Meningitis: Symptoms, Causes, Diagnosis, and Treatment Prevention
Meningitis is inflammation of the fluid that surrounds the brain and spinal cord. It is typically caused by a viral (most common) or bacterial infection, the latter of which is significantly more serious and can be fatal if untreated. Meningitis causes a headache, fever, and stiff neck, among other symptoms.
It may produce more serious complications, such as seizures or loss of consciousness. Early diagnosis and accurate identification of the cause is important because management of the illness is directed by the symptom severity and the cause of the illness.
Meningitis, especially bacterial meningitis, is not common in the United States, largely as a result of routine immunization against the most common infectious causes.
The symptoms of meningitis can develop over hours, or they may worsen over several days. Meningitis is more common in children, although adults and teenagers can develop meningitis as well.
Symptoms of Meningitis Include:
- Severe headaches; mild or moderate headaches can be early symptoms
- Sensitivity to light with a headache
- Stiff neck; children may arch back the head or complain of pain when attempting to bend the head towards the chest.
- Fever, ranging from low-grade (around 100.5 degrees) to high-grade (over 104 degrees)
- Irritability and restlessness
- Fatigue or sleepiness
- Nausea or vomiting
- A rash, which is usually non-blanching (doesn’t turn white when you press on it); more common with meningococcal meningitis
- Mental status changes, such as confusion, lethargy, delirium, hallucinations, or even coma
Newborns and infants with meningitis don’t have the same classic symptoms of meningitis. Instead, they may experience fussiness, excessive tiredness, diminished eating and drinking, and vomiting. In the case of bacterial meningitis, the soft spot on the skull (fontanel) may also bulge.
There are many different microorganisms that can cause meningitis. Viruses, bacteria, and fungi may all result in the condition.
The most common causes are contagious infections, which can be spread through the exchange of respiratory droplets by coughing, sneezing, or kissing.
The term aseptic meningitis describes meningitis that is caused by something other than bacteria and is often used to describe viral meningitis.
While only a small number of people who get infected with the viruses that cause meningitis will actually develop viral meningitis, some viruses which may cause the condition include:
- Enteroviruses are the most common viral cause of meningitis. Meningitis caused by enteroviruses is most common between June and October.
- Herpes viruses, including the chickenpox virus
- Measles virus
- Mumps virus
- Influenza virus
- West Nile virus is spread by a mosquito bite and is most common between August and October. In addition to meningitis symptoms, people with the virus often have a rash and swollen glands.
- Lymphocytic choriomeningitis virus
Bacterial meningitis tends to produce more severe infections than other types of meningitis, with a greater potential for long-term problems. It can become deadly in as little as a few hours. The specific bacterial cause of meningitis generally varies with age.
The most common causes of bacterial meningitis in young infants are:
- E. coli
- Group B streptococcus
- Listeria monocytogenes
Bacterial causes of meningitis in young children include:
- Streptococcus pneumoniae (pneumonococcus), which is the most common
- Neisseria meningitides (meninogococcus), the second most common
- Haemophilus influenzae type B (Hib): This was a more common cause of meningitis in children until the 1990s, but is now uncommon due to vaccination.
- Other possible causes, such as Lyme disease, syphilis, ehrlichiosis, leptospirosis, and tuberculosis
Less common causes of meningitis include fungal infections that affect the central nervous system; use of certain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) and certain antibiotics, such as trimethoprim-sulfamethoxazole; and non-infectious conditions that are characterized by inflammation, such as autoimmune diseases (rare).
Early diagnosis and treatment of meningitis can help prevent complications. Normally, meningitis can be diagnosed with a review of your history and a physical examination.
Lumbar puncture is necessary to confirm the diagnosis of meningitis and identify the cause in nearly every case.
- Physical examination: Your doctor will test for neck and back stiffness. Pain with the extension of your knee with a flexed hip (Kernig’s sign) is considered supportive of the diagnosis of meningitis. Likewise, if passively or actively moving the head down toward your chest causes pain and makes your hips and knees flex (Brudzinski’s sign), your doctor will suspect meningitis.
- Imaging tests: Imaging tests of the central nervous system, such as a brain CT, brain MRI, or spine MRI may be particularly useful in the evaluation of meningitis. These tests can rule out other causes of neurological symptoms. They can often identify inflammation of the meninges. A brain CT or brain MRI is often needed to determine whether it is safe to do a lumbar puncture.
- Lumbar puncture: A lumbar puncture is a procedure in which a sample of cerebrospinal fluid is removed so that it can be analyzed under the microscope and sent for a culture. The cerebrospinal spinal fluid is obtained by inserting a needle into an area in the lower back where fluid in the spinal canal is readily accessible.
Meningitis treatment depends on the severity and cause of the illness. Medication may be needed to not only treat the infection but to reduce inflammation and control the symptoms.
Pain and Fever Reduction
Regardless of the cause of meningitis, you might need to take pain medication to reduce the headaches and neck discomfort. Medications that reduce fever are also often needed. Over-the-counter medications are effective for most people.
It is important that treatment for bacterial meningitis starts early in the course of the disease. Most people start with a combination of intravenous broad-spectrum antibiotics, which are likely to treat a wide variety of bacterial infections.
The selection of antibiotics may change once the precise diagnosis is made. Sensitivities, tests that determine the antibiotics to which a specific bacterium is most susceptible, also help direct treatment.
Different antibiotics may be used to treat young children, largely because meningitis is caused by different bacteria in different age groups. A combination of a third-generation cephalosporin and ampicillin, or cefotaxime or ceftriaxone plus vancomycin, will likely be used until the infectious organism has been identified.
With viral meningitis, the goal of treatment is primarily supportive care. Viral infections do not respond to antibiotic treatment, and most do not respond to specific antivirals. However, when meningitis is caused by herpesvirus or influenza, antiviral medication may be helpful.
When meningitis is caused by an autoimmune disease, such as sarcoidosis or a drug reaction, steroids may be used to reduce inflammation.
There are a number of strategies that can help prevent meningitis. While these approaches cannot completely eliminate your chances of getting meningitis, they can substantially reduce the risk.
Avoiding common infections can reduce your chances of developing meningitis. The infectious organisms that cause meningitis are spread from person to person through respiratory droplets. Avoiding infections is the most effective way to prevent meningitis for people of all ages.
Precautions You Should Take
These precautions are especially important for young babies, who may not show signs of meningitis early and who may suffer more complications:
- Wash your hands often, especially when exposed to germs
- Do not share personal hygiene items like toothbrushes
- Disinfect surfaces regularly
- Avoid close or prolonged contact with others who may have infections
There are vaccines that can reduce your risk of having meningitis. These vaccines do not specifically protect against it, but they do protect you from infections that can cause meningitis.
Vaccines are recommended during childhood. College freshman, especially those who live in dormitories, are at higher risk for meningococcal disease and should receive meningococcal vaccinations as indicated by the Advisory Committee on Immunization Practices guidelines.
Vaccines that can help prevent meningitis include:
- N. meningitidis
- Streptococcus pneumoniae
- Herpes Zoster
- Meningococcal conjugate vaccine
Meningitis is a worrisome infection because it can lead to serious complications. Symptoms can be dramatic and may progress rapidly, but they can also be mild or vague, which may result in a delay in diagnosis. The sooner you get medical attention, the better your chances of receiving effective treatment. Medical treatment for meningitis is the best way to reduce complications and adverse outcomes of the infection.
If you or your child has meningitis, you may experience some lethargy and headaches for a few weeks after recovery. Most of the time, meningitis improves without long-term effects.
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