英文原文
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Now, the classic triad of meningitis symptoms are headaches, fevers, and nuchal rigidity, or neck stiffness. It can also cause photophobia, which is discomfort with bright lights, or phonophobia, which is discomfort with loud noises. Meningoencephalitis can cause an altered mental state or seizures.
The diagnosis of meningitis starts with a physical exam. One maneuver is when a person lies flat on their back facing upwards, and one of their legs is raised with the knee flexed to a 90 degree angle. Then, the leg is supported and slowly straightened at the knee. If this causes back pain, then it’s called Kernig’s sign. Another maneuver is when a person lies flat on their back facing upwards, and has their neck supported and flexed. If this causes them to automatically flex their knees or hips, then it’s called the Brudzinski’s sign.
If meningitis is suspected, a lumbar puncture can be done. This is when a needle goes through the lower lumbar vertebral levels of the spinal cord, between L3 and L4 for example. The needle penetrates into the subarachnoid space and a few milliliters of CSF is taken. The opening pressure can be measured, and this CSF can be analyzed for white blood cells, protein, and glucose. Polymerase chain reaction, or PCR, might also be used to find Specific causes, like HIV, enterovirus, HSV, or tuberculosis. If a particular infection seems like an obvious cause, then a test for that might be used, like the Western blot for Borrelia burgdorferi bacteria, or a thin blood smear for malaria.
The treatment of meningitis depends on the underlying cause. For bacterial meningitis, It’s common to administer steroids and then antibiotics, to prevent massive injury to the leptomeninges from the inflammation caused as the antibiotics destroy the bacteria. In general, the drug treatments like antivirals, antibacterials, antifungals, or antiparasitic are aimed at the specific cause of meningitis. Prevention with a vaccine is appropriate for some causes like Neisseria meningitidis, but also for mumps and for disseminated tuberculosis. Prophylactic antibiotics can also be administered to avoid outbreaks of bacterial meningitis like in households where individuals haven’t been vaccinated against Neisseria meningitidis.
All right, as a quick recap, meningitis is an inflammation of the leptomeninges, which is the inner two membranes that surround and protect both the brain and the spinal cord. It normally starts when a foreign substance, oftentimes bacteria, makes its way inside the leptomeninges, either by direct contact or hematogenous spread through the blood brain barrier. The immune system responds to the antigen by flooding the subarachnoid space with white blood cells, which release chemokines and create inflammation, and this results in the classic triad of symptoms, which is headaches, fevers, and neck stiffness.