Meningitis: why is his diagnosis often delayed?

The diagnosis of meningitis is often delayed because of unnecessary brain tests performed prior to lumbar puncture. The consequences can be fatal.

Meningitis is an acute inflammation of the "meninges" membranes that surround and protect the brain and spinal cord. Most often, this inflammation is secondary to infection with a virus or bacteria.

About 70% of bacterial meningitis cases occur in infancy, before the age of 5 years. The infection "purpura fulminans" (the most aggressive form of meningitis) occurs in 30% of cases of meningococcal meningitis. In 60% of cases, the patient has no sequelae, but 20% of them suffer deafness, blindness, paralysis, or fall into a coma. For the remaining 20% ​​meningitis is a fatal disease, especially because the diagnosis of meningitis is often delayed because of unnecessary brain tests performed before the lumbar puncture.

No identification of the virus or bacteria in 43% of cases

The Institute of Infectious and Global Diseases at the University of Liverpool (England) studied the diagnosis and treatment of more than 1000 patients and found that the majority of them (81%) had a cerebral scintigraphy, 70% of cases before lumbar puncture. However, national health recommendations encourage doctors to perform lumbar puncture on patients suspected of having meningitis in the first hour. If these guidelines had been followed, only 12% of the patients studied would have undergone brain scans before the lumbar puncture.

By examining these 1000 patients, the researchers also found that the virus or the bacteria responsible for the disease was not identified in 43% of them. However, quickly determining which bacterium or virus causes the disease is essential for prescribing appropriate treatment to patients and antibiotics must be administered urgently in case of bacterial meningitis. Conversely, if meningitis results from a virus, antibiotics are useless. "This study provides the first estimate of the incidence of viral meningitis in British adults and shows (...) that management is bad," says Dr. Fiona McGill of the Institute of Infectious and Comprehensive Diseases.There are so many brain scans unnecessary that it delays the correct diagnosis. "

According to Dr. Mike Griffiths, lead investigator of the study, "The rapid diagnosis of a specific cause of meningitis is essential for prescribing the right antibiotics if needed, or avoiding unnecessary antibiotics in patients with viral meningitis. focus on treating the symptoms and speeding up the hospital, which would be less painful for patients. " Vinny Smith, executive director of the Meningitis Research Foundation (MRF), adds that "the bacterial form of the disease can kill in a matter of hours." Many survivors have long-term, disabling side effects, as serious as brain damage and deafness (...) That is why it is crucial not to delay the performance of the lumbar puncture ".

A 20-year-old woman died of meningitis in the night of May 14-15 in Montpellier after being admitted to Lapeyronie Hospital. Two other fatal cases preceded him: a 23-year-old man near Dijon and a 13-year-old girl near Amiens.