Meningitis

(Acute Bacterial, Aseptic Viral, and Subacute Meningitis)

Meningitis is an inflammation of the meninges, the membranes that surround and protect the brain and spinal cord. The most common and acute types are caused by bacteria, typically meningococcus, Haemophilus influenzae type B (Hib), or pneumococcus.

When meningitis is caused by something other than bacteria it is called aseptic meningitis. Viruses, including Coxsackie and herpes, are the most frequent causes of aseptic meningitis. In some cases, the brain also becomes inflamed, a condition referred to as encephalitis. Subacute meningitis is usually secondary to other disorders, including tuberculosis, Lyme disease, syphilis, leukemia, lymphoma, AIDS, and brain cancer.

All forms of acute meningitis produce similar symptoms -- fever, headache, a stiff neck, and vomiting. The onset can be rapid, quickly evolving into confusion, drowsiness, stupor, and coma.

Diagnostic Studies and Procedures

Prompt and accurate diagnosis and treatment are essential, because acute bacterial meningitis can become life-threatening within hours. As part of the physical examination, a complete neurological workup will be performed. The head, throat, ears, and skin will be inspected for sources of infection.

The most important test, however, is a lumbar puncture, or spinal tap, in which a hollow needle is inserted between two vertebrae in the lower spine to aspirate a small amount of spinal fluid. Cloudy fluid that contains white blood cells strongly suggests bacterial meningitis, but laboratory analyses and culture will confirm the diagnosis and identify the causative organism. Other tests may include a CT scan or MRI to look for a possible brain abscess or other cause of inflammation.

Medical Treatments

Drug Therapy. If bacterial meningitis is suspected, the person will be hospitalized immediately and started on intensive intravenous antibiotics, even before the diagnosis is confirmed. Initially, a broad-spectrum antibiotic, such as cephalosporin or penicillin, may be given, although identification of the organism may require a later switch of drugs. Recently, the pneumococcus organism that causes some cases of meningitis has developed resistance to a number of antibiotics, greatly limiting choices of treatment.

Deciding upon treatment is even more difficult if viral meningitis is a possibility. In such cases, antibiotics have no effect, and the risk of their side effects, especially anaphylaxis, must be considered. Depending on the patients condition, a doctor may delay starting antibiotics for 8 to 12 hours to await results of culture studies. If a herpes virus is responsible, intravenous acyclovir (Zovirax) will be administered. Similarly, intravenous antifungal drugs will be given if a fungus is the cause.

Subacute meningitis may be treated with steroids, antibiotics, or other drugs. In all forms of the disease, drugs may be prescribed to reduce fever and alleviate nausea and head pain. Intravenous fluids are usually given, but care is needed to avoid giving too much, which can lead to brain swelling.

Surgical Treatment. In unusual cases, parasites form a brain abscess that can cause meningitis. Such an abscess may require surgical removal and drainage.

Alternative Therapies

Alternative therapies cannot cure meningitis and should never be substituted for prompt medical treatment.

Aromatherapy. During convalescence, a lavender bath or massage with lavender, rosemary, marjoram, or peppermint oil is soothing.

Herbal Medicine, Western herbalists may recommend black horehound for headaches with nausea and vomiting. It can also be combined with meadowsweet and chamomile tea.

Physical and Occupational Therapy. Sometimes severe meningitis causes tremor, palsy, and other neurologic problems, requiring rehabilitation under the guidance of physical and occupational therapists.

Self-Treatment

While undergoing medical therapy, the patient should stay in bed. Because light sensitivity is likely, a darkened room is advisable. During recovery, adequate rest is important, as is a nutritious diet and at least eight glasses of fluids per day. Do not take any medication, even aspirin or acetaminophen, without first checking with your doctor. Intensive antibiotic therapy carries a risk of possible drug fever, which is worsened by additional medications.

Epidemics of meningococcal meningitis sometimes occur in military barracks and similar settings. During such an outbreak, imnmunization can help stop the spread. Anyone exposed to the disease may also need preventive antibiotic treatment with rifampin.

Meningitis caused by Haemophilus influenzae type B can be prevented by Hib vaccine, now recommended for all infants, beginning at age two months.

Other Causes of Meningitis Symptoms

Lead poisoning can cause inflammation of the meninges; Rocky Mountain spotted fever produces symptoms similar to those of meningitis.