Meningitis

Abstract

Dr. Frederick K. Heath: The key to good management of meningitis is early suspicion of its presence. Prompt lumbar puncture with smear, culture, differential cell count, sugar and protein determinations on the spinal fluid should precede therapy and open the door to correct diagnosis and adequate treatment. Close attention to the patient until recovery pays dividends. Meningococcic meningitis responds well to high blood levels of sulfadiazine alone but in more severe cases intramuscular penicillin should be added. Intrathecal penicillin is required only in critical situations. Repeated spinal puncture is reserved for complicated severe cases. Cisternal block may respond to intrathecal streptokinase. Peripheral circulatory failure is a feature of severe infections demanding the entire gamut of antibacterial agents plus whole blood and supportive adrenal cortical agents. Pneumococcic meningitis is almost uniformly secondary to disease in the ear, less often to a pneumococcic focus elsewhere, and rarely follows basal skull fractures. Treatment consists of intensive and prolonged sulfadiazine, intramuscular and intrathecal penicillin, otologic measures as indicated, and streptokinase for blockage. Streptococcic meningitis may be regarded as similar to the pneumococcal disease. Tuberculous meningitis still does not do well despite long courses of streptomycin alone or plus the addition of promizole or para-amino-salicylic acid. The most favorable situation would seem to exist when miliary tuberculosis does not coexist. Meningitis of viral origin has no specific therapy, unfortunately, except in rare instances of lymphogranuloma venereum and possibly herpes which may respond to aureomycin or terramycin. Deafness and vestibular disturbances are common sequellae of all types of meningitis or its therapy. Special training is important to rehabilitate patients adequately with these complications. Not mentioned in this clinic were the gramnegative meningitides nor those due to yeasts. B. influenzae is the most common of the former and is chiefly a problem in pediatric practice; there is no specific therapy of proven value for the latter.