Some cases of meningitis improve without treatment in a few weeks. Others can be life-threatening and require emergency antibiotic treatment. Seek immediate medical care if you suspect that someone has meningitis. Early treatment of bacterial meningitis can prevent serious complications.
Early meningitis symptoms may mimic the flu influenza. Symptoms may develop over several hours or over a few days. Seek immediate medical care if you or someone in your family has meningitis signs or symptoms, such as:.
Bacterial meningitis is serious and can be fatal within days without prompt antibiotic treatment. Delayed treatment increases the risk of permanent brain damage or death. It's also important to talk to your doctor if a family member or someone you live or work with has meningitis. You may need to take medications to prevent getting the infection.
Meningitis is an infection and inflammation of the fluid and three membranes meninges protecting your brain and spinal cord. The tough outer membrane is called the dura mater, and the delicate inner layer is the pia mater.
The middle layer is the arachnoid, a weblike structure containing the fluid and blood vessels covering the surface of the brain. Viral infections are the most common cause of meningitis, followed by bacterial infections and, rarely, fungal and parasitic infections. Because bacterial infections can be life-threatening, identifying the cause is essential. Bacteria that enter the bloodstream and travel to the brain and spinal cord cause acute bacterial meningitis. But it can also occur when bacteria directly invade the meninges.
This may be caused by an ear or sinus infection, a skull fracture, or — rarely — some surgeries. Viral meningitis is usually mild and often clears on its own. Most cases in the United States are caused by a group of viruses known as enteroviruses, which are most common in late summer and early fall. Viruses such as herpes simplex virus, HIV , mumps virus, West Nile virus and others also can cause viral meningitis. Slow-growing organisms such as fungi and Mycobacterium tuberculosis that invade the membranes and fluid surrounding your brain cause chronic meningitis.
Chronic meningitis develops over two weeks or more. The signs and symptoms of chronic meningitis — headache, fever, vomiting and mental cloudiness — are similar to those of acute meningitis. No patient took oral antiviral treatment at the time of presentation. Mollaret cells were never detected. There was no consistent relationship to genital herpes. Encephalitis is caused by the herpes simplex virus. Most are caused by herpes simplex virus type 1 HSV1 , the virus that also causes cold sores.
The disease may also be caused by herpes virus type 2 HSV2. This virus can be spread by sexual contact or from an infected mother to her baby during childbirth. HSV1 infection can also be sexually transmitted to the genital area. These viruses remain in the body throughout a person's life, even when they're not causing signs of infection. Sometimes the meningoencephalitis occurs during the initial infection with the herpes simplex virus, but most often it is caused by reactivation of the virus from an earlier infection.
If you have viral meningitis, symptoms may include fever, light sensitivity, headache, and a stiff neck. If you have other symptoms, such as confusion, seizures, sleepiness, or a focal neurologic deficit—a nerve function problem that affects a specific area — these may suggest that your brain is also affected, and your healthcare provider may diagnose it as meningoencephalitis.
If, after reviewing your medical history and symptoms, your healthcare provider thinks you may have herpes meningoencephalitis, he or she will order various tests and exams to confirm the diagnosis. Other tests may include:. Neurological exam. Your provider will do a neurological exam to look for changes in motor and sensory function, vision, coordination and balance, mental status, and in mood or behavior.
The enteroviruses encompass Coxsackie A and B viruses, echoviruses, polioviruses, and the more recently identified viruses designated by number, such as enterovirus Coxsackie B viruses and echoviruses account for most cases of enterovirus meningitis. Enteroviral typing is essential to identify and monitor outbreaks. Infants and young children with no immunity are most susceptible to enteroviruses, and the incidence decreases with age. Infection is seasonal in temperate climates—highest in summer and autumn—but high all year round in tropical and subtropical climates.
Meningitis may be accompanied by mucocutaneous manifestations of enterovirus infection, including localised vesicles such as in hand, foot, and mouth disease; herpangina; and generalised maculopapular rash. Most cases that present clinically with meningitis are self limiting and carry a good prognosis. Nevertheless, enteroviral meningitis causes considerable morbidity, with moderate or high fever despite antipyretics and several days of severe headache warranting opiate analgesia.
No specific antiviral treatment is available, and management is conservative. Immunoglobulin replacement has a role in patients with hypogammaglobulinaemia, who are prone to severe and chronic enteroviral disease.
Confusion sometimes arises when herpes simplex virus is detected in the cerebrospinal fluid of a patient with clinical meningitis. Recognising that herpes simplex virus meningitis and encephalitis are discrete entities in the immunocompetent host, rather than part of a continuous spectrum, is essential. Whereas herpes simplex virus encephalitis is a life threatening medical emergency warranting empiric antiviral treatment, herpes simplex virus meningitis is a self limiting condition in patients with normal immunity.
Herpes simplex virus now ranks second among the causes of viral meningitis in adolescents and adults in developed countries. By definition, primary herpes simplex virus infection is the first infection with either virus type in the absence of pre-existing antibodies to HSV-1 or HSV Non-primary infection includes first episodes in the presence of pre-existing antibodies to HSV-1 or HSV-2 and recurrences.
Unlike primary infection, non-primary genital infection with herpes simplex virus is rarely accompanied by aseptic meningitis. HSV-2 meningitis may also occur in the absence of clinical genital herpes. As a consequence of the increasing incidence of genital herpes, 23 clinical cases of herpes simplex virus meningitis in the United Kingdom are set to increase. In addition to fever and symptoms of meningitis, constitutional symptoms of primary herpes infection may occur, with malaise and clinical features of genital herpes simplex virus infection.
HSV-2 meningitis can recur, especially in women with primary genital infection. Although antiviral treatment with aciclovir, valaciclovir, or famciclovir is indicated for the treatment of first episode genital herpes, therapeutic trials have yet to be done in herpes simplex virus meningitis. Patients with herpes simplex virus meningitis should be referred to a sexual health clinic after recovery.
However, the diagnosis of herpes simplex virus meningitis and possible associations with genital herpes may come as a shock to the patient, and this needs to be discussed sensitively at the earliest appropriate opportunity. Many people harbour genital herpes simplex virus infection and intermittently shed virus without ever having symptoms. Infection can thus be spread unknowingly to sexual contacts. The timing of transmission is unpredictable; it may occur only after several years within a monogamous sexual relationship.
Aseptic meningitis is a recognised but rare complication of primary infection with varicella zoster virus varicella. It is more commonly seen in association with reactivation of varicella zoster virus zoster and can also occur in the absence of cutaneous lesions.
Primary HIV infection is an important cause of aseptic meningitis. Atypical lymphocytes may be seen on the blood film in both primary HIV and Epstein-Barr virus infections both are causes of viral meningitis. The neurological symptoms generally resolve over several weeks. Early diagnosis may benefit intimate contacts, as the risk of transmission of HIV is greater in the early stages of infection.
Meningitis is by far the most common neurological manifestation of mumps virus infection. Meningitis is more common in male than female patients. A 37 year old woman presented with headache, neck stiffness, photophobia, and vomiting. She had been increasingly unwell over the preceding 10 days and had sought medical advice for severe dysuria on more than one occasion; she was receiving treatment for a presumptive urinary tract infection.
On examination, she was febrile with signs of meningism. Vulval inspection showed no evidence of vesicles. Polymerase chain reaction detected HSV-2 DNA in the cerebrospinal fluid, consistent with the diagnosis of herpes simplex virus meningitis.
Her symptoms resolved gradually, and she was discharged after six days. Her husband also attended; although asymptomatic, he had serological evidence of previous HSV-2 infection. One year later she has had recurrent genital herpes but not meningitis. A 32 year old woman presented with a three day history of headache, fever, and photophobia.
0コメント