Definition

The brain and spinal cord are encased by layers of tissue. These layers are called the meninges. Certain bacteria can cause an infection in these layers. This is called bacterial meningitis.

It is a serious infection that can cause death within hours. A quick diagnosis and treatment is vital.

Bacterial Meningitis

Meningitis
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Causes

The bacteria first cause an upper respiratory tract infection . Then it travels through the blood stream to the brain.

Worldwide, three types of bacteria cause the majority of cases of acute bacterial meningitis:

  • Streptococcus pneumoniae (the bacteria that causes pneumonia )
  • Neisseria meningitidis
  • Haemophilus influenzae b (Hib)
    • In the US, widespread immunization has almost eliminated meningitis due to Hib

Other forms of bacterial meningitis include:

  • Listeria monocytogenes meningitis
  • Escherichia coli meningitis
  • Mycobacterium tuberculosis meningitis

Newborn babies and the elderly are more prone to get sick.

Some forms are spread by direct contact with fluid from the mouth or throat of an infected person. This can happen during a kiss or by sharing eating utensils. In general, meningitis is not spread by casual contact.

Risk Factors

If you have any of these risk factors for meningitis, tell your doctor:

  • Age: infancy and early childhood; over 60 years of age
  • People in close and prolonged contact with patients with meningitis due to Hib or Neisseria meningitidis
  • A weakened immune system due to HIV infection or other conditions
  • Alcoholism
  • Smoking (for meningitis due to Neisseria meningitidis )
  • Living in proximity to others, such as dormitories and military barracks (for meningitis due to Neisseria meningitidis )

Symptoms

Classic symptoms can develop over several hours, or may take 1 to 2 days:

  • High fever
  • Headache
  • Very stiff, sore neck

Other symptoms may include:

  • Red or purple skin rash
  • Cyanosis (bluish skin color)
  • Nausea
  • Vomiting
  • Photophobia (sensitivity to bright lights)
  • Sleepiness
  • Mental confusion

In newborns and infants, symptoms are hard to see. As a result infants under three months old with a fever are often checked for meningitis. Symptoms in newborns and infants may include:

  • Inactivity
  • Unexplained high fever or any form of temperature instability, including a low body temperature
  • Irritability
  • Vomiting
  • Jaundice (yellow color to the skin)
  • Feeding poorly or refusing to eat
  • Tautness or bulging of soft spots between skull bones
  • Difficulty awakening

As the illness progresses, seizures and/or hearing loss can occur. This can happen to patients of all ages.

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done.

Tests may include the following:

  • Spinal tap —removal of a small amount of cerebrospinal fluid to check for bacteria
  • Other cultures—testing of samples of blood, urine, mucous, and/or pus from skin infections
  • MRI scan —a test that uses magnetic waves to make pictures of structures inside the body (to be sure the inflammation is not from some other cause, such as a tumor)
  • CT scan —a type of x-ray that uses a computer to make pictures of structures inside the body

Treatment

More than 90% of all people with this infection survive with immediate care including:

  • Antibiotics and corticosteroids—often given together
  • Fluids may also be given
Talk with your doctor about the best plan for you. Treatment options include:

Antibiotics

Antibiotics are given through an IV directly into a vein. This is started as soon as the infection is suspected. The antibiotics may be changed once tests name the exact bacterial cause. Patients usually stay in the hospital until fever has fallen. The fluid around the spine and the brain must also be clear of infection.

Corticosteroids

These are usually given by IV early in treatment. They control brain pressure and swelling. They also reduce the body’s production of inflammatory substances. This treatment can prevent further damage.

Fluid Replacement

Fluids can be lost due to fever, sweating, or vomiting. They may be replaced through an IV. It will be done carefully to avoid complications of fluid overloading.

Other Medications

  • Pain medications and sedatives may be used
  • Anticonvulsants may be prescribed to prevent seizures

Prevention

To help reduce your chances of getting bacterial meningitis, consider the following steps:

  • Vaccines against Hib —usually for children
  • Pneumococcal polysaccharide vaccine against Streptococcus pneumoniae usually for:
    • All people over age 65
    • People ages 2 to 64 with certain chronic medical problems
  • Pneumococcal conjugate vaccine against Streptococcus pneumoniae usually for:
    • Infants
    • All children older than 2 years old
  • Preventative antibiotics—for healthcare workers or family members in close contact with infected patients
  • Buying pasteurized milk and milk products—to prevent meningitis due to Listeria monocytogenes
  • Monitor for maternal infection during and before labor to prevent meningitis in newborns