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The facts about meningitis

infections in the brain and spinal cord can cause dangerous inflammation. This inflammation can produce a wide range of symptoms, including fever, headache, or confusion, and in extreme cases, can cause brain damage, stroke, seizures, or even death.

Infection of the meninges, the membranes that surround the brain and spinal cord, is called meningitis.

Causes
meningitis is most often caused by a bacterial or viral infection. Usually, the body's immune system is able to contain and defeat an infection. But if the infection passes into the blood stream and then into the cerebrospinal fluid that surrounds the brain and spinal cord, it can affect the nerves and travel to the brain and/or surrounding membranes, causing inflammation. This swelling can harm or destroy nerve cells and cause bleeding in the brain.

Meningitis also may be caused by a fungal infection, a reaction to certain medications or medical treatments, an inflammatory disease such as lupus, some types of cancer, or a traumatic injury to the head or spine.

Anyone can get meningitis, although people with weakened immune systems, including those persons with hiv or those taking immunosuppressant drugs, are at the highest risk.

Viral, or aseptic, meningitis is the most common form of meningitis in the united states. This typically mild and non-lethal disease is usually caused by enteroviruses - common viruses that enter the body through the mouth and travel to the brain and surrounding tissues where they multiply.

Enteroviruses are present in mucus, saliva, and feces and can be transmitted through direct contact with an infected person or an infected object or surface. Other viruses that cause meningitis include varicella zoster (the virus that causes chicken pox and can appear decades later as shingles), influenza, mumps, hiv, and herpes simplex type 2 (genital herpes).

Many fungal infections can affect the brain. The most common form of fungal meningitis is caused by the fungus cryptococcus neoformans (found mainly in dirt and bird droppings). Cryptococcal meningitis is common in aids patients. Although treatable, fungal meningitis often recurs in nearly half of affected persons.

Bacterial meningitis is a rare but potentially fatal disease. It can be caused by several types of bacteria that first cause an upper respiratory tract infection and then travel through the blood stream to the brain. The disease can also occur when certain bacteria invade the meninges directly. The disease can block blood vessels in the brain, causing stroke and permanent brain damage.

Pneumococcal meningitis is the most common form of meningitis and is the most serious form of bacterial meningitis. Some 6,000 cases of pneumococcal meningitis are reported in the united states each year. The disease is caused by the bacterium streptococcus pneumoniae, which also causes pneumonia, blood poisoning (septicemia), and ear and sinus infections. At particular risk are children under age 2 and adults with a weakened or depressed immune system. Persons who have had pneumococcal meningitis often suffer neurological damage ranging from deafness to severe brain damage.

Meningococcal meningitis, which is caused by the bacterium neisseria meningitides, is common in children ages 2-18. Each year in the united states about 2,600 people get this highly contagious disease. High-risk groups include infants under the age of 1 year, people with suppressed immune systems, travelers to foreign countries where the disease is endemic, and college students (freshmen in particular) who reside in dormitories. Between 10% and 15% of cases are fatal, with another 10% to 15% causing brain damage and other serious side effects.

Haemophilus meningitis was at one time the most common form of bacterial meningitis. Fortunately, the haemophilus influenzae b vaccine has greatly reduced the number of cases in the united states. Those most at risk of getting this disease are children in child-care settings and children who do not have access to the vaccine.

Other forms of bacterial meningitis include listeria monocytogenes meningitis, which can cross the placental barrier and cause a baby to be stillborn or die shortly after birth; escherichia coli meningitis, which is most common in elderly adults and newborns and may be transmitted to a baby through the birth canal, and mycobacterium tuberculosis meningitis, a rare disease that occurs when the bacterium that causes tuberculosis attacks the meninges.

Transmission
some forms of bacterial meningitis are contagious and can be spread through contact with saliva, nasal discharge, feces, or respiratory and throat secretions (often spread through kissing, coughing, or sharing drinking glasses, eating utensils, or such personal items as toothbrushes, lipstick, or cigarettes).

For example, people sharing a household, at a day care center, or in a classroom with an infected person can become infected. College students living in dormitories - in particular, college freshmen - have a higher risk of contracting meningococcal meningitis than college students overall. Children who do not have access to childhood vaccines are at increased risk of developing certain types of bacterial meningitis.

Because these diseases can occur suddenly, anyone who is suspected of having meningitis should immediately contact a doctor or go to the hospital.

Signs and symptoms
the hallmark signs of meningitis are sudden fever, severe headache, and a stiff neck. In more severe cases, neurological symptoms may include nausea and vomiting, confusion and disorientation, drowsiness, sensitivity to bright light, and poor appetite.

Meningitis often appears with flu-like symptoms that develop over 1-2 days. Distinctive rashes are typically seen in some forms of the disease. Meningococcal meningitis may be associated with kidney and adrenal gland failure and shock.

Diagnosis
following a physical exam and medical history to review activities of the past several days (such as recent exposure to insects or animals, any contact with ill persons, or recent travel), the doctor may order various diagnostic tests to confirm the presence of infection and inflammation. Early diagnosis is vital, as symptoms can appear suddenly and escalate to brain damage, hearing and/or speech loss, blindness, or even death.

A neurological examination involves a series of tests designed to assess motor and sensory function, nerve function, hearing and speech, vision, coordination and balance, mental status, and changes in mood or behavior. Doctors may test the function of the nervous system through tests of strength and sensation, with the aid of items including a tuning fork, small light, reflex hammer, and pins.

Laboratory screening of blood, urine, and body secretions can help detect and identify brain and/or spinal cord infection and determine the presence of antibodies and foreign proteins. Such tests can also rule out metabolic conditions that have similar symptoms. For example, a throat culture may be taken to check for viral or bacterial organisms that cause meningitis.

Analysis of the cerebrospinal fluid that surrounds and protects the brain and spinal cord can detect infections in the brain and/or spinal cord, acute and chronic inflammation, and other diseases. In a procedure known as a spinal tap (or lumbar puncture), a small amount of cerebrospinal fluid is removed by a special needle that is inserted into the lower back. The skin is anesthetized with a local anesthetic prior to the sampling. The fluid, which is completely clear in healthy people, is tested to detect the presence of bacteria or blood, as well as to measure glucose levels (a low glucose level is a sign of bacterial or fungal meningitis) and white blood cells (elevated white blood cell counts are also a sign of infection). The procedure is usually done in a hospital and takes about 45 minutes.

Computer-assisted imaging (ct scan or mri) can reveal signs of brain inflammation, internal bleeding or hemorrhage, or other brain abnormalities.

Electroencephalography, or eeg, can identify abnormal brain waves by monitoring electrical activity in the brain through the skull. Among its many functions, eeg is used to help diagnose certain seizure disorders, brain damage from head injuries, specific viral infections such as herpes virus, and inflammation of the brain and/or spinal cord. This painless, risk-free test can be performed in a doctor's office or at a hospital or testing facility.

Treatment
persons who are suspected of having meningitis should receive immediate, aggressive medical treatment. Both diseases can progress quickly and have the potential to cause severe, irreversible neurological damage.

Early treatment of bacterial meningitis is important to its outcome. Strong doses of general antibiotics may be prescribed first, followed by intravenous antibiotics in more severe cases. Antibiotics may also be given to prevent other bacterial infections. Appropriate antibiotic treatment for most types of meningitis can reduce the risk of dying from the disease to below 15%.

Infected sinuses may need to be drained. Corticosteroids such as prednisone may be ordered to relieve brain pressure and swelling and to prevent hearing loss that is common in patients with haemophilus influenza meningitis. Pain medicine and sedatives may be given to make patients more comfortable.

Unlike bacteria, viruses cannot be killed by antibiotics (an exception is the herpes virus, which can be treated with the antiviral drug acyclovir). Patients with mild viral meningitis may be allowed to stay at home, while those who have a more serious infection may be hospitalized for supportive care. Patients with mild cases, which often cause only flu-like symptoms, may be treated with fluids, bed rest (preferably in a quiet, dark room), and analgesics for pain and fever. The physician may prescribe anticonvulsants such as dilantin or phenytoin to prevent seizures and corticosteroids to reduce brain inflammation. If inflammation is severe, pain medicine and sedatives may be prescribed to make the patient more comfortable.

Fungal meningitis is treated with intravenous antifungal medications.

Prevention
effective vaccines are available to prevent pneumonia, h. Influenza, pneumococcal meningitis, and infection with other bacteria that can cause meningococcal meningitis.

Good personal hygiene can reduce the risk of getting the disease from an infected person. Avoid sharing food, utensils, glasses, and other objects with a person who may be exposed to or have the infection. Wash hands often with soap and rinse under running water.

People who live, work, or go to school with someone who has been diagnosed with bacterial meningitis may be asked to take antibiotics for a few days as a preventive measure.

Outcome
outcome generally depends on the particular infectious agent involved, the severity of the illness, and how quickly treatment is given. In most cases, people with very mild meningitis can make a full recovery, although the process may be slow.

Patients who experience only headache, fever, and stiff neck may recover in 2-4 weeks.

Patients receiving treatment for viral meningitis usually see some relief in 24-48 hours and recovery in about a month.

Patients with bacterial meningitis typically show some relief 48-72 hours following initial treatment but are more likely to experience complications caused by the disease. In more serious cases, these diseases can cause hearing and/or speech loss, blindness, permanent brain and nerve damage, behavioral changes, cognitive disabilities, lack of muscle control, seizures, and memory loss. These patients may need long-term therapy, medication, and supportive care.
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