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 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 Zhang Hui
Neurology
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Meningitis examination methods

The examination methods for meningitis mainly include several types. The first is the lumbar puncture examination, which is a very important diagnostic tool. Through lumbar puncture, one can observe the cerebrospinal fluid (CSF) pressure, its color, and perform laboratory tests on the CSF to examine biochemical properties and cell count changes. Additionally, it is possible to culture pathogens from the cerebrospinal fluid, which is of great auxiliary value in the diagnosis and differential diagnosis of meningitis. Secondly, patients with meningitis also need to undergo physical examinations. If signs of meningeal irritation are found during the physical examination, it also indicates meningitis. Thirdly, patients may need to undergo enhanced Magnetic Resonance Imaging (MRI) of the brain. If the meningitis lesions are severe, meningeal enhancement can be seen.

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Written by Zhang Hui
Neurology
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Differentiation between purulent meningitis and viral meningitis

Purulent meningitis and viral meningitis are different diseases. Purulent meningitis is caused by bacterial infection of the meninges. Viral meningitis is caused by viral invasion of the meninges. Generally, purulent meningitis is more severe, and patients may exhibit symptoms of systemic toxin poisoning, such as high fever, nausea, vomiting, sickly appearance, and general weakness. The symptoms of viral meningitis are relatively mild, and the fever is not particularly severe. Another important differentiation is based on the analysis of cerebrospinal fluid. In viral meningitis, the lumbar puncture shows that the white blood cell count is below 1000*10^6/L, and the levels of sugar and chloride are generally normal or slightly low, with protein usually mildly elevated. In purulent meningitis, the cerebrospinal fluid shows a significant increase in white blood cell count, even reaching from 1000*10^6/L to 10000*10^6/L; the protein content is significantly increased, the sugar content is markedly decreased, and chloride levels are reduced. Additionally, bacteria can be found in the cerebrospinal fluid and blood cultures in purulent meningitis, whereas viral meningitis cerebrospinal fluid cultures do not show bacteria.

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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 Hu Bai Yu
Pulmonology
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Does meningitis cause fever?

Generally, patients with meningitis exhibit symptoms of fever, along with headaches, nausea, vomiting, or some cognitive impairments and confusion. It is advised that everyone should be cautious and distinguish the symptoms of meningitis from those of common colds, and perhaps visit the department of neurology at a hospital for proper diagnosis and targeted treatment. Under the circumstance of meningitis, it is crucial to follow the doctor's guidance and actively cooperate with the treatment. Typically, a regimen involving anti-infection and antiviral medications is necessary for about two to three weeks, and most patients have a favorable prognosis. Additionally, it is important to maintain a relaxed mood, avoid excessive stress, and drink adequate water to promote excretion.