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97-501: Emperor Taishō was the first Emperor of Japan to be buried in Tokyo. He has been called the first "Tokyo Emperor" because he was the first to live his entire life in or near Tokyo. His father, Emperor Meiji , was born and reared in Kyoto; and although he later lived and died in Tokyo, his mausoleum is located on the outskirts of Kyoto, near the tombs of his Imperial forebears. It is under

194-438: A post mortem are usually a widespread inflammation of the pia mater and arachnoid layers of the meninges. Neutrophil granulocytes tend to have migrated to the cerebrospinal fluid and the base of the brain, along with cranial nerves and the spinal cord , may be surrounded with pus  – as may the meningeal vessels. For some causes of meningitis, protection can be provided in the long term through vaccination , or in

291-537: A CSF leak. Meningitis is potentially life-threatening and has a high mortality rate if untreated; delay in treatment has been associated with a poorer outcome. Thus, treatment with wide-spectrum antibiotics should not be delayed while confirmatory tests are being conducted. If meningococcal disease is suspected in primary care, guidelines recommend that benzylpenicillin be administered before transfer to hospital. Intravenous fluids should be administered if hypotension (low blood pressure) or shock are present. It

388-427: A cause of meningitis in young children in those countries. In the countries in which the disease burden is highest, however, the vaccine is still too expensive. Similarly, immunization against mumps has led to a sharp fall in the number of cases of mumps meningitis, which prior to vaccination occurred in 15% of all cases of mumps. Meningococcus vaccines exist against groups A, B, C, W135 and Y. In countries where

485-555: A couple of weeks before diagnosis. The most common fungal meningitis is cryptococcal meningitis due to Cryptococcus neoformans . In Africa, cryptococcal meningitis is now the most common cause of meningitis in multiple studies, and it accounts for 20–25% of AIDS-related deaths in Africa. Other less common pathogenic fungi which can cause meningitis include: Coccidioides immitis , Histoplasma capsulatum , Blastomyces dermatitidis , and Candida species. A parasitic worm

582-400: A different role in children than in adults. Though the benefit of corticosteroids has been demonstrated in adults as well as in children from high-income countries, their use in children from low-income countries is not supported by the evidence; the reason for this discrepancy is not clear. Even in high-income countries, the benefit of corticosteroids is only seen when they are given prior to

679-412: A glass is rolled over it) may also be present. The inflammation may be caused by infection with viruses , bacteria , fungi or parasites . Non-infectious causes include malignancy ( cancer ), subarachnoid hemorrhage , chronic inflammatory disease ( sarcoidosis ) and certain drugs . Meningitis can be life-threatening because of the inflammation's proximity to the brain and spinal cord; therefore,

776-402: A group of bacteria that includes Treponema pallidum (the cause of syphilis ) and Borrelia burgdorferi (known for causing Lyme disease ), and may also result from cerebral malaria (malaria infecting the brain). The types of bacteria that cause bacterial meningitis vary according to the infected individual's age group. A head injury potentially allows nasal cavity bacteria to enter

873-555: A higher likelihood of bacterial meningitis, as does a higher white blood cell count. If lactate levels are less than 35 mg/dl and the person has not previously received antibiotics then this may rule out bacterial meningitis. Various other specialized tests may be used to distinguish between different types of meningitis. A latex agglutination test may be positive in meningitis caused by Streptococcus pneumoniae , Neisseria meningitidis , Haemophilus influenzae , Escherichia coli and group B streptococci ; its routine use

970-435: A later stage to assess for complications of meningitis. In severe forms of meningitis, monitoring of blood electrolytes may be important; for example, hyponatremia is common in bacterial meningitis. The cause of hyponatremia, however, is controversial and may include dehydration, the inappropriate secretion of the antidiuretic hormone (SIADH), or overly aggressive intravenous fluid administration . A lumbar puncture

1067-537: A limited role in politics and undertook no official duties from 1919. His declining health led to appointment of his eldest son, Crown Prince Hirohito , as regent in 1921, and Hirohito succeeded him as emperor when he died in 1926. Prince Yoshihito was born at the Tōgū Palace in Akasaka, Tokyo to Emperor Meiji and Yanagiwara Naruko , a concubine with the official title of gon-no-tenji (imperial concubine). As

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1164-526: A matter of common knowledge. The two-party political system that had been developing in Japan since the turn of the century came of age after World War I , giving rise to the nickname for the period, " Taishō Democracy ", prompting a shift in political power to the Imperial Diet of Japan and the democratic parties . After 1918, the emperor no longer was able to attend Army or Navy maneuvers, appear at

1261-589: A particular place and population. For instance, in the United Kingdom, empirical treatment consists of a third-generation cefalosporin such as cefotaxime or ceftriaxone . In the US, where resistance to cefalosporins is increasingly found in streptococci, addition of vancomycin to the initial treatment is recommended. Chloramphenicol , either alone or in combination with ampicillin , however, appears to work equally well. Empirical therapy may be chosen on

1358-584: A person has meningitis. The jolt accentuation test is not specific or sensitive enough to completely rule out meningitis. If someone is suspected of having meningitis, blood tests are performed for markers of inflammation (e.g. C-reactive protein , complete blood count ), as well as blood cultures . If a CT or MRI is required before LP, or if LP proves difficult, professional guidelines suggest that antibiotics should be administered first to prevent delay in treatment, especially if this may be longer than 30 minutes. Often, CT or MRI scans are performed at

1455-441: A person with meningitis has been. Viral meningitis is typically caused by enteroviruses , and is most commonly spread through fecal contamination. The risk of infection can be decreased by changing the behavior that led to transmission. Since the 1980s, many countries have included immunization against Haemophilus influenzae type B in their routine childhood vaccination schemes. This has practically eliminated this pathogen as

1552-437: A temporary or long-term drainage device, such as a cerebral shunt . The osmotic therapy, glycerol , has an unclear effect on mortality but may decrease hearing problems. Empiric antibiotics (treatment without exact diagnosis) should be started immediately, even before the results of the lumbar puncture and CSF analysis are known. The choice of initial treatment depends largely on the kind of bacteria that cause meningitis in

1649-454: A type of meningoencephalitis where not only the meninges are affected but also the brain tissue . Meningitis may occur as the result of several non-infectious causes: spread of cancer to the meninges ( malignant or neoplastic meningitis ) and certain drugs (mainly non-steroidal anti-inflammatory drugs , antibiotics and intravenous immunoglobulins ). It may also be caused by several inflammatory conditions, such as sarcoidosis (which

1746-463: A vaccine) only elicit a weak response from the immune system , or cross-react with normal human proteins. Still, some countries ( New Zealand , Cuba , Norway and Chile ) have developed vaccines against local strains of group B meningococci; some have shown good results and are used in local immunization schedules. Two new vaccines, both approved in 2014, are effective against a wider range of group B meningococci strains. In Africa, until recently,

1843-430: Is "partially treated meningitis", where there are meningitis symptoms after receiving antibiotics (such as for presumptive sinusitis ). When this happens, CSF findings may resemble those of viral meningitis, but antibiotic treatment may need to be continued until there is definitive positive evidence of a viral cause (e.g. a positive enterovirus PCR). Meningitis can be diagnosed after death has occurred. The findings from

1940-431: Is a highly sensitive and specific test since only trace amounts of the infecting agent's DNA is required. It may identify bacteria in bacterial meningitis and may assist in distinguishing the various causes of viral meningitis ( enterovirus , herpes simplex virus 2 and mumps in those not vaccinated for this). Serology (identification of antibodies to viruses) may be useful in viral meningitis. If tuberculous meningitis

2037-460: Is done by positioning the person, usually lying on the side, applying local anesthetic , and inserting a needle into the dural sac (a sac around the spinal cord) to collect cerebrospinal fluid (CSF). When this has been achieved, the "opening pressure" of the CSF is measured using a manometer . The pressure is normally between 6 and 18 cm water (cmH 2 O); in bacterial meningitis the pressure

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2134-414: Is evidence of respiratory failure . If there are signs of raised intracranial pressure, measures to monitor the pressure may be taken; this would allow the optimization of the cerebral perfusion pressure and various treatments to decrease the intracranial pressure with medication (e.g. mannitol ). Seizures are treated with anticonvulsants . Hydrocephalus (obstructed flow of CSF) may require insertion of

2231-403: Is meningitis caused by Mycobacterium tuberculosis , is more common in people from countries in which tuberculosis is endemic, but is also encountered in people with immune problems, such as AIDS . Recurrent bacterial meningitis may be caused by persisting anatomical defects, either congenital or acquired, or by disorders of the immune system . Anatomical defects allow continuity between

2328-406: Is normally above 40% of that in blood. In bacterial meningitis it is typically lower; the CSF glucose level is therefore divided by the blood glucose (CSF glucose to serum glucose ratio). A ratio ≤0.4 is indicative of bacterial meningitis; in the newborn, glucose levels in CSF are normally higher, and a ratio below 0.6 (60%) is therefore considered abnormal. High levels of lactate in CSF indicate

2425-423: Is not clear whether intravenous fluid should be given routinely or whether this should be restricted. Given that meningitis can cause a number of early severe complications, regular medical review is recommended to identify these complications early and to admit the person to an intensive care unit , if deemed necessary. Mechanical ventilation may be needed if the level of consciousness is very low, or if there

2522-462: Is not encouraged as it rarely leads to changes in treatment, but it may be used if other tests are not diagnostic. Similarly, the limulus lysate test may be positive in meningitis caused by Gram-negative bacteria, but it is of limited use unless other tests have been unhelpful. Polymerase chain reaction (PCR) is a technique used to amplify small traces of bacterial DNA in order to detect the presence of bacterial or viral DNA in cerebrospinal fluid; it

2619-552: Is often assumed to be the cause of eosinophilic meningitis when there is a predominance of eosinophils (a type of white blood cell) found in the cerebrospinal fluid. The most common parasites implicated are Angiostrongylus cantonensis , Gnathostoma spinigerum , Schistosoma , as well as the conditions cysticercosis , toxocariasis , baylisascariasis , paragonimiasis , and a number of rarer infections and noninfective conditions. Rarely, free-living parasitic amoebae can cause naegleriasis , also called amebic meningitis ,

2716-409: Is suspected, the sample is processed for Ziehl–Neelsen stain , which has a low sensitivity, and tuberculosis culture, which takes a long time to process; PCR is being used increasingly. Diagnosis of cryptococcal meningitis can be made at low cost using an India ink stain of the CSF; however, testing for cryptococcal antigen in blood or CSF is more sensitive. A diagnostic and therapeutic difficulty

2813-520: Is then called neurosarcoidosis ), connective tissue disorders such as systemic lupus erythematosus , and certain forms of vasculitis (inflammatory conditions of the blood vessel wall), such as Behçet's disease . Epidermoid cysts and dermoid cysts may cause meningitis by releasing irritant matter into the subarachnoid space. Rarely, migraine may cause meningitis, but this diagnosis is usually only made when other causes have been eliminated. The meninges comprise three membranes that, together with

2910-462: Is thought to be caused by herpes simplex virus type 2 . There are a number of risk factors for fungal meningitis , including the use of immunosuppressants (such as after organ transplantation ), HIV/AIDS , and the loss of immunity associated with aging. It is uncommon in those with a normal immune system but has occurred with medication contamination . Symptom onset is typically more gradual, with headaches and fever being present for at least

3007-474: Is unlikely. Other problems can produce symptoms similar to those above, but from non-meningitic causes. This is called meningism or pseudomeningitis. Meningitis caused by the bacterium Neisseria meningitidis (known as "meningococcal meningitis") can be differentiated from meningitis with other causes by a rapidly spreading petechial rash , which may precede other symptoms. The rash consists of numerous small, irregular purple or red spots ("petechiae") on

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3104-452: Is usually caused by viruses, but it may be due to bacterial infection that has already been partially treated, when bacteria disappear from the meninges, or when pathogens infect a space adjacent to the meninges (such as sinusitis ). Endocarditis (an infection of the heart valves which spreads small clusters of bacteria through the bloodstream) may cause aseptic meningitis. Aseptic meningitis may also result from infection with spirochetes ,

3201-482: Is usually elevated. In cryptococcal meningitis , intracranial pressure is markedly elevated. The initial appearance of the fluid may prove an indication of the nature of the infection: cloudy CSF indicates higher levels of protein, white and red blood cells and/or bacteria, and therefore may suggest bacterial meningitis. The CSF sample is examined for presence and types of white blood cells , red blood cells , protein content and glucose level. Gram staining of

3298-675: The Akasaka Palace ; Emperor Meiji gave Prince Takehito responsibility for taking care of Prince Yoshihito, and the two princes became friends. From 1898, largely at the insistence of Itō Hirobumi , the Prince began to attend sessions of the House of Peers of the Diet of Japan as a way of learning about the political and military concerns of the country. In the same year, he gave his first official receptions to foreign diplomats, with whom he

3395-625: The Greek μῆνιγξ meninx , 'membrane', and the medical suffix -itis , 'inflammation'. In adults, the most common symptom of meningitis is a severe headache , occurring in almost 90% of cases of bacterial meningitis, followed by neck stiffness (the inability to flex the neck forward passively due to increased neck muscle tone and stiffness). The classic triad of diagnostic signs consists of neck stiffness, sudden high fever , and altered mental status ; however, all three features are present in only 44–46% of bacterial meningitis cases. If none of

3492-557: The Hayama Imperial Villa at Hayama , on Sagami Bay south of Tokyo (in Kanagawa Prefecture ). He was 47 years old and succeeded by his eldest son, Hirohito , Emperor Shōwa. The funeral was held at night (February 7 to February 8, 1927) and consisted of a 4-mile-long procession in which 20,000 mourners followed a herd of sacred bulls and an ox-drawn cart containing the imperial coffin. The funeral route

3589-571: The Mitsubishi shipyards in Nagasaki ). On 10 May 1900, Crown Prince Yoshihito married the then 15-year-old Kujō Sadako , daughter of Prince Kujō Michitaka , the head of the five senior branches of the Fujiwara clan . She had been carefully selected by Emperor Meiji for her intelligence, articulation, and pleasant disposition and dignity – to complement Prince Yoshihito in the areas where he

3686-402: The cerebrospinal fluid , enclose and protect the brain and spinal cord (the central nervous system ). The pia mater is a delicate impermeable membrane that firmly adheres to the surface of the brain, following all the minor contours. The arachnoid mater (so named because of its spider-web-like appearance) is a loosely fitting sac on top of the pia mater. The subarachnoid space separates

3783-423: The choroid plexus . Meningitis occurs in 25% of newborns with bloodstream infections due to group B streptococci ; this phenomenon is much less common in adults. Direct contamination of the cerebrospinal fluid may arise from indwelling devices, skull fractures, or infections of the nasopharynx or the nasal sinuses that have formed a tract with the subarachnoid space (see above); occasionally, congenital defects of

3880-714: The dura mater can be identified. The large-scale inflammation that occurs in the subarachnoid space during meningitis is not a direct result of bacterial infection but can rather largely be attributed to the response of the immune system to the entry of bacteria into the central nervous system . When components of the bacterial cell membrane are identified by the immune cells of the brain ( astrocytes and microglia ), they respond by releasing large amounts of cytokines , hormone-like mediators that recruit other immune cells and stimulate other tissues to participate in an immune response. The blood–brain barrier becomes more permeable, leading to "vasogenic" cerebral edema (swelling of

3977-546: The pneumococcal conjugate vaccine (PCV), which is active against seven common serotypes of this pathogen, significantly reduces the incidence of pneumococcal meningitis. The pneumococcal polysaccharide vaccine , which covers 23 strains, is only administered to certain groups (e.g. those who have had a splenectomy , the surgical removal of the spleen); it does not elicit a significant immune response in all recipients, e.g. small children. Childhood vaccination with Bacillus Calmette-Guérin has been reported to significantly reduce

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4074-405: The sensitivity of these tests is limited. They do, however, have very good specificity for meningitis: the signs rarely occur in other diseases. Another test, known as the "jolt accentuation maneuver" helps determine whether meningitis is present in those reporting fever and headache. A person is asked to rapidly rotate the head horizontally; if this does not make the headache worse, meningitis

4171-575: The Imperial villas at Hayama and Numazu , both of which are located at the sea. Although the prince showed skill in some areas, such as horse riding, he proved to be poor in areas requiring higher-level thought. He was finally withdrawn from Gakushuin before finishing the middle school course in 1894. However, he did appear to have an aptitude for languages and continued to receive extensive tutoring in French , Chinese , and history from private tutors at

4268-661: The administration of the Archives and Mausolea Department . The imperial graveyard in Hachiōji is designed as a semi-natural planted space which mainly consists of woodland, rocks and trees. In addition to the stone-topped Imperial mausolea, it also contains smaller monuments and religious structures, like Torii . The approach to the Musashi Imperial Graveyard from the Kōshū Kaidō is lined with zelkova and

4365-557: The afternoons on sports, but progress was slow due to his poor health and frequent fevers. From 1886, he was taught together with 15–20 selected classmates from the ōke and higher ranking kazoku peerage at a special school, the Gogakumonsho , within the Aoyama Palace. Yoshihito was officially declared heir on 31 August 1887, and had his formal investiture as crown prince on 3 November 1888. While crown prince, he

4462-526: The approach for prevention and control of meningococcal epidemics was based on early detection of the disease and emergency reactive mass vaccination of the population at risk with bivalent A/C or trivalent A/C/W135 polysaccharide vaccines, though the introduction of MenAfriVac (meningococcus group A vaccine) has demonstrated effectiveness in young people and has been described as a model for product development partnerships in resource-limited settings. Routine vaccination against Streptococcus pneumoniae with

4559-418: The arachnoid and pia mater membranes and is filled with cerebrospinal fluid. The outermost membrane, the dura mater , is a thick durable membrane, which is attached to both the arachnoid membrane and the skull. In bacterial meningitis, bacteria reach the meninges by one of two main routes: through the bloodstream (hematogenous spread) or through direct contact between the meninges and either the nasal cavity or

4656-472: The basis of the person's age, whether the infection was preceded by a head injury , whether the person has undergone recent neurosurgery and whether or not a cerebral shunt is present. In young children and those over 50 years of age, as well as those who are immunocompromised, the addition of ampicillin is recommended to cover Listeria monocytogenes . Once the Gram stain results become available, and

4753-472: The brain (tumor or abscess) or the intracranial pressure (ICP) is elevated, as it may lead to brain herniation . If someone is at risk for either a mass or raised ICP (recent head injury, a known immune system problem, localizing neurological signs, or evidence on examination of a raised ICP), a CT or MRI scan is recommended prior to the lumbar puncture. This applies in 45% of all adult cases. There are no physical tests that can rule out or determine if

4850-494: The brain due to fluid leakage from blood vessels). Large numbers of white blood cells enter the CSF, causing inflammation of the meninges and leading to "interstitial" edema (swelling due to fluid between the cells). In addition, the walls of the blood vessels themselves become inflamed (cerebral vasculitis), which leads to decreased blood flow and a third type of edema, "cytotoxic" edema . The three forms of cerebral edema all lead to increased intracranial pressure ; together with

4947-484: The broad type of bacterial cause is known, it may be possible to change the antibiotics to those likely to deal with the presumed group of pathogens. The results of the CSF culture generally take longer to become available (24–48 hours). Once they do, empiric therapy may be switched to specific antibiotic therapy targeted to the specific causative organism and its sensitivities to antibiotics. For an antibiotic to be effective in meningitis it must not only be active against

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5044-737: The cause of meningitis may be the skin signs of hand, foot and mouth disease and genital herpes , both of which are associated with various forms of viral meningitis. Additional problems may occur in the early stage of the illness. These may require specific treatment, and sometimes indicate severe illness or worse prognosis. The infection may trigger sepsis , a systemic inflammatory response syndrome of falling blood pressure , fast heart rate , high or abnormally low temperature, and rapid breathing . Very low blood pressure may occur at an early stage, especially but not exclusively in meningococcal meningitis; this may lead to insufficient blood supply to other organs. Disseminated intravascular coagulation ,

5141-470: The commencement of dexamethasone or a similar corticosteroid just before the first dose of antibiotics is given, and continued for four days. Given that most of the benefit of the treatment is confined to those with pneumococcal meningitis, some guidelines suggest that dexamethasone be discontinued if another cause for meningitis is identified. The likely mechanism is suppression of overactive inflammation. Additional treatment with corticosteroids have

5238-878: The condition is classified as a medical emergency . A lumbar puncture , in which a needle is inserted into the spinal canal to collect a sample of cerebrospinal fluid (CSF), can diagnose or exclude meningitis. Some forms of meningitis are preventable by immunization with the meningococcal , mumps , pneumococcal , and Hib vaccines . Giving antibiotics to people with significant exposure to certain types of meningitis may also be useful for preventing transmission. The first treatment in acute meningitis consists of promptly giving antibiotics and sometimes antiviral drugs . Corticosteroids can be used to prevent complications from excessive inflammation. Meningitis can lead to serious long-term consequences such as deafness , epilepsy , hydrocephalus , or cognitive deficits , especially if not treated quickly. In 2019, meningitis

5335-424: The condition, but does not protect against future infections. Resistance to rifampicin has been noted to increase after use, which has caused some to recommend considering other agents. While antibiotics are frequently used in an attempt to prevent meningitis in those with a basilar skull fracture there is not enough evidence to determine whether this is beneficial or harmful. This applies to those with or without

5432-423: The early stages of meningitis (in 30% of cases) and do not necessarily indicate an underlying cause. Seizures may result from increased pressure and from areas of inflammation in the brain tissue. Focal seizures (seizures that involve one limb or part of the body), persistent seizures, late-onset seizures and those that are difficult to control with medication indicate a poorer long-term outcome. Inflammation of

5529-406: The excessive activation of blood clotting , may obstruct blood flow to organs and paradoxically increase the bleeding risk. Gangrene of limbs can occur in meningococcal disease . Severe meningococcal and pneumococcal infections may result in hemorrhaging of the adrenal glands , leading to Waterhouse-Friderichsen syndrome , which is often fatal. The brain tissue may swell , pressure inside

5626-520: The external environment and the nervous system . The most common cause of recurrent meningitis is a skull fracture , particularly fractures that affect the base of the skull or extend towards the sinuses and petrous pyramids . Approximately 59% of recurrent meningitis cases are due to such anatomical abnormalities, 36% are due to immune deficiencies (such as complement deficiency , which predisposes especially to recurrent meningococcal meningitis), and 5% are due to ongoing infections in areas adjacent to

5723-670: The formation of blood clots in the veins ( cerebral venous thrombosis ), may all lead to weakness, loss of sensation, or abnormal movement or function of the part of the body supplied by the affected area of the brain. Meningitis is typically caused by an infection . Most infections are due to viruses , and others due to bacteria , fungi , and parasites . Mostly the parasites are parasitic worms , but can also rarely include parasitic amoebae . Meningitis may also result from various non-infectious causes. The term aseptic meningitis refers to cases of meningitis in which no bacterial infection can be demonstrated. This type of meningitis

5820-635: The graduation ceremonies of the military academies, perform the annual Shinto ritual ceremonies, or even attend the official opening of sessions of the Diet of Japan. After 1919, he undertook no official duties, and Crown Prince Hirohito was named prince regent ( sesshō ) on 25 November 1921. The emperor's reclusive life was unaffected by the Spanish Flu Pandemic of 1918 and Great Kantō Earthquake of 1923. Fortuitously, he had moved by imperial train to Tamozawa Imperial Villa at Nikko

5917-470: The head and neck area, such as otitis media or mastoiditis , can lead to meningitis in a small proportion of people. Recipients of cochlear implants for hearing loss are more at risk for pneumococcal meningitis. In rare cases, Enterococcus spp. can be responsible for meningitis, both community and hospital-acquired, usually as a secondary result of trauma or surgery, or due to intestinal diseases (e.g., strongyloidiasis). Tuberculous meningitis , which

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6014-437: The lowered blood pressure often encountered in sepsis , this means that it is harder for blood to enter the brain; consequently brain cells are deprived of oxygen and undergo apoptosis ( programmed cell death ). Administration of antibiotics may initially worsen the process outlined above, by increasing the amount of bacterial cell membrane products released through the destruction of bacteria. Particular treatments, such as

6111-400: The lungs is typically treated for six months, those with tuberculous meningitis are typically treated for a year or longer. Fluid given intravenously are an essential part of treatment of bacterial meningitis. There is no difference in terms of mortality or acute severe neurological complications in children given a maintenance regimen over restricted-fluid regimen, but evidence is in favor of

6208-591: The maintenance regimen in terms of emergence of chronic severe neurological complications. Additional treatment with corticosteroids (usually dexamethasone ) has shown some benefits, such as a reduction of hearing loss , and better short term neurological outcomes in adolescents and adults from high-income countries with low rates of HIV. Some research has found reduced rates of death while other research has not. They also appear to be beneficial in those with tuberculosis meningitis, at least in those who are HIV negative. Professional guidelines therefore recommend

6305-515: The mausolea planted with cryptomeria . In 2012 and 2013, the Imperial Household Agency confirmed press reports that Emperor Akihito and Empress Michiko do not plan to be buried like their immediate predecessors, but to be cremated, for which cremation facilities will be added to the Musashi Imperial Graveyard. Their ashes will then be interred in individual mausoleums, to be built side by side in an integrated fashion, on

6402-427: The meningeal space. Similarly, devices in the brain and meninges, such as cerebral shunts , extraventricular drains or Ommaya reservoirs , carry an increased risk of meningitis. In these cases, people are more likely to be infected with Staphylococci , Pseudomonas , and other Gram-negative bacteria . These pathogens are also associated with meningitis in people with an impaired immune system . An infection in

6499-415: The meninges may lead to abnormalities of the cranial nerves , a group of nerves arising from the brain stem that supply the head and neck area and which control, among other functions, eye movement, facial muscles, and hearing. Visual symptoms and hearing loss may persist after an episode of meningitis. Inflammation of the brain ( encephalitis ) or its blood vessels ( cerebral vasculitis ), as well as

6596-439: The meninges. Viruses that cause meningitis include enteroviruses , herpes simplex virus (generally type 2, which produces most genital sores; less commonly type 1), varicella zoster virus (known for causing chickenpox and shingles ), mumps virus , HIV , LCMV , Arboviruses (acquired from a mosquito or other insect), and the influenza virus . Mollaret's meningitis is a chronic recurrent form of herpes meningitis; it

6693-495: The organism in 70–85% of cases) but results can take up to 48 hours to become available. The type of white blood cell predominantly present (see table) indicates whether meningitis is bacterial (usually neutrophil-predominant) or viral (usually lymphocyte-predominant), although at the beginning of the disease this is not always a reliable indicator. Less commonly, eosinophils predominate, suggesting parasitic or fungal etiology, among others. The concentration of glucose in CSF

6790-467: The pathogenic bacterium but also reach the meninges in adequate quantities; some antibiotics have inadequate penetrance and therefore have little use in meningitis. Most of the antibiotics used in meningitis have not been tested directly on people with meningitis in clinical trials . Rather, the relevant knowledge has mostly derived from laboratory studies in rabbits . Tuberculous meningitis requires prolonged treatment with antibiotics. While tuberculosis of

6887-566: The practice at the time, Prince Yoshihito was entrusted to the care of his great-grandfather, Marquess Nakayama Tadayasu , in whose house he lived from infancy until the age of seven. Prince Nakayama had also raised Taishō's father, the Emperor Meiji, as a child. From March 1885, Prince Yoshihito moved to the Aoyama Detached Palace, where he was tutored in the mornings on reading, writing, arithmetic, and morals, and in

6984-458: The presence of positive Kernig's sign or Brudziński sign . Kernig's sign is assessed with the person lying supine , with the hip and knee flexed to 90 degrees. In a person with a positive Kernig's sign, pain limits passive extension of the knee. A positive Brudzinski's sign occurs when flexion of the neck causes involuntary flexion of the knee and hip. Although Kernig's sign and Brudzinski's sign are both commonly used to screen for meningitis,

7081-518: The protective membranes covering the brain and spinal cord , collectively called the meninges . The most common symptoms are fever , intense headache , vomiting and neck stiffness and occasionally photophobia . Other symptoms include confusion or altered consciousness , nausea , and an inability to tolerate light or loud noises . Young children often exhibit only nonspecific symptoms , such as irritability, drowsiness, or poor feeding. A non-blanching rash (a rash that does not fade when

7178-420: The rate of tuberculous meningitis, but its waning effectiveness in adulthood has prompted a search for a better vaccine. Short-term antibiotic prophylaxis is another method of prevention, particularly of meningococcal meningitis. In cases of meningococcal meningitis, preventative treatment in close contacts with antibiotics (e.g. rifampicin , ciprofloxacin or ceftriaxone ) can reduce their risk of contracting

7275-420: The sample may demonstrate bacteria in bacterial meningitis, but absence of bacteria does not exclude bacterial meningitis as they are only seen in 60% of cases; this figure is reduced by a further 20% if antibiotics were administered before the sample was taken. Gram staining is also less reliable in particular infections such as listeriosis . Microbiological culture of the sample is more sensitive (it identifies

7372-405: The short term with antibiotics . Some behavioral measures may also be effective. Bacterial and viral meningitis are contagious, but neither is as contagious as the common cold or flu . Both can be transmitted through droplets of respiratory secretions during close contact such as kissing, sneezing or coughing on someone, but bacterial meningitis cannot be spread by only breathing the air where

7469-417: The skin. In most cases, meningitis follows invasion of the bloodstream by organisms that live on mucosal surfaces such as the nasal cavity . This is often in turn preceded by viral infections, which break down the normal barrier provided by the mucosal surfaces. Once bacteria have entered the bloodstream, they enter the subarachnoid space in places where the blood–brain barrier is vulnerable – such as

7566-404: The skull may increase and the swollen brain may herniate through the skull base. This may be noticed by a decreasing level of consciousness , loss of the pupillary light reflex , and abnormal posturing . The inflammation of the brain tissue may also obstruct the normal flow of CSF around the brain ( hydrocephalus ). Seizures may occur for various reasons; in children, seizures are common in

7663-499: The speech was rolled up properly, as his manual dexterity was also handicapped. His lack of articulation and charisma, his disabilities and his eccentricities, led to an increase in incidents of lèse majesté . As his condition deteriorated, he had less and less interest in daily political affairs, and the ability of the genrō , Keeper of the Privy Seal , and Imperial Household Minister to manipulate his decisions came to be

7760-675: The three signs are present, acute meningitis is extremely unlikely. Other signs commonly associated with meningitis include photophobia (intolerance to bright light) and phonophobia (intolerance to loud noises). Small children often do not exhibit the aforementioned symptoms, and may only be irritable and look unwell. The fontanelle (the soft spot on the top of a baby's head) can bulge in infants aged up to 6 months. Other features that distinguish meningitis from less severe illnesses in young children are leg pain, cold extremities, and an abnormal skin color . Neck stiffness occurs in 70% of bacterial meningitis in adults. Other signs include

7857-611: The tombs of his imperial forebears; but Emperor Taishō's grave is in Tokyo, in the Musashi Imperial Graveyard in Hachiōji . His wife and his son, the Emperor Shōwa, are buried near him. Unless otherwise noted (as BC), years are in CE  / AD   Imperial Consort and Regent Empress Jingū is not traditionally listed. Meningitis Meningitis is acute or chronic inflammation of

7954-451: The trunk, lower extremities , mucous membranes, conjunctiva, and (occasionally) the palms of the hands or soles of the feet. The rash is typically non-blanching ; the redness does not disappear when pressed with a finger or a glass tumbler. Although this rash is not necessarily present in meningococcal meningitis, it is relatively specific for the disease; it does, however, occasionally occur in meningitis due to other bacteria. Other clues on

8051-406: The use of corticosteroids , are aimed at dampening the immune system's response to this phenomenon. Diagnosing meningitis as promptly as possible can improve outcomes. There are no specific signs or symptoms that can indicate meningitis, and a lumbar puncture (spinal tap) to examine the cerebrospinal fluid is recommended for diagnosis. Lumbar puncture is contraindicated if there is a mass in

8148-494: The vaccine for meningococcus group C was introduced, cases caused by this pathogen have decreased substantially. A quadrivalent vaccine now exists, which combines four vaccines with the exception of B; immunization with this ACW135Y vaccine is now a visa requirement for taking part in Hajj . Development of a vaccine against group B meningococci has proved much more difficult, as its surface proteins (which would normally be used to make

8245-527: The week before the devastating calamity; but his son, Crown Prince Hirohito, remained at the Imperial Palace where he was at the heart of the event. Carrier pigeons kept the Emperor informed as information about the extent of the devastation became known. In early December 1926, it was announced that the emperor had pneumonia . He died of a heart attack at 1:25 a.m. on 25 December 1926 at

8342-649: The west side of the tomb of Emperor Taishō. This adaptation of the imperial funeral rites will mark a historic change from some 350 years in which in-ground burials were the norm for monarchs and their spouses. The Imperial Household Agency plans that the two new mausoleums will have an area of some 3,500 square metres , about 80 percent of the 4,300 square metres of the tomb of the Emperor's parents, Emperor Shōwa and Empress Kōjun. [REDACTED] Media related to Musashi Imperial Graveyard at Wikimedia Commons Emperor Taish%C5%8D Yoshihito (31 August 1879 – 25 December 1926), posthumously honored as Emperor Taishō ,

8439-712: Was able to shake hands and converse graciously. His infatuation with western culture and tendency to sprinkle French words into his conversations was a source of irritation for Emperor Meiji. In October 1898, the Prince also traveled from the Numazu Imperial Villa to Kobe , Hiroshima , and Etajima , visiting sites connected with the Imperial Japanese Navy . He made another tour in 1899 to Kyūshū , visiting government offices, schools and factories (such as Yawata Iron and Steel in Fukuoka and

8536-399: Was common practice at the time, Emperor Meiji's consort, Empress Shōken , was officially regarded as his mother. He received the personal name of Yoshihito Shinnō and the title Haru-no-miya from the Emperor on 6 September 1879. His two older siblings had died in infancy, and he too was born sickly. Prince Yoshihito contracted cerebral meningitis within three weeks of his birth. As was

8633-439: Was diagnosed in about 7.7 million people worldwide, of whom 236,000 died, down from 433,000 deaths in 1990. With appropriate treatment, the risk of death in bacterial meningitis is less than 15%. Outbreaks of bacterial meningitis occur between December and June each year in an area of sub-Saharan Africa known as the meningitis belt . Smaller outbreaks may also occur in other areas of the world. The word meningitis comes from

8730-568: Was kept out of view of the public as much as possible, having suffered from various neurological problems. At the 1913 opening of the Imperial Diet of Japan , one of the rare occasions he was seen in public, he is famously reported to have rolled his prepared speech into a cylinder and stared at the assembly through it, as if through a spyglass . Although rumors attributed this to poor mental condition, others, including those who knew him well, believed that he may have been checking to make sure

8827-664: Was lacking. The Akasaka Palace was constructed from 1899 to 1909 in a lavish European rococo style, to serve as the Crown Prince's official residence. The Prince and Princess had the following children: Hirohito, Yasuhito, Nobuhito, and Takahito. In 1902, Yoshihito continued his tours to observe the customs and geography of Japan, this time of central Honshū , where he visited the Buddhist temple of Zenkō-ji in Nagano . With tensions rising between Japan and Russia , Yoshihito

8924-415: Was lit with wood fires in iron lanterns. The emperor's coffin was then transported to his mausoleum in the western suburbs of Tokyo. Emperor Taishō has been called the first Tokyo Emperor because he was the first to live his entire life in or near Tokyo. His father was born and reared in Kyoto; and although he later lived and died in Tokyo, Emperor Meiji's mausoleum is located on the outskirts of Kyoto, near

9021-408: Was often referred to simply as Tōgu ( 東宮 ) ('Eastern Palace', a metonymy for heir to the throne, which originated from China's Han dynasty ). When Yoshihito became the age to enter elementary school in 1886, due to his health problems, Takehiko Yumoto was appointed as the special education officer to educate him within the Tōgū Palace . For these health reasons, he spent much of his youth at

9118-504: Was proclaimed crown prince and heir apparent in 1888, his two older siblings having died in infancy. He suffered various health problems as a child, including meningitis soon after his birth. In 1900, he married Sadako Kujō , a member of the Kujō family of the Fujiwara clan ; the couple had four sons. In 1912, Yoshihito became emperor upon the death of his father, but as he suffered from neurological issues for much of his life, he played only

9215-629: Was promoted in 1903 to the rank of colonel in the Imperial Japanese Army and captain in the Imperial Japanese Navy. His military duties were only ceremonial, but he traveled to inspect military facilities in Wakayama , Ehime , Kagawa and Okayama that year. In October 1907, the Crown Prince toured Korea , accompanied by Admiral Tōgō Heihachirō , General Katsura Tarō , and Prince Arisugawa Taruhito . It

9312-737: Was the 123rd emperor of Japan according to the traditional order of succession, reigning from 1912 until his death in 1926. His reign, known as the Taishō era , was characterized by a liberal and democratic shift in domestic political power, known as Taishō Democracy . Yoshihito also oversaw Japan's participation in the First World War from 1914 to 1918, the Spanish flu pandemic , and the Great Kantō earthquake of 1923. Born to Emperor Meiji and his concubine Yanagiwara Naruko , Yoshihito

9409-468: Was the first time an heir apparent to the throne had ever left Japan. During this period, he began studying the Korean language , although he never became proficient at it. Emperor Taishō and Empress Teimei had four sons and twelve grandchildren (five grandsons and seven granddaughters). On 30 July 1912, upon the death of his father, Emperor Meiji , Prince Yoshihito ascended the throne. The new emperor

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