Issued Tuesday 28 March 2017
Meningitis
is an acute inflammation of the protective membranes covering the brain and
spinal cord, known collectively as the meninges.
The
most common symptoms are fever, headache and neck stiffness. Other symptoms
include confusion or altered consciousness, vomiting, and an inability to
tolerate light or loud noises.
Young
children often exhibit only nonspecific symptoms, such as irritability,
drowsiness, or poor feeding. ] If a rash is present, it may indicate a
particular cause of meningitis; for instance, meningitis caused by
meningococcal bacteria may be accompanied by a characteristic rash.
The inflammation may be caused by infection
with viruses, bacteria, or other microorganisms, and less commonly by certain
drugs.[4] Meningitis can be life-threatening because of the inflammation’s
proximity to the brain and spinal cord; therefore, the condition is classified
as a medical emergency.
A
lumbar puncture diagnoses or excludes meningitis.[2] A needle is inserted into
the spinal canal to collect a sample of cerebrospinal fluid (CSF) that envelops
the brain and spinal cord. The CSF is examined in a medical laboratory.
Some
forms of meningitis are preventable by immunization with the meningococcal,
mumps, pneumococcal, and Hib vaccines.[1] Giving antibiotics to people with
significant exposure to certain types of meningitis may also be useful.
The
first treatment in acute meningitis consists of promptly giving antibiotics and
sometimes antiviral drugs.
Corticosteroids can also be used to prevent complications from excessive
inflammation.
Meningitis
can lead to serious long-term consequences such as deafness, epilepsy,
hydrocephalus, or cognitive deficits, especially if not treated quickly.
In
2013 meningitis occurred in about 16 million people worldwide. This resulted in 303,000 deaths – down from
464,000 deaths in 1990. With appropriate
treatment the risk of death in bacterial meningitis is less than 15%. Outbreaks of bacterial meningitis occur
between December and June each year in an area of sub-Saharan Africa known as
the meningitis belt. Smaller outbreaks
may also occur in other areas of the world.
Symptoms
and causes
Early
meningitis symptoms may mimic the flu (influenza). Symptoms may develop over
several hours or over a few days.
Possible
signs and symptoms in anyone older than the age of 2 include:
Sudden
high fever
Stiff
neck
Severe
headache that seems different than normal
Headache
with nausea or vomiting
Confusion
or difficulty concentrating
Seizures
Sleepiness
or difficulty waking
Sensitivity
to light
No
appetite or thirst
Skin
rash (sometimes, such as in meningococcal meningitis)
Signs in new-borns
New-borns
and infants may show these signs:
High
fever
Constant
crying
Excessive
sleepiness or irritability
Inactivity
or sluggishness
Poor
feeding
A
bulge in the soft spot on top of a baby’s head (fontanel)
Stiffness
in a baby’s body and neck
Infants
with meningitis may be difficult to comfort, and may even cry harder when held.
When
to see a doctor
Seek
immediate medical care if you or someone in your family has meningitis
symptoms, such as:
Fever
Severe,
unrelenting headache
Confusion
Vomiting
Stiff
neck
Bacterial
meningitis is serious, and can be fatal within days without prompt antibiotic
treatment. Delayed treatment increases the risk of permanent brain damage or
death.
It’s
also important to talk to your doctor if a family member or someone you work
with has meningitis. You may need to take medications to prevent getting the
infection.
Causes
of Meningitis
Viral
infections are the most common cause of meningitis, followed by bacterial
infections and, rarely, fungal infections. Because bacterial infections can be
life-threatening, identifying the cause is essential.
Bacterial
meningitis
Bacteria
that enter the bloodstream and travel to the brain and spinal cord cause acute
bacterial meningitis. But it can also occur when bacteria directly invade the
meninges. This may be caused by an ear or sinus infection, a skull fracture,
or, rarely, after some surgeries.
Several
strains of bacteria can cause acute bacterial meningitis, most commonly:
•
Streptococcus pneumoniae (pneumococcus). This bacterium is the most common
cause of bacterial meningitis in infants, young children and adults in the
United States. It more commonly causes pneumonia or ear or sinus infections. A
vaccine can help prevent this infection.
•
Neisseria meningitides.
•
This bacterium is another leading cause of bacterial meningitis. These bacteria
commonly cause an upper respiratory infection but can cause meningococcal
meningitis when they enter the bloodstream. This is a highly contagious
infection that affects mainly teenagers and young adults. It may cause local
epidemics in college dormitories, boarding schools and military bases. A
vaccine can help prevent infection.
•
Haemophilus influenza. Haemophilus influenza type b (Hib) bacterium was once the
leading cause of bacterial meningitis in children. But new Hib vaccines have
greatly reduced the number of cases of this type of meningitis.
•
Listeria monocytogenes (listeria). These bacteria can be found in unpasteurized
cheeses, hot dogs and luncheon meats. Pregnant women, new-borns, older adults
and people with weakened immune systems are most susceptible. Listeria can
cross the placental barrier, and infections in late pregnancy may be fatal to
the baby.
Viral
meningitis
Viral
meningitis is usually mild and often clears on its own. Most cases in the
United States are caused by a group of viruses known as enteroviruses, which
are most common in late summer and early fall. Viruses such as herpes simplex
virus, HIV, mumps, West Nile virus and others also can cause viral meningitis.
Chronic
meningitis
Slow-growing
organisms (such as fungi and Mycobacterium tuberculosis) that invade the
membranes and fluid surrounding your brain cause chronic meningitis. Chronic
meningitis develops over two weeks or more. The symptoms of chronic meningitis
— headaches, fever, vomiting and mental cloudiness — are similar to those of
acute meningitis.
Fungal
meningitis
Fungal
meningitis is relatively uncommon and causes chronic meningitis. It may mimic
acute bacterial meningitis. Fungal meningitis isn’t contagious from person to
person. Cryptococci meningitis is a common fungal form of the disease that
affects people with immune deficiencies, such as AIDS. It’s life-threatening if
not treated with an antifungal medication.
Other
meningitis causes
Meningitis
can also result from non-infectious causes, such as chemical reactions, drug
allergies, some types of cancer and inflammatory diseases such as sarcoidosis.
Risk
factors
Risk
factors for meningitis include:
•
Skipping vaccinations. Risk rises for anyone who hasn’t completed the
recommended childhood or adult vaccination schedule.
•Age.
Most cases of viral meningitis occur in children younger than age 5. Bacterial
meningitis is common in those under age 20.
•
Living in a community setting. College students living in dormitories,
personnel on military bases, and children in boarding schools and child care
facilities are at greater risk of meningococcal meningitis. This is probably
because the bacterium is spread by the respiratory route, and spreads quickly
through large groups.
•
Pregnancy. Pregnancy increases the risk of listeriotic — an infection caused by
listeria bacteria, which also may cause meningitis. Listeriotic increases the
risk of miscarriage, stillbirth and premature delivery.
•
Compromised immune system. AIDS, alcoholism, diabetes, use of immunosuppressant
drugs and other factors that affect your immune system also make you more
susceptible to meningitis. Having your spleen removed also increases your risk,
and patients without a spleen should get vaccinated to minimize that risk.
Complications
Meningitis
complications can be severe. The longer you or your child has the disease
without treatment, the greater the risk of seizures and permanent neurological
damage, including:
•
Hearing loss
•
Memory difficulty
•
Learning disabilities
•
Brain damage
•
Gait problems
•
Seizures
•
Kidney failure
•
Shock
•
Death
With
prompt treatment, even patients with severe meningitis can have good recovery.
Prevention
For
some causes of meningitis, protection can be provided in the long term through
vaccination, or in the short term with antibiotics. Some behavioral measures
may also be effective.
How
to avoid meningitis
You
can reduce your risk of getting or spreading viruses and bacteria by taking a
few precautions:
•
Wash your hands frequently with warm water and soap. Wash for a full 20
seconds, taking care to clean under fingernails. Rinse and dry thoroughly.
•
Wash your hands before eating, after using the toilet, after changing a diaper,
or after tending to someone who is ill.
•
Don’t share eating utensils, straws, or plates.
•Cover
your nose and mouth when you cough or sneeze.
•
Stay up to date with immunizations and booster shots for meningitis.
•
Ask your doctor about immunizations before traveling to countries with higher
rates of meningitis.
If
you have signs of meningitis, seek medical attention immediately.
For further information, WHO web site, E mail
to azadehhassanmd10@gmail.com, text only to 002207774469,3774469.
Author
DR AZADEH Senior Lecturer at the University of the Gambia, Senior Consultant in
Obstetrics & Gyaecology, Clinical Director Medicare Health Services.
