Symptoms may occur up to 6 months after the injection. If people have any of these symptoms during the weeks or months after having a corticosteroid injection in their back, they should call their doctor.
Occasionally, chronic meningitis persists for months or even years, but no organisms are identified, and death does not result. This type of meningitis is called chronic idiopathic meningitis. Treatment with antifungal drugs or corticosteroids does not help. However, some people with chronic idiopathic meningitis eventually recover without treatment. The symptoms of subacute or chronic meningitis are similar to those of acute bacterial meningitis, except that they develop more slowly and gradually, usually over weeks rather than days.
Also, fever is often less severe. Symptoms of chronic meningitis may last for years. Some people get better for a while, then worsen relapse. Headache, confusion, a stiff neck, and back pain are common.
People may have difficulty walking. Weakness, pins-and-needles sensations, numbness, paralysis of the face, and double vision are also common.
Paralysis of the face, double vision, and hearing loss develop when meningitis affects the cranial nerves Overview of the Cranial Nerves Twelve pairs of nerves—the cranial nerves—lead directly from the brain to various parts of the head, neck, and trunk. Some of the cranial nerves are involved in the special senses such as seeing Meningitis due to the bacteria that cause tuberculosis usually worsens fairly rapidly over days to weeks but may develop much more rapidly or gradually.
Tuberculous meningitis can have serious effects. Pressure within the skull may increase. Blood vessels may become inflamed, sometimes leading to stroke. Vision, hearing, facial muscles, and balance may be affected.
Doctors ask about factors that increase the risk of chronic meningitis, such as a weakened immune system as may be caused by HIV infection or AIDS and travel to areas where Lyme disease or certain fungal infections are common. Doctors also ask about and look for symptoms that may suggest a cause.
To confirm the diagnosis, doctors do a spinal tap Spinal Tap Diagnostic procedures may be needed to confirm a diagnosis suggested by the medical history and neurologic examination. Electroencephalography EEG is a simple, painless procedure in which The cerebrospinal fluid is sent to a laboratory to be examined and analyzed.
The results can usually enable doctors to distinguish between chronic and acute meningitis. In chronic meningitis, the number of white blood cells in cerebrospinal fluid is higher than normal but is usually lower than that in acute bacterial meningitis.
Also, the type of white cells that are most common is usually different. Some infectious organisms that cause chronic meningitis, such as the fungus Cryptococcus neoformans , are visible under a microscope, but many, such as the bacteria that cause tuberculosis, are difficult to detect. The cerebrospinal fluid is also cultured. Organisms, if present, are grown so that they can be identified. However, culturing may take weeks. Special techniques, which may provide results more quickly, may be used to identify fungi and the bacteria that cause tuberculosis and syphilis.
For example, tests may be done to detect proteins released by Cryptococcus neoformans called antigen testing.
The polymerase chain reaction PCR technique, which produces many copies of a gene, may identify the unique DNA sequence of the bacteria that cause tuberculosis. Other tests may be done on samples of cerebrospinal fluid to document prior exposure to the bacteria that cause tuberculosis. Chest x-rays or computed tomography CT of the chest may detect evidence of prior or current tuberculosis.
Other tests on cerebrospinal fluid are done, depending on which disorders are suspected. For example, the fluid may be analyzed for cancer cells if cancer is suspected. The cause of chronic meningitis may be difficult to determine, partly because detecting microorganisms in cerebrospinal fluid can be difficult. Thus, spinal taps may be repeated to obtain more cerebrospinal fluid for culture.
If available, tests that can rapidly analyze large stretches of genetic material can be used to identify otherwise undetectable microorganisms in cerebrospinal fluid. To identify the cause, doctors may also need to culture samples of blood and urine or to biopsy infected meninges or other tissues, which are identified using magnetic resonance imaging MRI or CT.
For tuberculosis, syphilis, Lyme disease, or another bacterial infection: Antibiotics effective for the particular bacteria. For fungal infections: Usually antifungal drugs, such as amphotericin B, flucytosine , fluconazole , or voriconazole , given intravenously or by mouth.
Chronic meningitis due to Cryptococcus neoformans is commonly treated with amphotericin B plus flucytosine or fluconazole. These symptoms can appear in any order. You do not always get all the symptoms. You should get medical advice as soon as possible if you're concerned that you or your child could have meningitis.
Call NHS or your GP surgery for advice if you're not sure if it's anything serious or you think you may have been exposed to someone with meningitis. Meningitis is usually caught from people who carry these viruses or bacteria in their nose or throat but are not ill themselves. It can also be caught from someone with meningitis, but this is less common. People with suspected meningitis will usually have tests in hospital to confirm the diagnosis and check whether the condition is the result of a viral or bacterial infection.
Vaccines can protect against some diseases, such as measles, mumps, chickenpox, and influenza, which can lead to viral meningitis. Make sure you and your child are vaccinated on schedule.
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