Infectious Meningitis

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Abstract

Infectious meningitis is a large public health concern, especially in children and immunocompromised patients. Although the epidemiology of meningitis has shown significant decline in past decades, partly due to the introduction of vaccines, outbreaks are still reported worldwide. Diagnosis of meningitis is of critical importance, and it is considered to be one of the most urgent of the microbiological medical emergencies. In order to improve the treatment strategy, various diagnostic methods have been developed to detect the presence of infectious agents that cause meningitis, as well as their antibiotic resistance patterns. This article aims to enhance the understanding of meningitis and to highlight the most current updates that describe outbreaks of meningitis and the subsequent investigations. We also describe the current diagnosis and treatment options.

Introduction

Meningitis is an inflammation of the meningeal layers of the brain and spinal cord. The infection involves the arachnoid, the pia mater, and the intervening cerebrospinal fluid (CSF). The inflammatory process extends throughout the subarachnoid space of the brain and spinal cord and involves the ventricles. Meningitis can cause necrosis, decreased blood and CSF flow, and impaired central nervous system (CNS) functions. The early symptoms are headache, fever, and chills; however, a combination of 2 to 4 symptoms (headache, fever, stiff neck, and altered mental status) is found in 95% of patients. Death occurs from shock and other serious complications within hours of the appearance of symptoms (1, 2).

Meningitis is usually caused by an infection but may also occur in response to noninfectious irritants introduced into the subarachnoid space (1). Noninfectious cases are uncommon or rare compared with the infectious type, particularly with their inability to spread from one person to another (3). Therefore, meningitis could be divided into two categories according to the nature of the causative agents: infectious and noninfectious meningitis (2). Noninfectious meningitis can be induced by certain drugs, autoimmune hypersensitivity disorders, neoplasms, and chemical agents (Table 1). When present in the CSF, noninfectious agents or their products, such as tumor cell products, act as inflammatory irritants that induce inflammatory processes that can progress to meningitis.

Section snippets

Infectious Meningitis

Infectious meningitis is a serious disease of the CNS that involves inflammation of the meninges as a result of microbial infection, and it occurs in all age groups. It is caused most commonly by viruses and bacteria, rarely by fungi and parasites (9). The clinical presentation of meningitis depends on the virulence of the causative agent, the pathogenesis of spread to the CNS, and the area of CNS involvement (3). Headache, fever, stiff neck, confusion, vomiting, and pleocytosis are features of

Approaches for Laboratory Diagnosis

Diagnosis of an infection involving the CNS is considered to be a medical emergency. Combining the physical examination with confirmatory laboratory tests and a clinical history of the patient provides the strongest evidence of meningitis. Over the last few years, many approaches have been developed and used for the diagnosis of meningitis. Currently, several diagnostic methods were evaluated in order to achieve sensitive, rapid, and specific detection of meningitis etiology (10), especially in

Therapeutic Management

The ideal antibiotic for CNS infection would be inexpensive and would cover a broad range of gram-positive and -negative bacteria (13). If the infecting organism is observed on examination of the Gram-stained smear of the CSF sediment collected from a patient with suspected bacterial meningitis, specific therapy is initiated; otherwise, empirical antimicrobial therapy should be initiated. Prompt treatment of bacterial meningitis usually results in rapid recovery of neurologic function.

Bacterial

Conclusion

Infectious meningitis is a large public health concern. Continuous diagnosis improvement is necessary to minimize disease mortality and life-threatening complications. Continued updates to describe prevalence and expanded reporting of outbreaks will help to evaluate vaccination outcomes and impact. Viral genotyping in outbreaks provides a clearer picture for virus epidemiology and geographical distribution and helps predict the emergence of new strains by phylogenetic studies.

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