Meningitis

Meningitis

What is meningitis?

An inflammation or swelling on the delicate meninges (three protective membranes surrounding the brain and spinal cord), meningitis is typically caused by a viral, bacterial or fungal infection of the surrounding cerebrospinal fluid. Meningitis can also occur due to injury, fungi, chemical irritation, cancer or drugs and medication allergies.

Inflammation of the meninges results in typical symptoms of headache, fever and a stiff neck. Treatment for meningitis is dependent on the cause and will differ accordingly.

Meningitis can be a life-threatening condition, requiring urgent antibiotic treatment to prevent potentially severe complications.

If you suspect meningitis, it is best to see a medical professional as quickly as possible. The sooner this condition is treated, the less the risk for further complications. An infection can escalate quickly if not sufficiently identified and adequately treated.

Normal versus meningitis infection

Types of meningitis

What causes meningitis?

Of the various types of meningitis, viral and bacterial infections are contagious and can be transmitted through close contact (such as kissing) with another person, sneezing or coughing, as well as sharing eating utensils, a toothbrush or even a cigarette. A bacterial infection can be extremely life-threatening, while viral meningitis is typically less severe. Viral and bacterial infections are the most common cause of meningitis.

  • Viral meningitis: Typically, the most common form of infection, often occurring during the summer and autumn months. The infection is classified as either coxsackievirus A, coxsackievirus B or echoviruses and typically falls into an Enterovirus category. Generally, only a small percentage of individuals with a virus in this category fall ill with meningitis. Viruses which can develop into meningitis include mumps, measles, HIV, influenza (flu), herpes simplex viruses and the West Nile virus. Viral meningitis typically clears on its own, without much treatment and doesn’t affect the brain as severely as a bacterial infection can. Most with a viral infection will be able to recover completely once the infection clears.
  • Illustration of Neisseria Meningitidis (bacteria)Bacterial meningitis: This infection is highly contagious and can be life-threatening (it can be fatal within a matter of hours), with or without sufficient treatment. Immediate medical care is necessary for this type of infection. If not sufficiently treated, and quickly, it can also cause permanent damage to the brain, as well as other parts of the body. There are several types of bacteria which commonly cause this form of meningitis. These are Streptococcus pneumoniae (also known as pneumococcal meningitis which is generally found in the nasal cavity, sinuses and respiratory tract), Neisseria meningitides (also known as meningococcal meningitis which is easily spread through respiratory fluids, as well as saliva), Haemophilus influenza (also known as Hib, this can lead to other infections affecting the blood, windpipe, arthritis and cellulitis) and Listeria monocytogenes (a food-borne bacteria often found in unpasteurised cheeses and luncheon meats). Listeria can be dangerous for pregnant woman as the bacteria can cross the placental barrier. During the final stages of pregnancy, this infection can be fatal for a baby. Bacterial meningitis typically develops when any of these types of bacteria enter the body and gets into a person’s bloodstream. Close contact, coughing or sneezing can easily spread the infection. Once in the bloodstream an infection reaches the brain and spinal cord with ease, causing a life-threatening scenario.

Other types of meningitis include:

  • Fungal meningitis: A fungal infection (cryptococcal) is rare, but typically occurs in those individuals with particularly impaired immune systems. Fungal meningitis isn’t contagious, but can lead to chronic meningitis and also mimics bacterial meningitis infections. If not treated with an antifungal medication, fungal meningitis can be life-threatening and is especially high risk for those with impaired immune systems or who regularly suffer immune deficiencies.
  • Chronic meningitis: This typically develops as a result of slow-growing organisms that infect the meninges. Symptoms are typically similar to those of acute meningitis (bacterial meningitis) and tend to develop over several weeks.

Other related causes

Carcinomatous (a cancer-related inflammation of the meninges) is also a rare variation of meningitis. Chemical reactions, medication allergies and some types of inflammatory diseases (such as sarcoidosis) can result in non-infectious meningitis infections.

What are the signs and symptoms of meningitis?

Signs of meningitis can be misleading at first. You can easily assume you have a case of the flu. Symptoms for viral or bacterial meningitis infections can also be fairly similar in their early stages, developing within a few hours to a few days. Due to the nature of a bacterial infection, this form of meningitis will present more severe symptoms. There is no way to determine a meningitis type purely on observing symptoms alone, so it is imperative that if you suspect an infection, you see a medical professional as soon as possible for appropriate testing.

Any symptoms experienced can depend on a person’s age too (infant, young child or adult).

General symptoms for viral meningitis

  • Infants and young children: Fever, stiff neck and body (a baby may tend to arch their body) irritability, lethargy and excessive fatigue, constant crying, poor feeding and decreased appetite. A baby can also develop a bulge in the soft spot on the top of the head (fontanel). An ill baby will be incredibly difficult to comfort and may even seem more distressed when held.
  • Adults: Fever, headache, stiff neck, lethargy and fatigue, nausea, decreased appetite, bright light sensitivity and seizures.

Mother checking temperature of her ill little daughter

General symptoms for bacterial meningitis

  • Nausea and vomiting
  • Headache (this can be severe)
  • Fever (this can be sudden)
  • Irritability and moodiness
  • Stiff neck
  • Light sensitivity
  • Fatigue and lethargy (this can also include difficulty waking)
  • Altered mental status (confusion and inability to concentrate)
  • Lack of appetite or thirst
  • Skin rashes

What happens to the body

How does a meningitis infection affect the body?

  • Human brain and meningococcal bacteria. The central nervous system: This consists of the nerves, spinal cord and brain. When a meningitis infection occurs, it causes inflammation in this system, which in turn directly affects every other part of your body. Symptoms that typically occur due to this swelling come on quickly and include headaches (an early warning sign of the condition). Effects thereafter also come on quickly and progress swiftly too. Inflammation brings with it cognitive problems (affecting memory and concentration) and even seizures, as well as interference with a person’s senses. This can include tinnitus (ringing in the ears), partial hearing loss and even deafness. Speech may also be affected, along with pain in the eyes, weakened vision and sensitivity to light. Symptoms of fever will result in stomach upsets, nausea and vomiting and loss of appetite. Fever also causes infants and young children to become challenging to comfort, irritable and fussy. A compromised nervous system causes dizziness and clumsiness, as well as impaired coordination. If not adequately treated children can experience learning difficulties, sleep disturbances and emotional problems such as clinginess and general moodiness. Untreated, meningitis infections can lead to coma too.
  • Muscular and skeletal systems: Notable symptoms of meningitis are stiffness of the neck and back. In more serious instances, a person may become painfully rigid and even arched as a result. This is known as opisthotonos, and is commonly seen with babies and young children. When this occurs, a baby or young child may produce a very high-pitched scream when you try to hold or pick them up. Lingering effects can continue long after the condition has been treated in the form of joint stiffness and arthritis. Babies typically develop a bulging fontanel as a result of swelling / inflammation on the brain. This is to be regarded as a medical emergency and requires attention as soon as possible. While joints stiffen, muscles may weaken and add to symptoms of spasms, body aches and generalised weakness in some parts of the body.
  • Circulatory system and the skin (Integumentary system): The infection affects the bloodstream quickly, especially one caused by a bacterium. Septicaemia, which results when toxins from a bacterial infection are released into the bloodstream, can be deadly, causing bleeding under the skin. Bleeding can look like a mild rash on the surface of the skin. At first this can appear a little flushed and blotchy. A rash can spread and darken (deep red or purple in colour), occurring anywhere on the body and begin to resemble large bruises. A rash can leave lingering effects in the form of scars. Blood pressure may decrease and circulation will slow down. This causes damage to the blood vessels in the body, and in turn causes trouble for the lungs and kidneys. Circulation in general becomes increasingly poor and in dire situations can lead to amputation of the arms, legs, fingers and toes.

Diagnosing and treating meningitis

When should you see a doctor?

All suspected cases of meningitis should be evaluated and diagnosed by a medical professional (general practitioner or paediatrician) as swiftly as possible.

If you or someone you know experiences combined symptoms of fever, has a very bad / severe headache, nausea and vomiting, a stiff neck and signs of confusion, see a medical doctor as soon as possible.

A bacterial infection, once in the bloodstream, has rapid acting effects and can cause serious complications in a short space of time. Without prompt antibiotic treatment, the condition can result in serious brain damage or even death.

How will meningitis be diagnosed?

A doctor will need to assess a full medical health history and perform a physical exam. They will look for common risk factors, as well as assess the nature of your symptoms. Your doctor will check for any signs of infection around your throat, ears, head, as well as the skin along the spine.

Questions your doctor will likely ask you include:

  • How long ago did you start experiencing symptoms?
  • Would you describe your symptoms as mild or severe?
  • Have your symptoms gotten progressively worse (and how quickly has this happened)?
  • Do you know of anyone you’ve been in contact with who has been diagnosed with meningitis recently?
  • Are you aware of anyone in your household, school or place of work experiencing similar symptoms?
  • What vaccinations have you had (full history)?
  • Are you currently taking any immunosuppressant medications?
  • What other known conditions do you have and are treating?
  • Have you experienced allergic reactions to medications?

Are there any tests involved?

In order to confirm (diagnose) meningitis, a series of tests will need to be done. These can include:

  • Blood cultures: Samples of blood will be taken for testing. Samples are placed in a dish, stained with Gram’s stain and then analysed for the possible presence of microorganisms (bacteria growth).
  • Imaging tests: CT (computerised tomography) or MRI (magnetic resonance imaging) scans of the head may be recommended to check for any evidence of inflammation or swelling. X-rays of the chest or sinuses can also provide your doctor with a clear indication as to whether these areas are infected.
  • Lumbar puncture / spinal tap: Cerebrospinal fluid (CSF) is one of the best and most definitive ways to diagnose meningitis. A spinal tap will be performed to collect CSF and tested to see if glucose (sugar) levels are low and white blood cell counts (white blood cells typically increase when an infection is in the body as a natural way to fight an illness) and protein levels are high. The type of bacteria causing the infection can also be identified. The test is also helpful for assessing the level of increased pressure that may be present in the central nervous system, as well as determining the presence of bacteria in the spinal fluid. A doctor will use his or her findings of this test to prescribe the most effective antibiotic and treatment plan.
  • Polymerase chain reaction (PCR) amplification: If viral meningitis is suspected this test may be performed to check for viral DNA. This will help to determine a specific viral cause and as such, the most appropriate course of treatment.

Spinal tap or lumbar puncture illustration

Treatments and medications

Once your doctor has assessed your medical history, conducted a physical exam and performed various tests, the results of all will be analysed to determine the type (cause) of meningitis diagnosis to be made. Once a type is determined, your doctor can implement the most appropriate treatment plan.

  • Viral meningitis: This infection can clear up on its own (usually within 2 weeks), and as such does not require much medical intervention. There is little risk of serious long-term problems. Your doctor may merely send you home to recuperate in bed and suggest plenty of fluids. He or she may also recommend over-the-counter medications to help alleviate any symptoms of fever and body aches. Corticosteroids can also be recommended to alleviate swelling in the brain. If a patient is experiencing seizures, an anticonvulsant medication may be prescribed. If a herpes simplex virus is determined as a cause of a meningitis infection, antiviral medications will be recommended.
  • Bacterial meningitis: Your doctor will immediately admit you for hospitalisation. A patient will need to be treated with intravenous antibiotics (sometimes a combination), and corticosteroids as swiftly as possible to prevent further health complications. The antibiotic will depend on the type of bacteria identified as the cause. If a specific bacterial cause is not determined through initial testing, a doctor may prescribe a broad-spectrum antibiotic until such time as he or she can determine the type causing the infection. Any bacteria infected sinuses or mastoids (the bones on the outer ear) may also be drained.
  • Fungal and chronic meningitis: A patient with fungal meningitis will be treated with antifungal agents. The exact cause of chronic infections will need to be determined in order to determine the best course of treatment.
  • Other: Allergic reactions (to medications etc) or autoimmune diseases can lead to non-infectious meningitis. These cases are generally treated with corticosteroids. In some cases, no medicinal treatment may be required. Any cancer-related meningitis infections will be treated with therapies specific to individual cancer types. In some instances, the underlying meningitis cause is unclear. In this instance a doctor will prescribe antiviral and antibiotic treatment while conducting various tests.

Common complications and risk factors

A person’s age does play a role in the level of risk for meningitis infections. No human being is immune to any kind of meningitis infection. Meningitis can affect anyone.

Typically, contagious infections spread in places where people are living or congregating in close quarters for extended periods of time (crèche, boarding schools, military bases, university or college campuses or residences, places of work or retirement villages).

Age groups that are at higher risk and more susceptible are:

  • Children under the age of 5
  • Teens and young adults between the age of 16 and 25
  • Older adults (55 and older)

Medical conditions and treatments can also put certain individuals at a higher risk. Conditions such as immune system disorders, chronic illnesses or those with a damaged or absent spleen can easily fall ill when exposed to bacteria. Those who have undergone treatments such as chemotherapy and organ or bone marrow transplants may also have compromised immune systems, making them vulnerable to meningitis infections.

Other factors that will place a person at higher risk include:

  • Skipping essential vaccinations
  • Pregnancy (especially when exposed to listeria bacteria which can result in miscarriage, premature delivery or stillbirth)
  • Farm workers (especially those who work with animals are also at risk of listeria bacterial infections)

When complications develop, they can quickly become severe. The risk of permanent brain (neurological) damage and seizures can increase dramatically in a short space of time.

Other serious complications which can easily develop include:

  • Shock
  • Hydrocephalus or subdural effusion (swelling on the brain ‘water on the brain’ and fluid build-up between the skull and the brain)
  • Loss of hearing
  • Kidney failure
  • Gait problems
  • Memory and learning difficulties
  • Death

Preventing meningitis

Washing of hands with soap under running water

As with most viral and bacterial infections, there are steps you can take in your everyday life to minimise the risk of contracting meningitis. These include:

  • Hygiene habits: One of the simplest ways for bacteria and other infection causing organisms to spread is through poor hygiene. Practicing good hygiene habits and careful hand-washing, especially before and after using a toilet facility, before eating, after handling animals or pets and spending time in crowded public spaces. Be mindful of sharing foods, drinks, eating utensils, toothbrushes lipsticks and other lip care products with others too. If you cough or sneeze, get into the habit of covering your nose and mouth – this will minimise any infection transmission risk to others around you.
  • Protect your immune system: Maintaining a healthy lifestyle through regular exercise, nutritious diet and getting plenty of rest and sleep is essential for the function of your immune system. If you are in good health, your body is in peek condition to protect you from harmful infection.
  • Pregnancy and food choices: The presence of bacteria in some foodstuffs can be highly dangerous for a pregnant woman and her developing baby. A pregnant woman should take care with consuming deli meats (and opt for meat that is properly cooked) and avoid cheeses unless clearly labelled as being made with pasteurised milk.
  • Vaccinations: In most bacterial meningitis instances, immunisations can prevent infections. Depending on where in the world you reside, some recommended vaccinations (with some encouraged from as early as 2 months of age), include Haemophilus influenza type b (Hib), Pneumococcal conjugate vaccine (PCV13), Pneumococcal polysaccharide vaccine (PPSV23) and the Meningococcal conjugate vaccine. Some vaccines will require booster shots at specific times and ages as well.

FAQs

What is the difference between meningitis and meningococcal disease?

The underlying bacterial infection cause and symptoms are incredibly similar, but there is a difference.

Meningococcal disease is also known as meningococcus. It is also caused by the Neisseria meningiditis bacteria. The infection, like bacterial meningitis, also affects the meninges. The difference is that meningococcal disease also typically develops one of two bloodstream infections, known as septicaemia or bacteremia. The more severe of the two is septicaemia, resulting in meningococcal septicaemia or meningococcemia.

Once the bacteria enter the bloodstream, they multiply, causing bleeding under the skin and in the organs. This infection can rapidly damage the walls of the body’s blood vessels. Symptoms of meningococcal disease include fever, vomiting, fatigue, the chills, cold hands and feet, rapid breathing, severe pain or aches in the chest, abdomen, muscles and joints, diarrhoea and a dark purple rash.

Meningococcal disease is incredibly serious and develops rapidly. It can be fatal in as little as a few hours. Even if treated, permanent disabilities, impairments and other ailments can occur.

Is it possible to still get meningitis after being vaccinated?

Not all underlying causes of meningitis are protected by the vaccine. It is possible that you can still get meningitis from a different strain (viral, bacterial, fungal etc.) even if you have been vaccinated against an infection. The risk of falling ill with meningococcal meningitis (bacterial) is significantly reduced if you have been vaccinated.

Is there an incubation period for meningitis and how long is it?

An incubation period (the period of time between exposure to an infection and showing the first signs of illness) is largely dependent on the cause of a meningitis infection. If infected with bacterial meningitis, the incubation period is generally between 2 and 10 days. Symptoms for viral meningitis can last between 7 and 10 days (an infected person can be contagious for between 3 and 10 days after symptoms develop).

For the majority of meningitis causes, the range of incubation can typically be anywhere between 2 days and 2 weeks.

It is best to discuss your individual incubation period with your doctor once diagnosed. The diagnostic process will generally determine the underlying infection cause, and thus determine the time period you are likely to be ill and require recovery and treatment.

 

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