Meningitis

Introduction

The meninges are the membranes that cover the brain and spinal cord (central nervous system). They act as a barrier between the central nervous system and the rest of the body, acting as an extra barrier to infection.

Meningitis is infection of the meninges. It can be caused by bacteria or viruses. There are approximately 3500-4000 reported cases per year in the UK. Bacterial meningitis is a less common form of the disease. It is always serious and severe. Viral meningitis is more common but normally less serious.

Bacterial meningitis is caused by several different types of germs, which live naturally at the back of the nose and throat in one in ten people and can be spread by close prolonged contact, coughing, sneezing and kissing. Only in some do the germs overwhelm the body's defenses and cause meningitis. The bacteria cannot live long outside the body so cannot be picked up from water supplies, swimming pools, buildings or factories and only certain types of bacteria (meningococcal C) spread more rapidly in crowded areas. Incubation for bacterial meningitis is between 2 and 10 days.

Viral meningitis is a less severe illness but can still be very debilitating, and very rarely, can progress through headache, fever and drowsiness to deep coma. The incubation period for viral meningitis can be up to 3 weeks.

Symptoms

Bacterial meningitis

Bacterial meningitis is very serious. In babies and young children, death can occur in a matter of hours if left untreated. In some cases, the acute illness subsides into a chronic state, which may lead to serious brain damage. If you suspect meningitis you must seek urgent medical assistance.

Symptoms may not be easy to identify because initially they can be similar to symptoms of flu. Any of the symptoms below may appear in any order over 1-2 days, or in a matter of hours. It is also possible that there may be additional symptoms.

Symptoms in adults and older children may include:

• a constant generalized headache,

• confusion,

• a high temperature, although hands and feet may be cold,

• drowsiness,

• vomiting,

• stomach pain, sometimes with diarrhea,

• rapid breathing,

• neck stiffness - moving the chin to the chest will be painful at the back of the neck,

• a rash of red or purple spots or bruises (or darker than normal, in dark skins) that does not fade when you press a glass tumbler or finger against it – this may not be present in the early stages,

• joint or muscle pain, and

• sensitivity to bright lights, daylight or even the television.

Symptoms in babies and infants may include:

• high temperature, fever (possibly with cold hands and feet), 

• vomiting and refusing feeds, 

• high pitched moaning or whimpering cry, 

• blank staring expression, 

• pale itchy complexion, 

• floppiness, 

• dislike of being handled, 

• fretful, 

• neck retraction with arching of back, 

• convulsions, 

• lethargic and difficult to wake, and

• tense or bulging fontanel (soft spot on head).

A recent study by The Meningitis Research Foundation has found that the key early warning signs of meningitis in children (under 17 years old) often include: 

• cold hands and feet, 

• leg pains, and 

• abnormal skin color.

These are symptoms of blood poisoning (septicemia) that is often associated with meningitis. This is a medical emergency and needs urgent treatment with antibiotics. These symptoms can appear hours before such symptoms as sensitivity to bright light and a rash. If you suspect your child had meningitis do not wait for a rash to appear but seek medial advice immediately.

If there is a rash, the glass (tumbler) test can be used to determine if it might indicate septicaemia (blood poisoning). Press the side of a clear drinking glass onto the rash or bruises and check that they fade. If they do not fade, you should suspect septicaemia. In a small number of cases the rash may fade at first but may later change into one that does not fade.

Viral meningitis
Viral meningitis is a less severe illness but, very rarely, can progress from headache, fever and drowsiness, to deep coma. In severe cases there may be weakness of the muscles, paralysis, speech disturbances, double vision or partial loss of the field of vision, and epileptic fits. Most people make a full recovery within one to two weeks. Occasionally there maybe long term problems such as hearing or memory impairment.

Causes

Any bacteria or virus has the potential to cause meningitis.

Bacterial meningitis is caused by several different types of germs which live naturally at the back of the nose and throat and can be spread by close prolonged contact, coughing, sneezing and kissing.

In the UK the most common cause of bacterial meningitis is infection with the meningococcal or pneumococcal bacteria, but Hib, TB, E.Coli, and Group B streptococcal bacteria can also cause meningitis.

Viral meningitis may be caused by viruses such as Coxsackie’s, herpes simplex, mumps, the varicella zoster virus of chickenpox and shingles, poliovirus, echoviruses (including enterovisuses). Germs can be spread through coughing, sneezing, poor hygiene or sewage polluted water.

Meningitis can also be a feature of other diseases, including Lyme disease, Leptospirosis, Typhus, Tuberculosis and other infections.

Diagnosis

This is made on the basis of the symptoms and clinical signs, the culture of the germs from the blood, and analysis of cerebrospinal fluid through lumbar puncture (see article on Lumbar puncture). Stiff neck is an important sign.

If meningitis is suspected, antibiotics must be given immediately without waiting for confirmation from germ culture.

Treatment

Urgent treatment with antibiotics and appropriate hospital management is essential for someone with bacterial meningitis. The sooner they are diagnosed and treated, the greater chance there is they will make a full recovery. Anyone who has been in direct, close, prolonged contact with the infected person (normally family members and those deemed to be at an increased risk) should be given appropriate protective antibiotics if necessary.

Viral meningitis cannot be helped by antibiotics and treatment is based on good nursing care. Recovery is normally complete, but headaches, tiredness and depression may persist for weeks or even months.

Prevention

There is no known way to prevent meningitis, it is therefore important to be aware of the danger signs. If someone becomes unwell they may deteriorate quickly so medical advice must be sought if you suspect meningitis or septicemia.

Viral meningitis is most common in young adults and tends to occur in small outbreaks especially in schools and colleges. It is important to have any symptoms checked by a doctor immediately.

Vaccines are available against certain types of bacterial meningitis.  These are meningococci groups A and C and against Haemophilus influenza (HiB), which can also cause meningitis.

Meningococcal C and HiB now form part of the routine national immunization schedule for child health. Older children and adults need just one dose of Men C.

It is recommended that all young people under 25 should be immunized.

People who have been in close contact with someone that has been diagnosed with types A or C of bacterial meningitis should be vaccinated against that particular type; if they were in contact with type B, then vaccination is not advised.

Healthcentral 2005

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