CONDITIONS

Meningitis

What Is Meningitis

Meningitis is a disease caused by inflammation of the membranes—known as meninges—that surround the brain and spinal cord.  This condition—which can be severe, depending on what type is contracted—is usually caused by an infection of the cerebrospinal fluid (CSF)–the fluid surrounding the brain and spinal cord.

The inflammation associated with meningitis often causes the three hallmark signs and symptoms of this condition:

  • Headache
  • Fever
  • Stiff neck

The disease is contagious and is spread through the exchange of respiratory droplets resulting from coughing or sneezing, or from direct contact, like kissing.

Meningitis may be acute with a quick onset of symptoms, or it can be chronic, with slowly developing and longer lasting symptoms of a month or more in duration. Quick recognition of this condition is vital, as certain types of meningitis it can quickly lead to serious illness and death.

What Causes Meningitis

Meningitis may develop secondary to numerous causes; however, it is usually caused by bacteria or viruses.

Bacteria. Acute bacterial meningitis is the most common form of meningitis. Approximately 80 percent of all cases are acute bacterial meningitis. This usually occurs as a result of bacteria entering the blood stream and then traveling to the brain and spinal cord. However, it can also occur secondary to direct infection of the meninges secondary to chronic ear or sinus infection or skull trauma. As a result of the rapid inflammation and swelling, blood flow to the brain is interrupted, which may cause a stroke or even death. The most common types of bacteria that cause acute bacterial meningitis are Streptococcus pneumoniae, Nisseria meningitides (meningococcus), Haemophilus influenzae (haemophilus), and Listeria monocytogenes.

Viruses. According to the Mayo Clinic, “each year, viruses cause a greater number of cases of meningitis than do bacteria.” That being said, viral meningitis is usually mild and often clears on its own. The most common viruses that cause meningitis include enteroviruses, herpes simplex virus, HIV, mumps, and West Nile virus.

More rare causes include physical injury, cancer, or medications.

  • Fungi. Fungal meningitis is relatively rare and is usually slow in onset. Cryptococcal meningitis is the most common form of the disease and often affects people with weakened immune systems, such as those with HIV.
  • Parasites, such as ameobas and roundworms
  • Physical injury, such as head or spine trauma
  • Cancer
  • Drug allergies
  • Inflammatory diseases, such as sarcoidosis

Risk Factors For Meningitis

Risk factors for developing meningitis include:

  • Age—children between the ages of one month and two years are the most susceptible to bacterial meningitis
  • Alcohol abuse
  • Chronic nose and ear infections
  • Head or spinal cord injury
  • Pneumonia (secondary to the pneumococcal bacteria)
  • Weakened immune system, which may be due to chronic corticosteroids or if you have had your spleen removed
  • Widespread blood infection
  • Living situation—those living in close quarters with many people are at higher risk of developing meningitis, especially those living in college dormitories or military barracks
  • Being a smoker and prolonged exposure to secondhand smoke

Diagnosing Meningitis

A diagnosis of meningitis will likely include a medical history, physical exam, and laboratory tests. After assessing current medical problems and medications, your doctor will assess you for the hallmark symptoms and signs of meningitis, which are headache, fever, and stiff neck.

If your physician deems meningitis as a likely diagnosis, he or she will likely order a laboratory test to verify the presence of the conditions. Tests for meningitis include:

  • Blood cultures. During this test, blood is drawn from a vein and then placed in a special medium to allow any microorganisms present in the blood to grow and to be identifie
  • Imaging: X-rays, CT scans, or MRI scans. These tests may be ordered to assess for swelling and inflammation in the brain, spinal cord, sinuses, or chest.
  • Spinal tap. This diagnostic test requires a small needle placed in the middle of your back to obtain cerebrospinal fluid, or CSF, which is the fluid, which surrounds your brain and spinal cord. The CSF is then tested for glucose, which may be low if a microorganisms is present, white blood cells, which is a marker of infection, and for the presence of both viruses and bacteria.

Symptoms of Meningitis

Symptoms of meningitis include:

  • Fever and chills
  • Mental status changes
  • Nausea
  • Vomiting
  • Sensitivity to light (photophobia)
  • Severe headache
  • Stiff neck (meningismus)
  • Agitation
  • Bulging fontanelles (in babies)
  • Poor feeding or irritability in children
  • Rapid breathing
  • Unusual posture, with the head and neck arched backwards (opisthotonos)

Prognosis

Acute bacterial meningitis is a rare, but potentially deadly infection. According to the National Meningitis Association, “the disease strikes quickly and has devastating complications, including hearing loss, brain damage, limb amputations, loss of kidney function, and in some cases, death.”

Living With Meningitis

A diagnosis of meningitis can be frightening. However, with prompt diagnosis and treatment, prognosis is often excellent and full recovery can be expected. While being treated and once recovered, some things you can do to help yourself cope and to prevent a future episode of meningitis:

  • Learn about the condition so you can make informed decisions, advocate for yourself, and know what to expect.
  • Speak openly with friends and family, and ask for the help you need. You may also seek out help from a counselor or a survivors’ support group.
  • Eat well and exercise to support your overall health.

Screening

There is no standard screening test for meningitis.

Prevention

Prevention of meningitis is most effective with the use of the meningococcal vaccine. The Centers for Disease Control, or CDC, recommend the meningococcal vaccine for:

  • All children and adolescents ages 11 through 18
  • College freshman living in dormitories
  • Military recruits
  • Scientists routinely exposed to meningococcal bacteria
  • Anyone traveling to or living in a part of the world where the disease in common, such as Africa
  • Anyone with a damaged spleen or who has had is or her spleen removed
  • Anyone who has a terminal complement component deficiency (an immune system disorder)

Medication And Treatment

Several treatments are available for meningitis and depend on the type of meningitis.

  • Bacterial. typically causes by meningococcal bacteria. A range of antibiotics can treat the infection, including penicillin, ampicillin, chloramphenicol and ceftriaxone. Corticosteroids may also be administered to help control the swelling and inflammation. In addition to these treatments, patients will receive IV fluids and medications for pain and nausea.
  • Viral. the vast majority of viral meningitis cases will not require specialized medications. Rather, patients are treated symptomatically with fluid, bed rest, painkillers, and anti-emetics, also known as anti-nausea medications. If a patient requires specialized medication to target the offending virus, he or she can be started on an anti-viral.
  • Fungi. in addition to symptomatic treatment, patients will likely receive long-term, intravenous antifungal medications. This may include amphotericin B and flucytosine.
  • Parasites.  anti-parasitic drugs have not been shown to be especially effective against parasitic meningitis secondary to the high fatality rate of this type of meningitis. Nonetheless, physicians may choose to use medications, such as amphotericin B, miconazole, and rifampin.
  • Trauma. patients with brain and spinal cord trauma will be assessed for possible surgical intervention to prevent further swelling or damage. If surgery is not deemed appropriate, supportive therapy and intensive rehabilitation will be utilized.
  • Cancer. patients with cancer will be assessed for surgical intervention as well as chemotherapy and radiation to control the cancerous tissue and to minimize the symptoms of meningitis.
  • Inflammatory conditions. effective management of the underlying condition, such as sarcoidosis, is the most effective treatment option for meningitis caused by an inflammatory condition. Thus, treatment is targeted towards primary disease control and symptomatic control of meningitis in the meantime.

Complementary and Alternative Treatment

There is no viable alternative to modern medicine for treating meningitis. If it is infectious in nature, such as bacterial, it is vital that you receive proper antibiotic treatment. If the meningitis is secondary to trauma, cancer, or a drug allergy, it is also crucial the cause of the condition is quickly controlled and treated.

In addition to the standard medical treatments, patients are encouraged to utilize other complementary treatment options, such as acupuncture, massage, exercise, and meditation.

Care Guide

After completing treatment, you’ll need regular follow-up care to monitor your overall health and watch to make sure your recovery is complete and to avoid potential future episodes of meningitis. Your primary care physician and/or hospital from which you received treatment should coordinate your follow-up care.

When To Contact A Doctor

Meningitis symptoms may often seem like the flu or other common diseases. Talk to your doctor if you have symptoms that worry you and don’t go away.

Questions For Your Doctor

Treating meningitis may take more than one type of specialist. The doctors on your health care team may include:

  • A primary care physician or emergency medicine physician, may be the first physicians who you encounter before being admitted to the hospital
  • A neurologist, who specializes in the management of brain and spinal cord diseases
  • A neurosurgeon, who specializes in brain and spinal cord surgery
  • A critical care physician, who specializes in caring for patients who require specialized care and monitoring secondary to their critical condition
  • Other health care workers, such as an infectious disease physician, nurse, a dietitian, and a social worker

You can find a doctor near you through one of these sites:

Questions For A Doctor

When you go to see your doctor, it’s good to have a list of the questions you’d like to have answered. Take a moment to write down some of the things you want to know. Your questions for your doctor might include some of these:

  • What type of meningitis do I have?
  • What types of treatment options are available?
  • What is the outlook or prognosis of this specific meningitis?
  • Are there any side effects or potential complications from the treatment?
  • Will there be any long-term side effects from the condition?
  • How can I prevent a similar occurrence in the future?

Resources

Other useful resources to help you learn about meningitis can be found at:

National Meningitis Association

Meningitis Foundation of America

Meningitis Research Foundation