On my column last week, I wrote about a procedure known as a lumbar puncture that is commonly used for the diagnosis of a condition known as meningitis. This week I will explore a bit on the presentation, diagnosis and treatment of meningitis.
Meningitis is a clinical condition that results from inflammation of the meninges, which is a membrane that covers the brain. This condition occurs in both children and adults. It can be caused by bacteria, viruses and fungi.
The classic symptoms of meningitis are fever, headache and neck stiffness. Other symptoms include nausea and vomiting. They may be some confusion, irritability, delirium, sleepiness and in extreme cases patients can present in a coma. Depending on the cause the duration of symptoms may vary. In bacterial and some forms of viral meningitis the symptoms usually develop over a short period of time and the patients are usually very sick. In viral meningitis they may be a preceding history of body pains, fatigue and poor appetite.
Meningitis due to Tuberculosis (TB) or fungal organisms tends to have a more insidious course and symptoms develop gradually over weeks to months. These types of meningitis are more common in patients who are immunosuppressed, particularly by HIV in our setting. These patients often do not present with the classical features of headache, fever and neck pain. The only symptom may just be headache in some people; hence a high index of suspicion is needed to make the diagnosis. On examination they may have some enlarged lymph nodes and some cranial nerve abnormalities.
There are several complications of meningitis which can result if the condition is not treated adequately or if the diagnosis is not made timeously. Some of the complications include seizures, stroke or permanent brain damage. They can also develop hearing loss, memory problems and learning disabilities particularly in children. Some patients can develop kidney problems, shock and eventually death.
The different types of meningitis each require specific treatment. Bacterial meningitis is treated with intravenous antibiotics for a period of at least 10 days. The treatment of viral meningitis depends on the specific virus, some viruses need just supportive treatment while other will need antiviral treatment. Meningitis due to TB needs anti tuberculosis medication for a duration of nine months.
In addition, these patients must receive steroids in the first 2 months for better outcomes. Fungal meningitis particularly in the setting of advanced HIV can be difficult to treat and has poor outcomes. The treatment includes antifungal medications which can be given intravenously and as tablets. These patients often require recurrent lumbar punctures to reduce the pressure of the fluid surrounding the brain, if this is not done it can lead to complications such as blindness and death.
Meningitis is a condition that carries a high morbidity and mortality is diagnosis and treatment is instituted late. People with the classic features of meningitis should seek help as soon as possible. A high index of suspicion should always be maintained in those with advanced HIV.
