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Meningitis is a life-threatening disorder that is most often caused by bacteria or viruses.
Before the era of antibiotics, the condition was universally fatal. Nevertheless, even with great innovations in healthcare, the condition still carries a mortality rate of close to 25%.
Symptoms of bacterial meningitisTrusted Source appear suddenly and progress rapidly, often within 24 hours. The infection does not get better on its own. People with bacterial meningitis need urgent evaluation and treatment right away.
Most common bacterial causes of meningitis in the United States are:
Streptococcus pneumoniae (incidence in 2010: 0.3/100,000)
Group B Streptococcus Neisseria meningitis (incidence in 2010: 0.123/100,000)
Haemophilus influenza (incidence in 2010: 0.058/100,000)
Listeria monocytogenes
Consider less common bacteria such as Staphylococcus aureus in patients with recent surgery, central lines, and trauma.
Mycobacterium tuberculosis should be considered in immunocompromised hosts.
Borrelia burgdorferi in patients with travel to Lyme endemic areas.
Treponema pallidum in HIV/AIDS and individuals with multiple sexual partners.
Escherichia coli is an important pathogen in the neonatal period.
The most common viral agents of meningitis are non-polio enteroviruses (group b coxsackievirus and echovirus). Other viral causes: mumps, Parechovirus, Herpesviruses (including Epstein Barr virus, Herpes simplex virus, and Varicella-zoster virus), measles, influenza, and arboviruses (West Nile, La Crosse, Powassan, Jamestown Canyon)
Fungal meningitis typically is associated with an immunocompromised host (HIV/AIDS, chronic corticosteroid therapy, and patients with cancer). Fungi causing meningitis include: Cryptococcus neoformans Coccidioides immitis Aspergillus Candida Mucormycosis (more common in patients with diabetes mellitus and transplant recipients; direct extension of sinus infection)
Assessment, Evaluation and Medical Management
Assessment
Meningitis can have a varied clinical presentation depending on the age and immune status of the host. Symptoms typically include fever, neck pain/stiffness, and photophobia. More non-specific symptoms include headache, dizziness, confusion, delirium, irritability, and nausea/vomiting. Signs of increased intracranial pressure (altered mental status, neurologic deficits, and seizures) portend a poor prognosis. If you have bacterial meningitis, your symptoms could get worse rapidly.
In adults, the physical exam is centered on identifying focal neurologic deficits, meningeal irritation (Brudzinski and Kernig signs), and particularly in meningococcal meningitis, characteristic skin lesions (petechiae and purpura). Cranial nerve abnormalities are seen in 10%-20% of patients. Signs and symptoms are less evident in neonates and infants. They can present with and without fever or hypothermia, decreased oral intake, altered mental status, irritability, bulging fontanelle. It is important to obtain a full perinatal history and vaccine records. Some causes of meningitis are vaccine-preventable such as Pneumococcus, Haemophilus influenza type B, Meningococcus, Measles, and Varicella-virus.
In India, acute encephalitis syndromes (AES) related to the seasonal outbreak of tropical diseases occur regularly, causing substantial mortality especially in the pediatric age group. In over 50% of the patients with AES, the source or causal agent goes unrecognized. The treatment is largely supportive. The commonest etiological agent with a high endemic burden in India is the mosquito-borne flavivirus – Japanese encephalitis. The detection of IgM antibodies to the Japanese Encephalitis virus in the CSF or serum may confirm the diagnosis. MRI brain typically shows thalamic hyperintensities on T2 weighted imaging. The basal ganglia, brainstem and cerebellum may also show focal abnormalities. This disease has a high case fatality of ~25–30%, and a permanent neurological sequalae rate of ~50%. The incidence of Japanese encephalitis has however decreased in the recent years due to successful vaccination programmes in the 181 endemic districts of India, including eastern UP, Bihar, and West Bengal.19 More recently, many other viruses like the enterovirus, Chandipura virus, Nipah virus, Zika virus, dengue virus, Chikungunya virus etc., have emerged and have been implicated in the outbreaks of AES in the Indian subcontinent.
Evaluation
Meningitis is diagnosed through cerebrospinal fluid (CSF) analysis, which includes white blood cell count, glucose, protein, culture, and in some cases, polymerase chain reaction (PCR). CSF is obtained via a lumbar puncture (LP), and the opening pressure can be measured.
Additional testing should be performed tailored on suspected etiology:
Viral: Multiplex and specific PCRs
Fungal: CSF fungal culture, India ink stain for Cryptococcus
Mycobacterial: CSF Acid-fast bacilli smear and culture
Syphilis: CSF VDRL
Lyme disease: CSF burgdorferi antibody
The CSF findings expected in bacterial, viral, and fungal meningitis are listed in the chart: Expected CSF findings in bacterial versus viral versus fungal meningitis. Ideally, the CSF sample should be obtained before initiating antimicrobials. However, when the diagnosis of bacterial meningitis is seriously considered, and the patient is severely ill, antibiotics should be initiated before performing the LP.
Medical Management
Patients with bacterial meningitis are usually treated by primary care and emergency medicine physicians at the time of initial presentation, often in consultation with infectious diseases specialists, neurologists, and neurosurgeons.
Bacterial meningitis needs treatment with antibiotics right away. The doctor might give you a general or broad-spectrum antibiotic even before they’ve found the exact bacteria that caused your illness. Once they do, they’ll change to a drug that targets the specific bacteria they find with the spinal tap. You might also get corticosteroids to ease inflammation. In patients suspected with bacterial meningitis, broad spectrum parenteral antibiotics with a good CSF penetration and a bactericidal action, need to be started immediately without any delay for imaging or lumbar puncture (Table 1). Delaying appropriate antibiotic treatment by even a few hours has been associated with worse outcomes in patients with bacterial meningitis. A third generation cephalosporin, like ceftriaxone (2g iv q12h) and vancomycin (1g iv q12h) are reasonable choices to begin with. Ampicillin 2g iv q4h may be added in elderly and immunosuppressed patients to cover Listeria. In nosocomial infections, antipseudomonal cephalosporins (ceftazidime or cefipime) or carbapenems (meropenem) should be considered in order to cover resistant gram negative bacteria, along with Vancomycin. A quick shot of intravenous (iv) dexamethasone 10 mg precedes the initiation of antibiotics. If herpes encephalitis is one of the differentials of the patient, antiviral therapy with iv acyclovir 10 mg/kg may be added. In immunocompromised patients with suspected fungal meningitis, liposomal amphotericin-B 3-5 mg/kg iv daily is initiated.
Intensive care support with maintenance of perfusion, hydration and oxygenation is the common goal of therapy. Control of intracranial hypertension and management of seizures should be done to improve survival. The long-term morbidity remains very high.
Adults older than 50 years old and the immunocompromised Ceftriaxone IV and Vancomycin IV and Ampicillin IV.
The stepwise management of meningitis is as follows – first step, corticosteroids; second step, empiric antibiotics; third step, imaging; fourth step, lumbar puncture; and fifth step, management of complications.
Antibiotics
Ceftriaxone
Third-generation cephalosporin
Gram-negative coverage
Very effective against Streptococcus pneumoniae and Neisseria meningitis
Better CNS penetration than piperacillin-tazobactam (typically used in gram-negative sepsis coverage)
Vancomycin
Gram-positive coverage (MRSA)
Also used for resistant pneumococcus
Ampicillin
Listeria coverage (gram-positive bacilli)
Cefepime
Fourth-generation cephalosporin
Increased activity against pseudomonas
Cefotaxime
Third-generation cephalosporin
Equivalent to ceftriaxone
Safe for neonates
In bacterial meningitis high doses of antibiotics should be administered intravenously during the entire course of treatment because the blood-cerebrospinal fluid barrier improves after a few days of treatment, and therefore the penetration into CNS is gradually decreasing. Several older studies of ampicillin, chloramphenicol, and cefuroxime have shown good effect but are of little value today because the susceptibility pattern has changed over time and several case reports of treatment failures with these antibiotics have been presented [47]. During recent year third-generation cephalosporins has been the mainstay in treatment of community-acquired acute bacterial meningitis [7, 28–30]. Relevant randomized clinical trials (RCTs) are presented in Table 2.2 [48–58]. Two studies have shown delayed sterilization of cerebrospinal fluid with cefuroxime compared with ceftriaxone [48, 52]. Results from experimental studies in rabbit correspond well with treatment results in humans. An increasing clinical experience of, especially, cefotaxime and ceftriaxone alone or in combination with ampicillin has indicated that these antibiotics are safe and have good effect in acute bacterial meningitis.
Linezolid is also effective against resistant gram-positives including cephalosporin resistant pneumococci [60]. Since the bioavailability and penetration into CNS is good, linezolid is an alternative to vancomycin, but the antibacterial action is bacteriostatic rather than bactericidal, and the clinical efficacy is not as well documented as for vancomycin.
However, the clinical experience of quinolones is limited, and they should be considered second-line choice, such as in cases with allergy to penicillin and/or cephalosporins. The quinolones are often active against cephalosporin resistant pneumococci, but the antibacterial activity is not as effective as for vancomycin or linezolid.
In aggregate, cefotaxime or ceftriaxone ± ampicillin must be regarded first-line empiric treatment for community-acquired acute bacterial meningitis (Table 2.1). Ampicillin should be added if Listeria monocytogenes can be suspected as in the newborns, in the elderly (>50 years of age), and in immunocompromised state. In cases with cephalosporin/meropenem allergy, a combination of moxifloxacin and vancomycin/linezolid is recommended with addition of trimethoprim-sulfamethoxazole if listeriosis is suspected.
The first step is to start empiric antibiotics as stated above which should be done within 1 h from admission.
The second step is to adjust initial treatment according to 2 Community-Acquired Acute Bacterial Meningitis 16 early microbiological tests on cerebrospinal fluid such as microscopy, antigen detection, or polymerase chain reaction (PCR) results. If Streptococcus pneumoniae or Haemophilus influenzae is detected, monotherapy with cefotaxime or ceftriaxone is continued unless the S. pneumonia-cephalosporin resistance rate exceeds 1% in the country. If meningococci are detected, the regimen can be changed to monotherapy with penicillin G (benzylpenicillin).
The third step is to determine the final antibiotic regimen after culture and susceptibility testing of cerebrospinal fluid and/or blood. The minimum inhibitory concentration (MIC) should be analyzed routinely by a disk diffusion method for penicillin G, ampicillin, cephalosporins, and meropenem. If penicillinresistant pneumococci are noticed, further MIC-testing for vancomycin, moxifloxacin, rifampicin, and linezolid should also be analyzed.
The following recommendations should be applied in resource-rich settings. In resource-poor settings, the treatment should be modified according to available resources. Patients with acute bacterial meningitis and impaired mental status should be centralized to hospitals where neuro-intensive care is available. In comatose patients with markedly raised spinal opening pressure (>400 mmH2O), intracranial pressure-targeted treatment should be applied as soon as possible after admission. The diagnosis should be set rapidly by lumbar puncture. After a CT scan of the brain an external ventricular catheter should be applied in order to measure the intracranial pressure. Drainage of cerebrospinal fluid through this catheter should be the main intracranial pressure decreasing therapy. If an external ventricular drainage catheter cannot be applied due to technical problems or moderate coagulopathy, an intraparenchymatous pressure device should be considered for intracranial pressure control. The main goals should be intracranial pressure <20 mmHg and cerebral perfusion pressure >60 mmHg. A microdialysis catheter may be placed superficially in the brain parenchyma in order to measure the cerebral metabolism by analyzing the levels of glucose, lactate, pyruvate, and glycerol in cerebral interstitial tissue. If cerebral hyperemia is detected by transcranial Doppler and/or jugular bulb, monitoring hyperventilation aiming at pCO2 4.0–4.5 kPa should be applied. The body temperature should be normal, and pyrexia should be treated aggressively with paracetamol and, if necessary, by external cooling of the patient.
Steroid Therapy
There is insufficient evidence to support the widespread use of steroids in bacterial meningitis. Some studies report a reduction in mortality for Streptococcus pneumoniae meningitis, but not in Haemophilus influenza or Neisseria meningitides meningitis. In children, steroids were associated with a reduction of severe hearing impairment only in cases of Haemophilus influenza meningitis.
Increased Intracranial Pressure
If the patient develops clinical signs of increased intracranial pressure (altered mental status, neurologic deficits, non-reactive pupils, bradycardia), interventions to maintain cerebral perfusion include:
Elevating the head of the bed to 30 degrees
Inducing mild hyperventilation in the intubated patient
Osmotic diuretics such as 25% mannitol or 3% saline
Chemoprophylaxis
Chemoprophylaxis is indicated for close contacts of a patient diagnosed with N. meningitides and H. influenzae type B meningitis.
Close contacts include housemates, significant others, those who have shared utensils, and health care providers in proximity to secretions (providing mouth-to-mouth resuscitation, intubating without a facemask).
Antibiotic chemoprophylaxis for N. meningitidis includes rifampin, ciprofloxacin, or ceftriaxone, and for H. influenzae type B: rifampin.
Diagnostic Workup
CSF analysis is the key to diagnose and manage a case of meningoencephalitis. CSF analysis (via lumbar puncture (LP) / VP shunt tap) should be performed as early as feasible in all patients to guide treatment. However, two major issues that may delay a lumbar puncture include – a concern for uncal or tonsillar herniation, and the need to initiate empiric antibiotics urgently. Firstly, empiric antibiotics have to be started immediately in a patient with a clinical suspicion of infection, as CSF sterilization even with the most sensitive organisms takes atleast 4-6 hours. So, the results of CSF culture are not flawed even if the patient has been administered antibiotics in the last few hours. Secondly, a non-contrast computed tomography (NCCT) head should be done in all patients with a risk of brain herniation, such as patients with intracranial tumours, so as to rule out a raised ICP.
Role of CNS imaging: A CT head may help to identify patients with lesions that place them at risk of herniation following LP, and to diagnose conditions which make LP unnecessary or that would be missed if the patient's workup was limited to CSF analysis, such as a brain tumor. It has however, been debated that there is no role of performing a routine CT head in all patients suspected with meningoencephalitis, as it unnecessarily delays early antibiotic administration and CSF analysis, both of which play a very important role in improving patient outcomes.
The Infectious Diseases Society of America (IDSA) guidelines delineate criteria for the use of CT head before LP in adults with community-acquired meningitis.8 These include:
Immunocompromised states, such as HIV, patients receiving immunosuppressive therapy, or post-transplant – to rule out toxoplasma encephalitis or lymphoma
History of CNS disease (e.g., mass lesion, stroke, or focal infection)
New onset seizure (within 1 week of presentation)
Abnormal neurological findings such as papilledema, abnormal level of consciousness, and focal neurological deficits
MRI brain, though not routinely performed, is the most sensitive imaging modality in patients with meningoencephalitis. It detects the presence and extent of inflammatory changes in the meninges (in the form of leptomeningeal enhancement), along with the identification of complications such as hydrocephalus, cerebral edema or stroke. Distension of the subarachnoid space with widening of the interhemispheric fissure is an early finding seen in meningitis. In HSV encephalitis, hyperintensities and diffusion restriction in the cortical and subcortical regions of bilateral fronto-temporal lobes and insula are characteristically seen. In TBM, thick basal exudates, hydrocephalus, infarcts and ring enhancing lesions or tuberculomas are typically present on MRI brain.
EEG is strongly recommended in any suspected case of acute encephalitis.
The definitive treatment of meningoencephalitis depends upon the identification and antimicrobial sensitivity of the causative organism; taking care of the mass effect that the CNS infection may cause by means of antiedema measures; and modulation of the host immune response through steroids to minimize excessive inflammation while treating the infection.
Nursing Management, When to seek help, Risk Management and Follow Up
Monitoring and recording vital signs.
Assess the Glasgow Coma Scale and pay special attention to the motor response, immediately inform the on-duty doctor if it falls.
Assess the patient's mental status and provide psychological support if the patient is conscious.
Elevate the head of the bed to 30 degrees with a straight neck for venous drainage from the brain.
Ensure the patient has an IV line for fluids and medications.
Administer antibiotics as prescribed.
Offer oxygenation if the saturation level is low.
Administer mannitol, as prescribed, if the intracranial pressure is high.
Administer phenytoin, as prescribed, if the patient is having seizures.
Apply side rails as a patient safety measure as the patient may fall down while having seizures.
Check pupils size and responsiveness to light (think elevated intracranial pressure)
Assess hearing power in both ears.
Check labs (meningitis may cause SIADH)
Check renal and liver function tests.
Check cerebrospinal fluid lab results.
Change position every 2-hourly to prevent bedsore if the patient is bedridden and apply air mattress and thromboembolic deterrent stockings as needed)
Provide limb physio and chest physio to prevent the complications associated with immobility.
Never forget to measure random blood sugar before lumbar puncture while sending CSF for a glucose test.
A proper diet chart to provide adequate calories required for the body.
Put a nasogastric tube and start feeding for the unconscious patients, as instructed
Monitor intake and output.
Provide comfort measures.
When To Seek Help
If unresponsive
High-grade fever
New mental status changes
Hypotension
Hypoxia
Bradycardia
Seizures
Severe headache
Signs to watch for also include: Confusion, Fever, Headache, Numbness in your face Sensitivity to light, Stiff neck so that you can’t lower your chin to your chest, Upset stomach or vomiting, Sleepiness or a hard time waking up, Lack of appetite or thirst.
A "petechial" rash, which looks like small, red pinpricks on your skin. You may find them in spots where clothes put pressure on the skin – the waistband, for instance. A "purpuric" rash looks like splotches of red or purple, more like bruising. A petechial rash can progress to this stage. If you roll a clear drinking glass over the rash, it might disappear. If it does, it's a "blanching" rash. If it doesn't go away, it's a "non-blanching" rash. A meningitis rash may start as blanching but almost always will progress to non-blanching.
Outcome Identification
For patients treated promptly, the prognosis is good. However, patients who present with an altered state of consciousness have high morbidity and mortality. Some patients may develop seizures during the illness, which are very difficult to control or are prolonged. Any patient with a residual neurological deficit after meningitis treatment is also left with a disability. Patients art the greatest risk for death usually have the following features:
Advanced aged
Low Glasgow coma scale
CSF WBC count which is low
Tachycardia
Gram-positive cocci in the CSF
Serious complications in survivors include:
Ataxia
Hearing loss
Cranial nerve palsies
Cognitive dysfunction
Cortical blindness
Hydrocephalus
Seizures
Focal paralysis
The mortality is highest for children less than 12 months of age and decreases in middle age. However, the mortality rates increase with advancing age. Overall, 10% of patients will die from bacterial meningitis. The mortality is highest when the infection is caused by streptococcus and listeria. Patients with meningococcal meningitis do respond well to treatment, but if the presentation is late with meningococcemia, the mortality rates are nearly 30%.
Risk Management
Meningitis is a serious disorder with very high morbidity and mortality. The majority of patients with meningitis first present to the emergency department and a streamlined interprofessional approach is vital if one wants to lower the high morbidity. The triage nurse must be fully aware of the signs and symptoms of the illness and refer the patient immediately to the physician. Other specialists who are usually involved in the care of these patients are neurologists, pediatricians, intensivists, infectious disease specialists, and pharmacists. If bacterial meningitis is suspected, prompt antibiotics should be started even in the absence of laboratory results. To prevent this infection, the education of the public is vital. Complications of Meningitis Meningitis can cause severe complications in adults and children, especially if you delay treatment. Possible complications include: Seizures, Brain damage or stroke, Loss of hearing, Memory problems, Learning problems, a hard time walking, or paralysis, Kidney failure, Shock, or Death.
Potential Complications of Meningitis Meningitis is a serious condition that can lead to various complications, some of which can be life-threatening. These complications may include:
Septicemia - Meningitis can cause bacteria or viruses to enter the bloodstream, leading to septicemia or blood poisoning. This condition can result in organ failure, shock, and even death.
Hydrocephalus - In some cases, meningitis can disrupt the normal flow of cerebrospinal fluid (CSF) around the brain, leading to a condition called hydrocephalus. Hydrocephalus occurs when there is an accumulation of CSF, causing increased pressure on the brain.
Hearing loss - Meningitis, particularly bacterial meningitis, can cause damage to the cochlea, a part of the inner ear responsible for hearing. This can result in partial or complete hearing loss.
Neurological complications - Meningitis can cause inflammation of the brain (encephalitis) or the membranes surrounding the brain and spinal cord (meningoencephalitis), leading to various neurological complications. These may include seizures, cognitive impairments, motor deficits, and behavioral changes.
Even with proper treatment, meningitis can damage the brain and cause long-term complications. The most common complication is hearing loss, which occurs in approximately 5 to 10 percent of patients following bacterial meningitis. Hearing testing is usually performed around the time of discharge from the hospital. Other complications are less common and may include developmental delay or learning disabilities, spastic or paralyzed muscles, and seizures.
Discharge Planning
After hospitalization, the patient at home should:
Activities. Alternate rest and activity to conserve energy.
Asepsis. Promote simple home infection control procedures.
Infectious process. Identify signs and symptoms of an infectious process and report promptly to the provider.
Diet. Consume safe and healthy foods. Avoid drinking alcohol and smoking.
Should not climb high altitudes.
Be in the vicinity of family members
Report immediately to any near ones if any discomfort in the health status.
Never skip any medications unless advised to do so.
Don’t share items such as toothbrushes, eating utensils, or lipstick
Don’t share food items or drinks with other people.
Limit close contact with people who are sick
Wash your hands often. Rinse well. Also, teach your kids to wash their hands often, especially after eating, using the toilet, or when they’re in public places.
Cover your mouth and nose when you cough or sneeze.
Eat a healthy diet, get plenty of exercise, and rest at night.
Avoid foods made from unpasteurized milk and raw or undercooked meats, fish, and eggs.
Get immunized. Follow your doctor’s advice on getting immunization shots for diseases that may cause meningitis, including flu and pneumonia vaccines. Some vaccines can help protect you from meningococcal illness, which is caused by bacteria. MenACWY vaccine, which the CDC recommends for all teens and preteens. One dose is given at the age of 11 or 12, followed by a booster at age 16. It's also recommended for adults at high risk. MenB vaccine is recommended for children 10 and older who are at increased risk MenABCWY vaccine is a combination of MenACWY and MenB. If you're planning to get the other two at the same time, you can get this vaccine instead. The pneumococcal and Hib vaccines protect against bacteria that can cause bacterial meningitis. The Bacille Calmette-Guerin vaccine protects you against tuberculosis, which can cause meningitis.
Pearls and Other issues
Differentiating between bacterial, viral, and fungal meningitis may be difficult. CSF analysis may not be conclusive, and cultures do not immediately yield an answer. Given the morbidity and mortality, it is prudent to initiate empiric antibiotic therapy and admit all those with suspected meningitis to the hospital on droplet precautions.
Diet
Spicy food would interfere with your digestive system and should be avoided at all costs to avoid a catastrophe.
A nutritional diet that includes more antioxidants, omega 3 fatty acids, and probiotics can help with nutritional absorption for people with meningitis. Citrus fruits can also help boost the immune system. During meningitis, the immune system is under immense pressure to fight off the infection. Vitamin C acts as a powerful antioxidant, protecting immune cells from damage and aiding in their proper functioning. Consuming adequate amounts of vitamin C-rich foods can help bolster the immune response and promote a faster recovery. Foods that are high in Vitamin C such as citrus fruits, red capsicum, green leafy vegetables, broccoli, kiwi support the immune system and are powerful antioxidants. It's also important to drink plenty of fluids to avoid dehydration, which can worsen the effects of meningitis. Encourage to maintain the personal hygiene of the patient.
Maintaining a healthy gut is essential for overall wellbeing, and it can play a significant role in supporting recovery from meningitis. Let's look at the importance of gut health during meningitis recovery, discuss the potential benefits of probiotics and provide information on food sources and supplements that promote a healthy gut microbiome. Probiotics are beneficial bacteria that promote a healthy gut microbiome. They can help strengthen the immune system, reduce inflammation and support digestion. Taking probiotics during meningitis recovery may help restore the balance of good bacteria in the gut and enhance the body's natural defense mechanisms. Incorporating probiotic-rich foods into the diet is an effective way to support gut health. Fermented foods such as yogurt, kefir, sauerkraut and kimchi are excellent sources of probiotics. Including these foods in the diet regularly can help replenish beneficial bacteria in the gut and promote a healthy gut microbiome. In addition to food sources, probiotic supplements can be considered to support gut health during meningitis recovery. When choosing a probiotic supplement, it is essential to select a reputable brand that contains a variety of strains and has been tested for potency and quality. Consult with a healthcare professional to determine the appropriate dosage and duration of supplementation.
Adequate intake of essential micronutrients plays a vital role in supporting the immune system's function, which is crucial during meningitis. Scientific studies have shown that deficiencies in certain micronutrients, such as vitamin A, vitamin C, vitamin D, zinc and selenium, can impair immune responses and increase susceptibility to infections. Supplementing with these micronutrients, either through diet or supplements, may help enhance immune function and support the body's ability to combat meningitis.
Meningitis can lead to increased oxidative stress and inflammation in the body. Antioxidants, such as vitamins C and E, beta-carotene and polyphenols, possess anti-inflammatory properties and can help reduce inflammation caused by meningitis. Several studies have indicated that a diet rich in antioxidant-rich foods, such as fruits, vegetables, nuts and seeds, can attenuate inflammation and potentially improve outcomes in individuals with meningitis.
Omega-3 fatty acids, particularly docosahexaenoic acid (DHA), are essential for optimal brain function and development. Scientific research suggests that omega-3 fatty acids play a protective role in the central nervous system and may have potential benefits in managing neurological complications associated with meningitis. Omega-3 fatty acids can be found in fatty fish like salmon and mackerel, as well as plant-based sources like flaxseeds and chia seeds.
Follow-Up
All patients with community-acquired acute bacterial meningitis should be followed up for at least 2–6 months to assess hearing, neurologic, and neurocognitive deficits and to administer vaccination against Streptococcus pneumoniae. At discharge the patients should be informed about risks for sequelae and that the convalescence period can be long but that the long-term prognosis is relatively good. At least 2–4 weeks of sick leave, or corresponding rest, should be recommended routinely. A cochlear implant should be considered within 2–3 weeks if severe hearing deficit or deafness is noticed during the hospital stay. Audiometry should be performed if any clinical signs on impaired hearing ability are noticed. At the follow-up visit, a possible immune deficiency should be considered and appropriate investigations performed accordingly. A neuropsychiatric rehabilitation may be indicated in cases with persistent fatigue, concentration disability, or other neurologic deficits.
Most people survive most forms of meningitis. How well you do depends on the type you have and how quickly you receive treatment. If you have bacterial or fungal meningitis, you may need more time to recover, weeks or even months. You also might have lingering effects. If you have viral meningitis, your main symptoms may go away within a week. Even with treatment, bacterial meningitis is a life threatening illness. Hospital stays of 1–2 weeks are common. Most people with bacterial meningitis eventually recover and return to regular activities, but long-term complications can occur. You may want to work with your primary care physician after you leave hospital to screen for and treat long-term complications.
Meningitis isn't contagious. But some of the things that cause it are. Many things that cause bacterial and viral meningitis can be spread to other people.
With regard to acute CKD - The nephro has suggested a DMSA scan (dimercaptosuccinic acid scan), a diagnostic imaging test that uses a small amount of radioactive material to evaluate the structure and function of the kidneys. The scan will be used to detect scarring caused by infections and abnormal areas of development. If the scan is clear the nepro will proceed with renal biopsy used to evaluate an unexplained decrease in kidney function.
Support and care for people affected by meningitis
Achieved by ensuring that effective health systems and communities are capable of timely identification and management of sequelae of meningitis, and that people, families and carers affected by meningitis can access appropriate support and care services that meet their needs.
One in five people surviving an episode of bacterial meningitis may have enduring after-effects. Common sequelae include seizures, hearing and vision loss, cognitive impairment, neuromotor disability and memory and behavioural changes, as well as scarring and limb amputations after meningococcal sepsis. Many people will also experience a range of less serious after-effects that are not always immediately apparent, for example, emotional difficulties. Aftercare is expensive and may not be affordable for families. Policies and services for assessment of sequelae, treatment, rehabilitation and follow-up, including those in communities, are often absent or insufficient, and access to them is uneven, especially in low and middle-income countries.
Appropriate training on timely identification and management of disability and bereavement for health care professionals and community workers is limited, with inadequate numbers of trained staff at all levels of care from community to hospital. Given the global distribution of meningitis, it is essential to build and strengthen health systems to ensure that they can provide the necessary care and programmatic support for everyone who needs it. The capacity of educational institutions needs to be strengthened and linkages with health care services need to be established to train health workers as well as community members in the early recognition of developmental, psychosocial and cognitive after-effects of meningitis.
This pillar applies to meningitis from any cause. The aims are to:
(i) strengthen early recognition and management of sequelae from meningitis in health care and community settings;
(ii) increase the availability of and access to appropriate care and support for people affected by meningitis, their families and carers
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