They are three membranes which surrounds brain and spinal cord, which from the outside inwards are the dura mater, the arachnoid mater and the pia mater. Between the middle membrane and the inner membrane, in the subarachnoid space, is found the cerebrospinal fluid (CSF).
This fluid circulates from the ventricles via communicating apertures passing through the subarachnoid space, after which it flows over the surface of the brain and the spinal cord. Infective meningitis is a condition which is associated with inflammation of the arachnoid and pia mater with the presence of bacteria, viruses, fungi or protozoa in the CSF.
Meningitis is one of the most emotive of infectious diseases, and for good reason: even today, infective meningitis is associated with significant mortality and risk of serious sequelae in survivors.
In the UK, more than 1500 cases of meningitis are notified annually. The most common cause of meningitis is recorded as viruses, and are often less serious than bacterial or fungal forms of the disease.
Bacterial meningitis is seen in all age groups, it majorly seen in young children, with 40–50% of all cases occurring in the first 4 years of life. They are two bacterias, N. meningitidis and S. pneumoniae which account for about 75% of cases. However, the pattern of micro-organisms causing meningitis is related to the age of the patient and the presence of underlying disease.
Human enteroviruses such as echoviruses and Coxsackie viruses account for about 70% of cases of viral meningitis in the UK. Herpes virus as well as varicella zoster viruses account for most other cases.
Candida species are rare cause of shunt-associated meningitis. Cryptococcus neoformans is regarded as an important cause of meningitis in patients with late-stage HIV infection and other severe defects of T-cell function.
The most common diagnosis of meningitis is done by detection of the causative organism and/or demonstration of biochemical changes and a response of cells in Cerebrospinal Fluid.
CSF is collected with help of lumbar puncture, where a needle is inserted between the posterior space of the third and fourth lumbar vertebrae into the subarachnoid space. Before performing this procedure, the possibility of precipitating or aggravating existing brain herniation in patients with intracranial hypertension must be considered.
A CT scan must be performed before undertaking this procedure of lumbar puncture if any neurological abnormalities are present.
Acute bacterial meningitis is an emergency condition that requires urgent administration of antibiotics. In other forms of meningitis they may be use of adjunctive therapy such as steroids, and the administration of antibiotics to prevent secondary cases.
Empirical antimicrobial therapy have to be prescribed before the identity of the causative organism or its antibiotic sensitivities are known. The epidemiological features of the case, together with microscopic examination of the CSF is considered which is often helpful in identifying the likely pathogen.
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