Meningitis : Causes, signs and management

Meningitis or dropsy of the brain is the inflammation in the outer layer of the brain and spinal cord. This protective layer is also called meninges. It’s like a membranous covering of the central nervous system.

What are the common causes of meningitis?

The cause of meningitis depends mostly on the host, responsible for this. But, somehow it may be bacterial, viral, fungal, or protozoan. And that’s the reason behind the inflammation in the meninges.

 

Bacterial meningitis

Bacterial meningitis is also called septic meningitis. It is the most common cause behind inflammation of the meningeal layers. In this  Meningococcal pneumonia is most common in adults and Haemophilus influenza type-2 is mostly seen in children.

 

Causative organisms

 

  • Group B streptococcus and E.coli  affect the child aged between births to 4 weeks.
  • E.coli, pneumococcus, salmonella, and H. influenza are mostly seen in children between 4 to 12 weeks.
  • From 3 months to 3 years children are mostly affected by pneumococcus, meningococcus, and H.influenzae type bacterias.
  • Pneumococcus and meningococcus cause virulence in children after 3ys of age.

 

Viral meningitis

It is also called aseptic meningitis.

Causative organisms

  • Enterovirus or adenovirus
  • Arbovirus
  • HIV
  • Herpes simplex virus

 

Fungal meningitis

The cause of fungal meningeal infections are like; 

  • Cryptococcal meningitis 
  • Histoplasma 
  • Blastomyces
  • Coccidioides
  • Candida

 

Protozoan meningitis 

Protozoan meningeal infection is sometimes called eosinophilic meningitis. The causative organism is angiostrongylus cantonensis.

 

What are the risk factors of dropsy of the brain?

The risk factors are like;

 

Sign and symptoms of dropsy of the brain

The most common sign and symptoms are ;

  • Fever with chills
  • Headache
  • Generalized muscle ache
  • Tachycardia
  • Pain
  • Deterioration in the level of consciousness

Signs of bacterial meningitis

  • Increased white blood cells count in CSF
  • High protein level 
  • The low glucose level in CSF

 

Signs of viral meningitis

  • Abdominal pain
  • Chest pain

 

What are the hallmark signs of dropsy of the brain?

Fever with nocturnal rigidity (stiffness of neck) is the confirmatory sign. Also, these are the signs of meningeal irritation. Besides it, the positive Brudzinski’s sign and kerning sign are mostly considered signs of it.

 

Brudzinski’s sign

In Brudzinski’s positive sign, the flexion of the head causes flexion of both thighs as well as hips and knee flexion. That indicates dropsy of the brain.

Kernig sign

If the person has meningeal infections then flexion of thighs and knee to the right angle after that knee extension causes serious spasm. It occurs in the thigh muscles and back pain happens.

 

Children asked to kiss the knee. If he has dropsy of the brain they can’t do the maneuver due to stiffness of the spine.

 

Classifications

  1. Purulent meningitis (here the leukocyte increases from 100 to several thousand)
  2. Iatrogenic meningitis or physician induced meningitis ( caused by the complications of lumbar puncture)
  3. Tubercle meningitis( causative organism is the mycobacterium tuberculae)
  4. Meningococcal meningitis or cerebrospinal fever caused due to Neisseria meningitides and its clinical manifestation is red macular rashes on the skin.

 

Mode of transmission 

It is transmitted by direct contact from person to person. it also occurs due to droplets like sneezing and coughing. And direct contact like brain and spinal cord surgery. Other reasons are like the high population density areas and prisons etc. 

 

Diagnostic evaluation

  • History collection (droplet infection)
  • Physical examinations
  • Tuberculin test
  • PCR for viral infections
  • CBC
  • Blood culture
  • Lumbar puncture for CSF analysis

csf cerebrospinal fluid analysis

source image;https://litfl.com/csf-analysis/

Management

  • Rest
  • Plenty of water to prevent dehydration
  • For meningococcal meningeal infection, they should take the prescribed medications like penicillin, Ceftriaxone.
  • Acyclovir is advised for viral meningeal infections.
  • Metronidazole is also for a protozoan infection.

 

Other pharmacological interventions are like;

  • Osmotic diuretic like mannitol to decrease the intracranial pressure.
  • Antipyretic medication like acetaminophen.
  • Other medications are eption and dexamethasone.

 

Easy step to managing it 

  • Monitor the vital signs.
  • Observe the neurological signs.
  • Take the precautions for urine and stool in viral meningeal infections.
  • Isolation for pneumococcal meningeal infections.
  • Elevate the head of the bed.
  • Avoid hips and neck flexion.

 

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