Talk:Meningitis - Misplaced Pages

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Attribution

Some text in this article was originally taken from http://www.ninds.nih.gov/disorders/encephalitis_meningitis/detail_encephalitis_meningitis.htm (public domain)

Image of meninges

I have tried to find an extra image to better 'explain' the anatomy we are looking at. Showing the blood vessels and synapses which criss-cross the subarachnoid space, maybe highlight where infection can get in - File:Gray769.png is the best I can find in commons at the moment, but looks a bit 'stale' to me, I was hoping to find something more 3d. Any thoughts -? LeeVJ (talk) 16:29, 9 March 2009 (UTC)

Migraine as cause

"Rarely, migraine may cause meningitis, but this diagnosis is usually only made when other causes have been eliminated." This is confusing to me since migraine is a name given to a constellation of symptoms, not some well-defined pathophysiology. I'm not sure how migraine can cause meningitis. Xasodfuih (talk) 03:21, 10 March 2009 (UTC)

The source cited says no such thing either; the only time it mentions migraine is in this context: "Migraine may rarely present with fever, symptoms suggestive of meningo-encephalitis, and CSF pleocytosis, but this must be a diagnosis of exclusion." This seems to be a criteria for differential diagnosis. I'm at a loss how this got interpreted as a causal relationship. Xasodfuih (talk) 03:26, 10 March 2009 (UTC)

Ginsberg's article is not specific as to the mechanism, but he lists it is an inflammatory cause of meningitis rather than as a mimic. This entity has been known since the 1980s (PMID 668253, PMID 7635725) and now seems to have attracted the term HaNDL (PMID 9329235; those authors trace it to a 1995 report). One could argue that this is an epiphenomenon to a vasoactive disorder, but the presence of white cells in the CSF is meningitis almost by definition.

At the moment I'm open to persuation, but I think this entity deserves mention. The question is whether to list it as a mimic of meningitis or a rare form. Let me know what you think. JFW | T@lk 09:58, 10 March 2009 (UTC)

I've sent Prof Ginsberg an email. Hopefully he will clarify this. JFW | T@lk 10:09, 10 March 2009 (UTC)

Further to the above, Prof Ginsberg indicates that the distinction is one of semantics. JFW | T@lk 16:46, 10 March 2009 (UTC)

Meningitis is an emergency

Regarding the series of recent edits etc: evaluation of meningitis is a medical emergency, and reliable sources make this clear. Some sources properly note that viral meningitis may be treated at home - but the evaluation to establish cause is done as an emergency. --Scray (talk) 17:03, 11 March 2009 (UTC)

The editors of this article should read WP:OWN. I'm challenging this absolutist stance that *every* case evaluation is an emergency. If someone has had viral symptoms for 2 weeks and is already recovering when they are seen by their physician, you could even forego the lumbar puncture. No emergency exists. I'm not going to get into a pissing match with everyone here, but using your logic, you could make the argument that any condition is an emergency until evaluated and provides false information to the article's readers.--MartinezMD (talk) 17:42, 11 March 2009 (UTC)

I think you misunderstood my comments, and I wish you'd be slightly more careful before invoking WP:OWN and terms like "pissing match". Rather, disagreements should be resolved on the talk page, which is something we have now finally started doing. I'm with Scray that from the perspective of a layperson reading this article, symptoms suggesting meningitis should be regarded as an emergency. If a clinician then downgrades that on the basis of a careful assessment, then that is his professional responsibility, much like you'd regard a head injury with two subsequent self-terminating seizures as a medical emergency until a clinician has made an assessment.

Could I take this opportunity to request that you find a replacement for the source you added (http://www.ninds.nih.gov/disorders/encephalitis_meningitis/detail_encephalitis_meningitis.htm). This is a non-peer reviewed source that is less than ideal from the perspective of WP:MEDRS. If I find an alternative I will replace it myself. Also, could you get into the habit of using {{cite web}} for online sources? JFW | T@lk 18:53, 11 March 2009 (UTC)

All I did was change "emergency" to the less absolute "can be" because there are some exceptions. The article shouldn't conflict with a correct treatment plan. I do think their is a little protectionism happening when a relatively simple and reasonable revision gets changed back and then it progresses to a full discussion. I do apologize for the "pissing match" comment. I don't want to escalate the arguement.

As for the source, it is an NIH statement. I don't think we're going to see a controlled trial for the non-treatment arm of an illness like this anytime soon. Since this edit isn't acceptable to you, there is no need to even include the reference and you can simply delete it.--MartinezMD (talk) 20:08, 11 March 2009 (UTC)

The NINDS web site is mostly consumer oriented. We had a spat a while back about the way they categorize headaches in one of their articles, which isn't really up to date with today's standards. So, I wouldn't take their word as the ultimate best practice in meningitis either, but it does reflect what most (according my quick and dirty survey) books say. However, a lot of of mediocre sources don't necessarily trump some good ones. Xasodfuih (talk) 20:34, 11 March 2009 (UTC)

I agree with the statement, and I too would discharge someone with mild viral meningitis provided they are stable. I asked you for a source from a journal review (I don't expect a trial, please see WP:MEDRS) or a textbook. Xasodfuih has provided a good reason why NINDS pages are not necessarily good sources for Misplaced Pages articles. JFW | T@lk 20:39, 11 March 2009 (UTC)

If we're talking about validating viral cases as outpatients, I found what appears to be a good one (150 of 156 managed outpatient), but I'll have to have my hospital librarian pull it so I can review it. Here is the summary and abstract on PubMed: http://www.ncbi.nlm.nih.gov/pubmed/11203412?ordinalpos=9&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum This brings up a larger issue: verifying the sources is more difficult if the article is not available on the web. --MartinezMD (talk) 21:23, 11 March 2009 (UTC)

Please review WP:MEDRS. The source you are suggesting is interesting but not sufficient for this purpose. As for citing papers that are unavailable, this is an issue not limited to the current article; in fact, the vast majority of the sources are not only available online but free as well. JFW | T@lk 22:47, 11 March 2009 (UTC)

Evidence-based medicine has been around 15+ years. I understand well the different strengths and weaknesses of the classes. The problem is that historically there wasn't as much published on negative treatment (which seems to be changing because of criticism of big pharma) or when there is little dilemma (such as this case - if you're not too sick, you can go home). The NINDS statement and this one series are the only good matches I've come across up to now, but I'll look a little more. I'd be curious specifically where you find free full-text journal articles. I find some free online presumably because of their importance, but I often see a charge. I usually have my medical library get it - slower but always free for me.--MartinezMD (talk) 08:18, 12 March 2009 (UTC)

Most books only say explicitly that bacterial meningitis is a medical emergency . But they also say that LP is mandatory, so it's not too far fetched to infer that differential dx is an emergency, although most sources don't quite say that. Xasodfuih (talk) 19:00, 11 March 2009 (UTC)

Xasodfuih is absolutely right on this IMHO, without the differential diagnosis how does one know the cause is bacterial? Or have I missed something here? I know I risk contravening WP:NPOV, but I get called into the laboratory in the middle of the night, as an emergency, to examine CSF to confirm or exclude bacterial aetiology. Graham Colm 21:00, 11 March 2009 (UTC)

Excuse me if I'm being obtuse, but can't we simply find a way to say that (clinical) suspicion of meningitis warrants emergency treatment? That seems to be the point of this discussion. What I gather from the sources is that acute bacterial meningitis is the only true medical emergency among the common causes of meningitis (meningitides?), but the high variability in presentation, the rapid progression of meningococcal infection, etc. have led to a common practice whereby all suspected cases of meningitis are (or should be) treated as emergencies. Fvasconcellos (t·c) 15:19, 26 March 2009 (UTC)

Dead baby pictures on the front page

Thanks for that guys :/ Urpunkt (talk) —Preceding undated comment added 02:01, 2 April 2009 (UTC).

Agreed. Completely unnecessary and tactless. Besides, I just ate. ~Pesco 02:13, 2 April 2009 (UTC)

Uh, disagree since the baby isn't dead. She became famous for surviving the severe illness. http://www.babycharlotte.co.nz/ --MartinezMD (talk) 02:15, 2 April 2009 (UTC)

Uh, I'm agreeing with the intent of his note, that it's a really unnecessarily graphic image to have automatically pop up on the main page of Misplaced Pages since it's the featured article. ~Pesco 02:46, 2 April 2009 (UTC)

This discussion would be more appropriate on the front page talk page instead of the article talk page.--MartinezMD (talk) 03:33, 2 April 2009 (UTC)

I am not offended by this picture, but I am also not offended by pictures of genitals or murder victims and other potentially offensive things that may appear in several articles, but would NOT be posted on the front page of Misplaced Pages. That is great if this baby is a famous survivor, but that doesn't change the fact that millions of people view this page everyday, many of them children and some of them might find this a very disturbing image. If people wish to view this image, let them do so by clicking on the article. This picture MUST be removed from the front page, PLEASE. —Preceding unsigned comment added by 99.224.208.60 (talk) 08:17, 2 April 2009 (UTC)

The photo has been removed from the Main Page per a consensus that it isn't appropriate for the Main Page. However, given that the photo was removed from this article due to the mistaken belief that the subject didn't suffer from meningitis, could the photo now be restored here? Cheers, This flag once was red_deeds 12:16, 2 April 2009 (UTC)Photo has been restored to this article. This flag once was red_deeds 12:21, 2 April 2009 (UTC)

I thought the first picture in the article ( in this case layers of the mininges in the infobox) was the associated image, must of been wrong... L∴V 13:01, 2 April 2009 (UTC)

I'm not sure how it's decided, but for many articles the first image in the infobox might not necessarily be appropriate (i.e. interesting). For example, the first image in Scotland is a fairly boring flag (boring in that it's a simply, two-tone representation of the flag, rather than a dynamic photograph, say). In this case I suspect we've all learned that a boring image may be best! Cheers, This flag once was red_deeds 13:07, 2 April 2009 (UTC)

History

"and in 2002 evidence emerged that treatment with steroids could improve the prognosis of bacterial meningitis"

Are we limiting this statement to adults or mortality? It was shown nicely, http://content.nejm.org/cgi/content/abstract/319/15/964, (prospective, double-blinded, controls, 14% vs 1%) 14 years earlier that dexamethasone would reduce hearing loss in children. Any reason first not to mention this study and then not to adjust the history statement in some way? --MartinezMD (talk) 03:15, 2 April 2009 (UTC)

Meningitis vs meningococcal disease

These are two distinct (but related) conditions with distinct symptoms. The ~~dead~~ injured baby on the front page had meningococcal disease NOT meningitis. It's inappropriate and incorrect to use this picture in the article, especially to illustrate it on the front page. --68.111.221.83 (talk) 06:29, 2 April 2009 (UTC)

False argument - Charlotte's website states she had meningitis (as well as meningicoccal septicemia) and as mentioned above, this is not the forum to discuss what's on the front page. --MartinezMD (talk) 10:46, 2 April 2009 (UTC)

She may have had meningitis as well, although her web site does not say that, it says "Meningococcemia" and "Meningocoppal septicemia". The picture does not depict symptoms of meningitis. It's understandably hard to find a picture that would (most symptoms of meningitis are neurological, with the exception of occasional petechial rash.) But it does not make Charlotte's picture less misleading. --Itinerant1 (talk) 18:20, 2 April 2009 (UTC)

Her website says: 'I could hardly understand what she was saying but I managed to get, "Your baby's got meningitis!" ' Unfortunately with the embedded pages there isn't a direct link. In their release letter it doesn't include the results of a lumbar puncture but the CT showed brain injury. Regardless, the original argument was a straw man for not wanting the picture on the front page (which is gone now). --192.77.126.50 (talk) 22:01, 2 April 2009 (UTC)

Petichial rash is not a symptom of meningitis it is from septicaemia. Meningococcal septicaemia causes DIC, which causes the rash and in some cases damage to extremities. Unless you were looking at radiology, a brain at autopsy or maybe the retina there are very few visible signs of meningitis. cyclosarin (talk) 08:38, 3 June 2009 (UTC)

I don't think you're correct. It is possible to have a petechial rash without DIC if there is meningococcal bacteraemia, and bacteria can be demonstrated on biopsy of a lesion. Also, most cases of DIC do not lead to extremity gangrene, which is quite peculiar to meningococcal septicaemia. What source are you basing your statements on? JFW | T@lk 20:59, 3 June 2009 (UTC)

I agree that petechial rash is fairly specific to meningitis syndromes and thus it is reasonably included; however, I don't think the acral necrosis seen in purpura fulminans complicating meningococcemia is a particularly good illustration, because it is clinically indistinguishable from the same syndrome due to pneumococcal sepsis (with or without meningitis). --Scray (talk) 00:41, 4 June 2009 (UTC)

diagnosis delayed in divers

There have been case reports of a delay in the diagnosis and treatment of meningitis in scuba divers due to the similarity in symptoms that can also be present in decompression sickness.

Beckman TJ, Mullins ME, Matthews MD (1996). "Case report on a diver with type II decompression sickness and viral meningitis". Undersea and Hyperbaric Medicine. 23 (4): 243–5. PMID 8989855. Retrieved 2009-04-02. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
Davis, M (2002). "The diving doctor's diary: Eosinophilic meningitis presenting as decompression illness". South Pacific Underwater Medicine Society Journal. 32 (4). Retrieved 2009-04-02.

--Gene Hobbs (talk) 17:10, 2 April 2009 (UTC)

This is not mentioned in the major sources employed for this article, and I think the situation is very unusual. At the moment I doubt that we should include it in the article. JFW | T@lk 22:23, 2 April 2009 (UTC)

It is just a variation in the common theme of misdiagnosis. The same could be said for other illnesses.--MartinezMD (talk) 23:18, 2 April 2009 (UTC)

WP is not a medical treatment manual

The article currently says "Meningitis must be treated promptly with antibiotics and sometimes antiviral drugs." Well, yes, that is good medical practice. But WP is an encyclopedia. A statement like that could maybe appear in a section entitled "Treatment of meningitis" but it isn't otherwise encyclopedic in tone. Otherwise the reader simply asks "who says?", "or else what?". What does the "must" mean? Is that a legal admonishment? This is but one example of incorrect tone here - the article reads as if it is advice from a medical treatment book, not an encyclopedia. Paul Beardsell (talk) 16:26, 2 April 2009 (UTC)

If the sources say "must" then we can certainly quote them to that effect.

I'm not sure what you are bothered about. The article generally uses a descriptive tone of the diagnosis and treatment process of meningitis. Anything wrong with that? JFW | T@lk 22:20, 2 April 2009 (UTC)

Images

Here is a nice pathology image of bacterial meningitis on http://wiki.medpedia.com/Meningitis Wondering if we should use it?--Doc James (talk · contribs · email) 03:48, 30 May 2009 (UTC)

No, it's the same pusbrain image that has been discussed before. It has limited added value, has a high gross factor, and has been removed previously by consensus. JFW | T@lk 09:58, 31 May 2009 (UTC)

I got it in hospital

Nosocomial meningitis - http://content.nejm.org/cgi/content/short/362/2/146 - review article. JFW | T@lk 00:11, 14 January 2010 (UTC)

Excellent point. The article should address this topic. -- Scray (talk) 02:58, 14 January 2010 (UTC)

what is the most injury done to a victim of meningitis? —Preceding unsigned comment added by 98.14.193.179 (talk) 00:12, 14 May 2010 (UTC)

Addition

The following content was added. I do not know the source, and I'm not sure how informative it is.

Interleukins-1 and-6 and Tumor necrosis factor-α (TNF-α) are the early phase cytokines for bacterial meningitis. . While these cytokines signal T-cells, B-cells, plasma cells and antibodies that cause inflammation, IL-6 also reduces inflammation by down-regulationg IL-1 and TNF-α. Without IL-6, there is increased pleocytosis and chemokine concentration in the CSF. These cytokines also reset the hypothalamus thermoregulatory center, causing increased body temperature known as a fever, and induce chemokine and complement production. Chemokines then induce the leukocyte recruitment and migration across the endothelium and extracellular matrix and activate the receptors needed for the bacteria to attach to the leukocytes. Additionally they enhance superoxide generation, granule release, and phagocytosis in the CNS.

Opinions invited. JFW | T@lk 18:29, 27 October 2010 (UTC)

Lactate

doi:10.1186/cc9395 - CSF lactate possibly better than any other marker in identifying bacterial meningitis. Systematic review. JFW | T@lk 13:39, 12 January 2011 (UTC)

Eosinophils in yer head

doi:10.1128/CMR.00044-08 - CMR article on eosinophilic meningoencephalitis that may be better than our current sources. JFW | T@lk 22:57, 6 June 2011 (UTC)

Just come across it again. Must read it. JFW | T@lk 08:48, 13 June 2011 (UTC)

Why do I have the urge to say "Brazil represent". Fvasconcellos (t·c) 14:02, 13 June 2011 (UTC)

Meningococcus type A vaccine

GenOrl (talk · contribs) added a paragraph on MenAfriVac, a new vaccine against meningococcus type A. From the edit, I am not entirely clear why it is different from or better than the previous MenA vaccines. The first edit also included a lot of technical detail about the vaccine. I am not averse to discussing the vaccine as long as we can be clear whether it constitutes a major improvement. JFW | T@lk 09:10, 16 August 2011 (UTC)

Nowadays the page Meningitis doesn't reflect international point of view (just the USA's) and has outdated section on Prophylaxis of Meningitis. There should be section on meningitis vaccines available in the world. I naively added a few words in an innocent paragraph with the old news on MenAfriVac, a new highly efficient vaccine against meningococcus type A designed for low-income African countries. It is already a few years as a common knowledge that the vaccine was developed as an african alternative to currently available and a hundred times more expensive similar vaccine of the anglo-saxon world. The new vaccine passed all needed tests for having been used in mass scale in Africa. To my knowledge nobody has yet compared directly efficacy of all existing in the world vaccines. The only difference with MenAfriVac looks as being used in Africa, as of low cost of production. On numerous occasions the news was covered by WHO, the BBC World Service, as well as in professional magazines. Two times my edits about the vaccine in the article were deleted by JFW. It looks strange for the professional to do. I don’t see that anything on MenAfriVac needs to be discussed. A special article devoted to the preparation. At least in Meningitis, if it pretends to represent international perspective, should be reference to the MenAfriVac vaccine as having been succesfully used in Africa. Why international community shouldn't know new alternatives? I wonder why an innocent paragraph with relevant and trustworthy international information calls for somebody’s permission to be put in. But I was mistaken. It looks as in anglo-saxon world some physicians don't know or shouldn't know about long existence of the efficient MenAfriVac vaccine. Or is it simply and fervently guarding off commercial interests of pharmaceutical companies with their conventional vaccines? GenOrl (talk) 09:54, 16 August 2011 (UTC)

I have added a statement about MenAfriVac, placed somewhat more appropriately in the flow of the article and supported by reliable sources, linked to the main article about that vaccine. I find GenOrl's insinuations above to be unconstructive - and tend to undermine credibility (just isn't helpful to attack other editors). The biggest problem I had with the earlier edit was that it was poorly sourced (news outlets, primarily) and poorly placed in the article. -- Scray (talk) 14:54, 16 August 2011 (UTC)

I think adding the vaccine into the article is appropriate, but the initial edit had a large volume of information that is more suitable for its primary article. This article is about meningitis, not a vaccine (regardless of which one we are talking about) and their discussion should be comparatively brief. Personal attacks have no place here and are unconstructive especially when making assumptions about another editor's motives. MartinezMD (talk) 15:38, 16 August 2011 (UTC)

Thanks Scray for taking the time to clarify this. The sources we now have are reliable medical sources as defined by our consensus guidelines. JFW | T@lk 18:11, 16 August 2011 (UTC)

Review

doi:10.1128/CMR.00070-09 may perhaps be useful to generate some updates. JFW | T@lk 00:27, 11 December 2011 (UTC)

doi:10.1016/S1473-3099(09)70306-8 for kids. JFW | T@lk 00:30, 11 December 2011 (UTC)

References

Kilpatrick, Trevor, Richard M. Ransohoff, and Steven Wesselingh. "Brain Inflammation during Bacterial Meningitis." Inflammatory Diseases of the Central Nervous System. Cambridge: Cambridge UP, 2010. 161-68. Print.>.
Kilpatrick, Trevor, Richard M. Ransohoff, and Steven Wesselingh. "Brain Inflammation during Bacterial Meningitis." Inflammatory Diseases of the Central Nervous System. Cambridge: Cambridge UP, 2010. 161-68. Print.
Kilpatrick, Trevor, Richard M. Ransohoff, and Steven Wesselingh. "Brain Inflammation during Bacterial Meningitis." Inflammatory Diseases of the Central Nervous System. Cambridge: Cambridge UP, 2010. 161-68. Print.
Kilpatrick, Trevor, Richard M. Ransohoff, and Steven Wesselingh. "Brain Inflammation during Bacterial Meningitis." Inflammatory Diseases of the Central Nervous System. Cambridge: Cambridge UP, 2010. 161-68. Print.
Kilpatrick, Trevor, Richard M. Ransohoff, and Steven Wesselingh. "Brain Inflammation during Bacterial Meningitis." Inflammatory Diseases of the Central Nervous System. Cambridge: Cambridge UP, 2010. 161-68. Print.

== I called my hospital. 3-night stay required. Must keep patient on antibiotics and monitoring. What, you expect the hospital to write this in an advertisement? — Preceding unsigned comment added by 108.18.250.35 (talk) 15:19, 9 November 2012 (UTC)

If the article cannot demonstrate that diagnosis is a simple office procedure, then it is ominously incomplete. Evidence of POV trolling by hospital fans.

I am sorry, but phone calls are not reliable sources. -- O.Koslowski (talk) 15:22, 9 November 2012 (UTC)

If you are being personally affected by meningitis, or someone in your family is, I'm really very sorry to hear that. It's a very serious illness. However, Misplaced Pages has its own standards for sourcing claims made in articles. Your phone call to a hospital is called "original research" (see WP:OR) and it can't be used on Misplaced Pages. Please assume good faith of your fellow editors. There are perfectly good Misplaced Pages policy-based reasons for our concerns about your proposed edits other than the idea that we are engaging in "POV trolling by hospital fans." Zad68 15:26, 9 November 2012 (UTC)

It CAN be serious, yes. But an ordinary flu can swell the meninges. If you go to the doctor, he might panic and send you to the hospital. It's only a matter of time before a journalist will call a hospital and posit as having meningites symptoms, and realize that the hospitals DO tend to want to monitor/treat people suspected of having meningitis, for multiple days. Even when it turns out it's just a flu. Think of how many people get the flu, and that's a lot of money the hospitals can make. — Preceding unsigned comment added by 108.18.250.35 (talk) 15:33, 9 November 2012 (UTC)

Meningits is serious. If untreated, it is almost always fatal. If a patient presents with symptoms that suggest that he or she may be infected, it would be reckless not to rule it out, especially considering the incidence. It is not a money-making scheme devised by hospitals. O.Koslowski (talk) 15:39, 9 November 2012 (UTC)

Let's not forget the purpose of the article talk page-- discussion of suggested improvements to the article. Zad68 15:47, 9 November 2012 (UTC)

Just for balance, this and this are examples of widespread practice - it's a relatively simple procedure, generally - and our article does not need to be amended in the manner suggested above. -- Scray (talk) 01:11, 10 November 2012 (UTC)

If you're sick enough to have meningitis in the differential diagnosis, then consider the alternative of going to hospital. I cannot confirm that for suspected meningitis a 3-day stay is required. Many will advise a period of bed rest after a lumbar puncture (in the absence of decent evidence), but the sample can be processed within hours and if otherwise well the owner of said CSF can be discharged home if no abnormalities are detected. Lumbar punctures for other indications (e.g. in the diagnosis of MS) are often performed on a day case basis. JFW | T@lk 22:03, 12 November 2012 (UTC)

Gross pathology image available

This image is available for use in the article. — Preceding unsigned comment added by CFCF (talk • contribs)

We've previously had a similar image, and I didn't find it massively useful for general viewing when taking into account the gross/yuk factor. JFW | T@lk 17:25, 12 February 2014 (UTC)

Drug-induced meningitis

doi:10.1001/jamainternmed.2014.2918 - updated systematic review. JFW | T@lk 06:34, 8 July 2014 (UTC)

Childhood TBM

Meta-analysis of treatment outcomes and prognosis: has to be integrated doi:10.1016/S1473-3099(14)70852-7 JFW | T@lk 22:21, 27 September 2014 (UTC)

Done Added. JFW | T@lk 05:18, 28 September 2014 (UTC)

Inclusion of evidence regarding Fluid therapy for acute bacterial meningites

Fluid therapy is an important component of management of acute bacterial meningites.An updated Cochrane Systematic review is available in 2014 regarding the evidence available for it http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004786.pub4/abstract . I am an author of this review and hence would not like to edit this article in Misplaced Pages. (Drsoumyadeepb (talk) 15:27, 7 October 2014 (UTC))

Hello Droumyadeepb, thanks for flagging up this review. The DOI (for my reference) is doi:10.1002/14651858.CD004786.pub4. The article requires some updates, e.g. with regards to drug-induced meningitis, so I will aim to incorporate the Cochrane review at the same time. JFW | T@lk 19:53, 7 October 2014 (UTC)

Hello JFWGreat; Looking forward to the edits.(Drsoumyadeepb (talk) 06:13, 10 October 2014 (UTC))

UK guideline

doi:10.1016/j.jinf.2016.01.007 - the UK specialist societies guideline, which will update the now rather outdated guideline.

The IDSA (http://www.idsociety.org/Organ_System/) is also working on an update. JFW | T@lk 06:32, 2 March 2016 (UTC)

Urgency

It strikes me that the present wording of the article does not sufficiently convey to the reader the urgency of rapid treatment. By contrast this CDC ref makes it clear in the second sentence: "Death can occur in as little as a few hours." and reinforces it later with "Later symptoms of bacterial meningitis can be very serious (e.g., seizures, coma). For this reason, anyone who thinks they may have meningitis should see a doctor as soon as possible" (emphasis in original). In light of this recent news we should be conscious that readers need to understand that delay is dangerous, and reflect that in the article. LeadSongDog come howl! 15:23, 27 April 2016 (UTC)

seems reasonable to me--Ozzie10aaaa (talk) 21:52, 27 April 2016 (UTC)

Moi aussi. PermStrump(talk) 02:24, 28 April 2016 (UTC)

I am opposed to "anyone who thinks they may have meningitis should see a doctor as soon as possible", as it violates the principle that Misplaced Pages does not give medical advice. It should be sufficient to say that meningitis is a very serious condition for which rapid treatment is essential. Looie496 (talk) 15:05, 28 April 2016 (UTC)

I am with User:Looie496 on this one. We already say in the lead "The first treatment in acute meningitis consists of promptly giving antibiotics and sometimes antiviral drugs. ... Meningitis can lead to serious long-term consequences such as deafness, epilepsy,hydrocephalus, or cognitive deficits, especially if not treated quickly." This makes it perfectly clear the importance of early treatment. Nothing more is needed. Doc James (talk · contribs · email) 18:40, 28 April 2016 (UTC)

You perhaps have a higher opinion than of the minimum reader than do I, but then, IANAD. That statement on treatment is at the end of the third para. Only in the second para does mention of "life-threatening" and "medical emergency" appear. But by the time google previews the article, however, it is reduce to just 23 words:

"Meningitis is an acute inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges. The most common"

That really doesn't do the job. The most important thing to the concerned reader isn't the cause or the affected part, it's that this often kills, sometimes quickly. Whether one defines "often" as ~2% for all-types or ~15% for bacterial is secondary. The article has, I think, buried the lede. LeadSongDog come howl! 16:44, 29 April 2016 (UTC)

While giving direct advice is a problem per WP:MEDICAL, I'd support changing the opening to something that drive the point sharper and earlier, like "Meningitis is a fast-moving and potentially life-threatening inflammation of the protective membranes covering the brain and spinal cord..." if the sources support that kind of wording and emphasis. Zad68 16:56, 29 April 2016 (UTC)

"Meningitis can be life-threatening because of the inflammation's proximity to the brain and spinal cord; therefore, the condition is classified as a medical emergency." That surely is good enough? Been in the article for ages. JFW | T@lk 13:07, 25 May 2016 (UTC)

Acute bacterial meningitis in adults

doi:10.1016/S0140-6736(16)30654-7 JFW | T@lk 08:28, 2 September 2016 (UTC)

Awareness of Meningitis

I think it would be appropriate to include a section on the Meningitis Misplaced Pages page entitled 'Awareness' as awareness is in many cases, the key to prevention. Many people don’t know the warning signs of meningitis or that many types of meningitis are vaccine-preventable. In this section, I would recommend the mention of World Meningitis Day, held on the 24th of April each year. The piece I had previously added: "Each year, World Meningitis Day is celebrated on the 24th April. This is an opportunity for people all over the world to raise their voices against meningitis, through telling patient stories, raising awareness of the signs and symptoms of the disease and increasing knowledge of available vaccines. The campaign is organised by the Confederation of Meningitis Organisations (CoMO), a global community of over 45 meningitis organisations, which was founded in 2004 at the World Conference of Meningitis Organisations."

I understand that this might be considered a COI. However, I would argue that we are just wishing to raise awareness of World Meningitis Day and to acknowledge the importance of Meningitis Awareness. Please let me know your thoughts. Of course, we would be happy with minor changes made to the piece to fit the guidelines of Misplaced Pages. Would it be more appropriate to exclude the external link to our website?

Kind Regards, JoinHands (talk) 09:33, 18 November 2016 (UTC)JoinHands

We describe the symptoms, the cause, and the prevention of meningitis very well in this article. We also mention that World Meningitis Day is the 24th of Apr. I am not seeing a need to link to your charity. Doc James (talk · contribs · email) 19:29, 18 November 2016 (UTC)

Thank you for including World Meningitis Day; however, I do not feel that it's placement is adequate in 'history'. I would appreciate it if you could review this, bearing in mind the placement and mention for other World Health days eg. World Pneumonia day is listed under Society and Culture: (https://en.wikipedia.org/Pneumonia#Society_and_culture) Kind Regards, JoinHands (talk) 12:54, 23 November 2016 (UTC)JoinHands.

We do not have a society and culture section here so it is fine under history. Doc James (talk · contribs · email) 04:34, 24 November 2016 (UTC)

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Help requested with this Cochrane Update

I am looking for some help when performing a Cochrane update on the Meningitis article. The Meningitis article presently reads: "In children routine intravenous fluids for two days may improve outcomes in those who arrive at hospital after being sick for some time. " The new version of the Cochrane review states that: "The quality of evidence regarding fluid therapy in children with acute bacterial meningitis is low to very low and more RCTs need to be conducted. There is insufficient evidence to guide practice as to whether maintenance fluids should be chosen over restricted fluids in the treatment of acute bacterial meningitis." Meningitis Meningitis I am not familiar with present clinical guidelines and wanted to check on here to see if anyone has anything to add before I make any changes to the article.

Thanks. JenOttawa (talk) 02:48, 6 September 2017 (UTC)

Two options. Either remove it altogether, or say "It is not clear from studies as to whether intravenous fluid should be given routinely or whether this should be restricted". JFW | T@lk 15:00, 7 September 2017 (UTC)

Great, thanks for the advice! JenOttawa (talk) 00:22, 9 September 2017 (UTC)

http://www.comomeningitis.org/facts-about-meningitis/

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