meningitis

[MudPhud20XX]

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1. So it seems like symptom-wise viral meningitis = encephalitis, right? If not, how are they different?

Also, viral meningitis = atypical meningitis, correct?

2. Can anyone briefly explain the mechanism for dexamethasone for meningitis treatment? I think I heard that it reduces complication such as deafness, but can't seem to understand this. I feel like the steroid would rather be harmful since it will reduce immunity, right?

 

[Missorleans]

no no, meningitis = inflammation of the meninges. Encephalitis = inflammation of the brain parenchyma.
you can have neurologic deficits with encephalitis (go look at the symptoms of West Nile or HSV encephalitis, you can get polio-like symptoms with West Nile, altered mental status and personality changes with HSV). Coxsackie, on the other hand, causes meningitis. Symptoms basically the same as bacterial meningitis: photophobia, nuchal rigidity, fever, nausea, vomiting.

 

[bulldogmed]

1. So it seems like symptom-wise viral meningitis = encephalitis, right? If not, how are they different?

Also, viral meningitis = atypical meningitis, correct?

2. Can anyone briefly explain the mechanism for dexamethasone for meningitis treatment? I think I heard that it reduces complication such as deafness, but can't seem to understand this. I feel like the steroid would rather be harmful since it will reduce immunity, right?

"adjunctive treatment with dexamethasone before or with the first dose of antimicrobial therapy reduced the risk of unfavorable outcome from 25 percent to 15 percent...This benefit was a result of reduced mortality from systemic causes"

The essence of it is that in meningitis, your bodies immune system is going to respond to the infection as it would to any other infection in the body, except that in the brain, real estate is extremely conserved. So damage to the brain parenchyma due to ROS or inflammatory cytokines is going to be bad. Steroids reduce inflammation and thus complications. You're not going to significantly impair the bodies immune response in the short term.

 

[MudPhud20XX]

Guys thanks a bunch.

So using steroid to taper down the inflammation especially in the space limited brain makes so much sense.

I looked at Goljan audio/note and he says the way to differentiate meningitis and encephalitis is the "nuchal rigidity," which makes sense if you think meningitis infects meninges.

 

[bulldogmed]

Guys thanks a bunch.

So using steroid to taper down the inflammation especially in the space limited brain makes so much sense.

I looked at Goljan audio/note and he says the way to differentiate meningitis and encephalitis is the "nuchal rigidity," which makes sense if you think meningitis infects meninges.

For step 1, this is probably fine. Nuchal rigidity has low sensitivity for meningitis, around 50% I think. Encephalitis can probably cause nuchal rigidity late, by which I mean, if it has spread to the meninges.

 

[MudPhud20XX]

Got it that makes sense! Thanks!