meningitic


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men·in·git·ic

(men'in-jit'ik),
Relating to or characterized by meningitis.

men·in·git·ic

(men'in-jit'ik)
Relating to or characterized by meningitis.

meningitis

(men-en-jit'is) (-jit'i-dez?) plural.meningitides [ meningo- + -itis]
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MENINGITIS: Streptococcus pneumoniae in cerebrospinal fluid (Orig. mag. ×400)
Inflammation of the membranes of the spinal cord or brain, usually but not always caused by an infectious illness. Bacterial meningitis is a medical emergency that must be treated and diagnosed quickly to obtain the best outcome. It is fatal in 10% to 40% of cases, even with optimal therapy, and may result in persistent neurological injury in about 10% of patients who survive the initial infection. In the U.S., bacterial meningitis formerly affected infants and children more than adults; the demographics of the disease changed in the 1990s after vaccines against Haemophilus influenzae were introduced into pediatric care. Infectious meningitis now is largely a disease of adults and usually is caused by Streptococcus pneumoniae or Neisseria meningitidis, although other microbes may be responsible. Intravenous steroids (such as dexamethasone) given at the beginning of therapy decreases the risk of death and disability. illustration; meningitic (men-en-jit'ik), adjective

Etiology

Meningitis may result from infection with bacteria, viruses, mycobacteria, fungi, amebas, or noninfectious sources, such as chemical irritation. Occasionally, infectious meningitis follows head trauma or sinus or ear infection. It also may result from the spread of blood-borne infection.

Symptoms

The symptoms of meningitis include fever, chills, headache, stiff neck, altered mental status, vomiting, and photophobia. Many patients with meningitis present with only two or three of these clinical indicators. Acute bacterial meningitis and meningitis caused by some fungi and amebas may also cause rapid deterioration in mental status, seizures, shock, and death.

Diagnosis

Cerebrospinal fluid (CSF) must be examined. A cell count to assess the level of inflammation, a Gram stain to look for infectious organisms, measurement of spinal fluid pressure, and levels of bacterial antigens, glucose, lactate, and protein are typically obtained. CSF may appear milky-white due to the large numbers of white blood cells present.

Prevention

All children in the U.S. are now vaccinated against H. influenzae type b (Hib) and pneumococcus (Prevnar) as primary prevention against the disease. Meningococcal polysaccharide vaccines are highly effective in preventing the disease during epidemic outbreaks with this organism. Close family contacts of patients with meningococcal meningitis, day care center contacts of infected children, or any persons (including health care workers) with direct contact with the saliva of infected patients are to be treated with antibiotics to prevent disease transmission.

Treatment

Definitive treatment depends on identification of the underlying causes, but empirical therapies for infectious meningitis must be given immediately, hours before the causative agent is identified. Dexamethasone is administered intravenously before starting antibiotic therapy for best response to reduce the incidence of deafness in children (a common complication) and to help prevent death in adults with pneumococcal meningitis. The evolution of penicillin-resistant strains of pneumococci has altered traditional empirical treatments. Third-generation cephalosporins, ampicillin and gentamicin, chloramphenicol, or vancomycin plus rifampin have been given, depending on the patient's age, level of immune function, or clinical presentation. Antibiotic therapy is usually administered intravenously for 2 weeks, then orally for a prescribed period for bacterial infections. Viral meningitis treatment is supportive; recovery usually is complete (within 7 to 10 days). Antipyretic analgesics relieve headache and fever.

Patient care

Specific measures for coexisting conditions and for shock and other complications (disseminated intravascular coagulation, metabolic acidosis, or seizures) should be initiated when indicated. Supportive therapies include bed rest, a dimly lit room, and reduced sensory stimulation. Standard precautions apply, and airborne/droplet precautions are initiated if nasal cultures are positive. Neurologic function is closely monitored for changes in level of consciousness, signs of increasing intracranial pressure (ICP), and indications of cranial nerve involvement. Fluid and electrolyte balance is monitored, and fluids are provided in quantities to prevent or treat dehydration while avoiding fluid overload and resultant cerebral edema. The patient is assessed for adverse effects of antibiotic therapy with peak and trough blood levels assessed to ensure therapeutic levels and avoid toxic overdose. The patient is repositioned carefully and assisted with range-of-motion exercises to prevent skin, muscle, and joint complications. Frequent mouth care is provided and adequate nutrition and elimination are maintained. Small frequent meals, nasogastric or parenteral feedings are provided as required. Constipation is prevented by stool softeners or mild laxatives to prevent straining, which could increase ICP. Basic explanations, realistic reassurance, and support are provided, with reorientation if delirium or confusion is present. Questions from the patient and family should be answered honestly, with reassurance that behavioral changes usually resolve.

The patient with infectious meningitis may need monitoring in an ICU. Patients with neurologic deficits that appear to be continuing should be referred to a rehabilitation program once the acute phase of illness has ended. To help prevent meningitis, patients with chronic sinusitis or other chronic infectious or inflammatory illnesses should be taught the importance of proper hand hygiene and of following through with prescribed treatments. Sterile techniques should be strictly enforced when treating patients with head wounds, skull fractures, or lumbar puncture, ventricular shunting, or other invasive therapies.

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MENINGITIS

acute aseptic meningitis

A nonpurulent form of meningitis often due to viral infection. It usually runs a short, benign course, marked by fever and headache and ending with recovery.
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aseptic meningitis

Meningitis without obvious evidence of bacterial infection. It typically results from a viral infection (such as coxsackievirus or other enteroviruses) although frequently no causative organism is identified.

Symptoms

Patients report fever, headache, stiff neck, malaise, and sometimes altered mental status or photophobia.

Patient care

Treatment is supportive, with antipyretics and pain-relieving medications administered as prescribed. The virus can be spread by direct contact with saliva, sputum, mucus, or stools of an infected person. Standard precautions apply, with droplet precautions if nasal cultures are positive; contaminated articles are disposed of by double bagging. Neurological status is monitored for changes in level of consciousness and for increases in intracranial pressure. Personal hygiene is provided, and measures to prevent complications due to immobility are implemented. Gentle position changes are performed to reduce excessive stimulation. Artificial airway, suction, and oxygen are readily available. A quiet, dark atmosphere is provided, and siderails are padded to reduce the risk of injury. Prescribed analgesics are administered, and cool compresses are applied to the forehead to relieve headache. Intravenous fluids or tube feedings are administered as ordered, and intake and output are monitored. Assessments are made for complications such as shock, respiratory distress, and disseminated intravascular coagulation.

Since mosquitoes can spread some viruses that cause meningitis, avoiding mosquito bites during the warm months of the year by wearing insecticides (DEET) and barrier protection, and eliminating standing pools of water, where mosquitoes breed, may help prevent the disease. The public should be made aware of meningitis symptoms (fever, headache, stiff neck, altered levels of consciousness) and the importance of prompt attention for any patient suspected of meningitis.

bacterial meningitis

Meningitis caused by disease-causing and potentially life-threatening organisms, esp. Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, and Listeria monocytogenes.

basal meningitis

Meningitis at the base of the brain, usually due to tuberculosis.

carcinomatous meningitis

Meningitis by metastatic tumor cells. It may produce symptoms such as headache, backache, confusion, nerve palsies, or seizures and should be suspected when these symptoms arise in patients with known cancers. The diagnosis is confirmed by lumbar puncture with analysis of the cerebrospinal fluid for tumor cells.

cerebral meningitis

Acute or chronic meningitis of the brain.

cerebrospinal meningitis

Meningitis of the brain and spinal cord.

chronic meningitis

Meningitis marked by persistent fever, headache, and stiff neck (associated, on lumbar puncture, with cerebrospinal fluid pleocytosis and elevated spinal fluid pressure). The underlying cause of this cluster of findings may be initially difficult to determine. Syphilis, cryptococcosis, HIV infection, or invasion of the meninges by cancer cells may be responsible. Occasionally, repeated lumbar punctures reveal a vasculitis of the central nervous system or a partially treated bacterial meningitis.

cryptococcal meningitis

Fungal meningitis due to Cryptococcus neoformans. A rare cause of disease in healthy hosts, cryptococcal meningitis is an opportunistic infection usually seen in patients with advanced AIDS or patients taking high-dose steroids. It usually presents with gradually progressive headache and fever. The serum cryptococcal antigen test is a useful screening test. The diagnosis is established by the results of analysis and culture of cerebral spinal fluid.

Treatment

Treatment options include amphotericin B, often with flucytosine. Fluconazole and/or related antifungals are sometimes used for maintenance therapy.

meningococcal meningitis

Meningitis caused by various serogroups of Neisseria meningitidis.

Mollaret meningitis

See: Mollaret meningitis

pneumococcal meningitis

Meningitis due to Streptococcus pneumoniae, a disease predominantly found in adults. In the U.S., about 20% of affected patients die. Because of the worldwide emergence of streptococcal resistance to penicillins, chloramphenicol, and cephalosporins, vancomycin, rifampin, and other antibacterial agents are used to treat this infection. Intravenous steroids (such as dexamethasone) given at the beginning of therapy decrease the risk of death and disability caused by this infection.

meningitis serosa circumscripta

Meningitis accompanied by the formation of cystic accumulations of fluid that simulate tumors.

serous meningitis

Meningitis with serous exudation into the cerebral ventricles.

spinal meningitis

Inflammation of the spinal cord membranes.

traumatic meningitis

Meningitis resulting from trauma to the meninges.

tuberculous meningitis

Meningitis resulting from the spread of Mycobacterium tuberculosis to the central nervous system, usually from a primary focus of infection in the lungs.

viral meningitis

A form of aseptic meningitis due to infection with adenovirus, coxsackievirus, echovirus, HIV, mumps virus, lymphocytic choriomeningitis virus, polio viruses, and others. Patients report fever, headache, and stiff neck. Lumbar puncture reveals an excessive number of lymphocytes, typically without a decrease in cerebrospinal fluid glucose levels.
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References in periodicals archive ?
2] Many children have only mild neurologic sequelae, with headache, photophobia, and neck stiffness, consistent with mild meningitic symptoms.
The most common is ulceroglandular tularemia; more serious forms include pneumonic, typhoidal, and meningitic tularemia.
This form is manifested by painful radiculopathy, which can lead to paraplegia, sometimes following an acute (eosinophilic) meningitic illness.