Meningitis is an inflammation of the meninges and the subarachnoid space. It may result from infections, other diseases or drug reactions. Severity and acuity fluctuate. Symptoms are typically headache, fever and stiff neck; The diagnosis is made by a CSF analysis. Treatment includes antimicrobial drugs according to indications plus additional measures.

Meningitis is an inflammation of the meninges and the subarachnoid space. It may result from infections, other diseases or drug reactions. Severity and acuity fluctuate. Symptoms are typically headache, fever and stiff neck; The diagnosis is made by a CSF analysis. Treatment includes antimicrobial drugs according to indications plus additional measures.

(Infections of the brain, s introduction to infections of the brain;… Newborn meningitis, s Acute bacterial meningitis in newborns) Meningitis is an inflammation of the meninges and the subarachnoid space. It may result from infections, other diseases or drug reactions. Severity and acuity fluctuate. Symptoms are typically headache, fever and stiff neck; The diagnosis is made by a CSF analysis. Treatment includes antimicrobial drugs according to indications plus additional measures. Meningitis can be classified as acute, subacute, chronic or recurrent. It can also be divided on the cause: bacteria, viruses, fungi, protozoa or, occasionally, non-infectious forms. On gebäuchlisten for the clinic, however, the meningitis categories Acute bacterial meningitis Viral meningitis Noninfective meningitis Recurrent Meningitis Subacute and chronic meningitis Acute bacterial meningitis is very serious and moving very fast. Viral and non-infectious meningitis limit in the rule itself. Subacute and chronic meningitis usually take a more indolent course than other meningitis, but the determination of the cause can be difficult. The older term aseptic meningitis is sometimes used interchangeably with the term viral meningitis; however, it usually refers to an acute meningitis due to a cause other than bacteria which typically cause an acute bacterial meningitis. Thus, the aseptic meningitis can by viruses, non-infectious conditions (eg. As medications, diseases), or are sometimes caused by other organisms (eg. As Borrelia burgdorferi in Lyme disease, Treponema pallidum in syphilis). Symptoms and discomfort symptoms and complaints may vary, particularly with respect for the various types of meningitis. Severity and acuity. However, not all types of meningitis tend to call the following symptoms produced (except in young children) appear lethargic or worsened headache fever neck stiffness (neck stiffness) Patients can. Neck stiffness, an important indicator of meningeal irritation means resistance to passive or willful neck flexion. It may take some time before the neck stiffness is established. Clinical tests are (in order of ascending sensitivity) Kernig character (resistance to passive knee extension) brudzi?ski’s sign (complete or partial flexion of the hips and knees flexed neck) difficulties with the mouth closed chest touching with his chin difficulties forehead or the chin with the knee touching neck stiffness can be distinguished from a stiff neck due to a Osteoarthitis the cervical spine or an influenza with severe myalgia: in these conditions all directions of movement of the neck are usually affected. In contrast, neck stiffness mainly affects neck flexion due to a meningeal irritation; the neck can thus rotated in the rule, but not be bent. CSF analysis diagnosis The diagnosis is made v. a. by means of a cerebrospinal fluid. Since meningitis can be severe and the lumbar puncture is a safe procedure, a lumbar puncture should be performed, as a rule, if there are any suspected meningitis is. CSF findings can distinguish the type of meningitis rather, they may however partially overlap. A neuroradiological imaging -typischerweise a contrast-enhanced CT or -MRT -is carried out before the lumbar puncture, when patients exhibit symptoms increased intracranial pressure or a mass (z. B. focal neurological deficits, papilledema, deterioration of consciousness, seizures, in particular suggest in patients with HIV infection or a weakened immune system). In such patients, the lumbar puncture can cause impaction of the brain. Even with suspected. a bleeding disorder is so long not performed lumbar puncture until the bleeding disorder was ruled out or brought under control. If the lumbar puncture is deferred, blood cultures should be set, and it should directly follow an empirical antibiotic treatment. The lumbar puncture can be performed after the intracranial pressure is lowered and no Raunmforderung was detected. Should be infected via injection site skin, or when a subcutaneous or parameningeale Lumbalinfektion is suspected, the needle is inserted at another location. CSF findings in meningitis state Prevailing cell type * Protein * glucose * Specific tests Normal Liquor All lymphocytes ‡ (0-5 cells / ul) <40 mg / dl> 50% of blood glucose No Bacterial meningitis leukocytes (usually PMN) often greatly increased Increases <50% of blood glucose (can be extremely nied be rig) Gram staining (high yield, if 105 colony forming units of bacteria / ml are present) bacterial culture PCR, if Viral meningitis lymphocyte (which may be mixed available; PMN and lymphocytes h) Increases Usually normal Sometimes PCR (simplex during the first 24-48 for Überpüfung of enterovirus or herpes, herpes zoster, or West Nile Virus) IgM (for Überpüfung of West Nile virus or other arboviruses) † tuberculous meningitis PMN and lymphocytes (typically mixed pleocytosis) Increases <50% of the blood glucose (which may be extremely low) acid-fast staining PCR Mykobakterienkultur (ideally with a cerebrospinal fluid ? 30 ml) of interferon-? assays in serum, and (if available ) Liquor fungal meningitis Usually lymphocytes Increases <50% in blood glucose (can be extremely low) cryptococcal antigen test Serological tests for antigen of Coccidioides immitisoder Histoplasma sp., V. a. when patients have recently spent time in an endemic area fungal culture (ideally with a cerebrospinal fluid ? 30 ml) ink (for Cryptococcus sp.) * The change of cell count, glucose and protein may be minimal in severely immunocompromised patients. † In tubercular meningitis the acid-resistant Liquorfärbung may be insensitive, the sensitivity of the PCR is only about 50%, and a culture takes up to 8 weeks. Positive interferon-?-CSF testing indicate a tubercular meningitis, however, serum interferon-? tests can only point to a previous infection. Thus, the confirmation of the diagnosis of tuberculous meningitis is difficult; if this is unconfirmed, but is strongly suspected, is treated conjectural. ‡ A small number of cells can normally present in newborns or after a seizure. PCR = polymerase chain reaction; PMN = polymorphonuclear neutrophils. Antimicrobial therapy treatment according indication Additional therapeutic measures An infectious meningitis is treated according to the clinical indication with antibiotics. To additional treatments for meningitis may include Supportive tests or treatment of complications associated disorders causing discontinuation of medication In bacterial meningitis, corticosteroids

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