Meningitis and Inflammation, CSF, Symptoms and Treatment

If science is not coming up with a “bait, catch and destroy” system, we will lose the battle against all inflammation caused by viruses, bacteria and fungus invasion.

Could ME/CFS be an undiscovered Meningitis

Brudzinski neck sign raises suspicion of meningitis. It can be elicited by flexing the individual's neck while lying flat on their back. If passive flexion of the neck results in reflex flexion of the hips and knees, it's a positive sign. A lumbar puncture should be performed if meningitis is suspected.

Meningitis is an inflammation of the protective membranes, called the meninges, that surround the brain and spinal cord. This inflammation can be caused by infection with viruses, bacteria, or other microorganisms, and in some cases by certain drugs. Meningitis can be life-threatening due to its proximity to the brain and spinal cord, hence it is considered a medical emergency.

There are different types of meningitis, characterized mainly by the cause of the inflammation:

1. Viral Meningitis: This is the most common form and is generally less severe than bacterial meningitis. It's often caused by enteroviruses, but other viruses like the herpes simplex virus, HIV, and West Nile virus can also cause viral meningitis.

2. Bacterial Meningitis: This is more serious and can be life-threatening. Common bacteria that cause meningitis include Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae type b. Early antibiotic treatment is crucial.

3. Fungal Meningitis: This is a rare form of meningitis and typically occurs in people with weakened immune systems. It's caused by fungi spreading through blood to the spinal cord.

4. Parasitic Meningitis: Also rare, this is caused by parasites and is most common in sub-Saharan Africa.

5. Non-Infectious Meningitis: This can be caused by diseases, medications, surgery, or head injury.

Symptoms of meningitis can include a sudden high fever, stiff neck, severe headache, nausea or vomiting, confusion or difficulty concentrating, seizures, sleepiness or difficulty waking up, sensitivity to light, and lack of interest in eating or drinking. Infants may show different symptoms, like inactivity, irritability, vomiting, and a bulging fontanelle.

First step in the diagnosis of meningitis often includes looking for specific physical signs that indicate irritation of the meninges, such as the Brudzinski's sign and Kernig’s sign:

1. Brudzinski's Sign: This is a classic sign of meningeal irritation. During the examination, when the patient's neck is flexed (chin to chest), there is involuntary flexion of the hips and knees. It's considered positive when this movement occurs, suggesting the presence of meningitis.

2. Kernig’s Sign: This sign is also used to assess meningeal irritation. With the patient lying flat with the hip and knee flexed at a right angle, the doctor tries to straighten the leg at the knee. If there is resistance to straightening or pain in the lower back and hamstring, the test is considered positive. This resistance or pain is due to irritation of the meninges.

Both signs, if positive, can indicate meningitis, but they are not present in all cases. Additional tests involves a combination of clinical evaluation: laboratory tests, and sometimes imaging studies. The process usually includes:

1. Medical History and Physical Examination: The doctor will ask about symptoms and look for signs like fever, neck stiffness, and altered mental status. They may perform a physical examination focusing on signs that suggest meningitis or its complications.

2. Lumbar Puncture (Spinal Tap): This is the most definitive test for meningitis.  The CSF is then analyzed for signs of inflammation, bacteria, viruses, and other infectious agents. It can also be checked for glucose levels, white blood cells, and proteins.

3. Blood Tests: Blood cultures may be taken to check for bacteria or other infectious agents in the blood. Other blood tests can look for signs of inflammation or infection.

4. Imaging Tests: Although not used to diagnose meningitis directly, CT or MRI scans of the head may be done to rule out other conditions, like a brain abscess or tumor, especially if there are neurological symptoms or if the person is immunocompromised.

5. Other Tests: Depending on the suspected cause, other tests may be performed. For example, if viral meningitis is suspected, a PCR (polymerase chain reaction) test may be used to identify specific viruses in the CSF.

   While clinical signs like Brudzinski's and Kernig’s signs, along with symptoms and medical history, are important in initially suspecting meningitis, the definitive diagnosis of meningitis is typically made through analyzing cerebrospinal fluid (CSF) obtained via a lumbar puncture (spinal tap).

   Non-Infectious Meningitis:
   

   Non-infectious meningitis, unlike its infectious counterpart, is not caused by pathogens like viruses or bacteria. 

   This is known as drug-induced meningitis. Several types of medications have been associated with this condition:

   1. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Some common NSAIDs, like ibuprofen, have been reported to cause drug-induced meningitis, particularly in patients with autoimmune disorders like lupus.

   2. Antibiotics: Certain antibiotics, including penicillin, cephalosporins, and sulfa drugs, have been known to cause meningitis.

   3. Immunoglobulins: Intravenous immunoglobulin (IVIG) treatments, used for a variety of immune disorders, can occasionally lead to meningitis.

   4. Biologics: Biologic agents, such as those used to treat autoimmune diseases (e.g., TNF inhibitors like infliximab), have been associated with drug-induced meningitis.

   5. Chemotherapeutic Agents: Certain chemotherapy drugs used in cancer treatment can also lead to this condition.

   6. Other Medications: Seizure medications, like carbamazepine, and certain vaccines have been reported to cause meningitis in rare instances.

   Instead, it can result from a variety of other causes, which include:

   1. Autoimmune Diseases: Certain autoimmune conditions, such as systemic lupus erythematosus (SLE), can cause inflammation of the meninges. This is known as autoimmune meningitis.

   2. Cancers: Meningitis can occur as a complication of cancers, either due to the cancer itself (like lymphoma or leukemia involving the meninges) or due to metastatic cancer that spreads to the meninges from another site.

   3. Medications: Some medications can induce meningitis as a side effect. This type of meningitis is known as drug-induced meningitis. It usually resolves once the offending medication is discontinued.

   4. Surgical Procedures: Procedures involving the brain or spinal cord can occasionally lead to meningitis.

   5. Other Inflammatory Conditions: Conditions like sarcoidosis can involve the meninges and cause meningitis.

   The symptoms of non-infectious meningitis are similar to those of infectious forms and include headache, fever, stiff neck, and sensitivity to light. However, the course of the illness may differ, and the diagnosis is often made after infectious causes have been ruled out.

   Diagnosis typically involves a lumbar puncture to analyze the cerebrospinal fluid. While the CSF in non-infectious meningitis may show signs of inflammation, such as increased white blood cells or protein, it usually does not show the presence of infectious organisms, and glucose levels might be normal.

   Treatment of non-infectious meningitis focuses on managing symptoms and addressing the underlying cause. For example, if it's related to an autoimmune disease, corticosteroids or other immunosuppressive medications might be used. If it's caused by a reaction to a medication, stopping the medication is necessary. In cases related to cancer, treating the underlying cancer is a key part of managing meningitis.

   At the end , CSF is the end result
   

   During the lumbar puncture, a sample of CSF is collected from the spinal canal. This fluid is then examined for several key indicators of meningitis:

6. Appearance: Normally clear, CSF might appear cloudy if there's an infection.

7. White Blood Cell Count: An increased count is indicative of an infection or inflammation.

8. Glucose Levels: CSF glucose levels might be lower in bacterial meningitis.

9. Protein Levels: Elevated protein levels can occur in meningitis.

10. Microorganisms: The CSF can be cultured to check for bacteria, or PCR (polymerase chain reaction) tests can be used to detect viruses or other pathogens.

The specific findings in the CSF can help differentiate between viral, bacterial, fungal, and other types of meningitis, which is crucial for guiding appropriate treatment. For instance, bacterial meningitis typically shows a higher white blood cell count, lower glucose, and higher protein levels compared to viral meningitis. Identifying the exact cause helps in administering the correct antibiotics or antiviral medications.

Early and accurate diagnosis is crucial for effective treatment, especially in the case of bacterial meningitis, which can be life-threatening. If meningitis is suspected, it's typically treated as a medical emergency.