Complete Guide to Understanding Meningitis

Arising from viral or bacterial infections, meningitis presents as an infection and inflammation of the fluid and membrane enveloping the brain and spinal cord. Non-infectious conditions such as cancer or head injuries can also contribute to its occurrence. Primarily impacting infants, children, teenagers, and young adults, meningitis is a serious condition necessitating prompt treatment. While mild cases may not require intervention, severe instances can lead to death, necessitating emergency antibiotic treatment. In some cases, meningitis can escalate to life-threatening blood poisoning (sepsis), causing permanent damage to the brain or nerves. Let’s explore all facets of meningitis, encompassing vital information that will comprehensively analyse this significant health concern.

What is Meningitis?

The meaning of meningitis involves an infection and inflammation of the fluid and membrane area surrounding the brain and spinal cord. The protective membrane, meningis, is crucial in safeguarding the brain and spinal cord from injury, providing support and structure by including nerves, blood vessels, and cerebrospinal fluid. Inflammation from meningitis can manifest with symptoms such as headaches, fever, and a stiff neck. It is crucial to seek medical care promptly if symptoms indicative of meningitis are suspected to prevent potentially serious complications associated with this condition.

Symptoms of Meningitis

The symptoms of meningitis differ based on viral and bacterial meningitis. They may appear within several hours to a few weeks from the start of infection. The meningitis symptoms include:

1. Viral Meningitis

 In infants, the symptoms of meningitis may cause:

• Loss of appetite
• Irritability
• Respiratory illness
• Diarrhoea
• Skin rash
• Vomiting
• Fever

In adults, viral meningitis may cause:

• Tiredness
• Frequent headaches
• Stiffness and pain in the neck area
• Seizures
• Sensitivity to light
• Sleepiness
• Loss of appetite
• Changes in mental health

2. Bacterial Meningitis

The symptoms include:

• Purple area resembling bruises
• Altered mental status
• Tiredness
• Irritability
• Headaches
• Stiffness and pain in the neck area
• Seizures
• Sensitivity to light
• Sleepiness
• Loss of appetite
• Vomiting
• Nausea
• Fever

3. Fungal Meningitis

The symptoms of fungal meningitis may include:

• Fatigue
• Confusion
• Irritability
• Headaches
• Stiffness and pain in the neck area
• Seizures
• Sensitivity to light
• Sleepiness
• Loss of appetite
• Fever
• Nausea
• Vomiting

4. Chronic Meningitis

If the symptoms of meningitis are severe and last longer than four weeks, it could be chronic meningitis.

5. Meningitis Rash

The symptoms occur when you are infected with a bacterium named Neisseria meningitidis. The bacteria in the bloodstream causes a faint rash on the skin of the infected. The rash spots get darker and larger when the infection worsens and spreads.

It is essential to go to your doctor, who will perform tests to determine which type of meningitis you have.

Causes of Meningitis

As mentioned earlier, meningitis causes include different types of infections such as bacterial, viral, or fungal. These pathogens spread through the bloodstream and nerve endings or may reactivate in the nervous system, eventually reaching the brain or spinal cord. Additionally, non-infectious conditions like cancer, head injury-related diseases, and certain medications can also contribute to the occurrence of meningitis.

Types of Meningitis

While there are different meningitis conditions, the most common types of meningitis infections are viral and bacterial. The less common forms of meningitis include cryptococcal, caused by a fungal infection, and carcinomatous, which is cancer-related.

• Viral Meningitis

Viral meningitis is more prevalent than its bacterial counterpart, as many viruses can trigger the condition. Some may even cause diarrhoea. These viruses include:

• Coxsackievirus A
• Coxsackievirus B
• Echoviruses

Other viruses that can cause meningitis include:

• West Nile virus
• Influenza virus
• Mumps
• HIV
• Measles
• Herpes viruses
• Coltivirus, which causes Colorado tick fever

• Bacterial Meningitis

Bacterial meningitis occurs when bacteria access the bloodstream and travel to the brain and spinal cord. Alternatively, the bacteria may directly invade the membranes, often prompted by factors like ear or sinus infections, skull fractures, or specific surgical interventions.

Bacteria causing meningitis include:

• Streptococcus pneumonia: Streptococcus pneumoniae is the primary culprit for bacterial meningitis in infants, young children, and adults. Infections with this bacterium are responsible for ear infections, sinus infections, and the onset of meningitis.
• Neisseria Meningitides: This bacterium, Neisseria meningitidis, induces bacterial meningitis, specifically meningococcal meningitis. While the bacteria initially affects the upper respiratory system, if it enters the bloodstream, it can cause meningococcal meningitis, a condition notorious for causing highly contagious infections in teenagers and young adults.
• Haemophilus Influenza: Previously recognised as the primary cause of bacterial meningitis in children, infection due to the Haemophilus influenzae type b (Hib) bacterium has seen a decline in cases following the introduction of new Hib vaccines. The development and use of this vaccine have contributed to reducing instances of this particular type of bacterial meningitis.

Listeria Monocytogenes: These bacteria are generally found in unpasteurised cheeses, hot dogs, and lunchmeats. People with a weak immune system, like in the case of pregnant women, newborns, and older adults, are most susceptible to it, as during pregnancy, listeria can cross the placenta and later cause an infection that can be fatal to the baby.

• Chronic Meningitis

Chronic meningitis occurs in the case of slow-growing organisms like fungi and Mycobacterium tuberculosis. In this type of meningitis, the microorganisms invade the cell membrane and fluid surrounding the brain due to blood vessel damage and develop chronic meningitis. The symptoms of chronic meningitis can be severe, but case cases have mild symptoms, including headache, fever, vomiting, and mental cloudiness.

• Fungal Meningitis

Although infrequent, fungal meningitis can resemble acute bacterial meningitis. This condition arises from inhaling fungal spores, which are present in soil, decaying wood, and bird droppings. The fungus causing meningitis includes:

1. Cryptococcus is a fungus inhaled from dirt or soil. It is also present in bird droppings, especially pigeons and chickens.
2. Blastomyces is another fungus found in soil that can cause fungal meningitis.
3. Environments heavily contaminated with bat and bird droppings contain Histoplasma, which can cause fungal meningitis.
4. Coccidioides are found in soil and can cause fungal meningitis.

• Parasitic Meningitis

Parasitic meningitis may result from a tapeworm infection in the brain, cerebral malaria, categorised as eosinophilic meningitis, or amoebic meningitis, which can be acquired, albeit rarely, through freshwater swimming and poses a rapid, life-threatening risk. Parasitic meningitis does not spread from person to person.

Vaccination against Meningitis

The vaccine has been developed to cure bacterial meningitis. The causative agent Neisseria meningitidis is one version for which vaccines are available. So, for that purpose, two primary vaccines for meningitis have been developed for bacterial causes, including:

• Meningococcal Conjugate Vaccine (MenACWY)

The meningococcal conjugate, or MenACWY vaccine, has been designed to target four of the most common types of bacterial serotypes. This vaccine lasts longer and can be used as a booster dose as it offers greater protection. The CDC recommends vaccinating children aged 11 to 12, with a booster shot administered at 16 years of age.

• Serogroup B meningococcal, or MenB

The other vaccine, Serogroup B meningococcal or MenB, targets one specific strain. This vaccine has a short protection window, so it is recommended to administer it to certain populations. The CDC recommends administering this vaccine to individuals aged 10 and older, both adults and children, who are at an increased risk or have been diagnosed with meningococcal disease. Individuals with sickle cell disease, a compromised spleen, certain individuals with a rare immune disorder known as complement component deficiency, or those taking specific medications are recommended to receive this vaccine.

• Pneumococcal polysaccharide vaccine (PPSV23)

The vaccine provides protection against pneumococcal bacteria for older children and young adults. The CDC recommends giving this vaccine to individuals with weakened immune systems or underlying chronic conditions such as heart disease, diabetes, or sickle cell anaemia. It is also advisable for individuals without a spleen. The PPSV23 vaccine is suitable for adults over 65 years, younger adults, and children aged 2 with weakened immune systems.

• Haemophilus influenzae type b vaccine (Hib)

The World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) advocate for administering this vaccine to children 2 months and older. People with conditions such as sickle cell disease or AIDS and those without a spleen cannot receive this administration.

Diagnosis of Meningitis

The diagnosis of meningitis starts with a health history and physical examination where a doctor will check for symptoms like:

• Skin rash
• Increased heartbeat
• Neck stiffness
• Un-consciousness

Other tests include:

• Spinal Tap

A healthcare practitioner conducts a spinal tap to gather cerebrospinal fluid during this process. Examiners then analyse the collected fluid to identify signs such as low sugar levels, an increased count of white blood cells, and elevated protein levels. Sometimes, the fluid may also contain bacteria, causing meningitis. To detect viral- meningitis, you may need a DNA-based test known as polymerase chain reaction amplification. A spinal tap test can also determine suitable antibiotics for treatment using cerebrospinal fluid.

Other common test to diagnose meningitis includes the following:

• Blood Cultures: In the blood, bacterial culture identifies bacterial infection with Neisseria meningitidis and Streptococcus pneumonia, as these bacteria can cause sepsis and meningitis.
• Blood Tests: Examining white and red blood cell counts assesses treatment efficacy during these tests.
• Chest X-rays: A chest X-ray is performed to identify the presence of pneumonia, tuberculosis, or fungal infections.
• Computed Tomography (CT) Scan: This method utilises a high-powered X-ray to create detailed images of the head, aiming to identify brain abscesses or increased intracranial pressure caused by the dissemination of meningococcal bacteria.

Treatment of Meningitis

Meningitis treatments vary based on the cause and severity of the infection, whether bacterial, viral, or fungal. Potential treatments may encompass:

• Antibiotics: These can be employed to treat bacterial pneumonia, but they are not effective in cases of viral pneumonia. Nevertheless, a doctor may prescribe them if there is a concurrent bacterial infection alongside a viral one.
• Antifungal Medications: Antifungal medicines are used to treat pneumonia if the pneumonia is due to a fungal infection.
• Antiviral Medications:Viral pneumonia is mostly not treated with medication and goes away on its own.
• Chronic Meningitis: Fungal infection or autoimmune issues like rheumatoid arthritis can be involved in chronic meningitis. This type of meningitis treatment focuses on addressing the underlying cause initially.
• Oxygen Therapy It is prescribed when the patient faces difficulty breathing; the doctor gives oxygen therapy through a tube in the nose, as this can help a patient get enough oxygen.
• IV Fluids Fluids, when delivered directly to our veins, can help patients with dehydration.

Is Meningitis Contagious?

There are different types of meningitis. Some types of meningitis, such as fungal, parasitic, and non-infectious meningitis, are not contagious. Some, like viral meningitis, are contagious and can spread through direct contact while sneezing or coughing due to the formation of droplet nuclei of the body fluids, including mucus, faeces, and saliva.

Bacterial meningitis is known to be the most severe form of meningitis, which is highly contagious, especially if it’s meningococcal meningitis. This meningitis can spread through extended contact with an infected person in public places. Bacterial meningitis is more likely to have long-term health effects than other types of meningitis. Long-term effects of bacterial meningitis include:

• Vision or hearing loss
• Difficulty in concentrating
• Epilepsy
• Problems in movement and balancing
• Behavioural issues
• Difficulty in walking
• Arthritis
• Organ damage

Complications Linked to Meningitis

Meningitis may cause severe complications in people with compromised immune systems or chronic conditions. The complications include seizures, hearing loss, vision loss, memory problems, migraine headaches, brain damage, hydrocephalus, empyema, etc. Bacteria may enter and cause infection (known as Bacteremia) and reach the bloodstream, where they multiply and release toxins, causing meningitis infection. The meningitis infection may become life-threatening when there is blood vessel damage or blood leakage into the skin and organs. So, it is essential to treat patients with meningitis promptly.

Risk Factors Associated with Meningitis?

The risk factors for meningitis include:

1. Skipping vaccinations when a person still needs to complete the recommended childhood or adult vaccination schedule.
2. Age plays a role, with most viral meningitis cases occurring in children under 5 years old, while bacterial meningitis is prevalent among those under 20.
3. Living in large groups, especially during college days, students living in dormitories or children staying in boarding schools and childcare facilities are at greater risk of meningococcal meningitis because the bacterium releases the droplet nuclei and spreads through the respiratory route among large groups.
4. Pregnancy increases the risk of meningitis as pregnant women become more prone to an infection caused by listeria bacteria during premature delivery or miscarriage.

How Can Meningitis Be Prevented?

Reducing the risk of meningitis is best achieved by adopting a healthy lifestyle, particularly for individuals at an elevated risk of infection. The preventive measure can be:

• Getting vaccinated
• Practicing safe food handling
• Frequent hand washes to reduce your risk of getting infectious diseases
• Use of antibiotics to prevent infections in specific situations

Vaccines

Many vaccines are available that help to prevent bacterial and viral infections leading to meningitis. The vaccines can be against bacteria or viruses.

Vaccines against Bacteria

• The Meningococcal conjugate vaccine and Haemophilus influenzae serotype b (Hib) are immunisations designed to protect against bacterial infections that may lead to meningitis.
• Another vaccine, the tuberculosis vaccine, can also be used to prevent meningitis due to tuberculosis.

Vaccinations against Viruses

Vaccines such as chickenpox, influenza, measles, and mumps are employed to safeguard individuals from viral infections that can lead to meningitis.

Prophylactic Antibiotics

Your healthcare provider may prescribe prophylactic antibiotics to help prevent you from bacterial infection if you’re at high risk of getting infected with meningitis.

Other ways to help prevent meningitis:

• Washing hands frequently to maintain good hygiene practices.
• Masking the mouth and nose during coughing or sneezing.
• Avoiding contact with an infected person.
• Frequently disinfecting public places.
• Avoiding swimming in public pools.
• Avoid the use of drinking water in public places.
• Refrain from drinking unpasteurised milk or food.
• Use bug repellents to avoid bug bites.

Following such practices can help to prevent the spread of meningitis.

Conclusion

Meningitis can be a life-threatening infection, so always watchful about its symptoms. Early diagnosis can also prevent significant complications; other factors like diet play a major role in recovering from the infection. Proper rest can also help a person recover faster from meningitis. Having adequate health insurance coverage is crucial as it provides financial protection for hospitalization and treatment of meningitis. Now, some vaccines are also available in the market in particular against pneumococcal diseases like whooping cough, Hib (Haemophilus influenzae type b), and influenza vaccines that may not always prevent us against meningitis but may prevent severe complications related to this disease.

Disclaimer: The information provided in this blog is for educational and informational purposes only. It is not intended as a substitute for professional advice, diagnosis, or treatment. Please consult your general physician or another certified medical professional for any questions regarding a medical condition. Relying on any information provided in this blog is solely at your own risk, and ICICI Lombard is not responsible for any effects or consequences resulting from the use of the information shared.