How is meningitis treated?

Written by Han Shun Li
Pulmonology
Updated on September 09, 2024
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The treatment of meningitis is comprehensive. Firstly, medication should be based on the cause of the disease. For example, if it is caused by bacteria, sensitive antibiotics should be chosen for treatment; if caused by tuberculosis bacilli, standard anti-tuberculosis treatment should be applied; if caused by fungi, appropriate antifungal drugs should be used, and so forth. Additionally, symptomatic treatment is necessary, such as timely decompression treatment for increased intracranial pressure; fever reduction, especially for patients with high fever; and controlling seizures in patients with anticonvulsants. Moreover, it is important to maintain nutritional and electrolyte balance and ensure that the respiratory tract remains clear, among other things. If there are complications, they should be actively treated. (Specific medications should be administered under the guidance of a physician.)

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Written by Zhang Hui
Neurology
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Differences between Viral Meningitis and Tuberculous Meningitis

Virial meningitis and tuberculous meningitis sometimes require additional differentiation in clinical practice because their treatment plans are significantly different. Virial meningitis has a relatively abrupt onset and is caused by a viral infection, generally having a good prognosis. Patients with tuberculous meningitis usually exhibit symptoms of tuberculosis toxicity such as low fever, night sweats, and fatigue before the onset of the disease. Commonly, other forms of tuberculosis can be identified, such as pulmonary tuberculosis or intestinal tuberculosis. An important diagnostic tool for differentiation is the lumbar puncture. In viral meningitis, the lumbar puncture pressure is generally not particularly high, whereas in tuberculous meningitis, the lumbar puncture pressure is very high, reaching over 400 mm of water column. Additionally, the cerebrospinal fluid (CSF) in tuberculous meningitis is yellowish, and its protein levels are significantly elevated, as are its white blood cell counts, typically ranging from 50 to 500 × 10^6/L. In tuberculous meningitis, the levels of glucose and chloride in the cerebrospinal fluid are significantly decreased, especially chloride, which is a prominent indicator for diagnosing tuberculous meningitis. In contrast, such clear changes are not observed in the lumbar puncture for viral meningitis. Another aspect to consider is the treatment response; if antiviral treatment is ineffective, the possibility of tuberculous meningitis should be considered.

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Written by Zhang Hui
Neurology
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How to test for meningitis?

Meningitis is a very common disease in neurology, and the most common causes are infections, including viral infections, common bacterial infections, tuberculosis infections, and fungal infections. The main methods of examination for meningitis are as follows: First, physical examination. A physical examination can reveal neck stiffness in the patient, and positive meningeal irritation signs. These examinations are non-invasive and very safe. Second, a lumbar puncture can also be performed. A lumbar puncture can be used to observe whether the fluid pressure is high, and also to collect cerebrospinal fluid to examine its color, perform cytological and biochemical analyses, and culture the cerebrospinal fluid. This is very important to definitively determine the presence of meningitis and to identify the type of infectious agent involved. Additionally, enhanced magnetic resonance imaging can also be performed to see if there is significant enhancement of the meninges.

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Written by Li Jian Wu
Pulmonology
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How to test for meningitis?

The main methods for meningitis examination are lumbar puncture and cerebrospinal fluid testing. Cerebrospinal fluid examination may show increased pressure, turbid appearance, and purulent changes, containing a large number of white blood cells and neutrophils. Routine blood tests may also show a white blood cell count significantly higher than normal, predominantly composed of immature neutrophils. Additionally, it is possible to check electrolytes and use auxiliary diagnostic tools such as X-rays, CT scans, and MRI to confirm the diagnosis, facilitating early detection and treatment.

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Written by Li Jian Wu
Pulmonology
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Causes of Meningitis

The main causes of meningitis are bacteria, viruses, fungi, rickettsiae, or other pathogens, which invade the pia mater, spinal cord, and theca mater, causing infection. Clinically, bacterial meningitis is more severe. If it is not treated promptly or if the treatment is ineffective or misdiagnosed, it may lead to death within a few hours or even cause permanent brain damage, resulting in sequelae. Meningitis can affect the dura mater, arachnoid mater, and pia mater. It may also lead to secondary intracranial infections. It is important to choose antibacterial drugs and medications that nourish brain cells and alleviate cerebral edema for symptomatic treatment promptly.

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Written by Li Jian Wu
Pulmonology
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How is meningitis transmitted?

Meningitis, a disease primarily transmitted through close contact, airborne droplets, and poor dietary habits, is mainly caused by bacterial infections leading to purulent meningitis in clinical settings. Some cases are due to tuberculosis bacillus causing tuberculous meningitis. Additionally, there are viral forms of meningitis, most commonly from enteroviruses or Echo viruses. A minority of patients may also develop cryptococcal meningitis. Treatment should involve the use of appropriate antimicrobial drugs based on clinical symptoms and the infecting pathogen, coupled with measures to decrease intracranial pressure and relieve brain edema, ensuring early detection and treatment to prevent complications.