Meningitis

Meningitis is an acute inflammation of the meninges – the protective membranes covering the brain and the spinal cord.

It is considered a medical emergency, because of the inflammation’s proximity to the brain and spinal cord which can be a life-threatening.

Symptoms:

(LEARN THE SYMPTOMS…IT CAN KILL IN 24 HOURS…)

**Classic triad: fever, neck stiffness, mental status changes**

  • Infants:

Ø  Fever (possibly with cold hands/feet)

Ø  Refusing feeds/vomiting

Ø  High pitched moaning cry

Ø  Dislike of being handled/agitated

Ø  Neck retraction with arching of the back

Ø  Blank/staring expression

Ø  Child is difficult to wake/lethargic

Ø  Pale/blotchy complexion

Ø  Floppy/stiff/jerking movements

  • Children/Adults:

Ø  Stiff neck

Ø  Headache

Ø  Fever

Ø  Vomiting

Ø  Light sensitivity

Ø  Drowsiness/confusion

Ø  Joint pain

Ø  Fitting/convulsions/seizures

 

* Symptoms can appear in any order and may not all be present.

* Young children with meningitis may not have a stiff neck or light sensitivity.

* Rash may also occur with some forms of meningitis.

If concerned, SEE DOCTOR IMMEDIATELY!

Causes:common etiologies can differ, depending on the patient’sage group, associated illnesses, status of the immune system and lifestyle.

  • Bacterial
  • Viral
  • Fungal
  • Parasitic
  • Some Medications
  • Some Systemic Diseases: Kawasaki Disease, Sarcoidosis, Systemic Lupus Erythematosus, Wegener Granulomatosis, Multiple Sclerosis, Guillain-Barré Syndrome, Leukemia, Lymphoma.

Meningitis Worldwide Incidence and Prevalence:

♦ Meningitis belt

♦ Epidemic zones

♦ Sporadic cases

  • Meningococcal Meningitis Worldwide estimation: 400,000 – 600,000 cases/year.
  • It is estimated that 8.3% of all humans are colonized by meningococci at any point in time.
  • In 1997 (Worldwide) – 1,200,000 cases of bacterial meningitis (135,000 fatal) – Africa 500,000, America 80,000, Eastern Mediterranean 150,000, Europe 100,000, Southeast Asia 160,000, Western Pacific 210,000.
  • In 1998 (Worldwide) – 143,000 fatal cases of all forms of meningitis.
  • In 1999 (Worldwide) – 171,000 fatal cases of all forms of meningitis.
  • Global deaths from Pneumococcal / Hib / Meningococcal / other agents Meningitis were estimated at 124,900 / 118,900 / 77,100 / 171,300 respectively in 1990 and 118,400 / 83,000 / 75,000 / 146,400 respectively in 2010.
  • Overall mortality rate for patients with meningitis ranges between 2% – 30% depending on the causative microorganism (20% in most cases of bacterial meningitis).
  • 30%-50% of the patients who survive meningitis may develop neurologic disabilities.

Pathophysiology:

The bacteria invades the Nasopharynx through sharing saliva, it enters the bloodstream and crosses the blood-brain barrier. Then it proliferates the cerebrospinal fluid (CSF) and attacks the brain tissue and meninges causing the inflammation, leading to increase of the intracranial pressure (ICP) which leads the skull to block the blood flow in the brain that would decrease the nutrients that are needed by the brain.

Signs and symptoms start to appear and septicemia may occur too.

Meningitis can cause death in 24 hours. Seek medical treatment immediately!

Complications:

  • Persistent fever.
  • Disseminated Intravascular Coagulation (DIC) disease.
  • Syndrome of Inappropriate Anti-Diuretic Hormone (SIADH) secretion.
  • Opisthotonos (spasm of the muscles causing the head and the heels to bend backward and the body to bow forward).
  • Newborns/children may develop heart, liver, intestinal problems or malformed limbs.
  • Can lead to brain damage and long-term complications:
  • Behavioral/personality changes.
  • Learning disabilities.
  • Mental retardation.
  • Vision loss.
  • Hearing loss.
  • Speech loss.
  • Cerebral palsy.

Tests and Diagnosis:

Meningitis diagnosis is based on medical history, physical exam, and certain diagnostic tests, checking for signs of infection around the head, ears, throat, and skin along the spine. Patient may go through the following diagnostic tests:

  • Blood Cultures.
  • Imaging (X-ray/CT scan) of the head, chest and sinuses.
  • Lumbar Puncture: gives the definitive diagnosis by analyzingthe cerebrospinal fluid (CSF).

Treatment and Prevention:

  • Bacterial:
  • Antibiotics should be started as soon as possible (appropriate antibiotic treatment reduces the risk of dying from meningitis to below 15% – risk remains higher among young infants and elderly).
  • Complete recommended vaccine schedule (3 types of bacteria vaccines that can cause meningitis meningococcus, pneumococcus, Hib).
  • Antibiotics could be needed for close contacts of people with meningococcal meningitis, severe Hib infection, especially persons at higher risk. To reduce the risk of spreading the disease.
  • Maintaining healthy habits (not smoking, avoiding cigarette smoke, getting plenty of rest, not coming into close contact with people who are sick), especially important for higher risk people for severe disease (young infants, elderly, people with weakened immune system).
  • Viral:
  • Most cases have no specific treatment. Most recover completely on their own within 7-10 days.
  • Patients infected with herpes virus or influenza may benefit from treatment with antiviral medications.
  • Infants and people with weakened immune system who develop severe illness may need to be hospitalized.
  • There are no vaccines against non-polio enteroviruses (most common cause of viral meningitis). But some vaccinations can protect against disease that can lead to viral meningitis (measles, mumps, chickenpox, influenza).
  • Follow some precautions to help lower the chances of getting infected with viral meningitis or spreading it to other people:
  • Wash hands with soap and water more often.
  • Avoid touching face with unwashed hands.
  • Avoid close contact with sick people.
  • Cover coughs/sneezes with tissue not with hands.
  • Clean/disinfect frequently touched surfaces especially if someone is sick.
  • Stay home when sick.
  • Mice and rats control.
  • Avoid bites from mosquitoes or other insects that carry disease and can infect humans.
  • Fungal:
  • Treat with long courses of high dose antifungal medications, usually given intravenously.
  • Length of treatment depends on status of immune system and type of fungus causing the infection.
  • People with weakened immune system (HIV, Diabetes Mellitus, Cancer patients) often require longer treatment.
  • Avoid soil, contaminated water or other environments that are likely to contain fungus.
  • People with weakened immune system should try to avoid bird droppings, avoid digging and dusty activities.

Prognosis:

  • Viral meningitis patients usually have good full recovery in 7-10 days.
  • Patients < 2 years old, patients > 60 years old, patients with significant comorbidities or underlying immunodeficiency have worse prognosis.
  • Patients presenting with impaired level of consciousness or develop a seizure during an episode of meningitis have higher risk for developing neurologic sequelae or dying.
  • Patients with severe bacterial meningitis or who develop a very fast onset of illness have a death rate that can be as high as 90%. If the patient survives, even with proper treatment, long-term disabilities can result.
  • Patients with less severe cases of bacterial meningitis have a death rate thatstill can approach 25%. Long-term disabilities are possible. They may require prolonged period of hospitalization and rehabilitation.

Dr. Faten Mahdi Abdulla ♦ 

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