Meningitis is an inflammation or swelling of the coverings of our brain which is called as meninges. Annual hospital records from all over the world shows there are high number of patients with meningitis in every year. Meningitis presents with high fever, vomiting, neck pain. Health sectors have introduced vaccines for meningitis prevention.
Meningitis is mainly caused bacteria, viruses. But fungus, tuberculosis. And also autoimmune diseases and cancers have contribution for meningitis.
Meningitis can cause nerve problems and if untreated it can be fatal.
Simple triad of symptoms have clinically identified :
- high fever
- neck stiffness
Other than these symptoms, there are,
- Photophobia ( inability to look at a direct light )
In meningitis caused by bacteria have following extra symptoms.
- Body pain
- Fever with rigors, which developing within hours or minutes
- Prefer to lie still
- Consciousness may be affected if the condition is severe.
Symptoms in babies
Other than main symptoms above mentioned, new born babies may have,
- Poor feeding or vomiting
- Reduced activity
- Loss of consciousness
Only children who are old enough to talk can describe the symptoms. So moms must be alert for above symptoms. If the child has got meningococcal sepsis only a rash can be seen over the trunk.
Spreading of the disease
People get meningitis organisms by 2 main ways.
Direct spread – organisms enter into brain by infections in structures near to the brain. Such as ears, nose, throat. And even by injury to the head. This is the main pathway
Blood spread – organisms can spread to the brain from any infection in the body. And it comes through blood stream.
Organisms causing meningitis
The main bacterial causes for meningitis are,
- Streptococcus pneumoniae (pneumococcus). This is a bacteria causes pneumonia and ear infections. And it is the most common cause for bacterial meningitis in all age groups.
- Neisseria meningitidis (meningococcus). Teenagers and young adults are affected by this bacteria. It mainly identified in military bases, collage dormitories. This causes upper respiratory tract infection such as sore throat. And it spread through blood stream.
- Haemophilus influenzae (haemophilus). Haemophilus Influenza type b ( Hib ) is the commonest cause for meningitis in children few decades early. But now with the Hib vaccination the incidence are dropping down.
- Listeria monocytogenes (Listeria). This bacteria affects mainly people with weak immune system and pregnant mothers. Unpasteurized cheese, hot dogs are identified as causes for this bacterial infection. This can transmit to the baby through placenta. And causes serious problems to the baby.
Other than these there are identified cases with following bacteria.
- Staphylococcus aureus
- E coli
- Treponema pallidum
Viral meningitis is mainly caused by,
- Enteroviruses such as Coxsackie
- Poliomyelitis ( mainly eradicated worldwide)
- Herpes simplex
- Epstein – Barr
Fungal causes are,
- Cryptococcus neoformans
- Candida albicans
- Coccidiodes immitis
- Histoplasma capsulatum
- Blastomyces dermatitis
Consider following possible causes with the incidents.
|Skull fracture |
|Rash with chest pain||Enteroviruses|
Meningitis is diagnosed by clinical history and the physical examination showing specific signs. And the diagnosis is confirmed by doing a lumbar puncture. In doubtful cases also lumbar puncture can give a correct diagnosis. Cerebrospinal fluid is sent after lumbar puncture for checking cells, proteins and glucose levels. By these results clinicians can differentiate the cause.
Risk factors for meningitis
Following risk levels are identified,
- Avoid vaccination – Meningitis b vaccine is considered as preventive measure. The people who avoid this have a high chance of having meningitis
- Age – Extremes of ages like childhood and older adults are more prone to get bacterial meningitis. And young population has increased viral meningitis incidences.
- Living as groups – Because organisms causing respiratory infections have high tendency for spreading in groups. Military bases, collage dormitories and baby care centres are susceptible for this.
- Pregnancy – As discussed earlier pregnancy is at risk of Listeria. And spreading of Listeria into fetus can cause miscarriages also.
- Immune compromised people – People with HIV, Diabetes and treated patients with immune suppressant drugs for cancers and rheumatoid arthritis are more prone. And also people whose spleen is removed have high chance. So they are routinely vaccinated for meningococcal infection.
Complications of meningitis
New born babies develop more serious complications like,
- Memory problems
- Learning difficulties
- Hearing loss
- Problems with balance and walking
Older patients can have,
- Chronic kidney disease
Following these simple steps are very useful in Meningitis prevention.
- Practice good hand hygiene – Use proper hand washing before eating, after using toilet and after touching animals or soil. This can destroy the germs coming through hand.
- Avoid sharing things with others – sharing foods, drinks, cigarettes, toothbrushes are known causes to spreading infections from one person to another.
- Strengthen your immunity – eat healthy foods, avoid smoking and alcohol can improve your immune system.
- Special care for pregnant mothers – Listeria infection mainly caused by unpasteurized milk products. Its advisable to carefully choose the milk products like cheese.
Immunization for meningitis
Drugs like Rifampacin or Ciprofloxacin are currently using for people with close contacts. MenC vaccine is currently practicing in UK. And MenB, a meningococcal b vaccine is available for immunization of infants. And also it use in outbreaks. Combination of both C and B vaccines are used in UK prior to travel endemic areas. Such as Africa and Asia. In specific events such as the Hajj and Umrah in Mecca, using quadrivalent ACWY vaccine for Meningitis prevention.
Pneumococcal vaccine has reduced the incidence of pneumococcal meningitis. Pneumococcal polysaccharide vaccine is used in older adults, low immunity peoples. And patients who underwent spleenectomy is also vaccinated. Pneumococcal conjugated vaccine is now practicing in infants.
Hib vaccine is also a routinely practicing vaccine in the UK and many other countries.
Meningococcal conjugate vaccine is used in some countries as CDC recommendations. It use as a single dose be given to children ages 11 to 12, with a booster shot given at age 16. If the first vaccine is given during age 13 – 15, booster dose is given during 16 to 18 years of age. And if first vaccine is given after age of 16 years, no booster vaccine is needed.
Side effects of MenB vaccine
This vaccine is safe to administer but as with any vaccine, following side effects can occur.
- Pain, redness or swelling at the site
- Muscle pain