Meningitis is a disease in which the membrane surrounding the brain and spinal cord (called meninges) gets inflamed or swollen.
The inflammation can be caused due to an infectious agent (for e.g. bacteria, viruses, fungi and parasites) and non-infectious agents (for e.g. due to head injury, some specific drugs or in some other diseases). Due to the inflammation of the meninges membrane, nerves and part of the brain near to the swelling can be severely affected.
Meningitis can be caused because of many reasons however, the term meningitis is mostly referred to meningitis caused by bacteria.
Meningitis can occur at any age; however children under 5 years and elderly people (above 60 years) are at more risk for infectious meningitis.
Meningitis is most commonly caused due to viral or bacterial infection. Generally bacterial meningitis is more severe than viral meningitis. However, it is difficult to identify the cause at early stage.
Severity of infection and treatment options are very much dependent on the proper diagnosis and determination of the cause of the disease.
Bacterial meningitis is usually very serious and can be life-threatening. Most patients usually recover, however the infection may result serious brain damage, impair learning abilities or hearing disability. Urgent medical care is required to control the infection and prevent death or permanent disability, especially in children and elderly.
Viral meningitis is more common but generally less severe and full recovery is usually attained in most cases.
Meningitis can occur in any age, however children under 5 years and elderly people are more at risk
Because of the severity and rapid advancement of the infection, all cases of meningitis should be considered as medical emergency.
Generally bacterial meningitis is more severe than viral meningitis. However, it is difficult to differentiate between bacterial and viral meningitis at early stage
The symptoms of bacterial meningitis start to appear a few days after exposure to infectious agent (usually 3 – 7 days). Bacterial meningitis advances rapidly and affects the patient severely in a short time. Symptoms can get worse (seizure and coma) quickly, therefore it is important to seek medical care as soon as possible.
In severe cases, bacterial meningitis can cause septicemia (a type of poisoning), which can be serious and life-threatening.
Symptoms in children include:
- High fever (with cold hands and feet)
- Nausea and vomiting
- Loss of appetite
- Inactive and slow
- Photophobia (does not like bright light)
- Stiff neck – crying or feeling unsettled when moving or carrying baby
- Many babies develop red to purplish rash that does not disappear (for. e.g. rash on arm does not go away when you roll over a glass on the rash)
- Swell up soft spot in head (fontanelle) in infants
Symptoms in elder children and adults include:
- High fever with cold hands and feet
- Intense headache
- Nausea and vomiting
- Stiff neck and muscle pain
- Feeling drowsiness and confusion
- Photophobia (does not like bright light)
- Pale skin, Peculiar rash (not in all patients)
- Convulsions (like fits) and seizures (spasm)
All above symptoms may not appear in every patient. Don’t wait, if patient is sick and symptoms of meningitis are suspected, rush to the nearest clinic or hospital.
Symptoms of viral meningitis are similar to flu symptoms and include:
- Muscle and joint aches
- Runny nose and cough
Severe cases of viral meningitis may also include the below symptoms:
- Stiffness in neck
- Nausea and vomiting
- Indigestion and diarrhea
- Photophobia (increased sensitivity to bright light)
Meningitis is mostly caused by bacteria and viruses, rarely caused by fungi and protozoa
Some healthy people carry meningitis bacteria in their nose and throat without being sick. At most occasions, these bacteria are harmless in healthy person, but in situations (due to weakened immune system) if enter in blood stream, they can reach the brain and cause meningitis.
Transmission of meningitis bacteria from infected person to other person can happen; however it generally happens due to close contact for long period for (e.g. by kissing, sharing spoons & forks) or through touching with unclean hands containing/ covering salivary or nasal secretions. The bacteria can also be transmitted to other person through small droplets due to sneezing and coughing.
In some cases, people who are in close contact with patient are given preventive antibiotics (check with your Doctor)
Types of Meningitis
Depending on the cause, there are two main types of meningitis
1. Bacterial Meningitis (caused by Neisseria meningitidis and other bacterial species)
2. Viral meningitis (caused by many viruses)
Bacterial meningitis is mainly caused by the below mentioned bacterial species:
1. Neisseria meningitidis
2. Streptococcus pneumoniae
3. Haemophilus influenzae
4. Group B Streptococci (most affect infants)
5. Listeria monocytogens (mostly in new born and elderly from contaminated food)
There are 4 main strains (sub-types) of Neisseria that are referred as A, C, Y and W135 strains. It can be prevented by vaccination (see meningitis vaccine)
Meningitis caused by Strep pneumoniae and Haemophilus influenza is also quite common in Pakistan. Strep pneumoniae can also cause septicemia (blood poisoning) which is very serious. Effective vaccines for both Strep pneumoniae and H. influenza are available, which can prevent meningitis caused by them as well specific types of pneumoniae and ear infection (see vaccination).
Viral meningitis is usually mild and does not cause septicemia. Meningitis due to viral infection is more common than bacterial meningitis.
It is mostly caused by a family of viruses called Enteroviruses. The virus enters the body through close contacts or droplets from an infected person to an uninfected person. Other viruses for e.g. herpes virus and measles and mumps viruses may also cause meningitis.
Measles and Mumps viruses are also leading cause of meningitis in children. In recent years, implementation of Measles, Mumps and Rubella vaccine (MMR) vaccine has reduced viral meningitis cases globally. However, increased coverage of MMR vaccine is required in Pakistan to minimize meningitis infection caused by measles and mumps viruses.
Naegleria fowleri can also cause a type of meningitis. (see Naegleria leaflet)
Meningitis cases in mass gatherings:
Meningitis can spread in environments or situations when people are living or exposed to big groups like religious congregations (e.g. Hajj , Umrha ziarat, and Muharram gatherings). This is because meningitis vaccination is mandatory for people who are going to Hajj or Umrah.
Many meningitis symptoms are similar to other respiratory infections, therefore it is difficult to diagnose.
However, all suspected cases of meningitis should be considered as medical emergency and require instant medical help.
Based on clinical assessment in most suspected cases of meningitis, treatment is initiated before the laboratory confirmation since delaying treatment may have serious consequences.
The doctor will perform the physical examination of the patient and check the signs of septicemia (blood poisoning). Since severity of meningitis infection and treatment options are very much dependent on the proper diagnosis, the doctor may request lab test to confirm the cause of the disease.
The Lab test may include:
1. Blood culture test
2. Lumbar puncture test (testing of sample of spinal cord fluid to conduct several test)
3. Computerized tomography (CT) scan to check inflammation or any damage to the brain and spinal cord
In most suspected meningitis cases, treatment is initiated as soon as possible before laboratory confirmation since delaying treatment may have serious consequences.
Meningitis is a serious illness and patients are usually treated in hospital with Intravenous antibiotics and fluids (in the form of a drip).
Before the confirmed diagnosis, all suspected meningitis cases are treated as they are bacterial meningitis with effective antibiotics. After the lab confirmation (positive culture test), if the infection is due to a bacterium, specific antibiotic effective against that bacteria is administered.
In cases, where bacterial infection is not found (culture test negative) and patient’s condition has improved, antibiotic may be discontinued.
Confirmed viral meningitis is treated using supportive therapy for. e.g. maintaining fluids through IV, if required and giving pain and fever medication. Generally, there is no specific antiviral drug required to treat meningitis. Most viral meningitis patients recover within 7 – 10 days after being infected.
Most types of meningitis can be prevented by vaccination.
Most types of meningitis can be prevented by vaccination. Following listed vaccines can effectively prevent meningitis. See Vaccination Schedule
- Strep pneumoniae (Pneumococcal vaccine)
- Haemophilus Influenza type B (HiB) vaccine
- Neisseria meningitis (Meningococcal vaccine)
- Measles, Mumps and Rubella (MMR) vaccine
- Varicella zoster (Chicken pox vaccine)
Similar to other infectious disease, the below good hygiene practices can also decrease the risk of infection.
- Washing hands
- Covering nose and mouth when coughing and sneezing
- Cleaning dirty surfaces