h2g2 The Hitchhiker's Guide to the Galaxy: Earth Edition

Entry: Meningitis and Encephalitis - A52562450
Author: Alex Tufty Ashman [!] - U566116


Another medical entry - apologies if it's a bit dry.

Alex

Hi Alex,

Another great addition to the h2g2 first-aid kit

Minor style point: you use phrases like "Both conditions may present with the same symptoms of headache, neck stiffness and photophobia...". This is written for a medical professional (as I imagine most of your sources are) but as the general public are your audience here, can you turn it around a bit?

You might want to link Lyme disease to A13344969.

Is there a rule that we italicise the names of bacteria but not viruses? Just wondered.

Can you define PCR testing?

a public health team?

Icy

Nice work!

"Those at risk of pneumococcal meningitis include children under the age of two, the..."

--> children under the age of 2 *years* (I assume?)



"...once tests reveal the bacteria responsible and the antibiotics to which it is sensitive."

--> bacterium ??



In 'Prognosis': treatement --> treatment



Add a link to A948819 - A Beginner's Guide to the Immune System ??

Please could you link from 'viral encephalitis' to my Entry on WNV at A4540989.



(I'll read it through properly shortly )

A

I've made those changes

"Is there a rule that we italicise the names of bacteria but not viruses? Just wondered."

Whereas bacteria are often referred to by their Latin names and are thus often italicised ('Streptococcus pyogenes' would be italicised, though 'streptococcus' would not), viruses tend to be referred to by a name that is similar to their Latin name, but which is not italicised ('Varicellovirus' would be italicised, but 'Varicella zoster virus' is not).


"Please could you link from 'viral encephalitis' to my Entry on WNV at A4540989"

I've included that link, but I'm most definitely not going to link from an entry about encephalitis to an entry about a specific virus from the words 'viral encephalitis'. From the Writing-Guidelines:

"Links should be direct and relevant. For example, the word 'poetry' should link to Poetry, rather than Poetry Events and Gigs in Glasgow, which, though a laudable entry, does not define the word 'poetry'."

There's a definite scope for harm caused by casual linking - for instance:

A4540916 Notifiable Infectious Diseases in the UK
...links from the word 'tuberculosis' to...
A2903735 Robert Louis Stevenson
...which then links from the word 'tuberculosis' to...
A1026361 Microbes - the Harm They Do

... but by that logic you shouldn't be able to link to 'Ticks' from 'Lyme Disease' .

Fair enough - I had avoided doing so at first.

It's a judgment call, isn't it? The Ticks entry does have a section on Lyme disease, which is why I suggested it. (It's also one of the EGE's which have been referenced by published academic research papers)

Hmmm - I'm not sure what to do, but I've put the Ticks disease link back in so that both entries are linked to.

Right, I've sorted the matter out once and for all by changing it to 'tick-borne Lyme disease' and linking to 'Ticks' from the word 'tick'.

I hope you can understand my not linking to another entry from the phrase 'viral encephalitis', considering that this entry covers viral encephalitis whereas A4540989 covers a very specific form.

Whatever you're happiest with, Alex.

From a medical point of view pretty good. The only things missing were TB mengingitis, which has a slightly different course - often sub acute. It's supposed to be 'rare' but I've seen a case every year or so.

So what I wish I'd known about mengitis when I was your age

From a management point of view - more tips for the future than anything else.

We do use steroids to reduce the inflammation in bacterial mengitis to reduce cerebral oedema. The actual death is often from the swelling of the brain, rather than overwhealming sepsis. Though you can die from overwhealming sepsis as well.

Remember that often these people will need ITU for support whilst the antibiotics work. This is on of those situations where 'early warning scores' are very useful.

Also never ever ever ever forget to take blood cultures, as you are putting in the cannula to give the antibiotics, they will very often give you the diagnosis.

When you do the LP always remember to measure the opening pressure, it's a real hassle to faff about with the opening pressure when you just want a bit of fluid - but it is a useful bit of information. If it comes out the top of the mamometer remember it's probalby cryptococcoal.

There is a role for out of hospital IM Ben Pen in suspected mengitis and many GPs will give it on home visits.

At the moment we do CT before LP, last year we didn't, I suspect we will move towards CT prior to LP as out of hours CT becomes more commonplace. The disadvange of CT before LP is that you can delay antibiotics til after LP, but not until after CT and LP.

Another useful tip is to send the urine for pneumonoccocal antigen - it only takes 10 minutes and you'll have the answer by the post take ward round.

It's worth being clear about the difference between menginococcal septicaemia and menginococcal menginitis. You will usually have one without the other.

Enjoy - treating bacterial menigitis is stressful, but when they get better it's one of the best parts of the acute medical take. And getting pus out of the LP is a weird experience.

Also I don't think there's much on encephalitis - it's a totally different entity to menigitis = probably worth doing on it it's own.

Thanks very much, Z

I've added some of those points to the entry, especially TB

Do you think I should remove the mentions of encephalitis from this entry and write a separate entry on the subject?

Now I'm wishing I'd not read this (especially Z's commentary) while having lunch

I have nothing useful to add...

I would do a seperate encephalitis entry..

you don't need to be HIV + to get TB meningitis - none of my patients have been...

Is it really that icky this entry? which bits - all nice and clean stuff to me.


I should do an encephalitis entry, mind you I should submit that case report of an interesting cause to a journal first..

Ok, I've cut out the encephalitis bits and moved them to A53313455 - fancy using it to write an encephalitis entry?

Mostly just the "And getting pus out of the LP is a weird experience."

I'm not terribly squeamish, but some things get to me

(Now I'll stop topic drifting.)