Talk:Meningitis

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This article was previously a Medicine Collaboration of the Week.

Someone needs to repair the OP. Some jackass deleted it and replaced it with slander.

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Some text in this article was originally taken from http://www.ninds.nih.gov/disorders/encephalitis_meningitis/detail_encephalitis_meningitis.htm (public domain)

Contents 1 Ethics 2 Suggestions 3 CT before lumbar puncture 4 Treatment of Viral meningitis 5 extreme cold and meningitis 6 Removal of reference 7 Re-adding the "See also" links 8 What about amoebic meningitis? 9 Diffrences B/w types of meningitis ! 10 What is Graham sign? 11 So... 12 PCR for clinical or research only? 13 MCOTW 14 Vaccine question

[edit] Ethics

While looking at this article, it occurred to me that people may be using this and an emergency source of information (e.g. a worried mother who supects her child has contracted the disease). So i suggest that the inportant information in diagnosis be included first - in bullet point veiw - and the the infected brain be moved towards the end of the artcle, or replaced by a picture of visual symptoms in a live patient. Just thinking of morality, that's all.

Wikipedia does not profess to be an emergency medical manual, and we have a medical disclaimer. The intro should clearly mention the most important telltale signs (fever, neck stiffness, photo- and phonophobia and petechiae), as should be the case in all medical articles. The remainder should remain unchanged.

I agree the infected brain should be lower down in the article.

I dispute that Wikipedia has a moral duty beyond its stated objective to provide unbiased, sourced and verifiable information. JFW | T@lk 22:34, 29 October 2005 (UTC)

I agree that the tell tale signs should be listed at the top of the page - it would be useful for one (and yes I did just come here looking for them, not a true emergency but it'd be nice if that information was on wikipedia) 137.222.10.58 00:45, 8 February 2006 (UTC)

I added the most common signs/symptoms and (imho) the most relevant and important things about meningitis in the heading. Hopefully it will be more helpful. --Andrewr47 04:16, 26 June 2006 (UTC)

[edit] Suggestions

I'm completely out of my league with this article, and thus I'm not going to edit it. But I am aware of a few things that seem to be missing from this article:

1. What is meningococemia?

2. How long is the vacination effective? (i.e. is it once per lifetime, or yearly boost, or...?)

--Sdfisher 14:58, 26 Jan 2005 (UTC)

• Just got a meningitis shot. The nurse said it was effective for 10 years. 72.230.61.217 23:52, 16 June 2006 (UTC)

Answers:

1. Meningococcemia is also known as meningococcal septicemia ie blood-borne infection with considerably higher mortality rate than the meningitis disease.
2. Duration of effect depends on what vaccine you had - i.e. for which bacteria, and in the case of meningococcus, which strain of the bacteria. Also depends upon one's age (young children mount less of a response and so often need multiple courses to provoke a full protection. See Vaccination schedule for full details
   • Haemophilus influenzae vaccination (HiB) is routinely given as 3 shots to infants in UK, adults needing protection (eg asplenia following splenectomy) need just one dose for lifetime cover
   • Meningococcus - the Men A&C strain mix used for travel vaccinations lasts just 3 years.
   • Conjugated Meningococcus C (conj Men C) - given thrice to infants in UK, but for adults (again for asplenia but also in the catch up program to cover all school leavers), just a single dose is thought to give perminant protection ("perminant" is as yet somewhat ill defined)
   • There are other vaccines for other strains of Meningococcus - but I can't advise as to their duration of effects. David Ruben ^Talk 01:35, 17 June 2006 (UTC)

[edit] CT before lumbar puncture

Removed the advise to make a CT scan before all lumbar punctures. Evidence for this: PMID 10597758 PMID 11742046 PMID 8448711 PMID 16010480 --WS 01:23, 1 August 2005 (UTC)

[edit] Treatment of Viral meningitis

I'm not going to edit this article, as medicine is way out of my league, but the article seems to suggest the treatment for meningitis is always the use of broad spectrum antibiotics. Clearly, that can't be the case with viral meningitis.

On the Meningitis Foundation of America website, they state:

Unfortunately, there is no specific treatment for viral meningitis at this time. Medical Doctors recommend plenty of rest, relaxation, fluids, and medicine to relieve a fever or headache.

[1]

This seems to be a pretty important point for an article for the general public. Mmmbeer 14:06, 25 September 2005 (UTC)

• I disagree, although fully agreeing with your logical reading of the artice that such information is currently missing :-) - I would point out that the "general public" never themselves make a decision, or should even have suggested to them, on how to self-treat viral meningitis. All cases exibiting signs of meningism need to be urgently admitted to hospital, on the basis that there may be a progressive bacterial cause. UK guidelines are that any General Practitioner seeing a suspected case of menigitis should give an antibiotic injection even before the ambulance transports the patient to the hospital - such is the rapid risk of fatality from bacterial cases and the importance of early treatment being started. Of course, if subsequent lumbar puncture tests suggest a viral cause then further antibiotics need not be given and suitable advice can be given, but it should be remembered that whilst usually not fatal, viral meningitis very occassionally may be.
• Like all internet/book articles on medical topics, it is legally (and ethically) not possible to make diagnosis or give precise advice on an individual's treatment. Readers do and will erroneously interpret advice given, whatever disclaimers & cautions might be given. Therefore WP needs to take great care with this article (in particular) not to suggest that "Mild" symptoms might correlate with less serious causes of meningitis and thereby in anyway delay people from taking the necessary action, namely that all suspected cases, however mild, need emergency medical attention.
• I would suggest that the article, whilst mentioning that antibiotics must be promptly given for bacterial causes, does not explicity suggest that no treatment (ie no antibiotic) is needed for viral cases ("treatment" in the public's mind means seeing a doctor for all the things they do, so "no treatment" would be interpreted as "no need to see a doctor")
• If you can think of a round-about method of mentioning the points you raised, have a go (eg "Following treatment of meningitis cases, people often feel tired for some time for which rest is important and pain-killers for any continuing mild headadache may be advised.") But I think most doctors would be fairly concerned about the wording chosen, most of us will have seen cases that started with a "mild viral-like illness" that soon became something quite different :-) - David Ruben^talk 01:10, 26 September 2005 (UTC)
  • Your points are well taken. However, it seems that there are at the very least two things that can be distilled from what you said: 1) clarify that the treatment is for bacterial (you don't have to say that it excludes viral) 2) state in the first sentence all suspected cases, however mild, need emergency medical attention. Just a thought. Mmmbeer 01:40, 26 September 2005 (UTC)
    • Ok - so incorporated - David Ruben^talk 03:00, 26 September 2005 (UTC)

[edit] extreme cold and meningitis

I've read somewhere that extreme cold (like going around without a hat, at -30 C) increases the risk of meningitis? And in the article it says that meningitis is purely viral. Which of the statements is true? --rydel 15:38, 24 January 2006 (UTC)

Well, not purely viral. There are bacterial, viral and parasitic forms of meningitis. Apart from a very rare hereditary condition (CINCA/Muckle-Wells) there is no association between cold exposure and meningitis to my knowledge. JFW | T@lk 16:56, 24 January 2006 (UTC)

[edit] Removal of reference

I've removed: Hill, A. Edward. "Benign Lymphocytic Meningitis." "Caribbean Medical Journal", Vol. XI, No. 1, pp. 34-37. for several reasons. Mostly what has this to do with the current contents of the article ('Benign Lymphocytic Meningitis' is not mentioned) ? I could not find the reference in PubMed - the year of publication would have been helpful, is there on online copy of the article anywhere?

As best as I can tell from a quick search of PubMed [2] for 'Benign Lymphocytic Meningitis', the presence of lymphocytes may be associated with a number of different viruses. In the case of a meningitis outbreak, the quick identification of lymphocytes highlights viral cases from bacterial, given that full viral studies may take some time to undertake. However only a minority of cases with lymphocytes identified seem to be proved to be of any viral cause - "of 208 cases of aseptic lymphocytic meningitis seen over a nine-year period, 24 were diagnosed as viral infections" Becq-Giraudon B, Cremault A, Marechaud R, Abadie JC, Castets M, Sudre Y (1982). "[Viral etiology of aseptic lymphocytic meningitis. Twenty-four cases seen over a nine-year period (author's transl)]". Sem Hop 58 (12): 739-45. PMID 6283647. . David Ruben ^Talk 01:43, 7 May 2006 (UTC)

[edit] Re-adding the "See also" links

I've re-added the list of "See also" links. Andrewr47 and other editors/contributors, please leave this list on the page. Thank you. -- 201.78.233.162 16:50, 5 July 2006 (UTC)

[edit] What about amoebic meningitis?

There's no mention at all of this form of meningitis. Anyone able to provide some info on it?

[edit] Diffrences B/w types of meningitis !

Hello...

well although the topic is very good... but i could't find the differences b/w different types of meningitis like Viral,acute bacterial and tuberculous meningitis.... will u plz help me out :) thanx. Jinn

[edit] What is Graham sign?

Article refers to "Graham sign" which is not defined or linked. I can't Google anything about it. Probably should be removed. Gypsydoctor 22:51, 9 November 2006 (UTC)

Think this was just some nonsense applied by an anon editor in these edits - I have now fully reverted back (I had previously only reverted 1 out of their 2 edits).David Ruben ^Talk 01:27, 10 November 2006 (UTC)

[edit] So...

I've had viral meningitis, the doctor said if I did not come in that day i would have died. I am wondering if there are any long term effects viral meningiis could have had on my brain? SwiftGeneration 22:40, 17 November 2006 (UTC)

Also, I don't see any mention of a symptom I had, dark red splothes under my skin, as if the vessels were filled with dye and you could see them easily and quite clearly

[edit] PCR for clinical or research only?

I have seen 2 cases of meningitis in the last 3 years which had cloudy fluid from the lumbar puncture but which never cultured anything, so antibiotics for a wide variety of bacteria were administer IV: gram positive, gram negative, Legionaire's disease, etc. The infectious disease doctor refused to do PCR, saying it was never used for clinical applications, only for research. This was at a teaching hospital affiliated with a medical school. My question is, could a reference be added showing that PCR is an appropriate technique when the csf does not show any bacteria in culture, to identify the infectious agent and reduce the risk of harm from unneeded antibiotics. Edison 01:14, 22 December 2006 (UTC)

[edit] MCOTW

Ahh, this is now the MCOTW - for the last 2 weeks! There is a lot to be done here, and I cannot begin to see the things that need improving. There are no references, especially those very specific claims with regards to steroids (see PMID 17253505 for some developments). A useful recent review (community-acquired meningitis in adults, PMID 16394301) may be used as a backbone.

Some ideas:

• What signs and symptoms predict the presence of meningitis; is there such a thing as asymptomatic/atypical meningitis? How do children differ in their presentation from adults?
• How is meningitis diagnosed. Is a CT scan necessary pre-lumbar puncture?
• What are the forms (e.g. bacterial, viral, tuberculous/mycobacterial, parasitic, aseptic, autoimmune, traumatic). Can they be distinguished clinically (e.g. Listeria causing early cranial nerve pathology) and epidemiologically (again Listeria in alcoholics).
  • What are the commonest causative agents for each form?
  • How are these forms distinguished?
  • How is it related to meningoencephalitis?
• What are the complications (e.g. hydrocephalus)
• Pathogenesis: how does meningitis arise, is it different from infection of other organs and why (discuss blood-brain-CSF barrier). Discuss the peculiar phenomenon re. worsening of inflammation by bacterial breakdown products after commencement of antibiotics and benefit from glucocorticoids in particular forms.
• Treatment: discuss need for broad-spectrum empirical antibiotics, interference with lumbar puncture results, need to add viral or parasitic cover when suspected, the corticosteroid controversy (adults and Western world children only etc), the treatments for complications (neuromonitoring, pressure bolts/Ommaya reservoirs, ventriculosystemic shunts) etc etc.
• Prognosis: discuss natural history and prognosis with treatment (mention poor prognosis tuberculous and Listeria)
• Epidemiology: which populations are at risk (mention children, immunocompromised, pilgrims e.g. for the Hajj). What determines the Meningitis Belt?
• Vaccination: what strains are amenable to vaccination
• History: discovery, major historical developments. Perhaps also mention here any famous patients, significant mentions in world literature (e.g. Phillip in My Cousin Rachel, including mention of therapeutic LP) etc.

Whew. JFW | T@lk 22:23, 29 January 2007 (UTC)

JAMA - how to interpret CSF results! PMID 17062865. JFW | T@lk 22:27, 29 January 2007 (UTC)

Viral Meningitis is very cool to study. I am studying it right now.

[edit] Vaccine question

(moved from article page by MarcoTolo 22:24, 24 March 2007 (UTC))

It is a mistake made in this pages under vaccination. Pneumovax and Prevnar / Prevenar are two very different vaccines. Pneumovax- made by Merck is a polisacharid 23 valent vaccine (also Pneumo23 Pasteur). Prevnar / Prevenar - made by Wyeth is a conjugated 7 valent vaccine.—The preceding unsigned comment was added by 219.89.184.36 (talk • contribs).