麻豆传媒

LOS ANGELES, July 14-Film star Brad Pitt, 41, is resting at home today after a brief hospitalization for treatment of viral meningitis, according to his spokesperson.

The actor, who developed flu-like symptoms a week after returning from a trip to Ethiopia in East Africa, checked in to Cedars Sinai Medical Center on Monday night. After his release Wednesday, his publicist said Pitt was "diagnosed with a mild case of viral meningitis."

Pitt, who has been the subject of endless tabloid headlines since his split with actress Jennifer Aniston earlier this year, traveled to Ethiopia last week with actress Angelina Jolie, his co-star in the movie, "Mr. and Mrs. Smith. " She went there to finalize the adoption of a baby girl. A suspected Jolie-Pitt romance has likewise been a cover story for tabloids.

In April, the Ethiopian Health Ministry reported that at least 40 people had died and 433 had been taken ill with highly infectious meningococcal meningitis there over the past five months. Meningitis outbreaks are frequent during Ethiopia's dry season, which runs from December to May.

Although Pitt visited Ethiopia, it is unlikely that his illness is linked to the meningitis outbreak there because his meningitis is viral, not the bacterial meningococcal meningitis.

Meningitis is most often caused by a bacterial or viral infection, but it can also be caused by a fungal infection, or as a reaction to certain medications or medical treatments. Additionally, meningitis can sometimes develop in patients with chronic inflammatory diseases such as lupus or as the result of trauma to the head or spine.

By all accounts, Pitt's bout with viral meningitis was fairly typical. Meningitis often appears with flu-like symptoms that develop over one to two days, but the hallmark signs of meningitis are sudden fever, severe headache, nausea or vomiting, malaise, photophobia and meningismus.

According to the National Institute of Neurological Disorders and Stroke, viral or aseptic meningitis is the most common form of meningitis in the U.S. In most cases, this mild, non-lethal infection of the meninges is caused by enteroviruses present in mucus, saliva and feces and can be transmitted through direct contact with an infected person, contact with infected respiratory secretions, or by contact with an infected object or surface. Although the incidence of enteroviral infections, including meningitis, increases in the summer months, cases continue to occur throughout the year.

Enteroviruses are the most common cause of viral meningitis, accounting for well over half of all cases. They are a diverse group of RNA viruses including coxsackie viruses A and B, echoviruses, and polioviruses. While enteroviruses are the usual suspects, other viruses including varicella zoster, influenza, HIV, mumps and genital herpes simplex virus can also cause viral meningitis.

Hand washing is the best prevention for this infection because the virus enters the mouth and travels to the brain.

Although many patients with mild viral meningitis are treated at home, those who have a more serious infection may be hospitalized for supportive care. Treatment for mild infections that cause only flu-like symptoms includes fluids, bed rest (preferably in a quiet, dark room), and analgesics for pain and fever.

Additional treatments may include anticonvulsants such as Dilantin (phenytoin) to prevent seizures and corticosteroids to reduce brain inflammation. If inflammation is severe, pain medicine and sedatives may be prescribed to make the patient more comfortable.

Bacterial meningitis is less common than viral meningitis and it is a potentially fatal disease. Usually, bacterial meningitis develops as the result of an upper respiratory infection, but in some cases the bacteria invade the meninges directly. Bacterial meningitis can infect and occlude vessels in the brain causing ischemic stroke and permanent brain damage.

Pneumococcal meningitis, caused by Streptococcus pneumoniae, is the most common form and most serious form of bacterial meningitis, with some 6,000 cases reported annually in the United States. At particular risk are children under age two and adults with a weakened or depressed immune system. Persons who have had pneumococcal meningitis often suffer neurological damage ranging from deafness to severe brain damage.

The highly contagious meningococcal meningitis, which is caused by the bacterium Neisseria meningitides, is common in children ages two to 18, and roughly 2,600 cases are reported each year. An estimated 10% to 15% of cases are fatal and another 10% to 15% are associated with long-term sequelae, including brain damage. High-risk groups include infants under the age of one year, people with suppressed immune systems, travelers to foreign countries where the disease is endemic, and college students (freshmen in particular) who reside in dormitories.

Earlier this year the FDA licensed a meningococcal vaccine for persons ages 11 to 55, and in May the CDC recommended routing immunization with the vaccine for children ages 11 and 12. Many colleges also require proof of vaccination for students living in dormitories.

Haemophilus meningitis is a vaccine success story. At one time this was the most common form of bacterial meningitis, but routine Haemophilus influenzae b vaccination has reduced the number of cases to less than a blip on the CDC's radar screen.

Other forms of bacterial meningitis include Listeria monocytogenes meningitis, which can cross the placental barrier and cause a baby to be stillborn or die shortly after birth; Escherichia coli meningitis, which is most common in elderly adults and newborns and may be transmitted to a baby through the birth canal, and Mycobacterium tuberculosis meningitis, a rare disease that occurs when the bacterium that causes tuberculosis attacks the meninges.

Bacterial meningitis is treated with a variety of antibiotics, including broad-spectrum, intravenous antibiotics as indicated. Additionally, infected sinuses may need to be drained and prednisone may be ordered to relieve brain pressure and swelling.

The clinical distinction between viral and bacterial meningitis can be difficult. Typically, patients can be classified as having probable bacterial meningitis, probable viral meningitis, or indeterminate, based upon the history, physical examination and CSF findings.

Patients with suspected bacterial meningitis (positive gram stain, CSF cell count >1000/mm³ and CSF glucose <40 mg/dL are immediately treated with antibiotics.

Patients with probable viral meningitis (CSF cell count <500/mm³) with >50% lymphocytes, normal CSF glucose and gram stain are usually observed without antibiotic therapy unless they are infants, elderly, or otherwise immunocompromised.

When the diagnosis is indeterminate, the majority of clinicians use empiric antibiotics until culture results are available (24 to 48 hours). If the patient is symptomatically improved, antibiotics are generally discontinued when the culture is negative and the patient is discharged. If symptoms persist or worsen, a repeat lumbar puncture is performed and the differential diagnosis should include fungal and mycobacterial infections.

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