MENINGITIS: CHALLENGES, ADVANCEMENTS AND THE ROAD AHEAD FOR HOSPITALS

Meningitis is not just a medical condition - it is a test of a hospital's systems, discipline, and culture of safety.

- By Dr. Ganesh Veerabhadraiah, Head and Senior Consultant Neurosurgeon, Kauvery Hospital, Electronic City

Let me draw your attention to three different cases of meningitis and their outcomes.

A 26-year-old gentleman came to us after a road accident. He had a skull base fracture and a persistent watery discharge from the nose - CSF rhinorrhea. Unfortunately, this was neglected for almost ten days. By the time he arrived at our emergency, he had high fever, vomiting, and neck stiffness.

Cultures showed Klebsiella pneumoniae. Despite our best efforts - antibiotics, prolonged ICU stay, multiple external ventricular drains (EVDs), he developed ventriculitis. He survived, but not unscarred. During the follow-up, he had severe ataxia, memory loss, and personality changes. What strikes me is how avoidable this was. If the CSF leak had been repaired early, this young man might have walked away with his quality of life intact.

A few years ago, a 28-year-old man with worsening vision underwent endoscopic pituitary adenoma surgery. The tumour came out well, but there was an intraoperative CSF leak, which we sealed. Three days later, clear nasal discharge reappeared. Despite a lumbar drain and reinforced sealing, he developed meningitis with multidrug-resistant Acinetobacter. Even bilateral EVDs and intraventricular antibiotics couldn't stop the relentless infection. His brain filled with puss, and he slipped into coma. He had to undergo months of rehabilitation to once again to stand on his feet.

This case still haunts me. It is a reminder that in neurosurgery, CSF leaks are unforgiving. And it underscores how antimicrobial resistance can turn the most advanced ICUs into powerless bystanders.

Then I would like to mention about a third case. A 75-year-old woman, known diabetic with sugars > 300 mg/dl, arrived with altered sensorium, high fever, and neck stiffness. Her GCS was dangerously low. We intubated her immediately.