REVIEW ARTICLE

Abstract

Man, alone of all animal species, seems susceptible to meningitis, probably because of the very large amount of blood which perfuses his brain, thereby increasing the opportunities for blood-borne infection. Infants and young children, before they have acquired immunity to the common bacterial pathogens, are particularly prone to meningeal infection. Since they outwardly display less characteristic signs and symptoms of meningeal irritation than do adults, diagnosis is often delayed and the chances for recovery correspondingly impaired. Cyanosis, fever, vomiting in the newborn; fever, drowsiness, jitteriness, tenseness of the fontanelle in older infants; headache, vomiting, and stiffness of the neck in children, and so-called febrile convulsions in patients of any age, should point to the possibility of meningitis. Examination of the spinal fluid obtained by lumbar puncture is the only completely satisfactory way to establish the diagnosis, unless petechiae are present from which an organism can be recovered on smear. All things considered, the best chemotherapeutic agent for patients with H. influenzae meningitis is crystalline chloramphenicol; for those with meningococcal meningitis sulfadiazine, and for those with pneumococcal meningitis penicillin and sulfadiazine. Only if the etiologic agent cannot be identified should resort be had to drug combinations such as penicillin, sulfadiazine, and chloramphenicol; or to Terramycin® which is optimal in no type of meningitis, but fairly good in all. Whatever the chemotherapeutic agent employed, the physician should always remember that the management of patients with meningitis consists of far more than deciding which drug to prescribe. Treatment must start immediately the diagnosis is made and should include proper provision for the patient's rest and comfort, for an adequate fluid intake, for a minimal amount of discomfort (in the form of injections and restraint). Medication should come to an end as soon as safe in order to avoid unpleasant side-reactions: within 2 or 3 days in meningococcal meningitis and usually within a week in influenzal meningitis. Only in pneumococcal meningitis does the relatively high incidence of relapse make prolonged periods of treatment advisable. While complications during convalescence are much less common than formerly, the presence of fever beyond a few days, persistent anorexia or vomiting, restlessness, or focal neurologic signs should suggest the possibility of an intercurrent infection involving the ears, lungs or sites of antibiotic injection; or a subdural effusion. Only by constant alertness to possibility of meningitis in young children and by meticulous attention to all of the details of management can the mortality from meningitis be kept below 10 per cent (influenzal and meningococcal meningitis) and 20 per cent (pneumococcal meningitis).