Acute Meningitis: Etiology, Pathophysiology, Clinical Features, Diagnosis, And Treatment

Meningitis, which is defined by inflammation of the meninges, can appear as a potentially fatal illness that needs to be treated right once. We'll look at the etiology, pathophysiology, clinical characteristics, diagnosis, and treatment of acute meningitis in this comprehensive review, including both bacterial and viral etiologies.

Etiology

Bacterial Meningitis

Streptococcus pneumoniae: The most frequent cause, linked to risk factors like alcohol intake, diabetes mellitus, otitis/sinusitis, and pneumonia. The second most prevalent organism, Neisseria meningitidis, affects about 25% of adult cases. Listeria monocytogenes and Group B streptococci are additional bacteria that are more prevalent in particular age groups.

Viral Meningitis

Common viral culprits include HIV, Arboviruses, Coxsackie virus, Herpes Simplex Virus (HSV), Varicella-Zoster Virus (VZV), and Enteroviruses.

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Pathophysiology

Usually through bacteremia, organisms go from main sites of infection or colonization to the meninges. For instance, streptococcus pneumoniae is frequently linked to pneumonia, sinusitis, otitis, and nasopharyngeal colonization. Brain edema and elevated intracranial pressure are common pathophysiological aspects. Proinflammatory cytokines such as TNF-alpha and Interleukin-1 beta play a critical role. Excitatory amino acids like glutamate contribute to neuronal damage and possible seizure activity.

Clinical Features

Typical symptoms include fever and headache, which are frequently accompanied by nuchal stiffness. Common features also include seizures, altered mental status, and coma. Clinical indicators of meningeal irritation include the Brudzinski sign (hip and knee flexion with neck flexion) and the Kernig's sign (pain with passive extension of the knee).

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Diagnosis

The CSF analysis is a test for confirmation. Actions to do before to confirmation. If the patient has acute meningitis, a lumbar puncture should be done. If a lumbar puncture delay is predicted, it is advised to begin taking antibiotics. Starting with a blood culture is the first step.
Consider lumbar punctures; if you wait, begin taking antibiotics.
Prior to lumbar puncture, the crucial requirement.

If a patient has elevated intracranial tension and is not immunocompromised, there is a chance of death. 

Fundus exam: No papilledema was found. For these, no requirement Puncture of the lumbar region 

Prior to lumbar puncture, CT/MRI is recommended for all other patients. Since MRI may detect ischemia zones, it is recommended. 

Management

Empirical antibiotic therapy is started as soon as possible, taking into account the patient's age, risk factors, and probable microorganisms.
In cases of Neisseria meningitidis, Haemophilus influenzae, and Streptococcus pneumoniae, dexamethasone may be used as an adjuvant therapy to lessen inflammation and enhance results. 

Certain viral etiologies, such as HSV or VZV, may require antiviral medication, such as acyclovir or famciclovir. An essential part of the overall management plan is supportive care, which includes managing problems including seizures and elevated intracranial pressure.
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Conclusion

In order to reduce the chance of serious consequences and enhance patient outcomes, acute meningitis is considered a medical emergency that has to be diagnosed and treated as soon as possible. For healthcare workers caring for patients with meningitis, a comprehensive understanding of the etiology, pathophysiology, clinical characteristics, diagnosis, and therapeutic strategies is necessary. The burden of this potentially fatal illness can be mitigated by early detection and adequate treatment, which will ultimately improve patient outcomes and lower morbidity and mortality.

Hope you found this blog helpful for your NEET SS Infectious Diseases Preparation. For more informative and interesting posts like these, keep reading PrepLadder’s blogs.