Talk:Meningitis

Attribution

Some text in this article was originally taken from http://www.ninds.nih.gov/disorders/encephalitis_meningitis/detail_encephalitis_meningitis.htm (public domain)

Image of meninges

I have tried to find an extra image to better 'explain' the anatomy we are looking at. Showing the blood vessels and synapses which criss-cross the subarachnoid space, maybe highlight where infection can get in - File:Gray769.png is the best I can find in commons at the moment, but looks a bit 'stale' to me, I was hoping to find something more 3d. Any thoughts -? LeeVJ (talk) 16:29, 9 March 2009 (UTC)

Migraine as cause

"Rarely, migraine may cause meningitis, but this diagnosis is usually only made when other causes have been eliminated.[2]" This is confusing to me since migraine is a name given to a constellation of symptoms, not some well-defined pathophysiology. I'm not sure how migraine can cause meningitis. Xasodfuih (talk) 03:21, 10 March 2009 (UTC)

The source cited says no such thing either; the only time it mentions migraine is in this context: "Migraine may rarely present with fever, symptoms suggestive of meningo-encephalitis, and CSF pleocytosis, but this must be a diagnosis of exclusion." This seems to be a criteria for differential diagnosis. I'm at a loss how this got interpreted as a causal relationship. Xasodfuih (talk) 03:26, 10 March 2009 (UTC)

Ginsberg's article is not specific as to the mechanism, but he lists it is an inflammatory cause of meningitis rather than as a mimic. This entity has been known since the 1980s (PMID 668253, PMID 7635725) and now seems to have attracted the term HaNDL (PMID 9329235; those authors trace it to a 1995 report). One could argue that this is an epiphenomenon to a vasoactive disorder, but the presence of white cells in the CSF is meningitis almost by definition.

At the moment I'm open to persuation, but I think this entity deserves mention. The question is whether to list it as a mimic of meningitis or a rare form. Let me know what you think. JFW | T@lk 09:58, 10 March 2009 (UTC)

I've sent Prof Ginsberg an email. Hopefully he will clarify this. JFW | T@lk 10:09, 10 March 2009 (UTC)

Further to the above, Prof Ginsberg indicates that the distinction is one of semantics. JFW | T@lk 16:46, 10 March 2009 (UTC)

Meningitis is an emergency

Regarding the series of recent edits [2][3][4] etc: evaluation of meningitis is a medical emergency, and reliable sources make this clear. Some sources properly note that viral meningitis may be treated at home - but the evaluation to establish cause is done as an emergency. --Scray (talk) 17:03, 11 March 2009 (UTC)

The editors of this article should read WP:OWN. I'm challenging this absolutist stance that *every* case evaluation is an emergency. If someone has had viral symptoms for 2 weeks and is already recovering when they are seen by their physician, you could even forego the lumbar puncture. No emergency exists. I'm not going to get into a pissing match with everyone here, but using your logic, you could make the argument that any condition is an emergency until evaluated and provides false information to the article's readers.--MartinezMD (talk) 17:42, 11 March 2009 (UTC)

I think you misunderstood my comments, and I wish you'd be slightly more careful before invoking WP:OWN and terms like "pissing match". Rather, disagreements should be resolved on the talk page, which is something we have now finally started doing. I'm with Scray that from the perspective of a layperson reading this article, symptoms suggesting meningitis should be regarded as an emergency. If a clinician then downgrades that on the basis of a careful assessment, then that is his professional responsibility, much like you'd regard a head injury with two subsequent self-terminating seizures as a medical emergency until a clinician has made an assessment.

Could I take this opportunity to request that you find a replacement for the source you added (http://www.ninds.nih.gov/disorders/encephalitis_meningitis/detail_encephalitis_meningitis.htm). This is a non-peer reviewed source that is less than ideal from the perspective of WP:MEDRS. If I find an alternative I will replace it myself. Also, could you get into the habit of using {{cite web}} for online sources? JFW | T@lk 18:53, 11 March 2009 (UTC)

All I did was change "emergency" to the less absolute "can be" because there are some exceptions. The article shouldn't conflict with a correct treatment plan. I do think their is a little protectionism happening when a relatively simple and reasonable revision gets changed back and then it progresses to a full discussion. I do apologize for the "pissing match" comment. I don't want to escalate the arguement.

As for the source, it is an NIH statement. I don't think we're going to see a controlled trial for the non-treatment arm of an illness like this anytime soon. Since this edit isn't acceptable to you, there is no need to even include the reference and you can simply delete it.--MartinezMD (talk) 20:08, 11 March 2009 (UTC)

The NINDS web site is mostly consumer oriented. We had a spat a while back about the way they categorize headaches in one of their articles, which isn't really up to date with today's standards. So, I wouldn't take their word as the ultimate best practice in meningitis either, but it does reflect what most (according my quick and dirty survey) books say. However, a lot of of mediocre sources don't necessarily trump some good ones. Xasodfuih (talk) 20:34, 11 March 2009 (UTC)

I agree with the statement, and I too would discharge someone with mild viral meningitis provided they are stable. I asked you for a source from a journal review (I don't expect a trial, please see WP:MEDRS) or a textbook. Xasodfuih has provided a good reason why NINDS pages are not necessarily good sources for Wikipedia articles. JFW | T@lk 20:39, 11 March 2009 (UTC)

If we're talking about validating viral cases as outpatients, I found what appears to be a good one (150 of 156 managed outpatient), but I'll have to have my hospital librarian pull it so I can review it. Here is the summary and abstract on PubMed: http://www.ncbi.nlm.nih.gov/pubmed/11203412?ordinalpos=9&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum This brings up a larger issue: verifying the sources is more difficult if the article is not available on the web. --MartinezMD (talk) 21:23, 11 March 2009 (UTC)

Please review WP:MEDRS. The source you are suggesting is interesting but not sufficient for this purpose. As for citing papers that are unavailable, this is an issue not limited to the current article; in fact, the vast majority of the sources are not only available online but free as well. JFW | T@lk 22:47, 11 March 2009 (UTC)

Evidence-based medicine has been around 15+ years. I understand well the different strengths and weaknesses of the classes. The problem is that historically there wasn't as much published on negative treatment (which seems to be changing because of criticism of big pharma) or when there is little dilemma (such as this case - if you're not too sick, you can go home). The NINDS statement and this one series are the only good matches I've come across up to now, but I'll look a little more. I'd be curious specifically where you find free full-text journal articles. I find some free online presumably because of their importance, but I often see a charge. I usually have my medical library get it - slower but always free for me.--MartinezMD (talk) 08:18, 12 March 2009 (UTC)

Most books only say explicitly that bacterial meningitis is a medical emergency [5]. But they also say that LP is mandatory, so it's not too far fetched to infer that differential dx is an emergency, although most sources don't quite say that. Xasodfuih (talk) 19:00, 11 March 2009 (UTC)

Xasodfuih is absolutely right on this IMHO, without the differential diagnosis how does one know the cause is bacterial? Or have I missed something here? I know I risk contravening WP:NPOV, but I get called into the laboratory in the middle of the night, as an emergency, to examine CSF to confirm or exclude bacterial aetiology. Graham Colm ^Talk 21:00, 11 March 2009 (UTC)

Excuse me if I'm being obtuse, but can't we simply find a way to say that (clinical) suspicion of meningitis warrants emergency treatment? That seems to be the point of this discussion. What I gather from the sources is that acute bacterial meningitis is the only true medical emergency among the common causes of meningitis (meningitides?), but the high variability in presentation, the rapid progression of meningococcal infection, etc. have led to a common practice whereby all suspected cases of meningitis are (or should be) treated as emergencies. Fvasconcellos (t·c) 15:19, 26 March 2009 (UTC)

Dead baby pictures on the front page

Thanks for that guys :/ Urpunkt (talk) —Preceding undated comment added 02:01, 2 April 2009 (UTC).

Agreed. Completely unnecessary and tactless. Besides, I just ate. ~Pesco^{So say•we all} 02:13, 2 April 2009 (UTC)

Uh, disagree since the baby isn't dead. She became famous for surviving the severe illness. http://www.babycharlotte.co.nz/ --MartinezMD (talk) 02:15, 2 April 2009 (UTC)

Uh, I'm agreeing with the intent of his note, that it's a really unnecessarily graphic image to have automatically pop up on the main page of Wikipedia since it's the featured article. ~Pesco^{So say•we all} 02:46, 2 April 2009 (UTC)

This discussion would be more appropriate on the front page talk page instead of the article talk page.--MartinezMD (talk) 03:33, 2 April 2009 (UTC)

I am not offended by this picture, but I am also not offended by pictures of genitals or murder victims and other potentially offensive things that may appear in several articles, but would NOT be posted on the front page of Wikipedia. That is great if this baby is a famous survivor, but that doesn't change the fact that millions of people view this page everyday, many of them children and some of them might find this a very disturbing image. If people wish to view this image, let them do so by clicking on the article. This picture MUST be removed from the front page, PLEASE. —Preceding unsigned comment added by 99.224.208.60 (talk) 08:17, 2 April 2009 (UTC)

The photo has been removed from the Main Page per a consensus that it isn't appropriate for the Main Page. However, given that the photo was removed from this article due to the mistaken belief that the subject didn't suffer from meningitis, could the photo now be restored here? Cheers, This flag once was red^propaganda_deeds 12:16, 2 April 2009 (UTC)Photo has been restored to this article. This flag once was red^propaganda_deeds 12:21, 2 April 2009 (UTC)

I thought the first picture in the article ( in this case layers of the mininges in the infobox) was the associated image, must of been wrong... L∴V 13:01, 2 April 2009 (UTC)

I'm not sure how it's decided, but for many articles the first image in the infobox might not necessarily be appropriate (i.e. interesting). For example, the first image in Scotland is a fairly boring flag (boring in that it's a simply, two-tone representation of the flag, rather than a dynamic photograph, say). In this case I suspect we've all learned that a boring image may be best! Cheers, This flag once was red^propaganda_deeds 13:07, 2 April 2009 (UTC)

History

"and in 2002 evidence emerged that treatment with steroids could improve the prognosis of bacterial meningitis"

Are we limiting this statement to adults or mortality? It was shown nicely, http://content.nejm.org/cgi/content/abstract/319/15/964, (prospective, double-blinded, controls, 14% vs 1%) 14 years earlier that dexamethasone would reduce hearing loss in children. Any reason first not to mention this study and then not to adjust the history statement in some way? --MartinezMD (talk) 03:15, 2 April 2009 (UTC)

Meningitis vs meningococcal disease

These are two distinct (but related) conditions with distinct symptoms. The dead injured baby on the front page had meningococcal disease NOT meningitis. It's inappropriate and incorrect to use this picture in the article, especially to illustrate it on the front page. --68.111.221.83 (talk) 06:29, 2 April 2009 (UTC)

False argument - Charlotte's website states she had meningitis (as well as meningicoccal septicemia) and as mentioned above, this is not the forum to discuss what's on the front page. --MartinezMD (talk) 10:46, 2 April 2009 (UTC)

She may have had meningitis as well, although her web site does not say that, it says "Meningococcemia" and "Meningocoppal septicemia". The picture does not depict symptoms of meningitis. It's understandably hard to find a picture that would (most symptoms of meningitis are neurological, with the exception of occasional petechial rash.) But it does not make Charlotte's picture less misleading. --Itinerant1 (talk) 18:20, 2 April 2009 (UTC)

Her website says: 'I could hardly understand what she was saying but I managed to get, "Your baby's got meningitis!" ' Unfortunately with the embedded pages there isn't a direct link. In their release letter it doesn't include the results of a lumbar puncture but the CT showed brain injury. Regardless, the original argument was a straw man for not wanting the picture on the front page (which is gone now). --192.77.126.50 (talk) 22:01, 2 April 2009 (UTC)

Petichial rash is not a symptom of meningitis it is from septicaemia. Meningococcal septicaemia causes DIC, which causes the rash and in some cases damage to extremities. Unless you were looking at radiology, a brain at autopsy or maybe the retina there are very few visible signs of meningitis. cyclosarin (talk) 08:38, 3 June 2009 (UTC)

I don't think you're correct. It is possible to have a petechial rash without DIC if there is meningococcal bacteraemia, and bacteria can be demonstrated on biopsy of a lesion. Also, most cases of DIC do not lead to extremity gangrene, which is quite peculiar to meningococcal septicaemia. What source are you basing your statements on? JFW | T@lk 20:59, 3 June 2009 (UTC)

I agree that petechial rash is fairly specific to meningitis syndromes and thus it is reasonably included; however, I don't think the acral necrosis seen in purpura fulminans complicating meningococcemia is a particularly good illustration, because it is clinically indistinguishable from the same syndrome due to pneumococcal sepsis (with or without meningitis). --Scray (talk) 00:41, 4 June 2009 (UTC)

diagnosis delayed in divers

There have been case reports of a delay in the diagnosis and treatment of meningitis in scuba divers due to the similarity in symptoms that can also be present in decompression sickness.

• Beckman TJ, Mullins ME, Matthews MD (1996). "Case report on a diver with type II decompression sickness and viral meningitis". Undersea and Hyperbaric Medicine. 23 (4): 243–5. PMID 8989855. Retrieved 2009-04-02. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
• Davis, M (2002). "The diving doctor's diary: Eosinophilic meningitis presenting as decompression illness". South Pacific Underwater Medicine Society Journal. 32 (4). Retrieved 2009-04-02.

--Gene Hobbs (talk) 17:10, 2 April 2009 (UTC)

This is not mentioned in the major sources employed for this article, and I think the situation is very unusual. At the moment I doubt that we should include it in the article. JFW | T@lk 22:23, 2 April 2009 (UTC)

It is just a variation in the common theme of misdiagnosis. The same could be said for other illnesses.--MartinezMD (talk) 23:18, 2 April 2009 (UTC)

WP is not a medical treatment manual

The article currently says "Meningitis must be treated promptly with antibiotics and sometimes antiviral drugs." Well, yes, that is good medical practice. But WP is an encyclopedia. A statement like that could maybe appear in a section entitled "Treatment of meningitis" but it isn't otherwise encyclopedic in tone. Otherwise the reader simply asks "who says?", "or else what?". What does the "must" mean? Is that a legal admonishment? This is but one example of incorrect tone here - the article reads as if it is advice from a medical treatment book, not an encyclopedia. Paul Beardsell (talk) 16:26, 2 April 2009 (UTC)

If the sources say "must" then we can certainly quote them to that effect.

I'm not sure what you are bothered about. The article generally uses a descriptive tone of the diagnosis and treatment process of meningitis. Anything wrong with that? JFW | T@lk 22:20, 2 April 2009 (UTC)

Images

Here is a nice pathology image of bacterial meningitis on http://wiki.medpedia.com/Meningitis Wondering if we should use it?--Doc James (talk · contribs · email) 03:48, 30 May 2009 (UTC)

No, it's the same pusbrain image that has been discussed before. It has limited added value, has a high gross factor, and has been removed previously by consensus. JFW | T@lk 09:58, 31 May 2009 (UTC)

I got it in hospital

Nosocomial meningitis - http://content.nejm.org/cgi/content/short/362/2/146 - review article. JFW | T@lk 00:11, 14 January 2010 (UTC)

Excellent point. The article should address this topic. -- Scray (talk) 02:58, 14 January 2010 (UTC)

what is the most injury done to a victim of meningitis? —Preceding unsigned comment added by 98.14.193.179 (talk) 00:12, 14 May 2010 (UTC)

Addition

The following content was added. I do not know the source, and I'm not sure how informative it is.

Interleukins-1 and-6 and Tumor necrosis factor-α (TNF-α) are the early phase cytokines for bacterial meningitis. . While these cytokines signal T-cells, B-cells, plasma cells and antibodies that cause inflammation, IL-6 also reduces inflammation by down-regulationg IL-1 and TNF-α. Without IL-6, there is increased pleocytosis and chemokine concentration in the CSF. These cytokines also reset the hypothalamus thermoregulatory center, causing increased body temperature known as a fever, and induce chemokine and complement production. Chemokines then induce the leukocyte recruitment and migration across the endothelium and extracellular matrix and activate the receptors needed for the bacteria to attach to the leukocytes. Additionally they enhance superoxide generation, granule release, and phagocytosis in the CNS.

Opinions invited. JFW | T@lk 18:29, 27 October 2010 (UTC)

Lactate

doi:10.1186/cc9395 - CSF lactate possibly better than any other marker in identifying bacterial meningitis. Systematic review. JFW | T@lk 13:39, 12 January 2011 (UTC)

Eosinophils in yer head

doi:10.1128/CMR.00044-08 - CMR article on eosinophilic meningoencephalitis that may be better than our current sources. JFW | T@lk 22:57, 6 June 2011 (UTC)

Just come across it again. Must read it. JFW | T@lk 08:48, 13 June 2011 (UTC)

Why do I have the urge to say "Brazil represent". Fvasconcellos (t·c) 14:02, 13 June 2011 (UTC)

Meningococcus type A vaccine

GenOrl (talk · contribs) added a paragraph on MenAfriVac, a new vaccine against meningococcus type A. From the edit, I am not entirely clear why it is different from or better than the previous MenA vaccines. The first edit also included a lot of technical detail about the vaccine. I am not averse to discussing the vaccine as long as we can be clear whether it constitutes a major improvement. JFW | T@lk 09:10, 16 August 2011 (UTC)

• Nowadays the page Meningitis doesn't reflect international point of view (just the USA's) and has outdated section on Prophylaxis of Meningitis. There should be section on meningitis vaccines available in the world. I naively added a few words in an innocent paragraph with the old news on MenAfriVac, a new highly efficient vaccine against meningococcus type A designed for low-income African countries. It is already a few years as a common knowledge that the vaccine was developed as an african alternative to currently available and a hundred times more expensive similar vaccine of the anglo-saxon world. The new vaccine passed all needed tests for having been used in mass scale in Africa. To my knowledge nobody has yet compared directly efficacy of all existing in the world vaccines. The only difference with MenAfriVac looks as being used in Africa, as of low cost of production. On numerous occasions the news was covered by WHO, the BBC World Service, as well as in professional magazines. Two times my edits about the vaccine in the article were deleted by JFW. It looks strange for the professional to do. I don’t see that anything on MenAfriVac needs to be discussed. A special article devoted to the preparation. At least in Meningitis, if it pretends to represent international perspective, should be reference to the MenAfriVac vaccine as having been succesfully used in Africa. Why international community shouldn't know new alternatives? I wonder why an innocent paragraph with relevant and trustworthy international information calls for somebody’s permission to be put in. But I was mistaken. It looks as in anglo-saxon world some physicians don't know or shouldn't know about long existence of the efficient MenAfriVac vaccine. Or is it simply and fervently guarding off commercial interests of pharmaceutical companies with their conventional vaccines? GenOrl (talk) 09:54, 16 August 2011 (UTC)

I have added a statement about MenAfriVac, placed somewhat more appropriately in the flow of the article and supported by reliable sources, linked to the main article about that vaccine. I find GenOrl's insinuations above to be unconstructive - and tend to undermine credibility (just isn't helpful to attack other editors). The biggest problem I had with the earlier edit was that it was poorly sourced (news outlets, primarily) and poorly placed in the article. -- Scray (talk) 14:54, 16 August 2011 (UTC)

I think adding the vaccine into the article is appropriate, but the initial edit had a large volume of information that is more suitable for its primary article. This article is about meningitis, not a vaccine (regardless of which one we are talking about) and their discussion should be comparatively brief. Personal attacks have no place here and are unconstructive especially when making assumptions about another editor's motives. MartinezMD (talk) 15:38, 16 August 2011 (UTC)

Thanks Scray for taking the time to clarify this. The sources we now have are reliable medical sources as defined by our consensus guidelines. JFW | T@lk 18:11, 16 August 2011 (UTC)

Review

doi:10.1128/CMR.00070-09 may perhaps be useful to generate some updates. JFW | T@lk 00:27, 11 December 2011 (UTC)

doi:10.1016/S1473-3099(09)70306-8 for kids. JFW | T@lk 00:30, 11 December 2011 (UTC)

References

Fungal meningitis

The following was added by 75.72.192.61 (talk · contribs):

“ Fungal meningitis can occur in persons living with immune deficiencies such as with organ transplantation or HIV/AIDS. The most common fungal meningitis is cryptococcal meningitis due to Cryptococcus neoformans. In Africa, cryptococcal meningitis is the most common cause of meningitis, being more common than all causes of bacterial meningitis combined. Cryptococcal meningitis accounts for 20-25% of AIDS-related deaths in Africa. ”

The first source (doi:10.1186/1471-2334-10-67) is a primary source, while the second one (doi:10.1097/QAD.0b013e328322ffac) seems more suitable for the epidemiology section. It would be a better idea to provide a high-quality secondary source on the clinical aspects of fungal meningitis, and perhaps add a sentence to the "epidemiology" section about crypto. JFW | T@lk 00:11, 12 August 2012 (UTC)

Will see if I can improve upon it.Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:16, 12 August 2012 (UTC)

“ There are a number of risk factors for fungal meningitis including the use of immunosupressents such as with organ transplantation, HIV/AIDS and lose of immunity with aging. It however can still occur in those with a normal immune system. Symptom onset is typically more gradual with headaches and fever being present for at least a couple of weeks before diagnosis. The most common fungal meningitis is cryptococcal meningitis due to Cryptococcus neoformans. In Africa, cryptococcal meningitis is estimated to be the most common cause of meningitis overall where it accounts for 20-25% of AIDS-related deaths in Africa. ”

Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:47, 12 August 2012 (UTC)

References

We already have a number of sources on the subject of cryptococcal meningitis, such as Bicanic, Saag and Sloan. Any chance you could see if we could source more of your additions to those sources rather than introducing even more sources? JFW | T@lk 11:25, 12 August 2012 (UTC)

Bicanic and Saag are getting a little old. Sloan only really addresses treatment. Will take a look. Doc James (talk · contribs · email) (if I write on your page reply on mine) 12:42, 12 August 2012 (UTC)

NICE 2010 guideline

May be of use http://www.nice.org.uk/nicemedia/live/13027/49339/49339.pdf Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:30, 24 September 2012 (UTC)

Theilen et al are two years older, and there's not a lot of difference. JFW | T@lk 19:54, 24 September 2012 (UTC)

Recent news

The following discussion is closed. Please do not modify it. Subsequent comments should be made in a new section.

Does this belong in the article? Specifically Wikipedia is not really a news source.

"====U.S. outbreak==== On October 4, 2012, patients in nearly two dozen states that received steroid shots for back pain may have been infected with fungal meningitis. The shots were given between July and September of 2012 and hundreds to thousands of people could have gotten the shot. As of October 5th, 35 people in six states: Tennessee, Virginia, Maryland, Florida,North Carolina and Indiana have contracted the disease of which five have died, according to the Centers for Disease Control and Prevention. The product was also sent to: California, Connecticut, Georgia, Idaho,Illinois, Michigan, Minnesota, New Hampshire, New Jersey, Nevada, New York, Ohio,Pennsylvania, Rhode Island, South Carolina, Texas, and West Virginia where no cases had been reported. The pharmacy involved in manufacturing the drug is the New England Compounding Center of Framingham, Massachusetts." Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:39, 5 October 2012 (UTC)

Moved more recent news here "In 2012, an outbreak of fungal meningitis occured in the United States.

As of 5 October 2012, 47 cases had been reported in seven states, with five deaths. The outbreak was attributed to fungal contamination of an injectable steroid used to treat back pain. The contamination was reported to have occurred at a compounding pharmacy in Massachusetts that supplied the drug to clinics througout the United States. Because fungal meningitis is slow to develop, more cases are almost certain." Doc James (talk · contribs · email) (if I write on your page reply on mine) 09:43, 6 October 2012 (UTC)

News events are often coalesced and summarized in WP's articles. However, this article isn't about the fungal contamination and we have to avoid undue weight. I think a brief mention (one or two sentences maximum) is appropriate given the unusual and noteworthy(?) occurence. If an article is written about it, we can link to it.MartinezMD (talk) 17:58, 6 October 2012 (UTC)

Interesting, but small beer compared to epidemic bacterial meningitis in West Africa. I think this is a bit of WP:NOTNEWS and WP:RECENTISM. JFW | T@lk 12:08, 10 October 2012 (UTC)

I don't think we had enough consensus as people keep adding it. I went ahead and made a 6 word entry with the link to the WP article. I think this makes for a good compromise.MartinezMD (talk) 04:21, 21 October 2012 (UTC)

I don't think repeated addition of the same piece of news amounts to consensus, especially as the editor who has now added it twice (Frankblaze (talk · contribs)) has almost no other edits. I am extremely hesitant to include current affairs in one country into an article about a medical condition that is of worldwide relevance and claims 100x the number of victims in huge epidemics in Africa.

I will settle for MartinezMD's solution, and have added a source that most closely approximantes WP:MEDRS criteria. JFW | T@lk 09:10, 21 October 2012 (UTC)

I was the first to add this item, and I am hardly a first-time editor. The item has now been added several times independelty: I feel that each such addition represents a !vote in favor of adding this information, as opposed to perhaps two (experienced and dedicated) editors who oppose. WP:NOTNEWS does not preclude this sort of information: please re-read it carefully. WP:MEDRS does not apply to this item: it is about the use of items from the genral press to report scientific studies that have not yet gained scientific consensus, whereas these reference are reporting observed and reported facts: deaths, statements from the CDC, numbers of clinics, FBI raids at the pharamcy, etc. However, I also sympathize with the idea that this information should have an article of its own, and I also understand the sensistivity of our experienced editors, who have seen misinformation from the general press contaminate medically-oriented articels. I will go ahead and add a stub article (2012 fungal meningitis outbreak) that we can hope will allow us to segregate the outbreak from this more syndrome-oriented article. -Arch dude (talk) 14:42, 21 October 2012 (UTC)

Sorry, a more mature artilce already existe: New England Compounding Center meningitis outbreak. I was not up to date. -Arch dude (talk) 14:55, 21 October 2012 (UTC)

We mention this once. But adding significant content on this small issue is simply undue weight. Doc James (talk · contribs · email) (if I write on your page reply on mine) 03:13, 22 October 2012 (UTC)

I'd like to think the simple mention with the link is a balanced solution, and I agree we need to avoid undue weight.MartinezMD (talk) 04:21, 22 October 2012 (UTC)

Given [6] I would think a current events header or box would be appropriate, especially since this is expected to persist for months? Paum89 (talk) 06:44, 25 October 2012 (UTC)

Well, someone reverted the hatnote. http://www.google.com/trends/explore#q=meningitis&date=today%203-m strongly suggests that at least half the people searching are interested in the October outbreak, so I'm going to revert it back in. Perhaps there is evidence that more than half of the people searching aren't looking for the current event. Perhaps there will be discussion here on the subject. Paum89 (talk) 17:49, 25 October 2012 (UTC)

Earthquake does not have a hatnote for the latest earthquake. Election and Presidential election do not try to direct people to any particular election. This is not what hatnotes are for.-gadfium 20:00, 25 October 2012 (UTC)

This has gone back and forth long enough. It is hard for me to understand why there is so much resistance to a mention of the fungal meningitis outbreak. Please keep in mind the many Wikipedia readers that will not be able to find the outbreak article rather than some sort of purest notion about what's appropriate for this article. This article will not be somehow lessened because of a brief referral, or better yet, IMO, a brief discussion of, the fungal outbreak. Gandydancer (talk) 20:28, 25 October 2012 (UTC)

I suspect the large majority of people who search only for the term "Meningitis" want an article on the disease, not an article on the New England outbreak. For me, a Google search for "Meningitis New England" returns the specific Wikipedia article as the fourth hit. It may be higher for people who use google.com, rather than the country-specific version I use. This makes the Google trends link above irrelevant.

I did support the inclusion of a brief mention of the outbreak in the article. I opposed only the inclusion of an unreferenced mention which did not include a link to the detailed article.-gadfium 23:16, 25 October 2012 (UTC)

No, there should not be a hatnote. This is an isolated event that will eventually merge into all other isolated events. It gets newsprint/-bytes coverage because it happened to Yanks (as opposed to Nigerians or Ghanese). Could I recommend a sense of perspective? Would you expect an encyclopedia to reflect current events? No. The article already mentions the event in context with a WP:MEDRS-compatible source, rather than with a hatnote. JFW | T@lk 22:11, 25 October 2012 (UTC)

So you think it is more important to conform the article to what it will look like in the long term than to help the majority of people who are clearly searching for information about the specific outbreak. Why? How is uniformity over the long term more important than serving people who are searching today? If there was an outbreak in Nigeria or Ghana would you want to bury that in the wikipedias serving their languages in the face of multiple times as much search traffic too? Paum89 (talk) 22:17, 25 October 2012 (UTC)

No one is suggesting that the outbreak be buried in a language-specific Wikipedia.

Wikipedia:Systemic bias is relevant to this issue too. Would you be arguing that we should cover 24 deaths in Nigeria with such a hatnote? Note my point above that we do not use hatnotes for specific natural disasters in the articles on eg earthquakes.-gadfium 23:16, 25 October 2012 (UTC)

People who search for that information will hopefully see what the CDC and the New England Journal of Medicine have published. Wikipedia is an enclyclopedia, and every attempt to turn it into a news outlet reflects a misunderstanding of its purpose. When a very large outbreak of bacterial meningitis in West Africa was recently documented, it was added to this article in context, without a noisy hatnote. Using search traffic to determine encyclopedia content has no precedent at all. JFW | T@lk 22:27, 25 October 2012 (UTC)

I see that Google Trends results are cited in several deletion and noticeboard discussions. I suggest that the purpose of an encyclopedia is to help people find information on the subjects for which they search, even when it is a current event. Rejecting a hatnote because you believe it turns an article into a "news outlet" elevates the form of traditional print encyclopedias as superior to improvements which would support the majority of users in accordance with WP:NOTPAPER. I suggest that an RFC would resolve this disagreement. Paum89 (talk) 23:09, 25 October 2012 (UTC)

Yes, searching traffic is frequently used to determine content. I believe that the "hatnote" is helpful and I see nothing wrong with it, but if that is not used because of a policy problem, why the big problem with a few lines on the current outbreak? I know that it is argued here that it is not significant when one looks at the big picture, but it could be argued that it is significant in that it is unique in that it is a rare happening to actually have pumped the pathogen right into the unsuspecting patient. Furthermore, this outbreak is going to have a tremendous effect on drug safety in the US. Gandydancer (talk) 02:11, 26 October 2012 (UTC)

We have one line on the outbreak already. The thing is it is a big world and the US is just one of hundreds of countries.Doc James (talk · contribs · email) (if I write on your page reply on mine) 17:12, 27 October 2012 (UTC)

Hatnote for New England Compounding Center meningitis outbreak?

The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

---

Should the Meningitis article include a hatnote reading:

For the October 2012 U.S. outbreak, see New England Compounding Center meningitis outbreak.

for the duration of the outbreak, considering the relative number of people apparently searching for that article, WP:NOTNEWS, and WP:NOTPAPER? 23:15, 25 October 2012 (UTC)

• Support hatnote, as RFC requester. Paum89 (talk) 23:15, 25 October 2012 (UTC)
• Oppose, not what hatnotes are for, per above section.-gadfium 23:18, 25 October 2012 (UTC)
• Oppose because this is an encyclopedia. -- Scray (talk) 23:59, 25 October 2012 (UTC)
• Support: Let's leave this hatnote in place at least until the outbreak is resolved. Wikipedia is a new kind of resource, not merely an encyclopedia. WP:NOTNEWS, WP:NOTPAPER, and WP:RECENT all include discussions of both sides of this issue. Can we please work together to resolve this instead of taking dogmatic positions? -Arch dude (talk) 00:10, 26 October 2012 (UTC)

I like the spirit of your comment, but my definition of "working together" would not, generally, include unilaterally restoring the subject of an RFC. -- Scray (talk) 00:55, 26 October 2012 (UTC)

I will not restore it again, but I was not the first to reverse this hatnote after this discussion started. Your comment is exactly on point: we need to resolve this here, and not as part of an editwar. Please, let's find a way to perserve the integrity of this article while still catering for the possible 14,000+ US residents who are affected by the ongoing US outbreak, and who are not wikilawyers. -Arch dude (talk) 01:29, 26 October 2012 (UTC)

You do realize you just implicitly called those who disagree with you "wikilawyers"? Still not collaborative. -- Scray (talk) 01:59, 26 October 2012 (UTC)

I apoligize. I did not intend to imply that only those who oppose the hatnote are wikilayers. By comparison to the general public, both sides (this includes me) are wikilawyers. The curios general public do not care about our petty disputes. -Arch dude (talk) 02:35, 26 October 2012 (UTC)

• Support It is of no consequence to have the note for a period of time, a month or two perhaps, then remove it when it is no longer headline news. It will prevent edit warring and allow people looking for the information to find the article.MartinezMD (talk) 02:53, 26 October 2012 (UTC)
• Oppose We are not a news source but an encyclopedia. We already mention it in the article. Does not deserve this amount of undue weight. Most who have this disease are in Africa and there it occurs at rates higher than what we have seen in this "outbreak" but all the time. It just simply does not get news coverage. Just because the news gives completely inappropriate weight to health care issues does not mean we should. We do not even generally allow popular press stories as references as the popular press most of the time gets health care completely or mostly or at least dangerously wrong. Doc James (talk · contribs · email) (if I write on your page reply on mine) 06:22, 26 October 2012 (UTC)
• Oppose. Perhaps we need a project-wide tool to link news articles from the relevant Wikipedia articles, but on the whole a hatnote is inappropriate for this. I have provided further views in the previous section on this talkpage. JFW | T@lk 09:50, 26 October 2012 (UTC)

  I like this suggestion - people clearly get WP hits when searching for current news items, and the results could be region-specific (folks in the US are clearly more interested in this outbreak than people elsewhere) but that's an issue for WP as a whole, not the article editors. -- Scray (talk) 10:23, 26 October 2012 (UTC)

  Does Wikinews have an article on this outbreak? Maybe it is time we promote Wikinews to people who are looking for recent news? We could link it at the bottom. Doc James (talk · contribs · email) (if I write on your page reply on mine) 15:13, 26 October 2012 (UTC)

Sort of, but its in pretty bad shape: n:Meningitis outbreak spreads around several U.S. states. I understand that Africa gets many more cases, but it just seems more fair to the 6,000+ people per day looking for the obvious sub-article. It would probably save them half a minute, for those who don't give up before then. What harm is there in that? Paum89 (talk) 18:04, 26 October 2012 (UTC)

Maybe people / our readers will actually spend some time and learn something about meningitis and specifically about where meningitis is actually common. We might help balance the sensational media outburst and put in place a more global perspective. In fact this is one of the reason I write for Wikipedia. Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:50, 26 October 2012 (UTC)

• Oppose Absolutely not what a hatnote is for. Looking at the Google trend, there is no reason to assume that the people who have been searching for 'meningitis' recently meant to find the New England Compounding Center meningitis outbreak instead, in fact it would make perfect sense to think those who had already found the information they were looking for about the NECC (either here or elsewhere) were then doing a follow-up search on 'meningitis' to find out more general information about it. Zad68 17:49, 26 October 2012 (UTC)

The Google Trends results very closely mirror the article views. Do you have an alternative explanation for the recent excess interest? Compare to the many fewer readers who eventually find the specific article. That clearly indicates that about 4,000 people per day are not finding what they are looking for here because the link to it is buried -- about three people every minute. Paum89 (talk) 18:04, 26 October 2012 (UTC)

I agree with Zad. We are providing back ground info for people who see the media and want a balanced overview. Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:53, 26 October 2012 (UTC)

I also agree that it's people looking for background information about meningitis; not about the specifics of the particular outbreak in the US. Compare [7]. It would also be giving undue weight to what happens in the US. IRWolfie- (talk) 08:27, 27 October 2012 (UTC)

Are you suggesting that the spike in people searching for meningitis information aren't looking for information on the outbreak, a spike in searches for which occurred at the exact same time? Paum89 (talk) 18:09, 27 October 2012 (UTC)

• Paum89, again, the issue is that the use of the hatnote being proposed is specifically described as something we are not to use hatnotes for. You need to read WP:HATNOTE. Hatnotes are a tool for disambiguation, meaning they are to be used where there is one term that has multiple significantly different meanings. They are NOT a tool to use in one article to "advertise" another. It is reasonable to think that someone who heard about a historian with a name that sounded like "Andrei Sakharov" and did a search on that and ended up at Andrei Sakharov the physicist would appreciate the hatnote pointing to Andrey Nikolayevich Sakharov the historian. It is not reasonable to think that someone typing in "Meningitis" and ending up at Meningitis would be surprised to find that he is NOT reading an article about the New England Compounding Center meningitis outbreak. Google hit counts are actually entirely irrelevant (in spite of this, the answer to your question is, Yes, I fully expect people pulling up Meningitis expect to read about the disease, possibly as a result of hearing about the result of the outbreak somewhere else). Zad68 01:32, 28 October 2012 (UTC)

Which part of WP:HATNOTE do you want me to read? The first paragraph says, "Hatnotes help readers locate a different article they might be seeking. Readers may have arrived at the article ... because the sought article uses a more specific ... title.... Hatnotes provide links to the possibly sought article...." That's exactly what we need to help 4,000 readers per day who are looking for the article on the outbreak but do not find it. Apparently the fact that the outbreak is in the U.S. means we would be biased to help those 4,000 people per day? I don't understand this reasoning at all. Aren't the majority of enwiki readers in the U.S. to begin with? Perhaps we have a greater duty to keep it completely neutral for Africans who suffer more cases but don't read English? Paum89 (talk) 04:46, 28 October 2012 (UTC)

You need to pay attention to the over 100 uses of the word DISAMBIGUATE in various forms on that page, all of which you managed to carefully step around in your quote from it. Zad68 04:53, 28 October 2012 (UTC)

So, since most current users that type "meningitis" are really looking for the current outbreak, then the term "meningitis" does not really apply exclusively to the syndrome described in this article. Therefore by your definition we should create an article named "meningitis (disamgiguation)" that points to this article and to the outbreak article. I can do this, If you want. -Arch dude (talk) 01:58, 28 October 2012 (UTC)

There is no consensus for the hat note and their is no consensus for the disambig. Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:52, 28 October 2012 (UTC)

No, and that's not what I said. Zad68 03:33, 28 October 2012 (UTC)

• Support This is not my first choice; it should be briefly mentioned (by name) in the article. This information would not be found in a medical textbook in the meningitis section because it is more of a medication error than something directly related to meningitis. The editors of this article see this incident as a minor bump in the road not worthy of even a mention, and from a medical point of view, I agree with them. On the other hand, you can be certain that it will be included in future pharmacology textbooks because it is almost certain that compounding is going to see increased regulation due to information released related to this incident. But Wikipedia is not a medical or pharmacology textbook. We can have all the information that people want to read, but if they can't find it it is a waste of my editing time. That is one of the reasons that many of the articles that I have worked on had long arguments about how to list the article's name. We want to help readers find articles, not hide them. Right now I have no doubt that many readers are looking for the NECC article, not finding it, and assuming that no article exists. Gandydancer (talk) 15:27, 28 October 2012 (UTC)

• Gandy, I'm sorry, but you seem to be admitting your desire to see this hatnote added is not in line with its purpose, and instead you'd like to see it used as advertising to increase page-hits and drive more eyeballs to an article you've worked on. Guessing what the future impact this incident will have regarding regulation runs directly afoul of WP:CRYSTAL (which is part of policy). You're probably right, but we don't edit Wikipedia based on what we guess is going to happen, we edit it based on what has already been reported in reliable secondary sources. If and when major regulatory changes occur, we'll update Wikipedia at that time. If you're finding you're having a hard time driving readers to articles you've worked on, the solution isn't to cross-advertise your work against the WP:RULES, the solution is to work on articles that cover core encyclopedic topics. No disrespect meant to your work on it, but I think New England Compounding Center meningitis outbreak is not really the kind of topic Wikipedia should have articles on (at least not yet), and if it were up for AFD I wouldn't fight to keep it per WP:NOTNEWS. Zad68 16:54, 28 October 2012 (UTC)

I choose to ignore your attempts to dramatize this discussion by suggesting I'm trying to advertise the articles that I work on. That said, certainly you are welcome to your thoughts on what does and what does not constitute information that our readers should find here, as are all editors. But I hope that we can keep the discussion more civil in the future.Gandydancer (talk) 18:44, 28 October 2012 (UTC)

I apologize if my comment came across as uncivil, it wasn't meant to be. I guess we can agree to disagree on what constitutes proper use of the hatnote, and we'll both see how this RFC closes eventually. Cheers. Zad68 19:03, 28 October 2012 (UTC)

• Comment Are there any example of anywhere else on Wikipedia that this sort of thing is done? When there was a Cholera outbreak in Haiti did we add a hatnote to the article about the event? When the tsunami hit Indonesia did we add a hatnote to the article about the event? Did we add hatnotes from nuclear reactor, radiation, and nuclear power to the explosion in Japan? This sort of precedent probably cannot be decided here and will need to go to the policy pages. Doc James (talk · contribs · email) (if I write on your page reply on mine) 17:53, 28 October 2012 (UTC)

I realize you are being sarcastic, but... Yes, I worked on the Haiti article. We added the info in the article with a referral to the cholera outbreak. Same thing for the other articles you bring up. However, there may be one article that is somewhat similar, and that is the listeria article. There was a problem because most of the news sources were calling the recent outbreak listeria rather than listeriosis, so we added a hatnote. As I have already said, if a mention of this fungal outbreak were in the article we would not be faced with this hatnote argument. BTW, in the Haiti article it was argued that the cholera outbreak was not related to the hurricaine and must not get any copy also. They gave in, but it does not look like that will happen here. Gandydancer (talk) 18:30, 28 October 2012 (UTC)

No I am not being sarcastic and was unaware that you worked on the Haiti article. The work you do from my experience is excellent. We do link to the outbreak in this section Meningitis#Fungal through medication contamination. This could potentially be better worded. The article could use a section on "Society and culture" with which this local outbreak could be mentioned. I guess it could be mentioned under epidemiology but is a little small 250 verses 250,000 cases. We often link from the organism that causes a disease to the article about the disease. I do not see that as the same as what is proposed in this case. Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:48, 28 October 2012 (UTC)

Thanks for the compliment--I had a good teacher (you). :-). Looking at Jfd's post below, the article he refers to has a "Notable outbreaks" section. Do you think that would work? Gandydancer (talk) 22:37, 30 October 2012 (UTC)

The reason that we need a link from this article rather than from the organism article is very simple: readers are searching using the term "meningitis," not Exserohilum rostratum. (Incidentally, the current case count is now above 350 and is contionuing to grow at about ten new reported cases per day.) The practical problem we are trying to solve is how to allow these people to find the article on the outbreak. I really do not care what solution we use, but the current situation is not meeting the needs of our readers. I think a simple one-sentence description in the "fungal meningitis" section would suffice, but this was rejected. The current "medical contamination" link is far too obscure. A hatnote will also work. I feel that "Society and culture" section is not so good: sections of that sort tend to attract clutter, and this is an excellent article. -Arch dude (talk) 21:55, 29 October 2012 (UTC)

Please be bold enough to do it. If those who fight for tradition against the users revert it, then we can discuss it further. Otherwise it will stand. Paum89 (talk) 05:08, 30 October 2012 (UTC)

Not quite. We're past the BOLD, revert, discuss stage. There is no consensus for the change that you are suggesting. When there was a huge European outbreak of hemolytic-uremic syndrome (similar scale) due to bean sprouts contaminated with E. coli, the main article didn't have a noisy hatnote directing people to the relevant subarticle. There is really no precedent here. JFW | T@lk 21:21, 30 October 2012 (UTC)

Your example article has a short paragraph discussing that outbreak. That's exactly what I think would be appropriate here. I am not particularly in favor of a hatnote. -Arch dude (talk) 23:07, 30 October 2012 (UTC)

Also note that the German article on hemolytic-uremic syndrome has a slightly longer paragraph and a link to an article on the outbreak itself, exactly as you might suspect for an outbreak with extensive coverage in the German press. -Arch dude (talk) 23:13, 30 October 2012 (UTC)

Perhaps, but hemolytic-uremic syndrome is rare. Meningitis is more common, particularly in areas where there are epidemics (West Africa comes to mind). However awful fungal meningitis caused by contaminated medications is, this is not - in my opinion - in need of any more coverage than we are giving it now. JFW | T@lk 23:22, 30 October 2012 (UTC)

Please see WP:N. Notability is not relative. By your reasoning, we should not mention the Falklands war in an article about warfare in the 20th century. Our little outbreak very clearly meets all of the criteria for notability of an event: please see WP:EVENT-Arch dude (talk) 23:31, 30 October 2012 (UTC)

• Oppose - not what hatnotes are for. WP:NOTNEWS Vacation⁹ 02:33, 8 November 2012 (UTC)
• Oppose. I was randomly called by the RFCbot to comment on this issue. I have no previous experience with this article. There should definitely be a link to the event somewhere in the article, but a hatnote is not the right way to do it. Instead, it should be under "History" or another section. In fact, I'm surprised that there isn't a subhead about notable outbreaks. — Preceding unsigned comment added by Andrewman327 (talk • contribs) 23:29, 10 November 2012 (UTC)
  • That's because there's been too many. A subarticle might be appropriate if we wished to catalogue each epidemic. JFW | T@lk 22:03, 12 November 2012 (UTC)
• Oppose. Wikipedia is encyclopedia, not a billboard for latest news nor a search engine. Hatnotes have specific formats and purposes. People can invent many different reasons for various things to be of utmost importance to be put on top of something else. The basic article structure is a matter of community consensus. Staszek Lem (talk) 20:26, 12 November 2012 (UTC)

References

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

Inexpensive Diagnosis?

Every doctor I've talked to says you have to go to a hospital to get a spinal tap if you have meningitis symptoms. The hospital says it's a 3 night stay after a spinal tap because of various concerns. That sounds like certain bankruptcy to me.

How is that not relevant to the diagnosis discussion? POV editors are wrecking people's lives by sending them into bankruptcy, where they can lose a home and job. — Preceding unsigned comment added by 108.18.250.35 (talk • contribs)

You might want to step off your WP:SOAPBOX here. -- O.Koslowski (talk) 15:03, 9 November 2012 (UTC)

The only soapbox here is hospitals trying to take money from people. — Preceding unsigned comment added by 108.18.250.35 (talk) 15:06, 9 November 2012 (UTC)

Hi, 108.18.250.35, what you are saying might be true, but the sources you are providing do not meet Wikipedia's criteria for sourcing. Please see WP:RS and WP:MEDRS. Also, it is questionable that this sort of content goes into this article. This article is really about the disease. The costs you are talking about might only be relevant to one country, like the USA. We try to avoid having such country-specific socio-economic problems in a general article about a disease with worldwide scope. Thanks... Zad68 15:09, 9 November 2012 (UTC)

By your rather odd reasoning, such a warning could be put into virtually every article concerning diseases. Diagnostic and therapeutical services tend to cost money, which isn't really an inssue in parts of the world with health insurance. What you want to insert into the article has little do with Meningitis. -- O.Koslowski (talk) 15:09, 9 November 2012 (UTC)

So your main point is that in a country with socialized insurance, the taxpayer picks up the $20,000 bill. That doesn't make it any less costly. The point is that doctors get concerned when they see meningitis symptoms, and they send people into very expensive diagnoses because of it, and usually the result is benign or negative anyway. — Preceding unsigned comment added by 108.18.250.35 (talk) 15:12, 9 November 2012 (UTC)

The test doesn't cost anything near $20,000. A figure for which you don't even bother to cite reference. Did you bother to read WP:SOAPBOX? -- O.Koslowski (talk) 15:16, 9 November 2012 (UTC)

O.Koslowski, a little less bite-y please...

You would need to provide excellent, high-quality sources stating exactly what you are saying, without having a need to interpret it or make any assumptions, to include the material in this article. Zad68 15:17, 9 November 2012 (UTC)

I called my hospital. 3-night stay required. Must keep patient on antibiotics and monitoring. What, you expect the hospital to write this in an advertisement? — Preceding unsigned comment added by 108.18.250.35 (talk) 15:19, 9 November 2012 (UTC)

If the article cannot demonstrate that diagnosis is a simple office procedure, then it is ominously incomplete. Evidence of POV trolling by hospital fans.

I am sorry, but phone calls are not reliable sources. -- O.Koslowski (talk) 15:22, 9 November 2012 (UTC)

If you are being personally affected by meningitis, or someone in your family is, I'm really very sorry to hear that. It's a very serious illness. However, Wikipedia has its own standards for sourcing claims made in articles. Your phone call to a hospital is called "original research" (see WP:OR) and it can't be used on Wikipedia. Please assume good faith of your fellow editors. There are perfectly good Wikipedia policy-based reasons for our concerns about your proposed edits other than the idea that we are engaging in "POV trolling by hospital fans." Zad68 15:26, 9 November 2012 (UTC)

It CAN be serious, yes. But an ordinary flu can swell the meninges. If you go to the doctor, he might panic and send you to the hospital. It's only a matter of time before a journalist will call a hospital and posit as having meningites symptoms, and realize that the hospitals DO tend to want to monitor/treat people suspected of having meningitis, for multiple days. Even when it turns out it's just a flu. Think of how many people get the flu, and that's a lot of money the hospitals can make. — Preceding unsigned comment added by 108.18.250.35 (talk) 15:33, 9 November 2012 (UTC)

Meningits is serious. If untreated, it is almost always fatal. If a patient presents with symptoms that suggest that he or she may be infected, it would be reckless not to rule it out, especially considering the incidence. It is not a money-making scheme devised by hospitals. O.Koslowski (talk) 15:39, 9 November 2012 (UTC)

Let's not forget the purpose of the article talk page-- discussion of suggested improvements to the article. Zad68 15:47, 9 November 2012 (UTC)

• Just for balance, this and this are examples of widespread practice - it's a relatively simple procedure, generally - and our article does not need to be amended in the manner suggested above. -- Scray (talk) 01:11, 10 November 2012 (UTC)

If you're sick enough to have meningitis in the differential diagnosis, then consider the alternative of going to hospital. I cannot confirm that for suspected meningitis a 3-day stay is required. Many will advise a period of bed rest after a lumbar puncture (in the absence of decent evidence), but the sample can be processed within hours and if otherwise well the owner of said CSF can be discharged home if no abnormalities are detected. Lumbar punctures for other indications (e.g. in the diagnosis of MS) are often performed on a day case basis. JFW | T@lk 22:03, 12 November 2012 (UTC)

Gross pathology image available

"Tuberculous leptomeningitis
The leptomeninges overlying the brainstem and cerebellum are markedly thickened by inflammatory exudate. Greatest severity in this location is typical of tuberculous leptomeningitis."

This image is available for use in the article. — Preceding unsigned comment added by CFCF (talk • contribs)

We've previously had a similar image, and I didn't find it massively useful for general viewing when taking into account the gross/yuk factor. JFW | T@lk 17:25, 12 February 2014 (UTC)

Drug-induced meningitis

doi:10.1001/jamainternmed.2014.2918 - updated systematic review. JFW | T@lk 06:34, 8 July 2014 (UTC)

Childhood TBM

Meta-analysis of treatment outcomes and prognosis: has to be integrated doi:10.1016/S1473-3099(14)70852-7 JFW | T@lk 22:21, 27 September 2014 (UTC)

 Done Added. JFW | T@lk 05:18, 28 September 2014 (UTC)

Inclusion of evidence regarding Fluid therapy for acute bacterial meningites

Fluid therapy is an important component of management of acute bacterial meningites.An updated Cochrane Systematic review is available in 2014 regarding the evidence available for it http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004786.pub4/abstract . I am an author of this review and hence would not like to edit this article in Wikipedia. (Drsoumyadeepb (talk) 15:27, 7 October 2014 (UTC))

Hello Droumyadeepb, thanks for flagging up this review. The DOI (for my reference) is doi:10.1002/14651858.CD004786.pub4. The article requires some updates, e.g. with regards to drug-induced meningitis, so I will aim to incorporate the Cochrane review at the same time. JFW | T@lk 19:53, 7 October 2014 (UTC)

Hello JFWGreat; Looking forward to the edits.(Drsoumyadeepb (talk) 06:13, 10 October 2014 (UTC))

UK guideline

doi:10.1016/j.jinf.2016.01.007 - the UK specialist societies guideline, which will update the now rather outdated guideline.

The IDSA (http://www.idsociety.org/Organ_System/) is also working on an update. JFW | T@lk 06:32, 2 March 2016 (UTC)

Urgency

It strikes me that the present wording of the article does not sufficiently convey to the reader the urgency of rapid treatment. By contrast this CDC ref makes it clear in the second sentence: "Death can occur in as little as a few hours." and reinforces it later with "Later symptoms of bacterial meningitis can be very serious (e.g., seizures, coma). For this reason, anyone who thinks they may have meningitis should see a doctor as soon as possible" (emphasis in original). In light of thisrecent news we should be conscious that readers need to understand that delay is dangerous, and reflect that in the article. LeadSongDog come howl! 15:23, 27 April 2016 (UTC)

seems reasonable to me--Ozzie10aaaa (talk) 21:52, 27 April 2016 (UTC)

Moi aussi. PermStrump(talk) 02:24, 28 April 2016 (UTC)

I am opposed to "anyone who thinks they may have meningitis should see a doctor as soon as possible", as it violates the principle that Wikipedia does not give medical advice. It should be sufficient to say that meningitis is a very serious condition for which rapid treatment is essential. Looie496 (talk) 15:05, 28 April 2016 (UTC)

I am with User:Looie496 on this one. We already say in the lead "The first treatment in acute meningitis consists of promptly giving antibiotics and sometimes antiviral drugs.[2][6] ... Meningitis can lead to serious long-term consequences such as deafness, epilepsy,hydrocephalus, or cognitive deficits, especially if not treated quickly.[1][3]" This makes it perfectly clear the importance of early treatment. Nothing more is needed. Doc James (talk · contribs · email) 18:40, 28 April 2016 (UTC)

You perhaps have a higher opinion than of the minimum reader than do I, but then, IANAD. That statement on treatment is at the end of the third para. Only in the second para does mention of "life-threatening" and "medical emergency" appear. But by the time google previews the article, however, it is reduce to just 23 words:

"Meningitis is an acute inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges. The most common"

That really doesn't do the job. The most important thing to the concerned reader isn't the cause or the affected part, it's that this often kills, sometimes quickly. Whether one defines "often" as ~2% for all-types or ~15% for bacterial is secondary. The article has, I think, buried the lede. LeadSongDog come howl! 16:44, 29 April 2016 (UTC)

While giving direct advice is a problem per WP:MEDICAL, I'd support changing the opening to something that drive the point sharper and earlier, like "Meningitis is a fast-moving and potentially life-threatening inflammation of the protective membranes covering the brain and spinal cord..." if the sources support that kind of wording and emphasis. Zad68 16:56, 29 April 2016 (UTC)