significant exposure to certain types of meningitis may also be useful for preventing transmission.[1] The first treatment in acute meningitis consists of promptly giving antibiotics and sometimes antiviral drugs.[1][7] Corticosteroids can be used to prevent complications from excessive inflammation.[3][8] Meningitis can lead to serious long-term consequences such as deafness, epilepsy, hydrocephalus, or cognitive deficits, especially if not treated quickly.[2][3]

In 2019, meningitis was diagnosed in about 7.7 million people worldwide,[9] of whom 236,000 died, down from 433,000 deaths in 1990.[9] With appropriate treatment, the risk of death in bacterial meningitis is less than 15%.[1] Outbreaks of bacterial meningitis occur between December and June each year in an area of sub-Saharan Africa known as the meningitis belt.[13] Smaller outbreaks may also occur in other areas of the world.[13] The word meningitis comes from the Greek μῆνιγξ meninx, 'membrane', and the medical suffix -itis, 'inflammation'.[14][15]

  1. ^ a b c d e f g h i j "Bacterial Meningitis". U.S. Centers for Disease Control and Prevention (CDC). 1 April 2014. Archived from the original on 5 March 2016. Retrieved 5 March 2016.
  2. ^ a b c d e Sáez-Llorens X, McCracken GH (June 2003). "Bacterial meningitis in children". Lancet. 361 (9375): 2139–48. doi:10.1016/S0140-6736(03)13693-8. PMID 12826449. S2CID 6226323.
  3. ^ a b c van de Beek D, de Gans J, Tunkel AR, Wijdicks EF (January 2006). "Community-acquired bacterial meningitis in adults". The New England Journal of Medicine. 354 (1): 44–53. doi:10.1056/NEJMra052116. PMID 16394301.
  4. ^ a b Ginsberg L (March 2004). "Difficult and recurrent meningitis". Journal of Neurology, Neurosurgery, and Psychiatry. 75 Suppl 1 (90001): i16–21. doi:10.1136/jnnp.2003.034272. PMC 1765649. PMID 14978146.
  5. ^ Ferri FF (2010). Ferri's differential diagnosis : a practical guide to the differential diagnosis of symptoms, signs, and clinical disorders (2nd ed.). Philadelphia: Elsevier/Mosby. p. Chapter M. ISBN 978-0-323-07699-9.
  6. ^ Centers for Disease Control Prevention (CDC) (May 2008). "Primary amebic meningoencephalitis – Arizona, Florida, and Texas, 2007" (PDF). MMWR. Morbidity and Mortality Weekly Report. 57 (21): 573–27. PMID 18509301. Archived from the original on 2 April 2020. Retrieved 14 October 2017.
  7. ^ a b "Viral Meningitis". U.S. Centers for Disease Control and Prevention (CDC). 26 November 2014. Archived from the original on 4 March 2016. Retrieved 5 March 2016.
  8. ^ a b c d Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM, et al. (November 2004). "Practice guidelines for the management of bacterial meningitis". Clinical Infectious Diseases. 39 (9): 1267–84. doi:10.1086/425368. PMID 15494903.
  9. ^ a b c d "Global Disease Burden 2019". Archived from the original on 19 April 2022. Retrieved 26 April 2022.
  10. ^ Putz K, Hayani K, Zar FA (September 2013). "Meningitis". Primary Care: Clinics in Office Practice. 40 (3): 707–726. doi:10.1016/j.pop.2013.06.001. PMID 23958365.
  11. ^ "NHS medical conditions meningitis". National Health Service (NHS). 20 October 2017. Archived from the original on 26 April 2022. Retrieved 26 April 2022.
  12. ^ Cite error: The named reference WHO2023 was invoked but never defined (see the help page).
  13. ^ a b "Meningococcal meningitis Fact sheet N°141". World Health Organization (WHO). November 2015. Archived from the original on 5 March 2016. Retrieved 5 March 2016.
  14. ^ Mosby's pocket dictionary of medicine, nursing & health professions (6th ed.). St. Louis: Mosby/Elsevier. 2010. p. traumatic meningitis. ISBN 978-0-323-06604-4. Archived from the original on 10 September 2017.
  15. ^ Liddell HG, Scott R (1940). "μῆνιγξ". A Greek-English Lexicon. Oxford: Clarendon Press. Archived from the original on 8 November 2013.