The following is an archived discussion of a featured article nomination. Please do not modify it. Subsequent comments should be made on the article's talk page or in Wikipedia talk:Featured article candidates. No further edits should be made to this page.

The article was promoted by Raul654 10:55, 9 March 2009 [1].

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Meningitis[edit]

Nominator(s): JFW | T@lk

This top-importance health topic was medical collaboration of the week on two occasions and made it to good article in November 2008. It covers the topic comprehensively within the guidelines of WikiProject Medicine and I believe it worthy of being considered for featured status. JFW | T@lk 11:54, 1 March 2009 (UTC)[reply]

• Comment from Truco (talk · contribs) -- Using WP:REFTOOLS, and the dabs/external links checker tools, the ref formatting, dabs, and external links are found up to speed.--₮RUCӨ 14:46, 1 March 2009 (UTC)[reply]
  • Thanks. JFW | T@lk 20:18, 1 March 2009 (UTC)[reply]

• Comment from Scray (talk · contribs) -- It's very good overall, but the material on diagnosis of cryptococcal meningitis is problematic. As I dug deeper, I was surprised to find generally poor coverage of this topic in WP. The Cryptococcus neoformans article (appropriate) gives short shrift to the disease. Cryptococcosis, which should cover meningitis, is not cited in Meningitis and has only a little more information; it is not a high-quality article. Cryptococcal meningitis is rare and difficult to diagnose in people without HIV (the India ink test is usually negative). In people with AIDS, India ink has been replaced by cryptococcal antigen testing where it is available, because the latter is much more sensitive than India ink, is just as sensitive in serum as in CSF (thus diagnosis is not delayed if LP is delayed), requires less expertise, and is safer for lab personnel (no handling of HIV-laden CSF-coated glass slides/coverslips);[2] the Cochrane Collaboration review on the subject was focused on resource-limited settings, and agreed that India ink misses 20-50% of cases but highlighted the fact that it is much cheaper than the antigen tests.[3] The cited article from the British Medical Bulletin is poorly-worded and vague, but does not in any way say that the India ink test is required. Yes, I will try to find time to be WP:Bold, but in any case I think these issues should be addressed, and may involve improving the content on cryptococcus. --Scray (talk) 16:39, 1 March 2009 (UTC)[reply]
  • If you have a better source then please update the article accordingly. Please let me know if you can't, so I can chase this up. JFW | T@lk 20:18, 1 March 2009 (UTC)[reply]
    • Done. It's great to see all this activity on a great article - well done. I have not worked on the Crypto-related pages I linked above - that's for another day. --Scray (talk) 22:41, 1 March 2009 (UTC)[reply]
  • About differential diagnosis: should this article address potential alternative causes of the signs and symptoms described, for instance subarachnoid hemorrhage, encephalitis, brain abscess? I have to admit I have not read the Manual of Style closely enough to know where this sort of content belongs - maybe just in the page for the symptoms and signs themselves, e.g. meningism. I am amazed to find that Epidural abscess redirects to Abscess! That last point is a little off-topic for this FAC, though. --Scray (talk) 17:57, 1 March 2009 (UTC)[reply]
    • WP:MEDMOS is not clear, but I generally feel that "disease entity" articles shouldn't have a list of differential diagnoses (this is not a medical textbook), unless there are classic mimics that need to be excluded during the workup (e.g. sinus thrombosis in possible IIH). JFW | T@lk 20:18, 1 March 2009 (UTC)[reply]
  • Support - the article is excellent. --Scray (talk) 01:10, 3 March 2009 (UTC)[reply]

• Comments from GrahamColm (talk · contribs) - for now. The article needed input from a microbiologist and I have been bold and made a few edits [4]. But I am still concerned with the inconsistencies in naming the bacteria. Many readers will not know that "pneumococcus" and "pneumococci" mean "Streptococcus pneumoniae", and "meningococcus" and "meningococci" mean "Neisseria meningitidis". I advise using the proper names throughout the article but shortened to "S. pneumoniae" and "N. meningitidis" after the first occurrence. Also, these organisms are over-linked in the article. By the way, "coccus" is the singular form, "cocci" is the plural and "coccal" is the adjective—there were a few misuses. This sentence bothers me, "Meningitis caused by H. influenza and meningococci has a better prognosis compared to cases caused by group B streptococci, Gram-negative bacteria and S. pneumoniae", because N. meningitidis and H. influenzae are Gram-negative. Does "Gram-negative bacteria" mean other Gram-negative bacteria or is the source more specific, i.e. Enterobacteriaceae? I left an in-line comment in the text wrt this.Graham Colm ^Talk 16:46, 1 March 2009 (UTC)[reply]
  • Two comments: Great point on the confusing use of "pneumococcus"/"pneumococcal" and "meningococcus"/"meningococcal", but these are so pervasive, especially in conjunction with meningitis, that I would not strike them from this article - rather, I recommend defining them clearly. Regarding your last point, this could be fixed if one changed "Gram-negative bacteria" to "Gram-negative bacilli" (and overlap is minimal since H. influenza is generally described as a coccobacillus). Enterobacteriaceae is not a replacement for Gram-negative bacilli in this context, since some of the worst actors (in terms of prognosis) are not Enterobacteriaceae (e.g. Pseudomonas aeruginosa). --Scray (talk) 17:24, 1 March 2009 (UTC)[reply]
  • Thanks Graham for being as BOLD as you can. And I apologise for not getting you involved before nominating this as FAC. The sentence that bothers you is almost verbatim from the source, but it could be that it refers specifically to coliforms and enterobacteriaciae. I will chase this up when I can. JFW | T@lk 20:18, 1 March 2009 (UTC)[reply]
  • Support — Graham Colm ^Talk 07:12, 4 March 2009 (UTC)[reply]
• Comments from Looie496 (talk · contribs) Nice article in many respects. The greatest problem I see is that the article fails to discuss the relationship between meningitis and encephalitis, which is crucial because when meningitis causes death, it most frequently does so by progressing to encephalitis (at least, that's my understanding). I tried to add a mention of this to the lead but it was reverted. Also, since this article is likely to be read by non-experts who worry that a friend or relative might have the condition, it is probably worth stating that a lumbar puncture is a serious procedure that ought not to be performed unless there are positive grounds for suspecting meningitis -- i.e., not just out of an abundance of caution. Looie496 (talk) 19:09, 1 March 2009 (UTC)[reply]
  • Encephalitis is discussed in the "early complications" section. The sources indicate that encephalitis is only part of a wide-ranging set of complications that can lead to death; tentorial herniation can also result from hydrocephalus. Encephalitis sine meningitis is indeed deadly, but is actually a different disease. We are already clear that lumbar puncture is only performed when deemed safe, but it would be negligent not to do a lumbar puncture if there is even a remote possibility of meningitis! JFW | T@lk 20:18, 1 March 2009 (UTC)[reply]

• Comments -

  http://www2.ncid.cdc.gov/travel/yb/utils/ybGet.asp?section=dis&obj=menin.htm deadlinks.

  Otherwise, sources look okay, links checked out with the link checker tool. Ealdgyth - Talk 20:54, 1 March 2009 (UTC)[reply]

  • I have simply removed the deadlink. Thanks for pointing this out. JFW | T@lk 22:12, 1 March 2009 (UTC)[reply]

• Support - I feel this meets the criteria for inclusion as one of Wikipedia's best articles. Sorry that I don't have the time to conduct a more thorough support. —Cyclonenim (talk · contribs · email) 23:32, 2 March 2009 (UTC)[reply]

• Image concerns as follows:
  • File:Charlotte Cleverley-Bisman Meningicoccal Disease.jpg — I have set up the GFDL license template for this OTRS-ed image; can you verify if it is correct?
    • I guess this is okay if no one has disputed it yet. Jappalang (talk) 23:00, 6 March 2009 (UTC)[reply]
  • File:Ceftriaxone structure.png — I have a pre-university (pre-college) level of chemistry education, but I fail to see the carbon and other hydrogen atoms in this chain. Is this chain complete? Please enlighten me.
    • This is a standard representation of chemical structure, in which vertices are carbons unless otherwise indicated, and hydrogens can be deduced from standard bonding rules. You raise a more important issue, though, and I wondered silently about this yesterday: does this structure figure add anything to the text? To a certain extent it's an advert for ceftriaxone. The page is already a little short on images, but this one does not serve accessibility. --Scray (talk) 04:56, 3 March 2009 (UTC)[reply]
      • I agree that the image does not seem appropriate for this subject; this review, however, is for checking the correct licensing/fair-use of images. Perhaps bring it up in the article's talk page (or be bold and remove it, stating why in the edit summary), or add on to your comments above? Jappalang (talk) 12:05, 3 March 2009 (UTC)[reply]
    • The image is OK by current WP:CHEMS guidelines, but would be better with a 15px (transparent) border: images with borders are what we usually class as "our very best work", but they're a pain to do on a regular basis! We usually go for 10px, but this image is quite wide so I'd recommend 15px. In any case, I agree with the other comments that the image doesn't really add anything to the article. Physchim62 (talk) 01:29, 4 March 2009 (UTC)[reply]
    • The main empirical treatment for bacterial meningitis is "not appropriate". I think I disagree, but outvote me if you need to. JFW | T@lk 07:13, 4 March 2009 (UTC)[reply]
  • File:Meningite.png — what is the base map for this image?
    • Do you mean what data is it based on? It seems to be an amalgamation of the three sources listed in the image file. LeeVJ (talk) 01:59, 4 March 2009 (UTC)[reply]
      • The base map is the "atlas"—the lines and tracings of the various countries. Per commons:Commons:Image casebook#Maps, the base map must be in the public domain or appropriately licensed. Jappalang (talk) 20:58, 4 March 2009 (UTC)[reply]
        • The base map would be a version of File:Blank map of world no country borders.PNG ( same size and outline ) but is not specifically stated - I could recreate a new one if required. LeeVJ (talk) 23:49, 4 March 2009 (UTC)[reply]
          • Hmmm, the creator gave no sources to the map. Can you recreate the map from File:LocationWorld.png, which is sourced from the CIA Worldbook? Jappalang (talk) 00:32, 5 March 2009 (UTC)[reply]
            • How's File:Meningitis-Epedemics-World-Map.png? I'd already recreated using base-map recommended from some place on wp - if not ok then will try again using the base image you've recommended. LeeVJ (talk) 16:49, 6 March 2009 (UTC)[reply]
              • That is fine; if you follow back the links, it is based on the CIA Worldbook. You might want to note it on the image page (Source) itself for clarification. Jappalang (talk) 23:00, 6 March 2009 (UTC)[reply]
  • These should be simple and quick to resolve. Jappalang (talk) 01:57, 3 March 2009 (UTC)[reply]
    • All images are verifiably in the public domain or appropriately licensed. Jappalang (talk) 23:00, 6 March 2009 (UTC)[reply]

• Comment from garrondo (talk · contribs) First of all it seems a great article, and I am sure it is going to become a FA. For the moment one comment (I will probably add some more as I read all the article): In the signs and symtoms/diagnostic features says Other signs commonly associated with meningitis include photophobia (intolerance to bright light), phonophobia (intolerance to loud noises), irritability and delirium (in small children). If I am not mistaken delirium does not only occur in children (even more: how do you diagnose delirium in very small children?). I have gone to the ref and says: Classic meningitis of children and adults usually begins with fever, chills, vomiting, photophobia, and severe headache. Occasionally, the first sign of illness is a convulsion that can recur during progression of the disease. Irritability, delirium, drowsiness, lethargy, and coma can also develop. I believe that even if the article is on infant meningitis here it is talking of meningitis symptoms in general.--Garrondo (talk) 10:17, 4 March 2009 (UTC)[reply]
  • I agree that these symptoms are mentioned especially in relation to small children because they may not report any of the classic symptoms. I will rephrase this at the earliest opportunity. JFW | T@lk 18:53, 5 March 2009 (UTC)[reply]
  • Done. JFW | T@lk 12:53, 8 March 2009 (UTC)[reply]

• Comment from garrondo (talk · contribs) I have finished reading the article and I have only two other related minor comments: I have found several sentences in the diagnosis section difficult to understand; probably due to technicalities: A pressure between 200 and 500 mm H2O (20-50 cm) and also In bacterial meningitis, the CSF glucose to serum glucose ratio is ≤0.4 Both should be better explained and wikilinked (in the second one would probably be enough to wikilink serum, glucose, and ratio; the first one I simply did not understand a word).--Garrondo (talk) 10:37, 4 March 2009 (UTC)[reply]
  • Thanks for pointing this out. I will try to make the terminology easier to understand at the earliest opportunity. JFW | T@lk 18:53, 5 March 2009 (UTC)[reply]
  • Done. JFW | T@lk 12:53, 8 March 2009 (UTC)[reply]

• Support As I read through this for FAC, I left some suggestions on the talk page. Many have already been addressed. I found the article very readable and generally accessible to a lay person. The sources are excellent. Great to see such an important topic covered well. Colin°^Talk 22:53, 8 March 2009 (UTC)[reply]

• Support: All my issues have been addressed. Great article. --Garrondo (talk) 08:36, 9 March 2009 (UTC)[reply]

The above discussion is preserved as an archive. Please do not modify it. No further edits should be made to this page.