Published on Jun 06, 2019 and last reviewed on Jun 08, 2019 - 6 min read
Acute inflammation of the meninges, which are three protective membranes surrounding the brain and spinal cord, is called meningitis.
Acute inflammation of the meninges, which are three protective membranes surrounding the brain and spinal cord, is called meningitis. This inflammation is mainly caused by a bacterial, viral, or fungal infection, and sometimes due to certain drugs or toxins, cancer, and other rare types of infection. It is a medical emergency and can be life-threatening, if not detected and treated early.
Ear pain or discharge.
Signs and symptoms in adults
Neck pain and stiffness.
Nausea and vomiting.
Intolerance to bright light and loud noises.
Loss of appetite.
Signs in infants
Body and neck stiffness.
Bulge in the fontanel.
The types and causes are:
1) Bacterial Meningitis:
This is the most severe type of meningitis and is caused by several types of bacteria. It is highly contagious and spreads through person-to-person contact. This can result in death or permanent
disabilities, if not treated immediately. And many times associated with lung, ear or skin infections. Recent
skull trauma or head and neck surgery allows nasal cavity bacteria to enter the meningeal space. Some of the bacteria that cause this infection are:
Group B streptococcus.
Gram negative bacteria.
This is the most common type of meningitis and is comparatively less severe than the bacterial type. Infants and people with a weakened immune system are more likely to develop viral meningitis. It can also be spread through person-to-person contact. The viruses that can cause this infection are:
Herpes simplex type 2 virus.
Chickenpox (Varicella-Zoster virus).
HIV (human immunodeficiency virus).
Lymphocytic choriomeningitis virus.
Arboviruses (like dengue).
This is a rare type of meningitis, and cannot be spread from person-to-person contact. It is caused
when fungus from some other part of the body travels through the bloodstream and infects the
cerebrospinal fluid or spinal cord. Fungal spores are present in the soil and environment and enter the
human body through inhaling dirt or soil. People with a weak immune system (for example, people on immunosuppressants therapy for organ transplants, HIV/AIDS, on long term steroid therapy, and old age with multiple comorbidities like diabetes Mellitus, etc.) are at risk of developing fungal meningitis. Some of
the common fungi that cause this are:
This type of meningitis is spread through parasites present in dirt and feces, and on snails, raw fish, and poultry. Eosinophilic meningitis or eosinophilic meningoencephalitis or EM is a type of meningitis that can also be caused by parasites. Here, there is an increase in the levels of eosinophils in the cerebrospinal fluid (CSF). The three most common parasites that cause EM are:
Primary amebic meningoencephalitis (PAM) is a type of fatal meningitis that is caused by microscopic ameba Naegleria fowleri. A person can get infected when water containing the ameba enters the body through the nose.
Non-infectious meningitis is caused by certain medicines or other medical conditions like:
Drugs like NSAIDs, and some antibiotics.
Not all types of meningitis are contagious. Meningitis that is caused by bacteria and viruses are contagious, and that caused by parasites and fungus are not contagious. The microorganism spread through coughing, kissing, and sneezing. It can also spread by eating soft cheese, hot dogs, and meat that contain bacteria like Listeria.
If you have a fever, neck stiffness, increased heart rate, and reduced concentration, your doctor might suspect meningitis. He or she might ask you to get the following tests:
CBC (complete blood count), CRP (C-reactive protein), and other routine blood tests.
Blood culture - The presence of bacteria is seen in the blood sample.
Spinal tap or lumbar puncture - The cerebrospinal fluid (CSF) is collected, as CSF shows low glucose level and increased white blood cells and protein in bacterial meningitis (Raised neutrophils count), fungal and tubercular meningitis (raised lymphocytes count), and normal glucose level with increased WBC (lymphocytes) and protein in viral meningitis. LP is contraindicated in brain mass or tumor or if there is raised intracranial pressure. Hence before doing a lumbar puncture, a CT or MRI scan recommended to rule out above possibilities.
CT scan or MRI - This imaging might show inflammation or swelling in the head.
Depending on the type of meningitis, the treatment options are:
Bacterial meningitis - Intravenous antibiotics ( rd generation Cephalosporin such as Ceftriaxone or Cefotaxime plus Vancomycin) and corticosteroids (start just before the first dose of IV antibiotics and to continue for 4 days) to reduce the risk of complications. If blood or CSF culture is positive, then treat accordingly with proper antibiotics.
Viral meningitis - Typically only requires supportive therapy. Most cases improve over time with rest, fluids, and painkillers. Herpes simplex and the varicella-zoster virus may respond to antiviral treatment like Acyclovir. Corticosteroids to reduce swelling or anti-seizure medicines for seizures.
Fungal meningitis - Antifungal medicines like a high dose of Amphotericin B and Flucytosine. Raised ICP is common in fungal meningitis and frequent lumbar punctures helpful to relief from those symptoms.
Non-infectious meningitis - Hydration, bed rest, and corticosteroids.
Some vaccines that are available for various types of meningitis are:
Haemophilus influenzae type b (Hib) vaccine.
Pneumococcal conjugate vaccine (PCV13).
Pneumococcal polysaccharide vaccine (PPSV23).
Meningococcal conjugate vaccine (quadrivalent vaccine against group A,C,W135,Y).
Childhood vaccination with BCG for Tubercular meningitis.
Some of the factors that increase the risk of meningitis are:
Weakened immunity - HIV infection, chemotherapy, autoimmune diseases, organ transplant, and bone marrow transplant.
People living in close quarters - Boarding schools, day care centers, and hostels.
Children under 5 years.
People working with animals.
Heavy alcohol abusers.
Ear or sinus infections.
Recent head and neck surgery.
The complications associated with meningitis are:
Some tips to prevent meningitis are:
Stay away from sick people.
If you have a bacterial infection, take antibiotics.
Get vaccinated, which will protect you against some types of meningitis.
Practice good personal hygiene.
Eat healthily and exercise regularly.
Cover your mouth and nose when you sneeze.
Avoid sharing personal items.
Be aware of the signs and symptoms of meningitis, as it will help you get immediate medical attention. To know more about meningitis, consult a neurologist online.
A person affected with bacterial meningitis usually requires emergency hospitalization. Early diagnosis and medical treatment will prevent further brain damage and the death of the person. Results are better if the bacterial meningitis is treated with intravenous antibiotics. Viral meningitis can be cured by hospitalization procedures only. But in some cases of viral meningitis, it is treated with intravenous antiviral medications.
In most of the people, bacterial meningitis initially starts when a pathological bacteria gets into their bloodstream through many routes like from the person's sinuses, ears, or throat. The bacteria travel from the patient's bloodstream to his or her brain. The bacteria that cause meningitis can also spread through respiratory droplets, which an affected person coughs or sneezes.
A person affected with viral meningitis gets cured in about seven to 10 days; symptoms start to recede slowly in that period. Bacterial meningitis is commonly cured with the help of antibiotic treatment. The time taken to cure varies by person to person and mainly corresponds to the decrease in that person's symptoms.
Symptoms significant of bacterial meningitis usually appear very quickly, or it might take several days. Also, they develop by having a short incubation period of three to seven days after exposure. Later the symptoms of bacterial meningitis can also be so serious like seizures and coma. Due to these serious complications, any person who feels the typical symptoms of meningitis, they should immediately seek medical care from a doctor without fail.
To rule out meningitis, there would be a series of tests that needed to be done at the hospital. That includes
- A problem focussed physical examination on checking for symptoms and signs of meningitis.
- A blood test to look for the presence of bacteria or viruses.
- A lumbar puncture will be needed in which a sample of cerebrospinal fluid will be taken from the lower spine area and checked for bacteria or viruses.
- A CT scan is an essential tool to check for any brain tissue damage, like swelling.
Bacterial meningitis is usually prevalent in young adolescents at the age of 20. Living in a locality where there is an epidemic also increases the risk. College students who live at hostels, and children who study at boarding schools are at high risk of acquiring Meningococcal meningitis.
Due to meningitis's short incubation period, the person may not stay without knowing the symptoms for a long period. Symptoms are seen within three to seven days. So, when the time exceeds that, the patient will start developing mild difficulties to severe complications like seizures or coma.
Stiff neck occurs as a mandatory symptom accompanied by a severe headache that the patient might explain as the most severe headache in recent times that is different from the normal ones. Along with problems, there is also the presence of symptoms like nausea, vomiting, confusion, and difficulty concentrating.
No, the person can not move his or her neck as usual when he or she is affected by meningitis. This is due to the fact that one of the most key symptoms of meningitis is a stiff neck.
The rash of meningitis could be very difficult to see on the naked eye in a dark-skinned person. Still, it may be readily visible in paler areas of the body, especially at the soles, palms, abdomen, or on the eyelid's inner surface and the roof of the mouth. The 'glass test' can confirm if a rash is or not a symptom of meningitis.
The stiff neck most commonly involves a reduced ability of the person to flex the neck in the forward direction. It is also being termed as the nuchal rigidity. Based on the severity of the stiff neck in a person, the collar will be able to bend at least about half the potential than usual. Sometimes, it might not flex at all.
The headache commonly presents with generalized pain all over the head. Drowsiness and confusion and severe disorientation may also occur along with the widespread problem in the more severe forms of meningitis.
The common signs and symptoms in adults affected with meningitis include the following.
- Sudden onset of high fever.
- Stiff neck especially limiting forward flexing.
- Severe headache that seems so unordinary.
- Headache episodes associated with nausea or vomiting.
- Confusion and difficulty concentrating on routine tasks.
- Excessive sleepiness with difficulty waking up.
- Sensitivity to light.
- Decreased appetite and thirst.
- Skin rashes especially in a case of Meningococcal meningitis
Several strains of bacteria are capable of causing acute bacterial meningitis, which most commonly includes Streptococcus pneumonia. This bacterium is the most frequent causative agent of bacterial meningitis in all age groups. It can affect infants, young children, and adults. It usually causes untreated or chronic pneumonia, ear, or sinus infections.
Bacterial meningitis is a severe medical condition. So, if you experience any symptoms or feel that your child has symptoms of typical meningitis, it is essential to seek immediate medical care from a doctor.
Yes, several medicines, such as the Ibuprofen and Naproxen, can help in relieving pain associated with meningitis. These medications are also noted to have significant anti-inflammatory properties that can help with neck pain also. It should be noted that the anti-inflammatory effect of these drugs is not that strong enough to cure the inflammation in meningitis itself.
No, meningitis cannot be tested at home. When you experience symptoms that are significant to be meningitis, you should immediately seek proper physician care. This can avoid unnecessary complications such as brain damage and seizures. Once you reach the hospital, the physician will recommend certain diagnostic tests that are performed in the hospital setting. It is the right way to test for meningitis at home.
The initial presentation of meningitis mimics the flu. It also presents with an atypical rash that is significant in Meningococcal meningitis. Flu and rash appear to be the earliest symptoms of the disease. In some patients, there might be differences in symptoms.
To establish a definitive diagnosis of meningitis, the doctor will use certain diagnostic procedures like the spinal tap to collect cerebrospinal fluid. This test will check the presence of a virus or bacteria. The cerebrospinal fluid also shows a low glucose level along with an additional increase in the white blood cell count and elevated protein levels.
Since meningitis's main symptoms is a stiff neck associated with generalized headache, meningitis hurts the neck and head. The rashes can also be painful. Almost all the patients report severe pain after the appearance of rashes.
The bacteria that are usually found in the nasal and throat regions are normally harmless. However, in certain people who are having immunocompromised states, those bacteria can be harmful. If these people are recovering from a cold or the flu, the bacteria causing the infection can spread to the brain from the blood and cause meningitis. Therefore, it can be a life-threatening condition if it is not treated promptly.
Patients affected with viral meningitis will typically have a fever, headache, and a stiff neck. Trying to flex the chin to the direction of the chest causes pain and maybe impossible. Moving the head in other directions is difficult. Symptoms may resemble bacterial meningitis but are usually less severe and progress more slowly.
A sore throat is not a typical sign of meningitis. But if the sore throat is not treated adequately and left the same for an extended period of time, it might enter the bloodstream. Once the bacteria enter the bloodstream, it might enter the brain and cause meningitis.
Yes, meningitis presents in abnormal blood count. There is an increased level of white blood cell count. Also, blood cultures can be done to establish the presence of a bacteria or virus.
Yes, meningitis can be detected in the urine. In places where there is no laboratory available, meningitis can be identified by the use of a urine patch test. But in places where the Human immunodeficiency virus is endemic and where cryptococcal meningitis is shared, neither the patch tests nor routine laboratory examination of the cerebrospinal fluid can identify the infection adequately.
The symptoms in a meningitis patient include a general feeling of malaise, fever, easy irritability, and vomiting. Some patients might also have a sore throat, cough, or a runny nose known as rhinorrhea. All these insignificant symptoms may resemble the symptoms of a viral infection.
Coxsackievirus and the Echovirus groups of enteroviruses are the most frequent cause of viral meningitis. Meningitis caused by these organisms usually produce no symptoms, or only very mild symptoms like sore throat, colds, and other flu-like symptoms. Rarely diarrhea can also be present.
Viral meningitis usually resolves on their own, even with or without treatment. Rarely, it causes complications such as brain damage. It mainly depends on the immune status of the affected person to overcome the disease by themselves.
People with meningitis will usually need to stay at the hospital for a few days to a week. But in some instances, like immunocompromised patients, the treatment might be required for several weeks to months. You should consult with your doctor regarding the discharge and other treatment guidance.
Yes, you need to be hospitalized for treating meningitis. It will require frequent monitoring of the virus or bacterial load, adequate treatment if complications are present, and infusion of fluids, all possible only in hospitals. Hospitalization can also prevent the spread of infection unnecessarily to those at the patient's home.
No, meningitis does not last forever in any patient. Mostly the disease resolves on its own, and the other cases resolve with treatment. Mortality is also common. You should consult your doctor for treatment options so that your health issue can be resolved better.
Yes, since meningitis presents with flu-like symptoms, it usually presents with fever. The fever is very high in temperature, and it is of sudden onset. These symptoms of fever might resemble other conditions. So, it is necessary to get proper diagnosis.
Meningococcal meningitis, which is commonly caused by the bacteria Neisseria meningitidis is the deadly form of the disease. It can be very dangerous if it is not diagnosed as early as possible and treated quickly.
Meningitis is one of the very contagious diseases. It can spread through the respiratory droplets of the affected patients when they cough, sneeze and speak. Diseases that could spread through air-borne routes could spread easily, and it is necessary to follow ideal precautionary measures.
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