How Is Meningitis Diagnosed and Treated?

The treatment and care will depend on the type of meningitis the patient has and how unwell the patient is.

If the doctor suspects you have meningitis, you will be hospitalized immediately for proper testing and to manage the illness. These tests include 

• Blood tests: A complete blood count, blood urea, and creatinine levels, blood sugar levels, levels of the inflammatory markers in the blood (CRP), and liver function tests will be done.
• Lumbar puncture (or spinal tap): This test examines the spinal fluid that surrounds the brain and drains into the brain cavities. During this test, a specific needle is inserted into space between two spinal bones at the lower level of the spine. Spinal fluid is collected through a needle and sent to the lab to be examined. The first results are given to the doctor in a few hours. It may take up to three days to get the final test results.
• A magnetic resonance imaging (MRI) or brain scan: This scan checks for the inflammatory changes in and around the brain. If the doctor suspects bacterial meningitis, the patient will receive an intravenous course of antibiotics until the final lab results are ready. Other medicines, such as intravenous fluids and mannitol, may also be given to keep the body hydrated and reduce the swelling around the brain.

Apart from these standard protocols, the doctor may order other tests depending on the patient’s symptoms, such as

• Blood cultures
• Serum electrolytes
• Human immunodeficiency virus (HIV) profile
• Testing for tuberculosis
• Chest X-ray

Other tests may be done as the physician deems fit.

The treatment and care will depend on the type of meningitis the patient has and how unwell the patient is.

Viral meningitis

• Generally, viral meningitis is not as severe as bacterial meningitis.
• It affects children.
• Most children may get better on their own without treatment.
• In most cases, the treatment may be done to help ease symptoms (fever medications and intravenous fluids with nutrition).
• In cases of herpes viral meningoencephalitis, intravenous acyclovir is given for the specified number of days.
• Babies and children with a weakened immune system may need to stay in the hospital.

Bacterial meningitis

• If the lab report confirms bacteria, the patient will be treated for a longer time. The treatment period depends on the type of bacteria that is causing meningitis and its sensitivity to the available antibiotics.
• Apart from antibiotics, supportive treatment is required.
• The supportive treatment includes hydration, correction of electrolyte imbalances, paracetamol for fever, anticonvulsant medications, and corticosteroids. The steroid decreases swelling (inflammation) and reduces the pressure in the brain. Steroids also reduce the risk for hearing loss and brain damage in children as well as adults. Anticonvulsant medications may be prescribed to control seizures during an active infection or because of meningitis complications.
• Other medications may be administered as deemed suitable by the physician. These may be prescribed by the physician on an individual basis.
• Depending on the type of bacteria that caused meningitis, family members may also need to be treated.

Fungal meningitis

• Rarely, meningitis can be caused by a fungal infection instead of bacteria or a virus. In this case, antifungal medication will be administered intravenously or orally.

Tuberculosis (TB) meningitis

• The individual will be treated with a course of anti TB medicines over one year.
• Treatment is done as per WHO guidelines for tuberculosis.

Non-infective meningitis

• Noninfective meningitis may be seen in cases of cancer, certain autoimmune diseases, or rupturing of the brain cyst.
• This may be treated with corticosteroids and other treatments specific to the cause. For example, cancer-related meningitis requires therapy to manage cancer.
• In some cases, no treatment may be required because the condition can get better on its own.

Symptomatic treatments may include

• Bed rest is recommended as the patient recovers. Bed rest is necessary after treatment for bacterial and viral meningitis until a patient regains their strength.
• Over-the-counter (OTC) medication may help reduce fever and muscle aches associated with meningitis. They may be the only medications in a patient with mild-to-moderate cases, especially in the case of viral meningitis.
• Preventing dehydration is especially important to treat meningitis. In the case of meningitis, patients may receive intravenous fluids and the doctor may also recommend drinking an adequate amount of fluids to avoid any signs of dehydration.