Meningitis: Symptoms, Causes, Risks, Complications, Diagnosis, Treatment and Prevention

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Illustration of Meningitis

1Overview

The brain is a very important part of the body as it acts as the control center for many functions and processes. It’s also a delicate organ that’s why it’s protected by the skull and the meninges. The meninges are three layers of protective tissue named the arachnoid mater, dura mater, and pia mater. These layers protect not only the brain but also the spinal cord.

When the meninges become infected and inflamed, it leads to a potentially fatal condition called meningitis. Meningitis is an inflammation of the membranes that surround the brain and spinal cord. The swelling may trigger hallmark symptoms such as fever, headache, and a stiff neck.

It can affect anyone but is most common in infants, young children, adolescents and young adults. Most cases of meningitis in the United States are caused by a viral infection, but there are cases linked to bacteria and fungi. Some causes of meningitis may improve even without treatment but others may lead to life-threatening complications and may need treatment with antimicrobials.

If the condition is not treated appropriately, it may cause potentially-fatal blood poisoning called septicemia and in the long run, may cause permanent damage to the nerves and the brain. Thus, early treatment of meningitis is important and vital.

There are available vaccines to protect against meningitis and these are usually given to infants.

2Symptoms

The symptoms of meningitis differ in adults and infant.

The early symptoms of meningitis may be similar to those of flu and the symptoms can develop over many hours and a few days. The symptoms are seen in people more than two years old include:

  • Sudden high fever
  • Severe headache
  • Stiff neck
  • Blotchy rash that doesn’t fade when a glass is rolled over it
  • Dislike of bright lights
  • Nausea and vomiting
  • Seizures
  • Confusion or problems with concentration
  • Sleepiness and difficulty waking up
  • No appetite
  • No thirst

The signs and symptoms in newborns or babies less than two years old include:

  • High fever
  • Excessive irritability and sleepiness
  • Excessive and constant crying
  • Sluggishness and inactivity
  • Poor feeding
  • Stiffness in the baby’s neck and body
  • Bulge in the soft spot on the top of the infant’s head or the fontanel

3Causes

The main cause of meningitis is the infection and inflammation of the meninges caused by various microorganisms. Viral infections are the most common causes of meningitis, followed by bacterial infections and in rare cases, fungal infections. The other causes of meningitis are parasites.

Types and causes of meningitis

The most common types of meningitis are viral and bacterial, but there are also other types of meningitis present today.

Viral meningitis – Viral meningitis is the most common kind of the infection. Enteroviruses cause about 85 percent of all cases and these are usually acquired during the fall and summer seasons. The viruses that cause meningitis include coxsackievirus A, coxsackievirus B, and echoviruses. These viruses in the enteroviruses category lead to about 10 to 15 million cases each year, but not all patients develop meningitis.

The other viruses that may cause meningitis include the influenza virus, West Nile virus, mumps, HIV, measles, the herpes virus, and coltivirus.

Bacterial meningitis – Bacterial meningitis can be transmitted from one person to another and is caused by certain bacteria. This type of meningitis is potentially-fatal if it’s left untreated. Approximately 5 to 40 percent of children and about 20 to 50 percent of adults who develop the condition die, sometimes even with proper treatment.

The bacteria that may cause this fatal disease are Streptococcus pneumonia, Neisseria meningitides, Haemophilus influenza, and Listeria monocytogenes.

Other types of Meningitis:

Fungal meningitis – Meningitis cases caused by fungi are rare, but people can get the infection through inhalation of spores in the environment. Some people are vulnerable to getting this type of disease, including those who have diabetes, HIV and cancer.

Parasitic meningitis – Parasites may cause meningitis but they are less common than bacterial and viral meningitis.

How meningitis is spread

The viruses and bacteria that cause meningitis can be spread through sneezing, coughing, kissing, sharing utensils and toothbrushes. The microorganism can be spread by someone infected with the virus or bacteria in their throat and nose but are not ill themselves. Someone with meningitis can also spread These microorganisms but it’s less common.

4Risk Factors

Some people are more predisposed in getting the infection than others. The risk factors of meningitis include:

Age – Most cases of viral meningitis happen in children who are younger than five years old. Bacterial meningitis, on the other hand, is common in those who are 20 years old and below.

No vaccinations – Many vaccinations are available for meningitis. The risk increases in people who haven’t completed the recommended vaccination schedule.

Pregnancy – Pregnant women are predisposed to a disease called listeriosis, which is an infection caused by the bacteria listeria. This may lead to meningitis as a complication and may also increase the tendency of stillbirth, miscarriage and premature childbirth.

Living in community setting – People who live in crowded places such as dormitories, boarding schools, child care facilities and military bases are at a heightened risk of meningococcal meningitis. This is because the microorganisms can be spread through the respiratory route and can be passed quickly through large groups.

Weakened immune systems – People with compromised immune systems are at a higher risk of getting meningitis. The conditions that may lower the immune system include human immunodeficiency virus (HIV), Acquired immunodeficiency syndrome (AIDS), autoimmune disorders, chemotherapy, alcoholism, diabetes, and organ or bone marrow transplants.

5Complications

If meningitis is left untreated, it could lead to severe complications. The longer the person has the infection without proper and immediate treatment, the higher the risk of permanent neurological damage such as:

  • Hearing loss
  • Seizures
  • Brain damage
  • Hydrocephalus
  • Subdural effusion or fluid buildup between the brain and skull
  • Problems with memory
  • Gait problems
  • Learning disabilities
  • Kidney failure
  • Shock
  • Death

6Diagnosis

The diagnosis of meningitis starts with taking the patient’s health history and performing a thorough physical examination. The living conditions and age can be important clues to the diagnosis.

The doctor may also conduct a physical examination to look for signs of fever, increased heart rate, reduced consciousness and neck stiffness. To confirm the diagnosis, the doctor may request the following diagnostic tests:

Blood cultures – Samples of blood are acquired and cultured in a petri dish to look for the growth of microorganisms over time. This is particularly used in suspected bacterial meningitis.

Spinal tap or lumbar puncture – To confirm a diagnosis, the doctor will recommend the test called spinal tap or lumbar puncture, wherein a sample of the cerebrospinal fluid (CSF) is acquired for testing. The CSF will show low sugar or glucose levels with an increased blood cell count when a person has meningitis. Aside from these, the analysis of the CSF could show which particular microorganism is present in the meninges to help in choosing the best antibiotics to use.

Imaging tests – Some imaging tests such as computerized tomography scan (CT scan) or magnetic resonance imaging (MRI) scan of the head can show the severity and degree of inflammation in the brain.

7Treatment

The treatment of meningitis is determined by the cause of the infection.

Bacterial meningitis – Usually, the treatment of bacterial meningitis requires immediate admission to the hospital. Early detection and initiation of treatment may help prevent disease progression and brain damage or even death. The usual drugs used in this type of meningitis are intravenous antibiotics. The antibiotic to be used will also depend on the type of bacteria present in the meninges.

Aside from antibiotics, the doctor may also prescribe corticosteroids, to lessen the inflammation in the brain and reduce the risk of complications like brain swelling and seizures.

Viral meningitis – Viral meningitis is usually not treated since viruses are self-limiting. This means that the infection will resolve on its own. The symptoms will go away within two weeks without treatment. There are also no serious long-term problems linked to viral meningitis.

8Prevention

To prevent meningitis, these steps are precautions to follow, particularly because meningitis can spread through sneezing, kissing, sharing utensils and coughing.

  • Practice proper handwashing is important to prevent germs. Educate the children to wash their hands regularly, particularly before eating and after using the toilet. Also, if the kids were exposed to crowded public places, wash their hands or use hand sanitizers after.
  • Stay healthy by boosting the immune system. This can be done through getting enough sleep and rest, regular exercise, and eating a well-balanced diet with plenty of vegetables, fruits, and whole grains.
  • Practice good hygiene by not sharing drinks, straws, foods, utensils or toothbrushes.
  • Cover the mouth when sneezing or coughing.
  • For pregnant women, avoid eating raw and uncooked food. Cook meat including hot dogs properly and avoid eating cheese from unpasteurized milk.
  • Get vaccinated with vaccines such as Haemophilus influenza type b (Hib) vaccine, pneumococcal conjugate vaccine (PCV13) and pneumococcal polysaccharide vaccine (PPSV23). The Centers for Disease Control and Prevention (CDC) also recommends the meningococcal conjugate vaccine to be given to children who are 11 to 12 years old. A booster dose is given at age 16.