Meningitis Health Dictionary

Cerebrospinal fever. Inflammation of the pia mater and arachnoid covering of the brain and spinal cord. A notifiable disease. Hospitalisation. Diagnosis is difficult without a lumbar puncture. Caused by a wide range of virus, bacteria, protozoa and fungi. Three most common bacterial causes in England and Wales are N. Meningotidis, H. influenzae and streptococcus-like infection with sore throat; then fever, vomiting, headache and mental confusion; half-open eyes when asleep, delirium, sensitive to light, possibly drifting into coma. Sometimes onset is gradual over 2-3 weeks. Treatment by hospital specialist.

Poor housing and passive smoking suspected. Its association with non-germ meningitis, and inflammatory drugs is well recognised. Also caused by injury or concussion.

Commence by cleansing bowel with Chamomile enema.

Cerebrospinal relaxants indicated: Passion flower (cerebral), Black Cohosh (meningeal), Ladyslipper (spinal meningeal). (A.W. & L.R. Priest)

If patient is cold, give Cayenne pepper in honey to promote brisk circulation.

Aconite and Gelsemium. “For irritation of the meninges of the brain and spinal cord Aconite is indispensible. Combined with Gelsemium for restlessness it is an exceptional remedy. Tincture Aconite (5-15 drops) with Gelsemium (3-10 drops) hourly. Also used in combination with other agents as may be dictated by the course of the disease. (W.W. Martin MD., Kirksville, Mo., USA)

Crawley root. Decoction: 1 teaspoon to half a pint water, simmer 20 minutes. Dose: 1 teaspoon or more 3-4 times daily for children over 6 months. A powerful diaphoretic and sedative. (Dr Baker, Adrian, Michigan, USA)

Lobelia and Echinacea. Equal parts, Liquid Extract 30 drops in water every 3 hours. (Dr Finlay Ellingwood)

Lobelia, alone. Hypodermic injections of Lobelia in five cases of epidemic spinal meningitis, with complete recovery in every case. Dose: 10 drops hourly until symptoms abate, then twice daily. (Dr A.E. Collyer, Ellingwood Therapeutist)

Ecclectic School. Echinacea commended.

Before the Doctor comes. As onset is rapid, often less than 5 hours, an anti-inflammatory is justified. Teas or decoctions from any of the following: Catmint (Catnep), Prickly Ash berries, Pleurisy root, Boneset, Wild Cherry bark, Bugleweed (Virginian), Ladyslipper. When temperature abates and patient feels better: Chamomile tea or cold Gentian decoction with pinch Cayenne.

Hydrotherapy. Hot baths make patient feel worse. Sponge down with cold water.

Protective throat spray: equal parts, Tincture Myrrh and Tincture Goldenseal.

Protective gargle: 10-20 drops Tincture Myrrh and Goldenseal to glass of water.

Garlic. Dr Yan Cai, Department of Neurology, Ren Ji Hospital (affiliated to Shanghai Second Medical University), China, referred to the extensive use of Garlic in Chinese folk medicine and his hospital’s experience with Garlic products – diallyl trisulphide in particular – to treat viral infections including crypotococcal meningitis for which disease results were impressive.

Garlic appears to be a reliable preventative.

Diet. Fast as long as temperature is elevated; with fruit juices, red beet juice, carrot juice or herb teas. Note. GPs and other practitioners may help stop meningitis claiming lives by giving massive doses of Echinacea before they are admitted to hospital.

Note: The infection is often difficult to diagnose. At the end of each year (November and December) when the peak in cases approaches, every feverish patient with headache should be suspected, especially where accompanied by stiff neck.

The above entry is of historic interest only; more effective orthodox treatment being available. 

Inflammation of the meninges (membranes covering the brain and spinal cord), usually due to infection. Viral meningitis tends to occur in epidemics in the winter; it is relatively mild. Bacterial meningitis is life-threatening. It is mainly caused by the HAEMOPHILUS INFLUENZAE bacterium, and MENINGOCOCCUS type B and C bacteria.

The infection usually reaches the meninges via the bloodstream from an infection elsewhere in the body. Less commonly, it passes through skull cavities from an infected ear or sinus, or from the air following a skull fracture.

The main symptoms are fever, severe headache, nausea and vomiting, dislike of light, and a stiff neck. In viral meningitis, the symptoms are mild and may resemble influenza. In bacterial meningitis, the main symptoms may develop over only a few hours, followed by drowsiness and, occasionally, loss of consciousness. In about half the cases of meningococcal meningitis, there is also a rash under the skin that does not fade with pressure (see glass test). The rash starts as pin-prick spots that can join to give a bruise-like appearance.

To make a diagnosis, a lumbar puncture is performed. Viral meningitis needs no treatment and usually clears up within a week or two with no after-effects. Bacterial meningitis is a medical emergency. It is treated with intravenous antibiotic drugs. With prompt treatment, a full recovery is usually made. However, brain damage may occur in some cases.Vaccines are now given to protect children against 2 of the major types of bacterial meningitis: those caused by the HAEMOPHILUS INFLUENZAE bacterium and the MENINGOCOCCUS type C bacterium (see immunization). For other types of bacterial meningitis, antibiotic drugs are given as a protective measure to people who have come into contact with the infection.

In?ammation affecting the membranes of the BRAIN or SPINAL CORD, or usually both. Meningitis may be caused by BACTERIA, viruses (see VIRUS), fungi, malignant cells or blood (after SUBARACHNOID HAEMORRHAGE). The term is, however, usually restricted to in?ammation due to a bacterium or virus. Viral meningitis is normally a mild, self-limiting infection of a few days’ duration; it is the most common cause of meningitis but usually results in complete recovery and requires no speci?c treatment. Usually a less serious infection than the bacterial variety, it does, however, rarely cause associated ENCEPHALITIS, which is a potentially dangerous illness. A range of viruses can cause meningitis, including: ENTEROVIRUSES; those causing MUMPS, INFLUENZA and HERPES SIMPLEX; and HIV.

Bacterial meningitis is life-threatening: in the United Kingdom, 5–10 per cent of children who contract the disease may die. Most cases of acute bacterial meningitis in the UK are caused by two bacteria: Neisseria meningitidis (meningococcus), and Streptococcus pneumoniae (pneumococcus); other bacteria include Haemophilus in?uenzae (a common cause until virtually wiped out by immunisation), Escherichia coli, Mycobacterium tuberculosis (see TUBERCULOSIS), Treponema pallidum (see SYPHILIS) and Staphylococci spp. Of the bacterial infections, meningococcal group B is the type that causes a large number of cases in the UK, while group A is less common.

Bacterial meningitis may occur by spread from nearby infected foci such as the nasopharynx, middle ear, mastoid and sinuses (see EAR, DISEASES OF). Direct infection may be the result of penetrating injuries of the skull from accidents or gunshot wounds. Meningitis may also be a complication of neurosurgery despite careful aseptic precautions. Immuno-compromised patients – those with AIDS or on CYTOTOXIC drugs – are vulnerable to infections.

Spread to contacts may occur in schools and similar communities. Many people harbour the meningococcus without developing meningitis. In recent years small clusters of cases, mainly in schoolchildren and young people at college, have occurred in Britain.

Symptoms include malaise accompanied by fever, severe headache, PHOTOPHOBIA, vomiting, irritability, rigors, drowsiness and neurological disturbances. Neck sti?ness and a positive KERNIG’S SIGN appearing within a few hours of infection are key diagnostic signs. Meningococcal and pneumococcal meningitis may co-exist with SEPTICAEMIA, a much more serious condition in terms of death rate or organ damage and which constitutes a grave emergency demanding rapid treatment.

Diagnosis and treatment are urgent and, if bacterial meningitis is suspected, antibiotic treatment should be started even before laboratory con?rmation of the infection. Analysis of the CEREBROSPINAL FLUID (CSF) by means of a LUMBAR PUNCTURE is an essential step in diagnosis, except in patients for whom the test would be dangerous as they have signs of raised intracranial pressure. The CSF is clear or turbid in viral meningitis, turbid or viscous in tuberculous infection and turbulent or purulent when meningococci or staphylococci are the infective agents. Cell counts and biochemical make-up of the CSF are other diagnostic pointers. Serological tests are done to identify possible syphilitic infection, which is now rare in Britain.

Patients with suspected meningitis should be admitted to hospital quickly. General pracitioners are encouraged to give a dose of intramuscular penicillin before sending the child to hospital. Treatment in hospital is usually with a cephalosporin, such as ceftazidime or ceftriaxone. Once the sensitivity of the organism is known as a result of laboratory studies on CSF and blood, this may be changed to penicillin or, in the case of H. in?uenzae, to amoxicillin. Local infections such as SINUSITIS or middle-ear infection require treatment, and appropriate surgery for skull fractures or meningeal tears should be carried out as necessary. Tuberculous meningitis is treated for at least nine months with anti-tuberculous drugs (see TUBERCULOSIS). If bacterial meningitis causes CONVULSIONS, these can be controlled with diazepam (see TRANQUILLISERS; BENZODIAZEPINES) and ANALGESICS will be required for the severe headache.

Coexisting septicaemia may require full intensive care with close attention to intravenous ?uid and electrolyte balance, control of blood clotting and blood pressure.

Treatment of close contacts such as family, school friends, medical and nursing sta? is recommended if the patient has H. in?uenzae or N. meningitidis: RIFAMPICIN provides e?ective prophylaxis. Contacts of patients with pneumococcal infection do not need preventive treatment. Vaccines for meningococcal meningitis may be given to family members in small epidemics and to any contacts who are especially at risk such as infants, the elderly and immuno-compromised individuals.

The outlook for a patient with bacterial meningitis depends upon age – the young and old are vulnerable; speed of onset – sudden onset worsens the prognosis; and how quickly treatment is started – hence the urgency of diagnosis and admission to hospital. Recent research has shown that children who suffer meningitis in their ?rst year of life are ten times more likely to develop moderate or severe disability by the age of ?ve than contemporaries who have not been infected. (See British Medical Journal, 8 September 2001, page 523.)

Prevention One type of bacterial meningitis, that caused by Haemophilus, has been largely controlled by IMMUNISATION; meningococcal C vaccine has largely prevented this type of the disease in the UK. So far, no vaccine against group B has been developed, but research continues. Information on meningitis can be obtained from the Meningitis Trust and the Meningitis Research Foundation.

n. an inflammation of the *meninges due to infection by viruses or bacteria or fungi. Meningitis causes an intense headache, fever, loss of appetite, intolerance to light (photophobia) and sound (phonophobia), rigidity of muscles, especially those in the neck (see also Kernig’s sign), and in severe cases convulsions, vomiting, and delirium leading to death. The most important causes of bacterial meningitis are *Haemophilus influenzae (especially in young children); two strains of Neisseria meningitidis (the meningococcus), B and C; and Streptococcus pneumoniae (pneumococcal meningitis). Immunization against Haemophilus, Neisseria meningitidis B and C, and pneumococcal meningitis is now routine for children (see Hib vaccine; meningitis B vaccine; meningitis C vaccine; pneumococcal vaccine); In meningococcal meningitis (meningitis B and C, previously known as cerebrospinal fever and spotted fever) the symptoms appear suddenly and the bacteria can cause widespread meningococcal infection, which may be associated with meningococcal septicaemia, with its characteristic purple haemorrhagic rash anywhere on the body. The rash does not disappear on pressure (if a glass is pressed on the rash, it is still visible through the glass). Unless quickly diagnosed and treated, death can occur within a few hours.

Bacterial meningitis is treated with antibiotics administered as soon as possible after diagnosis. With the exception of herpes simplex *encephalitis (which is treated with aciclovir), viral meningitis does not respond to drugs but normally has a relatively benign prognosis. See also leptomeningitis; pachymeningitis.