Joseph R. Anticaglia, MD
Medical Advisory Board
Meningitis is an inflammation of the meninges–the thin membrane that surrounds the brain and spinal cord.
Meningitis can be a deadly infection if untreated. In November, 2013 a freshman student at the University of California had both feet amputated as a result of poor blood supply to his lower limbs after he contracted meningitis.
In December, 2013 there was an outbreak of meningitis on the campus at Princeton University in New Jersey. A particular strain of meningitis, classified as type B, was the infecting agent. Three months later, a student at Drexel University in Philadelphia died from the same strain of meningitis that caused the outbreak at Princeton University.
Children who are under 5 years of age and persons with weakened immune systems because of disease (HIV), medications used to treat cancer (chemotherapy) and transplant patients are at a higher risk to contract meningitis.
Meningitis can be caused by a variety of different infectious agents; there are two main types of meningitis:
Meningitis
- Viral meningitis is the most common type of the disease. It spreads through air droplets and direct contact with an infected individual by coughing, sneezing, kissing or sharing beverages.
Influenza, measles, mumps can cause viral meningitis but it’s most commonly caused by a non-polio type off virus. It can, but rarely’ cause death. - Bacterial meningitis can be fatal. It’s caused by a bacterium, and is transmitted people to people in a manner similar to viral meningitis. In fatal cases, death can occur within 24 hours after typical symptoms appear.
Meningococcal and pneumococcal types are the most common causes of bacterial meningitis. Meningitis is seldom caused by tuberculosis, a parasite or a fungus.
The disease was first described in 1805 when an outbreak struck Geneva, Switzerland. Below is the experience of a teenager in the 21 st century.
Barry’s Story
It was the summer of 2006 and 19 y/o Barry was elated about an upcoming 3 week vacation to Africa. It was billed as an African Safari and he anticipated being up close to lions, cheetahs and cape buffaloes. He looked forward to camping out, enjoying the African sunset, encounters with giraffes, flamingoes, wildebeests and the opportunity to meet with the Masai.
Five days before departing for Africa, Barry was wondering what to expect while visiting Nairobi, Kenya or South Africa’s, Soweto–the township where Nelson Mandel resided for several years. And then it happened.
“What a time to come down with the flu and on my birthday!” he thought. It was early morning when he developed a fever, and became extremely tired and sensitive to light. It seemed within hours, he was complaining of a bad headache, feeling groggy and a stiff neck. That evening he was taken to the emergency room of a nearby hospital. A neurologist was consulted and after his examination said,
“I suspect Barry has meningitis, what type of meningitis is the important question. That’s why he needs blood tests, a CT of the brain, a throat culture and a spinal tap to rule out a bacterial cause of the disease.
His parents were stunned. All too slowly, for them, the tests results became available: The neurologist summarized the findings:
“There’s a lot of good news. The CT showed no evidence of a brain mass and the blood tests points to a viral infection. The spinal tap fluid suggests a non-bacterial infection – viral meningitis – all good news.”
His mother asked, “Well, how you do treat viral meningitis?”
“We treat this problem as if Barry has the flu. I’ll prescribe medications to reduce the fever and to relieve the headache. He’s going to need plenty of rest, fluids and no aspirin and no antibiotics. He’s going to feel tired and might sleep a lot.”
“We’ve made plans to vacation in Africa and are scheduled to leave in one week. I’m embarrassed to ask but will he be well enough to get on the plane?
“It depends on what happens over the next 24-48 hours. He should be lying flat on his back for several hours to minimize a headache from the spinal tap. The nurse will give you my written instructions before you leave the ER. Call me at any time if you have questions.- At any time.”
Barry and his parents left the hospital unsure what was in store for them over the next 24-48 hours.
Symptoms
The different types of meningitis have many symptoms in common. Prominent symptoms among adults are fever, headache, stiff neck and altered mental status.
Children are irritable, difficult to wake, refuse food with neck retraction and arching back. The figures and information below are courtesy of the Meningitis Foundation, New Zealand.
| Children/Adult | Infants |
|---|---|
 Stiff Neck |
 Fever, possibly with cold hands and feet |
 Headache |
 Refusing feeds or vomiting |
 Fever |
 High pitched moaning cry or whimpering |
 Vomiting |
 Dislike of being handled or fretful |
 Light Sensitivity |
 Neck retraction with arching of back |
 Drowsiness or Confusion |
 Blank & staring expression |
 Joint Pain |
 Child is difficult to wake, lethargic |
 Fever |
 Pale, blotchy complexion |
Treatment
Bacterial meningitis (e.g. meningococcal and pneumococcal meningitis) is medical emergencies. After a spinal tap (lumbar puncture) and other tests, intravenous antibiotic medications should be initiated as soon as possible.
Regarding viral meningitis, most doctors recommend rest in a dimly lit room, fluids and medications to reduce fever and relieve headache. There are no specific treatments for most viral causes of meningitis. However, one should not underestimate the seriousness of this form of meningitis and people should seek immediate medical attention.
Prevention
Several vaccines are recommended for infants to prevent certain types of bacterial meningitis (meningococcal, pneumococcal, Hemophilus influenza B).
Unfortunately, 5% to 10% of patients die even when the correct diagnose is made early in the course of the disease and indicated I.V. antibiotics are initiated.
Takeaways
- Meningitis is an inflammation of the meninges. It can cause septicemia–a bloodstream infection.
- It’s a medical emergency. The earlier the treatment is commenced, the better the outcome.
- Viruses and bacteria are the principal causes of meningitis. Bacterial meningitis is the most dangerous type whereas viral meningitis is the most common type.
- People who survive bacterial meningitis, 20% will experience permanent after effects such as loss of hearing, neuropsychological difficulties
- Treatment and incidence of meningitis depend on age, country and what bug (pathogen) caused the disease
- Symptoms appear typically 3 to 7 days after being exposed to the bacteria
- Vaccinations have reduced the incidence of meningitis in the U.S.
Oh, yes, Barry received permission to travel. He slept a good part of the time on the non-stop flight to Africa. He rested most of the next day. By the third day, he was back to his usual self and greeting people by saying, “Jambo, hubari gani.”
References
World health Organization, Meningococcal Meningitis; International Travel and Health, 2003
NIH, NINDS; Meningitis and Encephalitis Fact Sheet; May 8, 2017
CDC, Bacterial Meningitis- National Center for Immunization and Respiratory Diseases; January 25,2017
Olaf Hoffman, JR Weber; Pathophysiology and treatment of bacterial meningitis; Neurologic disorders; June 2, 2009
H. Schmidt et al; Neuropsychological sequelae of bacterial and viral meningitis; Brain, Dec 19, 2005
Meningitis Foundation, New Zealand Rosenstein, N E et al; Meningococcal Disease; New England J of Medicine
Rosenstein, N. E., et al; Meningococcal Disease. New England Journal of Medicine. 2001
This article is intended solely as a learning experience. Please consult your physician for diagnostic and treatment options.