MENINGITIS
In this disorder, the brain and the spinal cord meninges become inflamed, usually as a result of bacterial infection. Such inflammation may involve all three meningeal membranes: the dura mater, the arachnoid, and the pia mater. The prognosis is good and complications are rare, especially if the disease is recognized early and the infecting organism responds to antibiotics. However, the death rate in untreated disease is 70% to 100%. The prognosis is poorer for infants and elderly people.
CAUSAL ORGANISM- BACTERIAL INFECTION
Meningitis is almost always a complication of another bacterial infection: bacteremia (especially from pneumonia, pus in a body cavity, osteomyelitis, or endocarditis), sinus or middle ear infection, encephalitis, myelitis, or brain abscess.
SYMPTOMS
The cardinal symptoms of this disorder are the same as those of infection (fever, chills, malaise) and of increased intracranial pressure (headache, vomiting and, rarely, swelling of the optic disk). Signs of meningeal irritation include rigidity at the nape of the neck, involuntary knee flexion when the neck is passively flexed, inability to extend the leg completely when sitting, exaggerated and symmetrical deeptendon reflexes, and backward arching of the back and extremities so that the body rests on the head and heels.
Other symptoms are irregular heartbeats, irritability, extreme sensitivity to light, double vision and other visual problems, and delirium, deep stupor, and coma.
PREVENTION AND CURE
To treat this disorder, the person receives appropriate antibiotic therapy and vigorous supportive care. Usually, intravenous antibiotics are given for at least 2 weeks, followed by oral antibiotics. Such antibiotics include Bicillin, Omnipen, or Nafcil. However, if the person is allergic to penicillin, Chloromycetin or Kantrex may be given. Other drugs include a cardiac glycoside such as Lanoxin to control irregular heartbeats, Osmitrol to decrease brain swelling, an anti seizure drug (usually given intravenously) or a sedative to reduce restlessness, and aspirin or Tylenol (or another acetaminophen product) to relieve headache and fever.
Supportive measures include bed rest, reduction of body temperature, and measures to prevent dehydration. The person must be isolated if the nasal cultures are positive for certain organisms. Of course, treatment includes appropriate therapy for any coexisting conditions, such as pneumonia.
