Meningitis

Overview

Meningitis is an infection and inflammation of the fluid and membranes surrounding the brain and spinal cord. It can be caused by various organisms, including viruses, bacteria, fungi, and parasites. The inflammation triggers symptoms such as fever, headache, and a stiff neck. While most cases are caused by viral infections, bacterial meningitis can be life-threatening and requires prompt antibiotic treatment. It's essential to seek immediate medical care if you suspect meningitis or have been exposed to someone with the infection.

Understanding the disease

Symptoms

Symptoms of meningitis may include sudden high fever, stiff neck, severe headache, nausea or vomiting, confusion or trouble concentrating, seizures, sleepiness or trouble waking, sensitivity to light, and no appetite or thirst. In newborns and infants, signs may include high fever, constant crying, being very sleepy or irritable, trouble waking from sleep, being inactive or sluggish, not waking to eat, poor feeding, vomiting, a bulge in the soft spot on top of the baby's head, and stiffness in the body and neck. It is important to seek immediate medical care if you or someone in your family has these symptoms, as bacterial meningitis can cause death within days without prompt antibiotic treatment.

Risk Factors

Risk factors for developing meningitis include:

1. Skipping vaccinations: Risk increases for anyone who hasn't completed the recommended childhood or adult vaccination schedule.
2. Age: Most cases of viral meningitis occur in children under 5 years old, while bacterial meningitis is common in those under 20.
3. Living in a community setting: College students, military personnel, and children in boarding schools and childcare facilities are at greater risk due to the bacterium's transmission through respiratory routes and larger groups.
4. Pregnancy: Pregnancy increases the risk of infections caused by listeria bacteria, which can lead to meningitis and other complications.
5. Weakened immune system: Factors such as AIDS, alcohol use disorder, diabetes, immunosuppressant drug use, and spleen removal can increase the risk of meningitis. People without a spleen should get vaccinated to lower the risk.

Development

Meningitis can develop through different pathways, depending on the causative organism. Here's a summary of how the various types of meningitis develop:

1. Bacterial meningitis: Bacterial meningitis can occur when bacteria directly invade the meninges or enter the bloodstream and travel to the brain and spinal cord. Several strains of bacteria can cause bacterial meningitis, with Streptococcus pneumoniae being the most common in infants, young children, and adults. Other bacterial causes include Neisseria meningitidis and Haemophilus influenzae.
2. Viral meningitis: The most common cause of meningitis in the United States is a viral infection. Viruses can enter the body through various routes, such as respiratory droplets, contaminated food or water, or insect bites. Once inside the body, the virus can infect the brain and spinal cord, causing inflammation of the meninges.
3. Fungal meningitis: Fungal meningitis is less common in the United States and typically develops over a longer period, such as two weeks or more. Fungi like Cryptococcus or Histoplasma can invade the meninges when inhaled from soil, wood, or bird droppings. Fungal meningitis often affects people with weakened immune systems.
4. Parasitic meningitis: Parasitic meningitis is rare and is usually associated with certain parasitic infections, such as Naegleria fowleri, which can be contracted through exposure to contaminated water. In all cases, prompt medical attention is crucial for proper diagnosis and treatment, as meningitis can cause serious complications or be fatal if left untreated.

Assessment and Diagnosis

Triage

You should see a doctor immediately if you or someone in your family has meningitis symptoms, such as a severe headache that doesn't go away, fever, confusion, vomiting, or a stiff neck. Bacterial meningitis can be life-threatening and requires prompt antibiotic treatment to prevent serious complications, including death and permanent brain damage. Early treatment is crucial to minimize the risk of complications. If you have been exposed to someone with meningitis, it's also essential to consult your healthcare provider, as you may need preventive medication.

Diagnosis

To diagnose meningitis, a healthcare provider will typically use a combination of a medical history, a physical exam, and certain tests. The provider may check for signs of infection around the head, ears, throat, and skin along the spine during the exam. Common tests for diagnosing meningitis include blood cultures to check for the presence of bacteria, imaging tests such as CT or MRI scans to show swelling or inflammation, and a spinal tap to collect cerebrospinal fluid for analysis. If viral meningitis is suspected, a DNA-based test or an antibody test may be used to identify the specific cause and proper treatment.

Management and Treatment

Complications

Common complications of meningitis include seizures, hearing loss, memory problems, learning disabilities, brain damage, trouble walking, kidney failure, shock, and death. These complications can occur if the infection is not promptly treated or if the individual has a weakened immune system, such as from AIDS, alcohol use disorder, diabetes, or immunosuppressant drugs. Prompt treatment can significantly improve the chances of recovery and reduce the risk of serious complications.

Prevention

Meningitis can be prevented through proper hygiene, healthy habits, and vaccinations. Washing your hands regularly, avoiding sharing personal items, covering your mouth when coughing or sneezing, and maintaining a healthy immune system can help prevent the spread of germs that cause meningitis. Additionally, vaccinations against specific types of bacteria that cause meningitis, such as Neisseria meningitidis and Haemophilus influenzae type b, are recommended for children and some adults who are at higher risk.

Home Remedies

If you suspect meningitis, it is important to seek immediate medical care as the condition can be serious and life-threatening. Home remedies are not effective in treating meningitis, which requires prompt medical attention and antibiotic treatment for bacterial cases.

Treatment

The treatment for meningitis depends on the type of meningitis:

1. Bacterial meningitis: Acute bacterial meningitis requires immediate treatment with intravenous antibiotics and sometimes corticosteroids to reduce the risk of complications, such as brain swelling and seizures.
2. Viral meningitis: Antibiotics can't cure viral meningitis, and most cases improve on their own in several weeks. Treatment includes bed rest, plenty of fluids, pain medicine to reduce fever and relieve body aches, and medications to reduce swelling in the brain and control seizures if necessary. If a herpes virus caused the meningitis, an antiviral medicine is available.
3. Other types of meningitis: If the cause of meningitis is unknown, you may start antiviral and antibiotic treatment while the cause is determined. Treatment for chronic meningitis, noninfectious meningitis, and cancer-related meningitis depends on the underlying cause and may involve medications like antifungal, antibiotics, corticosteroids, and specific therapies for the related cancer. To prepare for your appointment, describe your symptoms to your healthcare provider and discuss your vaccination history, exposure to meningitis, and any other health problems. It is important to seek immediate emergency care if you have been exposed to bacterial meningitis and develop symptoms.

Preparing for medical consultation

To prepare for an appointment for meningitis, follow these steps:

1. Make a list of all medicines, vitamins, or supplements you're taking.
2. Take a family member or friend along for support, as meningitis can be a medical emergency, and it's helpful to have someone who can help remember information and stay with you if needed.
3. Write down questions to ask your healthcare provider, such as:
   • What kinds of tests do I need?
   • What treatment do you recommend?
   • Am I at risk of long-term complications?
   • If my condition is not treatable with antibiotics, what can I do to help my body recover?
   • Am I contagious? Do I need to be isolated?
   • What is the risk to my family? Should they take preventive medicine?
   • Is there a generic alternative to the prescription medicine you're recommending?
   • Do you have any printed information I can have? What websites do you recommend?
4. Be aware of any pre- or post-appointment restrictions and ask if there's anything you need to do in advance, such as restricting your diet. Also ask if you may need to stay at your healthcare provider's office for observation following your tests.
5. Write down symptoms you're experiencing, including changes in your mood, thinking, or behavior, and note when you developed each symptom and whether you had cold- or flu-like symptoms.
6. Write down key personal information, including any recent moves, vacations, or interactions with animals. If you're a college student, your provider may ask questions about any similar signs or symptoms in your roommates and dorm mates. Your provider also will want to know your vaccination history.
7. Prepare to describe the type and severity of your symptoms to the healthcare provider when you call for an appointment. By gathering this information and being prepared with your symptoms and medical history, you can ensure a productive conversation with your healthcare provider and receive the appropriate care for your condition.