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Meningitis (Diagnosis)

How meningitis is diagnosed?

The diagnosis of meningitis is done on the basis of clinical history, physical examination, lab investigations, and imaging tests:

Clinical history

The doctor would take a detailed history and would suspect meningitis on its basis especially if the above-discussed risk factors are present and the patient belongs to or has traveled to an endemic area.

 

Physical examination

The doctor would do general physical, neurological and certain specific examinations for meningitis such as:-

• Checking for neck stiffness.

• Eye examination to look for papilledema- which is swelling of the optic disc in the eye.

• Physical examination to check for meningeal irritation- Kernig’s sign and Brudzinki’s sign.

• Presence of skin rash– tiny pinkish rashes that don’t fade away on pressing with clear glass against the skin.

• Any complications like focal weakness or loss of sensation in a particular part of the body.

 

Blood tests

Apart from CBC, DLC and other general lab tests, following specific tests can be done for meningitis.

• Blood culture- where blood is taken out from the patient, is kept in a nutrient medium to grow micro-organisms to confirm the presence of infection and the type of micro-organism.

• Microscopic examination and staining: the blood taken out is seen under a microscope after putting a special dye such as gram stain. This allows the visualization of certain micro-organisms.

• Procalcitonin

 

Imaging tests

These tests are done to diagnose meningitis, rule out other causes, and to look for any complications of meningitis. This includes the following tests:

• Computerized tomography (CT) scan of head without contrast: to look for complications of meningitis like infarct, hydrocephalus, and to rule out other medical conditions.

• Computerized tomography (CT) scan of head with contrast: done to confirm the diagnosis of meningitis, look for complications of meningitis like infarct, hydrocephalus, and to rule out other medical conditions.

• Magnetic resonance imaging (MRI) scan of head: this is considered better than a CT scan in diagnosing meningitis and its complications. Contrast MRI is better than MRI without contrast.

• X-rays or CT scans of the chest or CT scan of sinuses: may be done to check for the source of infection present in other areas of the body. show infection in other areas that may be associated with meningitis.

However, not all cases of meningitis can’t be diagnosed on imaging and thus spinal tap/ lumbar puncture is required to be done in case of significant clinical suspicion.

 

Lumbar puncture (Spinal tap)

lumbar-puncture

This test is done to confirm the diagnosis of meningitis. Here a needle is put in your spine to take out the cerebrospinal fluid (CSF) that surrounds the brain and the spinal cord. The CSF collected can be sent to check for:-

• Glucose- generally low in bacterial meningitis.

• Protein- usually high in bacterial and fungal meningitis.

• White blood cells- usually high in bacterial meningitis.

• Antibodies- polymerase chain reaction (PCR) test or antibody test done for certain viruses are performed in case of suspicion of viral meningitis.

• Bacteria

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