What is meningitis?

Meningitis is an inflammation of the meninges, the membranes that surround the brain. There are three meninges, including the following:

• dura mater - the outside membrane that adheres to the inside of the skull.
• arachnoid - the middle membrane.
• pia mater - the innermost membrane, which adheres to the brain.

What causes meningitis?

There are two distinct types of meningitis, each with different causes:

viral - caused by a virus

Viral meningitis is more common than bacterial meningitis, although rarely life threatening. Viral meningitis can be caused by different viruses, and is spread between people by coughing or sneezing, or through poor hygiene. Other germs can be found in sewage polluted water. Viral meningitis cannot be helped by antibiotics. Recovery is normally complete, but headaches, fatigue, and depression may persist.

bacterial - caused by a bacterium

Bacterial meningitis, although rare, may be fatal. Bacteria may be spread through the exchange of respiratory and throat secretions, such as coughing and kissing, but they cannot live outside the body for long. They cannot be picked up from water supplies, swimming pools, buildings, etc. Many species of bacteria can cause meningitis, but three types account for about 80 percent of cases, including the following: Neisseria meningitidis (meningococcus) Meningococcus is found in the nasopharynx of about 5 percent of the population and is spread by respiratory droplets and close contact. For unknown reasons, only a small fraction of carriers develop meningitis. Meningococcal meningitis occurs most often in the first year of life, but may also occur in closed populations, such as schools. Haemophilus influenzae type b Haemophilus influenzae type b accounts for most meningitis in children older than 1 month, but usually not in adults unless there is a predisposing factor such as head trauma or a compromised immune system. Vaccines against this type are given to children as part of a routine vaccination program. streptococcus pneumoniae (pneumococcus) Pneumococcus is the most common cause of adult meningitis. Those at high risk may include persons with chronic ear infections, sinus infections, closed head injury, recurrent meningitis, and pneumococcal pneumonia.

How does the infection reach the brain?

The infection can reach the brain via several different routes, including through the bloodstream from another infected part of the body, through the bones of the skull from infected sinuses or inner ears, or from a head injury, such as a fractured skull or penetrating wound. In particular, this occurs when the body's resistance is compromised by certain factors such as following surgery or an extended hospitalization, a weakened immune system, or as a result of chronic kidney failure.

What are the symptoms of meningitis?

The following are the most common symptoms of meningitis. However, each individual may experience symptoms differently. Symptoms may include:

• fever
• headache
• nausea and vomiting
• stiff neck
• photophobia (low tolerance to bright light)
• confusion
• joint aches or pains
• drowsiness
• seizures

Symptoms for children may also include:

• fever
• high-pitched cry
• pale, blotchy skin color
• not wanting to eat
• vomiting
• fretful and fussy
• arching back
• difficult to wake

It is important to note that these symptoms may not occur all at once, nor in everyone who contracts meningitis. The symptoms of meningitis may resemble other conditions or medical problems. Always consult your physician for a diagnosis.

How is meningitis diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for meningitis may include the following:

• lumbar puncture (spinal tap) - a special needle is placed into the lower back, into the spinal canal. This is the area around the spinal cord. The pressure in the spinal canal and brain can then be measured. A small amount of cerebral spinal fluid (CSF) can be removed and sent for testing to determine if there is an infection or other problems. CSF is the fluid that bathes the brain and spinal cord.
• blood testing
• computed tomography scan (Also called a CT or CAT scan.) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.

Treatment for meningitis:

Specific treatment for meningitis will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the disease
• the organism that is causing the infection
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference

Treatment may include:

• bacterial meningitis
  Treatment for bacterial meningitis usually involves intravenous (IV) antibiotics. The earlier the treatment is initiated, the better the outcome.
• viral meningitis
  Treatment for viral meningitis is usually supportive (aimed at relieving symptoms). With the exception of the herpes simplex virus, there are no specific medications to treat the organisms that cause viral meningitis.
• fungal meningitis
  An intravenous anti-fungal medication may be administered to treat fungal meningitis.
• tuberculous (TB) meningitis
  A long course (one year) of medications is recommended for persons who develop TB meningitis. The therapy usually involves treatment with several different medications for the first few months, followed by other medications.

What is supportive therapy for meningitis?

While a person is recovering from meningitis, other therapies may be initiated to improve healing and comfort, and provide relief from symptoms. These may include the following:

• bed rest
• medications (to reduce fever and headache)

In addition, supplemental oxygen or mechanical ventilation (respirator) may be required if you become very ill and have difficulty breathing.

Prevention of meningitis:

Several vaccines are currently available to prevent some of the bacterial organisms that can cause meningitis, including the following:

• Haemophilus influenzae type b vaccine is given as a three or four part series during your child's routine immunizations starting at 2 months.
• Although pneumococcal vaccines have been used for older children and adults for many years, the American Academy of Pediatrics (AAP) now recommends a new form of pneumococcal vaccine for all children younger than age 2. This vaccine is called pneumococcal conjugate vaccine (PCV7).
• The AAP also recommends that PCV7 be given to all children ages 24 to 59 months of age that are at very high risk for pneumococcal infection. This includes children who have weakened immune (infection-fighting) systems, such as those with sickle cell disease and HIV infection (human immunodeficiency virus).
  
  PCV7 can be given along with other childhood vaccines and is recommended at the following ages:
  
  
  • 2 months
  • 4 months
  • 6 months
  • 12 to 15 months
  Children who are sick or have a fever should wait until they are well to get the PCV7 vaccine. Children who have had a prior reaction to any type of pneumococcal vaccine should not receive PCV7.
  
  
• For Neisseria meningitidis (meningococcal meningitis), a meningococcal vaccine is currently only used for high-risk groups. Immunization for the bacteria is not widespread due to its uncommon occurrence. Individuals who may require immunization include the following:
  
  
  • asplenic children (children without a spleen)
  • college students (immunization of college students is recommended by the American College Health Association)
  • military recruits
  • individuals who are traveling to countries where the incidence of meningococcal infections is higher (parts of Africa)
  • treatment of family members or close contacts of individuals with meningitis may be necessary if the following types of bacterial meningitis are present:
    
    
    • Haemophilus influenzae type b
    • Neisseria meningitidis (meningococcal)

If you have questions regarding prevention, consult your physician.