Talk:Meningitis/GA1

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This is a really impressive article. It gives a good overview and doesn't go into unnecessary detail; as far as I can see everything that needs to be covered is. It's also very well organized and very clearly written (although there are a few cases where wording might be simplified a bit for the lay reader, e.g. uses of 'intracranial pressure'). Sources are of the highest quality and are provided where needed. I saw no major issues so I think this article currently meets Good Article standards. However below I've brought up some minor issues and questions, mostly cosmetic, in my typical neurotic detail:

Lead:

•  Not done the pic in the infobox is informative, but I usually expect to see a picture of the condition itself in the infobox. I'd suggest this but it's probably too disgusting. I don't know if it's possible to address this concern, not a big deal at any rate.
  • I found the image in question very uninformative, and that was the reason I removed it. Any suggestions for other images are very much appreciated. JFW | T@lk 19:16, 10 November 2008 (UTC)[reply]
•  Done "non-blanching rash" is meaningless unless you already know about it. maybe just "a characteristic rash" for the lead with detail below.
•  Not done "must be treated promptly with antibiotics and sometimes antiviral drugs" - This makes it sound like antibiotics would be used in all cases, surely it's trying to say it would be treated based on what's causing it. Maybe "must be treated promptly, usually with antibiotics or sometimes antiviral drugs" or something (unless antibiotics are given preemptively?).
  • Only a brave doctor will treat a patient with presumed meningitis with antivirals alone on the basis of history & examination. I prefer "and". The same point was raised by the author of the CMR review, who felt that antivirals are usually not of any use. JFW | T@lk 19:16, 10 November 2008 (UTC)[reply]
•  Not done What is "overactive inflammation"? Could the lead just use "inflammation" and explain this later in the body?
  • Every infection causes a degree of inflammation, but scientific consensus now seems to be that in meningitis the inflammation is excessive and possibly causes more damage than the actual infectious agent! In than sense, inflammation is "overactive" in this particular sense. JFW | T@lk 19:16, 10 November 2008 (UTC)[reply]
•  Done Might be good to combine the third and forth paras in the lead.

S/S

•  Done Sentences with statistics need refs. e.g. "the most common symptom of meningitis (87%)". If a later ref covers it, it might be useful to put a hidden comment saying so; that way if other material gets introduced between the info and its ref
•  Done It's not clear whether the s/s listed apply to all forms of meningitis or only to a specific subtype (e.g. bacterial). If the latter, it should really be indicated, but it'd be nice to indicate either case.
  • I believe all these studies were done in bacterial meningitis. Judging by LoganMacMahon, there seems to be little data in any other forms (despite viral meningitis being most common). I will try to work this into the S&S section. JFW | T@lk 20:02, 10 November 2008 (UTC)[reply]
•  Done
  Brudzinski's sign both redirect to meningism
  .
•  Done Awkward: anyone at increased risk of bacteria entering the meninges
•  Done Inflammation of the brain tissue may also obstruct the normal flow of CSF around the brain (hydrocephalus), as well as causing seizures. - seizures mentioned twice in quick succession in this sentence and earlier one
  • I have completely restructured the section on seizures, as it was indeed illogical and confusing. JFW | T@lk 21:39, 10 November 2008 (UTC)[reply]

Causes

•  Done followed by
  parasites
  . - shouldn't this be and?

Mechanism

•  Not done components of the bacterial cell membrane are identified by the immune system-related cells is it really cell membrane components they recognize? Isn't the membrane inside the cell wall?
  • Gram positive bacteria (e.g. pneumococci) don't have a cell wall. JFW | T@lk 21:39, 10 November 2008 (UTC)[reply]
•  DoneRecently, there has been more evidence to suggest that ..." see
  WP:DATED
  • Whole sentence was rather speculative and has been removed. JFW | T@lk 21:39, 10 November 2008 (UTC)[reply]

Treatment

•  Not done treatment with wide-spectrum antibiotics should not be delayed - avoid should
  • As with the intro, this reflects the general consensus of all guidelines and reviews cited. All other alternatives sound forced. JFW | T@lk 21:39, 10 November 2008 (UTC)[reply]
•  Done It seems like both of these sentences are saying "once you know what the pathogen is, you can target it with more specific drugs". I'm not clear on the difference in what they're saying: Once the Gram stain results become available, it may be possible to change the antibiotics to those likely to deal with the presumed pathogen. Once the results of the CSF analysis are known, which generally takes longer, empiric therapy may be switched to specific antibiotic therapy targeted to the specific causative organism and its sensitivities. Is it saying the CSF analysis is more specific?
  • Gram stain only gives a general impression as to which type of bacteria is being treated (eg Gram positive vs Gram negative). Culture provides a more definite answer. JFW | T@lk 21:39, 10 November 2008 (UTC)[reply]

Prognosis

•  Not done I'm surprised there's not more to say about the complications, I'd think they would comprise a list as long as your arm.
  • Wanted to avoid overkill. I think we are mentioning the most important ones: deafness, seizures and cognitive impairment. If there are specific ones that definitely need covering, please let me know. JFW | T@lk 21:39, 10 November 2008 (UTC)[reply]

Prevention

•  Doing... Section doesn't mention things like "don't drink after someone with meningitis", I don't know how important that is. Similarly, Causes doesn't go into detail about how it's spread. e.g. why's it more of a risk in crowded living conditions? What's the mechanism by which it spreads in these cases?
  • Will need fleshing out. Consider me tasked with this. We need to avoid WP:HOWTO, though. JFW | T@lk 21:39, 10 November 2008 (UTC)[reply]

Images

•  Not done You can probably get away with this, but Image:Meningite.png is probably improperly tagged--it's unlikely that the uploader drew the entire map themselves. Rather, they probably altered a grey map. Presumably the original is free, but technically the image needs to list the original this one is modified from to be GFDL compliant.
  • If you don't mind I will "wait on events" with that one. From the image description page it is not clear whether the original uploader (to Commons, as well!) used a stock vector image of the world or not. JFW | T@lk 21:39, 10 November 2008 (UTC)[reply]

General

•  Not done not a super big deal, but I noted some redundant wording that could possibly be cut down. e.g. bulging of the fontanelle may be present -> the fontanelle may bulge.
  • It is phrased in a way that clearly indicates that unless you look for this sign, you are not necessarily going to notice it. JFW | T@lk 21:39, 10 November 2008 (UTC)[reply]

Excellent work, here it is: delldot ∇. 03:10, 10 November 2008 (UTC)[reply]

Thanks delldot! Simply amazing that you have found the time to sort this one out while trying to get traumatic brain injury sorted. I will look specifically into better sources for transmission of meningococcus bacteria. In clinical practice it is presumed that this is by respiratory droplets. JFW | T@lk 21:39, 10 November 2008 (UTC)[reply]