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Meningitis
Recent news headlines have advised of an outbreak of fungal meningitis. Rear Adm. Joyce Johnson, D.O., reviews the causes, symptoms, diagnosis, and treatment of meningitis.
Meningitis is inflammation of the meninges — membranes protecting the brain and spinal cord. Meningitis caused by bacteria or viruses can spread from person to person, but transmission is rare and requires close personal contact, e.g., kissing. Fungal meningitis results when a fungal infection in the blood spreads to the central nervous system. Fungal spores occur naturally in dirt and can be inhaled. Treatment involves IV antifungal drugs, usually administered in the hospital. Those with impaired immune systems are most susceptible.
Several hundred cases of fungal meningitis (and more than 20 fatalities) have been linked to steroid injections that might have been contaminated with the Exserohilum rostratum fungus (a different fungus than usually causes fungal meningitis). Relatively little is known about the natural history of this disease.
Also serious is bacterial meningitis. Each year in the U.S., more than 4,000 cases are reported; about 500 people die from it, and others have permanent disabilities. It is most common in newborns, though people of any age can get it. Immediate treatment with antibiotics and other supportive care is critical. Vaccines can help prevent three types of bacterial meningitis — meningococcus, pneumococcus, and Hib.
Viral meningitis often is linked to enterovirus in preschool children, which is transmitted via feces (often during diaper changes). It also is linked to mumps, measles, chicken pox, flu, and other viruses and can affect people of all ages. Most cases last a week or two. If there is no underlying immune problem, recovery generally is complete. Handwashing reduces transmission.
A specific single-cell amoeba, found in some warm lakes and rivers, can cause parasitic meningitis. Most years, only a couple of cases are diagnosed nationwide.
Meningitis also can be caused by head trauma (including brain surgery), some drugs, cancer, and some diseases (such as lupus, an autoimmune disease).
Whatever the cause, the early symptoms are sudden fever, severe headache, and stiff neck. Nausea, vomiting, sensitivity to light, confusion, and changes in alertness are also common. Symptoms in infants might include fever, irritability, not wanting to eat, and difficulty awakening. Meningitis can progress rapidly. Seizures and coma can develop. Making an accurate diagnosis quickly is critical to identify the types of meningitis requiring early, aggressive treatment.
Diagnosis includes a spinal tap. A blood culture can help identify an infective organism. A CT scan of the head can identify strokes or other related problems. The results of a full history and physical exam are important for an accurate diagnosis.
MO
— Rear Adm. Joyce Johnson, USPHS (Ret), D.O., M.A., is vice president, Health Sciences, Battelle Memorial Institute, Arlington, Va. Find more health and wellness resources at
www.moaa.org/wellness. For submission information, see page 6.
Prevent Meningitis One way to prevent meningitis is to have all recommended vaccines, especially the meningococcal vaccine for college students and others living in close quarters. If you are exposed to someone with bacterial meningitis, preventive antibiotics might be prescribed.
*online: Visit
www.cdc.gov/meningitis to learn more.
48 MILITARY OFFICER DECEMBER 2012
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