Introduction
Meningitis is the inflammation of the meninges, caused by a variety of infectious and non-infectious agents. Prompt diagnosis and treatment are essential to prevent serious complications or death. A systematic clinical approach helps in early recognition and management.
1. Clinical Presentation
Key Symptoms:
- Fever
- Headache
- Neck stiffness
- Photophobia
- Altered mental status
Classic Triad: Fever, neck stiffness, and altered consciousness
Other Features:
- Vomiting
- Seizures
- Focal neurological signs
- Skin rash (especially in meningococcal infections)
- Bulging fontanelle or poor feeding in infants
2. History Taking
Focus on:
- Onset and duration
- Recent infections or travel
- Immunization history
- Immunosuppression or chronic illness
- Recent neurosurgery or trauma
- Exposure to sick contacts or crowded settings
3. Physical Examination
- General: Fever, malaise, rash
- Neurological: Confusion, cranial nerve palsies, positive Kernig’s/Brudzinski’s sign
- Fundoscopy: Signs of raised ICP
- Look for signs of shock or sepsis
4. Investigations
Blood Work:
- CBC, CRP, ESR, renal and liver functions
- Blood cultures (before antibiotics)
Neuroimaging (CT/MRI):
- If focal signs, seizures, or altered sensorium present
Lumbar Puncture (if no contraindication):
- CSF Analysis: Opening pressure, cell count, protein, glucose, Gram stain, culture, PCR
CSF Findings Summary:
5. Empirical Management
Begin immediately after blood cultures, do not delay for LP or imaging if meningitis is strongly suspected.
Empirical Antibiotics:
Adjunctive Treatment:
- Dexamethasone (before or with first dose of antibiotics): Especially for Streptococcus pneumoniae to reduce inflammation and neurological sequelae
6. Common and Specific Meningitis Treatments
Once the causative organism is known, switch to targeted therapy:
7. Prevention
- Vaccines: Hib, Pneumococcal, and Meningococcal vaccines reduce incidence
- Chemoprophylaxis: For close contacts of meningococcal and Hib cases
- Hygiene & infection control: Especially in hospital or community outbreaks
Conclusion
Meningitis is a medical emergency. A rapid, structured approach—based on clinical suspicion, early empiric treatment, and supportive care—is crucial for improved outcomes. Identification of the causative organism guides specific therapy, and preventive measures play a vital role in reducing incidence.