Meningitis Theoritical Background

What is Meningitis?

Meningitis is an inflammation symptom that is in brain and spine outter membrane caused by viruses or bacterias. This kind of disease is caused by microorganism, cancer, fungi, physical trauma, certain drugs, and parasite that is spread from blood to brain fluid and brain membrane. This disease is a serious problem in the world, it needs immediate treatment because this disease is very dangerous for the brain, movement of the muscles, mind, and even death.

Meningitis symptoms

That is why patient with meningitis should be diagnosed  as soon as possible, it is useful for distinguish among bacteria, viruses, or fungi causes. Specific treatment should be apply based on the causes.

Meningitis Types

Based on the types, meningitis can be divided into 2 types.

Viral meningitis

This type of meningitis rarely cause serious illness. In severe condition, this meningitis can make progressive fever with seizure.

Bacterial meningitis

Bacterial meningitis is very dangerous. It need serious care and medication to prevent brain damage and death.

Causes

Basically, meningitis which is caused by viruses is not dangerous and it can be heal by itself. It is different with meningitis which is caused by bacterias, it can make serious illness such as like brain damage, learning process disturbance, hearing loss, and even death. Meningitis can be caused by fungi, but this case is rarely rare. The people that is risky for fungi infection is usually  in immune system damage (AIDS)

Now, we will focus on the most serious illness, meningitis caused by bacterias. The bacterias that can attack brain membrane are:

Streptococcus Pneumonia (pneumococcus)

Streptococcus pneumonia (pneumococcus) is one of the bacteria that can infect the brain membrane. This kind of bacteria is the most common cause in meningitis. The victims of this bacteria infection are babies and children. Not only infect brain membrane, but also infect lung or respiration system, lung, and sinus.

Neisseria Meningitidis (meningococcus)

Based on many resources, this bacteria is in second position in meningitis cases. This bacteria can infect the brain membrane from upper respiration tract to brain membrane. This bacteria infection is really fatal if the treatment is not done because only one to two days the patient will die.

Haemophilus Influenza (haemophilus)

Haemophillus influenza type B is a bacteria can cause upper respiratory tracts,  inner ear and sinus. This bacteria infection can be prevented by vaccine (Hib vaccine)

Listeria Monocytogenes (listeria)

This bacteria can be found in many place, even in daily foods. This bacteria is from pet, contaminated food. The foods that is have contaminated potention are in cheeze, hot dog, and sandwich.

Staphylococcus Aureus and  Mycobacterium Tuberculosis

Another meningitis bacteria is staphylococcus aureus and mycobacterium tuberculosis, this bacteria can cause TBC too.

Classification

Based on the change of brain fluid, the meningitis can be divided in two classifications.

Serosa meningitis

This meningitis is an infection in arachnoid and piameter layer with transparent brain fluid. The cause of this meningitis classification is mycobacterium tuberculosis. Other causes are viruses, toxoplasmosis gondhii and rickets.

Purulent meningitis

This meningitis is pus inflammation in arachnoid and piameter. The causes of this meningitis are diplococcus pneumoniae, neisseria meningitis, streptococcus haemolyticuss, staphylococcus aureus, haemophilus influenza, Escherichia coli,, klebsiella pneumonia, Pseudomonas aeruginosa.

Phatophysiology

Phatophysiology of meningitis is a problem in anatomy and physiology of the brain (to know more about human function, you may click here). Bacterial meningitis begins with infection in orphaning and followed with septicemia, then spread to upper brain membrane and medulla spinals.

Predisposition factors involve upper respiratory tract infection, otitis media, mastoiditis, anemia, sickle cell and hemoglobinophaty, recent nervous surgery, and head trauma. 

Veins from posterior nasopharing, middle ear and mastoid canal lead to bacteria development. The microorganisms in blood flow make inflammation reaction inside the meninges and enlarge toward  brain cortex, those make thrombus and brain blood supply decrease. Cerebral or brain tissue has metabolism problem because of exudate, vasculitis, and hyper perfusion. Exudate can spread to brain and medulla basis.

Inflammation spreads to cerebral ventricle wall. Bacteria meningitis has a relation with intracranial physiology changes, blood vessel permeability is increase, brain barrier or brain protection, cerebral edema, and intra cranial pressure in high pressure.

Sign and symptoms of meningitis

The sign and symptoms in teenagers and adults are neck stiffness and pain while put chin onto chest, fever, seizure, vomit, headache, and loss of consciousness.

In children have different sign and symptoms. For babies , the sign and symptoms is little bit hard to detect because they can express their feelings, the babies maybe hard to please, painful laceration on the skin and loss their appetite. In children, the sign and symptoms in children are like flu or hard to breath. And the last is for the adult, mostly sign and symptoms in adults are just headache and fever.

In detail, these are the sign and symptoms of meningitis based on infection and intracranial pressure:

1. Headache and fever (first symptoms)
2. Consciousness level changes, it can be lethargy, unresponsive, even coma
3. Meninges irritation cause many sign such as neck stiffness (touch the chin to chest is hard to do) it is because the neck muscle spasm
4. Kerning sign is positive: when patient lay down with thigh in flex position toward abdomen, the feed can not be extension perfectly.
5. Brzezinski sign : when patient’s neck is folded, knee and hip flex will be there. It passive flex is done in lower extremity in one direction then the same movement is seen in opposite extremity.
6. Photo phobia (sensitive with high exposure of light)
7. Seizure caused by focal cortex that is sensitive toward infection and intra cranial pressure caused by cerebral edema, the vital signs usually tachycardia, irregular breathing, headache, vomit, and decrease the consciousness level.
8. Skin laceration is a specific infection caused by meningococcus meningitis
9. Fulminating infection with septicemia signs: sudden fever, pupura lession, shock, and coagulopathy sign, intravasculer disseminate.

Diagnostic Exam

Cerebrospinal fluid analysis is the most common procedure that is very effective in meningitis diagnostic examination. Cerebrospinal fluid analysis in lumbal puncture procedure is to know the cause of microorganism that infect the brain membrane. In bacteria meningitis, intracranial pressure is increase, turbid fluid, white blood cells and protein is increase, glucose is also increase, a positive result of bacteria infection.

In virus infection is signed by uncertain intracranial pressure, cerebrospinal fluid is clear or transparent, white blood cells increase, normal glucose and protein level, bacteria culture is usually negative, and need to do special virus culture.

Other diagnostic examinations are blood electrolyte usually in abnormal condition, ESR is increase in meningitis, blood, nose, or urine culture to know the source of infections. MRI or CT scan can be helpful to localize lession, to know the inflammation size, etc.

Treatment

If the sign and symptoms above are exist, the patient should find medical treatment or doctors. Lumbal puncture is the most important test for meningitis diagnostic examination. Lumbal puncture take the spine or brain fluid to know the cause of meningitis whether bacteria, virus, or fungi. Then the medication is based on the result of the test.

Meningitis prevention

Meningitis is contagious. The transmissions are from cough and contact in short range. That is why we must see doctors if we found the sign and symptoms of meningitis.

Maintain and increase the hygiene.

Meningitis transmission can be prevented by increase and maintain the hygiene for individual with infection risk. The most important thing is washing hand, because the hand is the most risky media to transmit the viruses or bacterias. We should wash our hand regularly and use anti-germ soap.

Avoid sharing tools

Some tools such as like plate, glass, straws, towels, and other tools that is used together make meningitis germ transmission easy. We need to avoid it to prevent meningitis.

Close mouth and nose when sneeze