About Drugs That Cause Meningitis Symptoms

Meningitis, inflammation of the tissues surrounding the brain, can be caused by bacteria, parasites, viruses and fungi, along with certain medications. While drug-induced aseptic meningitis can nearly always be resolved quickly with no long term complications, it is important to rule out a bacterial or infectious cause first. Symptoms of meningitis of any etiology should not be ignored, as the brain can be affected if the swelling persists.

History

• While the symptoms of meningitis were first described by Persian physician Avicenna in 1020, the recognition that it was in fact a communicable disease did not come until 1805, when there was an outbreak in Geneva, Switzerland. However, drug-induced aseptic meningitis is not recognized in the medical literature prior to about 1980. While it is not known how many cases of meningitis are the result of medications, it is thought to be a rare side effect. Brain scans and more effective laboratory tests have helped differentiate drug-induced meningitis from other forms of aseptic meningitis.

Types

• Meningitis is most often caused by an infection, (viral, bacterial or even fungal), but some drugs can also produce symptoms. These include:
  Antibiotics--ciprofloxacin/Trimethoprim sulfamethoxazole/ amoxicillin/metronidazole/penicillin/cephaleixn
  Immune system--OKT-3 monoclonal antibody/immunogobulin/azathioprine
  Anti-convulsive--carbamazepine
  NSAID--ibuprofen/tolmentin/sulindac/naproxen
  Antituberculous--isoniazid
  Intrathecal (drugs injected into the spine)--methotrexate/cystine arabinoside
  Uricosuric (drugs that eliminate excess uric acid)--allopurinol
  Vaccines--hepatitis B/mumps
  Anti-heartburn/GERD--ranitidine
  Other noninfectious causes of meningitis include underlying conditions such as sarcoidosis, lupus, and central nervous system vasculitis. Recurrent migraines and post infection syndromes can also cause meningitis.

Effects

• "Meningitis" means "inflammation of the meninges," which are the tissues that line the brain and spinal column. Symptoms are generally headache, fever, rash and stiff neck, but may also include nausea and vomiting. A spinal tap will usually reveal a high white blood cell count in the spinal fluid.

Considerations

• If meningitis is suspected, the treating physician must be sure that there is no infectious cause before altering the patient's medications. Bacterial meningitis has a high mortality rate and must be treated immediately. In fact, if bacterial meningitis is even a possibility, it is recommended that the patient be given an antibiotic classed as a third generation cephalosporin.
  Normally, another drug in the same category can be substituted for the one that is causing the symptoms, though it is thought that drug hypersensitivity plays a role in drug-induced meningitis, so replacements must be chosen carefully and the patient monitored. If it is determined that a vaccine has caused meningitis, the symptoms should be transient. Treatment consists of fluids, pain-relievers and anti-nausea drugs if necessary. If inflammation is severe, the patient may be given glucocorticoids to relieve swelling.

Prevention/Solution

• The symptoms of meningitis, particularly a persistent headache with stiff neck, should not be ignored under any circumstances, nor should the patient simply stop taking what he suspects to be the offending medication. Only a doctor can determine what specifically is causing the meningitis. If it is drug-induced meningitis, the physician must decide which drug should be substituted for the one that is causing the symptoms. Once an appropriate replacement drug is found, the symptoms should disappear completely.