Meningitis

A couple of months back, I had a patient at my clinic. He was a 23-year-old gentleman who was working at a well-known organization. He came in with complaints of severe headache, vomiting and tiredness for 2 weeks. He reported that his previous doctors diagnosed these headaches as acute migraine headaches after normal MRI scan. He was put on analgesics, which worked briefly.  As I talked to him, he reported the pain as nine on a score of 10. He agreed that he had been neglecting recurring low-grade headache for the past 8 months. On examination, he was afebrile. Neurological examination including neck stiffness was normal. I admitted him at the hospital and started investigating. Later that evening, this young gentle man started to show signs of confusion and disorientation. A repeat MRI scan was unremarkable. A spinal tap was ordered which revealed high protein, normal sugar, high cell counts with lymphocytic predominance and elevated LDH level. Intravenous steroid and antitubercular drugs were started along with analgesics. His condition improved gradually over a period of 1 week and was discharged after a 10-day stay at the hospital.

Those of you who have are from medical profession must have already diagnosed this case. It is a case of tubercular meningitis. Today, I am going to write about “meningitis”.

By definition, meningitis refers to a condition where the protective covering of brain and spinal cord gets inflamed. Pyogenic bacteria, viruses, fungus and aseptic microbes including tuberculosis are the most common causes of meningitis. The suspected organism as it grows irritates the protective layer leading to severe headache and vomiting and fever. Increased light sensitivity, altered consciousness, disorientation and seizure are other common symptoms this condition is associated with. The inflamed meninges restrict movements of the neck. Therefore, most patients have a stiff neck that is hard to flex on physical manipulation.  Almost all the cases need a spinal tap. Lumbar puncture and CSF examination therefore, are the gold standard tests for diagnosis. Various permutations and combinations of CSF reports allow your clinician to predict the causative organisms. In some cases, the causative organism is isolated through cultures and serological tests. 

Meningitis is similar to any simple infection. However since the infection is in close proximity to the brain which is the centre for all body function, it is considered as a deadly infection. Treatment and recovery is fruitful if we recognize the condition early and start the right treatment.  Late treatment or undiagnosed condition can result in complications, which can be fatal.

Historically, it is not very clear when this condition was first coined. However, there are reports about this condition in ancient medical textbooks. I presume the condition got recognition and medical importance after epidemic outbreaks such as the first recorded Geneva outbreak in 1805. However currently it is estimated to have caused more than 500,000 deaths. Most of these cases are found in African, Asian and South American countries. We have been able to prepare vaccines for few meningitis causing pathogens. The rest of it can be prevented with good personal hygiene and sound knowledge of this infection. 

Finally, my message to all the readers is to understand this condition and not ignore early warning signs. If you have a severe headache which is unusual; multiple, recurring vomiting and fever, it could be due to meningitis. Do not neglect such symptoms and visit the closest healthcare provider at the earliest.