How is meningitis diagnosed. What are the early signs of meningitis. Can meningitis be detected through blood tests. What is the gold standard test for meningitis diagnosis. How quickly can meningitis progress.

Understanding Meningitis: Types and Severity

Meningitis is a serious condition characterized by inflammation of the meninges, the protective membranes surrounding the brain and spinal cord. This inflammation can be caused by various factors, leading to different types of meningitis:

• Bacterial meningitis: The most severe and life-threatening form
• Viral meningitis (aseptic): The most common type, generally less serious
• Fungal meningitis: An uncommon type caused by fungal infections
• Parasitic meningitis: A rare form caused by parasites

Bacterial meningitis requires immediate medical attention and antibiotic treatment to prevent potentially fatal complications. Viral meningitis, while more common, is typically less severe and may resolve on its own without specific treatment. The rarer fungal and parasitic forms require specialized treatment approaches.

Recognizing Meningitis Symptoms: When to Seek Medical Help

Identifying meningitis symptoms early is crucial for timely treatment and prevention of complications. However, meningitis can sometimes be mistaken for other conditions such as the flu, dehydration, or gastroenteritis. Key symptoms to watch for include:

• Severe neck stiffness without apparent cause
• Persistent, painful headache
• Disorientation or confusion
• Nausea and vomiting
• High fever (101°F or higher), especially when combined with other symptoms

Is immediate medical attention necessary for suspected meningitis? Absolutely. Seeking emergency care is crucial if you or someone close to you experiences these symptoms. Early treatment, ideally within 24 hours but no later than 2-3 days of symptom onset, can significantly improve outcomes and prevent severe complications.

Diagnostic Approach: Physical Examination and Initial Assessment

The diagnostic process for meningitis typically begins with a thorough physical examination. During this initial assessment, healthcare providers will:

1. Gather information about symptoms and medical history
2. Inquire about recent travel to regions with higher meningitis rates
3. Examine the body for unusual markings, signs, or lumps
4. Look for a characteristic rash that doesn’t blanch under pressure
5. Check for specific signs of meningeal irritation

Two classic tests for meningeal irritation are Brudzinski’s sign and Kernig’s sign. In Brudzinski’s test, neck flexion causes involuntary bending of the knees and hips. Kernig’s sign involves pain in the back or thigh when the leg is straightened from a flexed position. However, it’s important to note that recent research indicates these signs may not be present in all cases of meningitis, and their absence does not rule out the condition.

Laboratory Tests: Blood Cultures and Analysis

Blood tests play a crucial role in diagnosing meningitis and identifying the causative agent. These tests include:

• Bacterial cultures: Blood samples are cultured to grow and identify specific bacteria
• Complete blood count (CBC): Checks for elevated levels of certain cells and proteins
• Total protein count: Assesses protein levels that may indicate infection
• Procalcitonin test: Helps differentiate between bacterial and viral infections

How long does it take to get results from blood cultures? Bacterial culture results typically take several days, as the organisms need time to grow. However, preliminary results from microscopic examination of stained samples may be available sooner.

Cerebrospinal Fluid Analysis: The Gold Standard for Diagnosis

While blood tests provide valuable information, the definitive diagnosis of meningitis often relies on cerebrospinal fluid (CSF) analysis. This procedure, known as a lumbar puncture or spinal tap, involves:

1. Inserting a needle into the lower back to collect CSF
2. Analyzing the fluid for cell counts, protein levels, and glucose concentration
3. Culturing the CSF to identify any bacteria or other pathogens
4. Performing additional tests such as PCR to detect viral genetic material

Why is CSF analysis considered the gold standard for meningitis diagnosis? CSF analysis provides direct information about the condition of the central nervous system and can definitively identify the presence and type of infection. It allows healthcare providers to distinguish between bacterial, viral, and other forms of meningitis, guiding appropriate treatment decisions.

Imaging Studies: Visualizing Brain and Spine Inflammation

Imaging studies are often employed to support the diagnosis of meningitis and rule out other conditions. These may include:

• Computerized tomography (CT) scans
• Magnetic resonance imaging (MRI)
• X-ray imaging

These imaging techniques can reveal signs of inflammation in the brain and spine, as well as identify complications such as:

• Internal bleeding (hemorrhage)
• Fluid buildup in tissue (abscess)
• Brain swelling

In some cases, imaging studies may be performed before a lumbar puncture to ensure it’s safe to proceed with the procedure. Conditions like increased intracranial pressure can make a spinal tap dangerous or impossible to perform.

Differential Diagnosis: Distinguishing Meningitis from Other Conditions

Given that meningitis symptoms can mimic other illnesses, healthcare providers must consider a range of potential diagnoses. The differential diagnosis process may involve:

1. Evaluating symptoms in the context of the patient’s overall health and risk factors
2. Considering alternative explanations for symptoms, such as influenza or migraine
3. Assessing the progression and severity of symptoms
4. Utilizing a combination of clinical findings, laboratory tests, and imaging studies

How can healthcare providers differentiate between viral and bacterial meningitis? While definitive diagnosis often requires CSF analysis, certain clinical and laboratory findings can provide clues. Bacterial meningitis typically presents with more severe symptoms, higher fever, and more significant abnormalities in blood and CSF tests. The procalcitonin blood test can also help distinguish between bacterial and viral causes.

Rapid Diagnostic Tests: Accelerating the Diagnostic Process

In recent years, rapid diagnostic tests have been developed to expedite the diagnosis of meningitis, particularly in emergency settings. These tests include:

• Latex agglutination tests: Detect bacterial antigens in CSF
• Polymerase chain reaction (PCR) assays: Identify genetic material from bacteria or viruses
• Point-of-care tests: Provide quick results for certain pathogens

While these rapid tests can provide valuable information, they are typically used in conjunction with traditional diagnostic methods rather than as standalone tools.

Treatment Approaches: Tailoring Therapy to the Specific Cause

The treatment of meningitis depends on the underlying cause and severity of the infection. Key aspects of meningitis treatment include:

• Immediate antibiotic therapy for suspected bacterial meningitis
• Antiviral medications for certain viral causes
• Antifungal treatments for fungal meningitis
• Supportive care, including fluid management and fever control
• Management of complications and sequelae

How quickly should antibiotic treatment be initiated for bacterial meningitis? Antibiotic therapy should be started as soon as possible, ideally within an hour of presentation, even before the diagnosis is confirmed. Delaying treatment can significantly increase the risk of severe complications and mortality.

Prophylaxis and Prevention: Protecting Close Contacts

In cases of bacterial meningitis, prophylactic antibiotics may be recommended for close contacts of the infected individual. This preventive measure aims to reduce the risk of secondary cases. Additionally, vaccination plays a crucial role in preventing certain types of bacterial meningitis, particularly those caused by Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae type b.

Long-term Outcomes and Follow-up Care

While many individuals recover fully from meningitis, some may experience long-term effects or complications. These can include:

• Hearing loss
• Cognitive impairments
• Seizures
• Motor deficits
• Psychological issues

Follow-up care is essential for monitoring recovery and addressing any lingering effects of the infection. This may involve:

1. Regular check-ups with healthcare providers
2. Hearing and vision tests
3. Neurological assessments
4. Psychological support and counseling
5. Rehabilitation services, if needed

How long does recovery from meningitis typically take? The recovery period can vary widely depending on the type and severity of meningitis. While some individuals may recover within a few weeks, others may require months of rehabilitation and support. Ongoing medical care and monitoring are crucial for optimizing long-term outcomes.

Emerging Research and Future Directions

The field of meningitis diagnosis and treatment continues to evolve. Current areas of research include:

• Development of more rapid and accurate diagnostic tests
• Novel therapeutic approaches, including targeted immunotherapies
• Improved vaccines to prevent a broader range of meningitis-causing pathogens
• Enhanced understanding of the long-term effects of meningitis on brain function

These advancements hold promise for improving the early detection, treatment, and prevention of meningitis, potentially reducing its global burden and improving outcomes for affected individuals.

Public Health Implications: Surveillance and Outbreak Management

Meningitis, particularly bacterial meningitis, has significant public health implications. Effective management of this condition at a population level involves:

1. Robust surveillance systems to detect and monitor cases
2. Rapid response protocols for potential outbreaks
3. Vaccination programs targeting high-risk groups
4. Public education initiatives to increase awareness of symptoms and prevention strategies
5. International collaboration to address meningitis in endemic regions

How do public health agencies respond to meningitis outbreaks? When an outbreak is detected, public health officials typically implement a multifaceted approach that includes:

• Case identification and contact tracing
• Provision of prophylactic antibiotics to close contacts
• Mass vaccination campaigns when appropriate
• Enhanced surveillance and reporting
• Public communication and education efforts

These coordinated efforts aim to contain the spread of infection and protect vulnerable populations.

Special Considerations for High-Risk Groups

Certain populations are at increased risk for meningitis and may require special attention in terms of prevention, diagnosis, and treatment. These groups include:

• Infants and young children
• Adolescents and young adults, particularly those in close-contact settings like college dormitories
• Individuals with compromised immune systems
• Travelers to regions with high rates of meningitis
• Laboratory workers handling meningitis-causing pathogens

Tailored prevention strategies, such as targeted vaccination programs and enhanced surveillance, are often implemented for these high-risk groups.

The Role of Technology in Meningitis Management

Advancements in technology are playing an increasingly important role in the diagnosis, treatment, and prevention of meningitis. Some key areas of technological innovation include:

1. Artificial intelligence algorithms for rapid image analysis and diagnosis
2. Telemedicine platforms for remote consultation and follow-up care
3. Mobile health applications for symptom tracking and patient education
4. Big data analytics for epidemiological surveillance and outbreak prediction
5. Gene sequencing technologies for pathogen identification and antibiotic resistance detection

How is artificial intelligence being used in meningitis diagnosis? AI algorithms are being developed to analyze medical images, such as CT scans and MRIs, to detect signs of meningitis more quickly and accurately. These tools have the potential to assist healthcare providers in making faster and more precise diagnoses, particularly in resource-limited settings.

Challenges in Global Meningitis Control

Despite advances in diagnosis and treatment, meningitis remains a significant global health challenge. Some of the key obstacles to effective meningitis control include:

• Limited access to healthcare in resource-poor settings
• Antibiotic resistance in bacterial pathogens
• Inadequate surveillance systems in some regions
• Vaccine hesitancy and misinformation
• Emerging and re-emerging pathogens causing meningitis

Addressing these challenges requires a coordinated global effort involving governments, healthcare systems, research institutions, and international organizations.

Patient Education and Support: Empowering Individuals and Communities

Effective management of meningitis extends beyond medical interventions to include patient education and support. Key aspects of this approach include:

1. Raising awareness of meningitis symptoms and the importance of early medical attention
2. Providing clear information about treatment options and potential outcomes
3. Offering psychological support for patients and families affected by meningitis
4. Facilitating peer support networks for individuals recovering from meningitis
5. Educating communities about prevention strategies, including vaccination

How can healthcare providers effectively communicate with patients about meningitis? Clear, compassionate communication is essential. Providers should:

• Use plain language to explain complex medical concepts
• Provide written materials to reinforce verbal information
• Encourage questions and address concerns patiently
• Offer resources for additional support and information
• Involve family members or caregivers in discussions when appropriate

By empowering patients and communities with knowledge and support, healthcare systems can improve outcomes and reduce the overall burden of meningitis.

The Economic Impact of Meningitis

The economic burden of meningitis extends beyond direct medical costs to include broader societal impacts. These may include:

• Lost productivity due to illness and long-term disability
• Costs associated with long-term care and rehabilitation
• Economic strain on healthcare systems, particularly during outbreaks
• Impact on education and workforce participation for affected individuals
• Costs of public health interventions and vaccination programs

Understanding the full economic impact of meningitis is crucial for informing policy decisions and allocating resources for prevention and treatment efforts.

Neck, Physical Exam, at Home, and More

Testing for meningitis can include various tests, including a physical exam, blood tests, bacterial cultures, and cerebrospinal fluid tests.

Meningitis happens when the membranes, or meninges, around your spinal cord and brain become swollen from inflammation.

Four types of meningitis are possible:

• Bacterial: The most severe and life-threatening form of meningitis. This type can be fatal if it’s not treated immediately with antibiotics to prevent the spread of the infection and further complications.
• Viral (aseptic): The most common cause of a meningitis infection. This type usually isn’t as serious as bacterial meningitis and often goes away without requiring treatment.
• Fungal: This uncommon type is caused by a fungus that gets into your spinal cord from your bloodstream.
• Parasitic: This much less common form of meningitis is caused by parasites.

You don’t always need treatment for nonbacterial meningitis. The infection may clear up on its own. Meningitis can be mistaken for the flu, dehydration, or gastroenteritis. It can also be overlooked because symptoms may be mild or not always apparent.

Seek emergency medical attention if you notice any symptoms of meningitis. You should also contact your doctor if someone close to you at home or work has been diagnosed. Watch out for these symptoms:

• having severe neck stiffness with no apparent cause
• experiencing a constant, painful headache
• feeling disoriented
• feeling sick and throwing up
• running a high fever (101°F and higher), particularly with the above symptoms

Early treatment, within 2 to 3 days (less than 1 day is recommended), can help prevent long-term or severe complications. Bacterial meningitis can quickly become deadly or cause brain damage in a few days without antibiotics.

Your doctor will conduct a full physical examination as the first step in looking for signs of meningitis.

First, your doctor will ask you about your symptoms, your medical history, and whether you’ve been on any recent trips to regions with a higher rate of certain types of meningitis.

Then, your doctor will check your entire body for any unusual markings, signs, or lumps. A purplish or reddish skin rash that doesn’t get lighter or disappear when you press against it can be a sign of severe infection with one of the types of bacteria that causes meningitis.

Your doctor may also look for two specific signs of a meningitis infection:

• Brudzinski’s sign: Your doctor will pull your neck forward slowly. Neck stiffness and involuntary bending of the knees and hips can indicate meningitis.
• Kernig’s sign: Your doctor will flex your leg at the knee and bend the leg forward at the hip. Then, they’ll slowly straighten your leg. Intense pain in your back or thigh can indicate meningitis. Your doctor may repeat this test on both legs.

However, more recent research shows that many people with meningitis doesn’t display these signs. A negative result on either of these tests doesn’t rule out the possibility of meningitis.

To take a bacterial culture, your doctor will collect a blood sample through a needle in a vein in your arm. The blood is transferred to small dishes known as petri dishes. Bacteria or other microorganisms can grow and become more abundant in these nutrient-rich dishes.

After a certain period of time (usually a few days), your doctor can look at the bacteria through a microscope and diagnose the specific bacteria causing an infection in the blood.

Your doctor can also put a sample on a microscope slide and stain it so that the bacteria are easier to see under a microscope. The results of this test may come back earlier than those from a culture.

To do a blood test for signs of meningitis, a technician inserts a needle into a vein in your arm and draws out a sample of your blood to send to a lab for testing.

A complete blood count (CBC) or total protein count check for heightened levels of certain cells and proteins that can suggest a meningitis infection.

A procalcitonin blood test can also help your doctor tell if an infection is more likely caused by either bacteria or a virus.

Blood tests may also be done at the same time as a spinal tap to compare the levels of cells, antibodies, and proteins and confirm the diagnosis.

An imaging test, such as computerized tomography (CT) scan, allows your doctor to take detailed images of your head and chest to look for signs of brain and spine inflammation associated with meningitis and help confirm a diagnosis.

A CT scan, in addition to magnetic resonance imaging (MRI) and X-ray imaging tests, can also help your doctor notice other things that can cause severe symptoms of meningitis, such as:

• internal bleeding (hemorrhage)
• fluid buildup in tissue (abscess)
• swelling of the brain

These conditions may make it dangerous or impossible for your doctor to perform a spinal tap, so imaging tests are typically done before your doctor decides whether to do a spinal tap.

This is the only test that can truly diagnose meningitis. To perform this test, your doctor inserts a needle into your spine in order to collect cerebrospinal fluid (CSF) that’s found around your brain and spinal cord. Then, your doctor sends your CSF to a lab for testing. Meningitis is often confirmed when your CSF fluid has:

• low levels of sugar (glucose)
• high levels of white blood cells
• high levels of blood protein
• heightened level of antibodies responding to infection

A CSF test can also help your doctor figure out what type of bacteria or virus caused your meningitis.

Your doctor may also request a polymerase chain reaction (PCR) test. This test can analyze your CSF fluid for antibodies that increase in number during viral infections to decide what treatment will work best.

In theory, it’s possible to do the Brudzinski and Kernig tests at home to check for meningitis. However, you should still see your doctor for a diagnosis. These tests need to be performed by a professional — and even then they aren’t reliable as a sole method of diagnosis.

Remember that meningitis can be dangerous. Even if you could diagnose it at home, you wouldn’t be able to determine which type you have, and some types are life-threatening. Get emergency medical help if you have these symptoms:

• neck stiffness
• constant, painful headache
• feelings of disorientation
• vomiting or nausea
• high fever (101°F and higher)

Here’s how to do the Brudzinski test at home:

1. Lie flat on your back.
2. Gently and slowly push on the back of your neck so that your head moves forward. For better results, have someone do this for you.
3. Note if your hips and knees flex involuntarily as you raise your head. This is a positive Brudzinski sign, meaning that you may have meningitis.

And the Kernig test:

1. Lie flat on your back.
2. Lift your leg up at the hip and bend your knee to a 90-degree angle.
3. Gently and slowly lift your leg up at the knee.
4. Note if your back or thigh starts to hurt. This is a positive Kernig sign, meaning that you may have meningitis.

Always see your doctor for a diagnosis.

The different types of meningitis have different causes:

• Bacterial meningitis happens when bacteria pass through your blood into the CSF. Bacteria can also get into your meninges and infect them directly. Bacteria can be spread through infected blood.
• Viral (aseptic) meningitis happens when a virus gets into your CSF from your bloodstream. This can be caused by many types of viruses, such as the herpes virus, HIV, West Nile virus, and enteroviruses.
• Fungal meningitis happens when a fungus, such as Cryptococcus, gets into your meninges or CSF from your bloodstream. It’s most common in people who have weak or compromised immune systems from cancer or HIV.
• Parasitic meningitis happens when a parasite gets into your meninges or CSF from the bloodstream. It’s often caused by eating or drinking something that’s been contaminated by an infectious parasite that normally only infects animals.

Bacterial meningitis needs to be treated right away or it may result in severe complications, such as brain damage, or become deadly.

Seek emergency medical attention if you think you have a bacterial meningitis infection. Early and effective treatment can save your life and reduce your chance of complications.

Other causes may go away after a few days without treatment. See your doctor as soon as you can if you suspect that you have a meningitis infection caused by a virus or parasite.

Meningitis: Tests, symptoms, diagnosis

Meningitis occurs when the meninges, the protective coating around the brain and spinal cord, becomes inflamed. Because meningitis can be a life-threatening emergency, a person who thinks they may have meningitis should seek immediate medical care.

A meningitis test can diagnose meningitis, and help determine what caused it.

A cerebrospinal fluid (CSF) analysis can definitively diagnose meningitis. However, a doctor may recommend additional tests to rule out other causes.

If a doctor suspects bacterial meningitis, they may begin antibiotic treatment before meningitis test results come back.

Meningitis causes swelling and inflammation of the meninges. The meninges are three membranes that protect the brain and spinal cord.

Meningitis usually happens when an infection – often a virus or bacteria – travels to the meninges.

Less commonly, a fungus or parasite can cause meningitis. Bacterial meningitis can kill a person within a few hours without treatment, while viral meningitis often goes away on its own.

Very rarely, an amoeba called Naegleria fowlerican travel through water, up the nose, and into the brain. This type of meningitis is almost always fatal.

Meningitis can also occur without an infection, as a result of cancer or other diseases. Meningitis tests can tell a doctor which type of meningitis a person has, and guide treatment decisions.

This article explores the importance of seeking immediate medical attention to test for meningitis, types of tests and how doctors diagnose meningitis, meningitis causes, and the outlook for a person diagnosed with various types of the disease.

Meningitis can be a life-threatening emergency, especially if a person has bacterial meningitis. Bacterial meningitis can kill a person in a few hours.

Outcomes for viral meningitis are usually better, and a person may recover on their own without treatment.

However, it is impossible to know which type of meningitis a person has without medical testing.

Though meningitis is very serious, prompt care can save lives.

Go to the emergency room or call a doctor immediately if a person has:

• a stiff neck
• a very intense headache
• a high fever, especially following an illness such as the flu
• sensitivity to light
• an unexplained rash
• seizures
• vomiting
• confusion

There are a number of different tests a doctor can perform to diagnose meningitis, depending on which type of meningitis they think a person may have. They include:

Physical examination

Meningitis testing usually begins with a physical exam, during which a doctor assesses how likely it is that a person has meningitis. A doctor may ask about any recent illnesses, all symptoms, and when any symptoms appeared.

A doctor may also perform physical tests to assess for inflammation of the meninges. Two specific tests are often used to help diagnose meningitis.

One test looks for what is known as the Brudzinski sign. During this test, a person lies on their back while a doctor flexes their neck upward and toward the chest. If this causes the person to flex their knees or hips, this suggests inflammation of the meninges, and may mean a person has meningitis.

The other test looks for what is called the Kernig sign. During this test, a person lies on their back. A doctor bends the knee toward the chest, then attempts to straighten the leg upward. If this is very painful or impossible, a person may have swelling in the meninges, suggesting meningitis.

Blood tests and culture

Meningitis testing also generally includes blood work, which can rule out some other potential causes of meningitis, such as sepsis.

Some blood test results, such as a very high white blood cell count, may help with diagnosing a severe infection, including meningitis.

A doctor may also order bloodwork to test for other issues, such as poisoning or dangerous changes in blood glucose.

High levels of the chemical procalcitonin can also help a doctor determine whether an infection is more likely to be viral or bacterial. High procalcitonin suggests a bacterial infection.

A blood culture, which tests the blood for certain organisms, may be able to detect some types of meningitis in the blood, including some forms of bacterial and fungal meningitis. This can help guide treatment, especially when a doctor needs to know which type of antibiotic to use for bacterial meningitis.

However, a blood culture cannot definitively diagnose or rule out meningitis. According to a 2017 American Family Physician article, just 62–66% of adults under 60 with bacterial meningitis had a positive culture. Among adults over 65, the figure was slightly higher, at 73%.

Cerebrospinal fluid test

The most reliable way to diagnose meningitis is with a lumbar puncture. During a lumbar puncture, a doctor inserts a long, thin needle in between two vertebrae in the lower back. This allows them to withdraw some cerebrospinal fluid (CSF), which is the fluid that cushions the brain and spinal cord.

The doctor then sends the CSF to the lab to analyze it for signs of infection. A CSF culture can usually detect the specific organisms causing meningitis.

When a person has viral or noninfectious meningitis, there are not usually organisms in the CSF. Instead, a doctor will look for slightly elevated protein levels and elevated white blood cell counts.

Imaging tests

For some people, a lumbar puncture may not be safe. This may include those with high pressure inside the skull, certain brain diseases, a history of stroke, and those with weak immune systems because of HIV or certain drugs.

A CT scan uses x-rays to take pictures of the brain and skull. This can help with detecting whether there is any increased pressure in the head that may make a lumbar puncture unsafe. A doctor may recommend proceeding to a lumbar puncture if the CT scan indicates it would be safe.

A CT scan, however, is not a fully reliable measure of pressure in the head. A doctor may recommend foregoing both the CT scan and the lumbar puncture and beginning treatment if there are other signs of meningitis.

At-home tests

No home tests can conclusively prove that a person does or does not have meningitis. Instead, anyone with symptoms of meningitis should seek immediate medical care. Some warning signs include:

• a stiff neck
• a very intense headache
• a high fever, especially following an illness such as the flu
• sensitivity to light
• an unexplained rash
• seizures
• vomiting
• confusion

Looking for Kernig or Brudzinski signs may provide evidence that a person has meningitis. However, it is easy to perform these tests incorrectly, especially without medical training.

Many different infections and diseases can cause meningitis. They include:

• Viral meningitis: Viral meningitis happens when a virus, such as measles, mumps, or the flu, spreads to the meninges. Symptoms usually are less serious than other types of meningitis. Viruses that cause viral meningitis spread from one person to another.
• Bacterial meningitis: Bacterial meningitis happens when a bacterial infection spreads to the meninges. Many organisms can cause this infection, but some common culprits include group B streptococcus and Haemophilus influenzae. A person can spread group B strep to a newborn when giving birth vaginally. The infections that cause bacterial meningitis can spread from one person to another.
• Fungal meningitis: Fungal meningitis happens when a person contracts a fungal infection, often by inhaling spores from the environment. The infection can then spread to the meninges. Candida, a common fungal infection on the skin that can cause yeast infections or thrush, may also spread to the meninges, but this is rare.
• Parasitic meningitis: Parasitic meningitis happens when a parasite gets into the meninges. This is uncommon but can happen when a person eats raw or contaminated food, or has contact with raccoon feces from soil.
• Amebic meningitis: This rare and highly lethal type of meningitis happens when a bacteria that lives in the water travels up the nose to the meninges.
• Non-infectious meningitis: This means that the meninges become swollen without an infection. This can happen when a person has a serious disease like lupus erythematosus, a head injury, a recent brain surgery, or cancer.

The outlook depends on the type of meningitis a person has.

Bacterial meningitis has a much higher fatality rate than viral meningitis. In 2010, overall, 14.3% of people with bacterial meningitis died. Factors such as age – being either very young or very old – and having a weak immune system can increase the risk of death.

Amebic meningitis has a death rate that is much higher. Of 34 infections reported to Centers for Disease Control and Prevention (CDC) between 2009 and 2019, just 3 people survived.

Among people who do survive meningitis, complications are common, especially when meningitis damages the neurological system.

A 2010 meta-analysis of children diagnosed with meningitis found the following complication rates after hospital discharge:

• hearing loss: 6%
• behavioral issues: 2.6%
• cognitive challenges: 2.2%
• motor skill problems: 2.3%
• seizures: 1.6%
• vision impairments: 0.9%

Early testing and prompt treatment for meningitis is critical to survival.

A person who thinks they might have meningitis should not delay care, and should be clear and specific at the emergency room about what symptoms they are experiencing.

A person should tell a doctor about any recent potential meningitis exposures, and request testing for meningitis immediately.

How to recognize meningitis and diagnose the disease in the Optimum medical laboratory in Sochi (Adler)

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Symptoms, diagnosis and prevention of meningitis

Meningitis is an inflammation of the membranes of the brain or spinal cord, which can be triggered by infections of viral and bacterial etiology. Pathology is accompanied by a severe headache, a typical body position in bed, hemorrhagic rashes on the skin and stiffness of the muscles of the occipital zone. Children and adolescents, as well as elderly people with weakened immune systems, are especially susceptible to this disease.

Causes of meningitis

The main cause of meningitis are infections of viral and bacterial etiology. The causative agent of the inflammatory process can be:

• pneumococci;
• Haemophilus influenzae;
• Escherichia coli;
• streptococci;
• amoeba.

In childhood, the main cause of the development of pathology is enteroviruses that enter the body by airborne droplets. Infection can occur during childbirth, through contaminated food, dirty water, and insect bites. The main causes of non-infectious meningitis are trauma and damage to the skull, as well as tumor processes occurring in the brain.

Mechanism of development

For the development of pathology, the pathogen must penetrate the cranial cavity and provoke an inflammatory process in the brain. In some cases, this is observed when foci of infection occur in tissues located near the meninges. Pathologies such as purulent otitis media or sinusitis can provoke meningitis.

In some cases, craniocerebral trauma becomes a provoking factor in the development of pathology, but the infection mainly penetrates into the cranial cavity along with the blood flow. The very process of entering the pathogen into the blood and its further spread to the meninges is associated with a poor state of immunity.

Symptoms

Meningitis causes the following clinical picture:

• rise in body temperature;
• photophobia;
• muscle tension in the occipital region;
• confusion;
• convulsive syndrome;
• strabismus;
• muscle pain syndrome;
• mental disorders;
• tachycardia;
• rashes on the skin.

If these symptoms develop, seek medical attention as soon as possible because meningitis has a high mortality rate.

Diagnostic methods

The main method for diagnosing meningitis is lumbar puncture with further examination of cerebrospinal fluid. This diagnostic method is used in all cases when there is a suspicion of a disease.

In addition, the doctor analyzes the patient’s complaints and collects an anamnesis, as well as conducts a neurological examination. With the help of a blood test, it is possible to diagnose signs of inflammation, and PCR of blood and cerebrospinal fluid helps to identify the pathogen.

Computed and magnetic resonance imaging allows to assess the structure of the brain and diagnose indirect manifestations of the pathological process in the meninges of the brain.

Prevention

Some forms of meningitis can be prevented by vaccination, which is effective for several years. As a preventive measure, it is recommended to treat chronic and acute pathologies of an infectious nature in a timely manner and take courses of immunostimulating drugs in the foci of meningococcal disease. In addition, you should harden the body, avoid visiting places with large crowds of people and severe hypothermia. In the autumn-winter period, you need to drink multivitamin complexes or vitamin C.

Tests for meningococcal infection

The causative agent of meningococcal infection is Neisseria meningitidis (meningococcus). Meningococcus colonizes the posterior wall of the human nasopharynx and, depending on the virulence of the strain and the resistance of the infected person, causes an infectious process with a wide range of clinical manifestations: asymptomatic carriage, nasopharyngitis and a generalized form – meningococcemia and / or meningitis. Meningococcal infection affects people of all ages, but more often (70%) children get sick. The lethality rate averages 10%, which determines the high social significance of the disease. Capsular strains of meningococcus, depending on the chemical structure of the capsular polysaccharide, are divided into a number of serological groups: A, B, C, X, Y, Z, W-135, 29-E, H, I, K, L. More than 90% of cases of generalized forms of meningococcal infection are caused by strains of serogroups A, B and C, much less often by strains of serogroups X, Y and W-135, the remaining serogroups are not of epidemiological interest. The determination of the serogroup is the most important procedure for the selection of an adequate vaccine product. All meningococci express on their surface one of the allelic variants of class 2 or 3 outer membrane proteins (PorB). Most meningococci express class 1 proteins (PorA). The antigenic structure of the PorB protein determines the serotype of the strain, while the PorA protein determines the serosubtype. Based on the chemical structure of the capsular lipopolysaccharide, the immunotype is determined. The antigenic characteristic may include some other AGs: Ora and Ors (class 5 outer membrane proteins), pili, FetA surface protein.

Indications for examination

• Diagnostic studies are carried out in a hospital with suspected purulent meningitis and / or a generalized form of meningococcal infection;
• studies according to epidemic indications are carried out in the focus of a generalized form of meningococcal infection among those who have been in contact with the patient and have clinical manifestations of nasopharyngitis.

Study material

• Blood – microscopic examination, culture;
• CSF – microscopic examination, culture, DNA detection, AH detection;
• swabs from the oropharynx and nose – culture;
• blood serum – detection of hypertension, determination of specific antibodies

Differential diagnosis

• Causative agents of purulent meningitis of other etiologies: Streptococcus pneumonia, Haemophilus influenza, Staphylococcus aureus, etc.;
• in the study of the nasopharynx – pigmenting Neisseria subflava, Neisseria flavescens, Neisseria mucosa, Neisseria sicca, Neisseria lactamica.

Laboratory diagnosis of a generalized form of meningococcal infection includes microscopy of biological material, inoculation of biological material with further cultural and biochemical identification of the pathogen, determination of antibiotic sensitivity; detection of specific genetic fragments of meningococcus and its AG, detection of specific antibodies.

Comparative characteristics of laboratory research methods and features of interpretation of their results. Microscopy of native cerebrospinal fluid or a “thick drop” blood product (stained with an aqueous-alcoholic solution of methylene blue) on a blue background reveals morphologically clear cocci, diplococci, stained in dark blue, resembling coffee beans or bean seeds, adjacent to each other with concave sides , sometimes the capsule comes to light. Microbial cells can be located both outside and inside leukocytes. The intensity of CSF contamination by microbial cells varies considerably and depends on the stage of development of the infectious process at the time of sampling. If antibiotic treatment has been carried out, the typical microbial cell morphology is lost. The study is recommended to be carried out in the active phase of the disease (the first two days after admission to the hospital).

Inoculation of CSF and blood on nutrient media with further incubation for 24 hours at 37°C in an atmosphere with 5–10% CO2 and high humidity makes it possible to identify the characteristic tinctorial properties of the pathogen. The study is recommended to be carried out in the active phase of the disease (the first two days after admission to the hospital) before the start of intensive antibiotic therapy.

When determining the saccharolytic activity, the results of sowing a pure culture on dense nutrient media with carbohydrates are taken into account. The method makes it possible to differentiate different types of Neisseria and some other types of microorganisms (Table 16). Sometimes there is variability in saccharolytic activity in different strains of the same species.

Clarification of the biochemical properties of meningococci is carried out using reagent kits for an extended study of their enzymatic and metabolic activity, which within 2 hours allows you to determine the species of the pathogen.

The determination of the serogroup of meningococci is carried out in the agglutination reaction on glass with a set of agglutinating serogroup antisera (serogroups A, B, C, X, Y, Z, W-135,29E). The reaction is carried out only with a pure culture of meningococci that has passed all stages of identification. Meningococci of serogroups A, B and C are most often the cause of generalized forms of meningococcal infection, the agglutination reaction is carried out primarily with antisera to meningococci of these serogroups. The absence of a reaction with one of the main serogroup antibodies indicates the need to continue similar studies with other specific antisera (X, Y, Z, W-135, 29e). Only if a strain of meningococcus confirmed by all tests did not show a positive result in the agglutination test with a full set of agglutinating antisera, it should be classified as a non-agglutinating strain (NA).

Latex agglutination reaction is used to detect AG in CSF and/or blood serum. The study of native cerebrospinal fluid (express method) is carried out if it contains signs of purulent inflammation and / or microscopic detection of pathogens. The use of the reaction allows in the shortest possible time (15-20 minutes) to identify specific AG of meningococci of the most common serogroups (A, B, C, Y, W-135). It is recommended to conduct a study in the active phase of the disease (the first two days after admission to the hospital).

CSF and/or a fresh pure culture of Neisseria meningitidis grown on Petri dishes is used to detect pathogen DNA. Detection of specific genetic fragments of the microorganism is performed using PCR. The method has high diagnostic sensitivity and specificity, allows to detect microorganisms contained in single quantities or in a non-viable state in a clinical sample, is characterized by high reproducibility and short deadlines for performing the study (within several hours).

Indications for conducting studies to detect DNA in the diagnosis of bacterial meningitis are:

• negative results of diagnosis by other methods, especially in the case of examination of CSF samples after massive antibiotic therapy or in the late stages of the disease;
• the need for an urgent response about the etiology of the pathogen;
• Examination of material samples delivered frozen or fixed in ethanol.

Detection of specific antibodies in the blood serum in the diagnosis of meningococcal infection is carried out using RNHA. It is recommended to conduct the study twice: in the active phase of the disease (the first two days after admission to the hospital) and on the 12-14th day of the disease. The diagnosis is considered confirmed when the increase in titers of antibodies by four or more times within the specified period.

The use of RNHA for research in “paired sera” reveals the dynamics of the increase in titers of specific antibodies to meningococcus in the blood and allows you to determine whether the pathogen belongs to the most common serogroups of meningococci (A and C). The detection of AT makes it possible to conduct a retrospective laboratory diagnosis of generalized forms of meningococcal infection, since the final answer is obtained only 12-14 days after the onset of the disease. The primary research opportunities are laboratory confirmation of meningococcemia, in which the use of other methods of laboratory diagnostics, as a rule, is not very effective.