Meningitis is inflammation of the meninges, the linings surrounding the brain and spinal cord. It is usually caused by an infection with bacteria or viruses. The hallmarks of meningitis are fever, headache and stiffness of the neck when you try to bend the head forward onto the chest. It is usually an acute and severe illness.

There are two main types of meningitis; viral (caused by a virus) and bacterial (caused by bacteria). Viral meningitis may start in a similar way to a bacterial cause, and may be treated in the same way. However, it is not influenced by antibiotics and patients should make a good recovery in a few weeks.

Bacterial meningitis is much more serious and can be fatal even with prompt treatment. It may attack healthy people at any age. The first symptoms can be just like flu. The patient does not like bright lights and is irritable and may vomit.

One common form (meningococcal) may start with a rash which looks like tiny spots or bruises spreading rapidly over the skin. The spots do not fade when a glass is pressed over them.

How does it occur ?

Many healthy people carry the germs of meningitis in their noses or throats without being ill. The germs can be spread between people by coughing, sneezing, kissing and other close contact. When, for some unknown reason, resistance is lowered, the infectious organism gets into the brain from the bloodstream. Once there, it spreads rapidly through the linings of the brain, causing swelling. The germ of meningococcal meningitis can also spread in the bloodstream and as a result can cause shock and collapse (septicaemia).

Why does it occur ?

In most cases, no reason is apparent. Young people in military camps or college residencies, where there is overcrowding, are susceptible. Infection in the ear or sinuses can sometimes track through into the brain, particularly where there has been as previous skull fracture.

This damages the usual barriers protecting the brain. People who have had their spleen removed are at greater risk of getting meningitis due to the pneumococcus bacterium. Such people need to be protected by prior immunisation. Occasionally outbreaks occur in one locality for no obvious reason.

Treatment involved …

As soon as the disease is suspected, antibiotics, usually penicillin will be given. The patient will be admitted to hospital and will often have a brain scan (usually MRI). This is to make sure that there isn’t a collection of infection such as an abscess, and that the fluid in the brain can circulate normally.

They may then have a lumbar puncture which samples fluid from inside the meninges though a needle inserted between the bones of the lower spine. This should allow doctors to identify the organism (if it is bacterial) and to give the best treatment.

With bacterial meningitis, antibiotics are given into a vein through a tube or drip. The patient is nursed in a quiet dark place if possible and supportive treatment such a steroids (cortisone-like drugs) or even intensive care may be required. Improvement is usually quite rapid but the drip may carry on for 10 to 14 days. Further lumbar punctures are sometimes needed to check progress and the response to treatment.

Viral meningitis may make you feel very ill with a high fever, but the spinal fluid is less cloudy and does not show bacteria. Antibiotics are not needed, and simple best rest with headache tablets will allow you to recover in a few days or weeks.

There are now vaccination programs to protect susceptible people at certain times, or if going to places where the risk is high. Meningococcal C vaccine protects young people going to college from this particular type of meningitis. Pneumococcal vaccines are given to people who have had their spleen removed. There are no vaccines for most other types of meningitis.
After treatment …

Most patients make a full recovery and the acute danger is soon over. However, many people will continue to have headaches and feel easily tired after meningitis. Second attacks can occur even with viral meningitis. Fortunately they are rare. Some children are left with some degree of deafness after meningitis. Septicaemia with bacterial meningitis can cause damage to blood vessels in the limbs or skin and other organs.

When the meninges have been very inflamed, temporary or permanent blockage of drainage of fluid from the brain may become a problem. In such cases a plastic tube may be inserted into the brain cavities to assist drainage. This is done by a brain operation (craniotomy).
If left untreated …

Acute bacterial meningitis is very dangerous and the majority of people would die if not treated. Viral meningitis is followed by full recovery even without treatment.

Effects on family

It can often be a very worrying time for family and friends but most patients make a good recovery. It is unusual to ‘catch’ meningitis from somebody with the disease. Close contacts may be tested and given antibiotics by mouth for short periods. Once the patient has been treated, they cannot give the disease to anyone else.  

Signs and symptoms

Meningitis and meningococcal septicaemia may not always be easy to spot at first, because the symptoms can be similar to those of flu. They may develop over one or two days, but sometimes develop in a matter of hours. The incubation period is between two and ten days.

Symptoms do not appear in any particular order and some may not appear at all. It is important to remember that other symptoms may occur.

In babies:

• High temperature, fever, possibly with cold hands and feet
• Vomiting, or refusing feeds
• High pitched moaning, whimpering cry
• Blank, staring expression
• Pale, blotchy complexion
• Baby may be floppy, may dislike being handled, be fretful
• Fontanelle (soft spot on their head) may be tense or bulging
• Difficult to wake or lethargic

 In children and adults:

• High temperature, fever, possibly with cold hands and feet
• Vomiting, sometimes diarrhoea
• Severe headache
• Neck stiffness (unable to touch the chin to the chest)
• Joint or muscle pains, sometimes stomach cramps with septicaemia
• Dislike of bright lights
• Drowsiness
• Fitting
• Patient may be confused or disoriented

Septicaemic rash

Patients with septicaemia will develop a rash which may start anywhere on the body as a cluster of tiny blood spots, which look like pinpricks in the skin. If untreated, these blood spots will join to give the appearance of fresh bruises.

The "glass test" can be used to see if a rash might be septicaemia. If you press the side of a clear drinking glass firmly onto the spots or bruises, they will not fade. NB. In a small number of cases, the rash may disappear at first, but may later change into one that does not.

Even though the rash can be harder to see on dark skin. The glass test can still be done. Look for the spots or bruises on paler parts of the skin, e.g. palms of the hand or soles of the feet. There is sometimes a rash on the surface of the eye - the part mainly covered by the eyelid.

Do not wait for a rash. It may be the last symptom to appear, and in cases of meningitis without septicaemia may not appear at all.

What should you do?

1. If someone you know is ill and you suspect meningitis/meningococcal septicamia contact your GP immediately.
2. Describe the symptoms carefully, mention that you think it might be meningitis or meningococcal septicaemia.
3. If your doctor is not available go straight to the nearest Accident and Emergency Department and insist on seeing someone.
4. If it is meningitis or meningococcal septicaemia, early treatment with antibiotics is vital

Meningitis and meningococcal septicaemia need URGENT medical attention.

Medpages Medical Reference from: www.surgerydoor.co.uk

Last Updated: 28/1/2009
This information is not intended to replace the advice of a doctor. Disclaimer