Meningitis, commonly caused by meningococcus and pneumococcus
bacteria, is a rare but serious inflammation of the membranes lining the
brain and spinal cord. Prompt treatment is vital if the serious
complications of the disease are to be avoided.
What is happening
Meningitis is a condition that involves inflammation of the membranes (meninges) that cover the brain and spinal cord. This inflammation is usually caused by a bacterial or viral infection although it can also be caused by a fungal infection, certain neurological conditions and even certain drugs. When the inflammation is caused by something other than bacteria it is sometimes referred to as aseptic meningits.
Meningitis can affect people of any age at any time. However, the disease more commonly occurs during winter and early spring and tends to affect young children (under five years), young adults (15 to 24 years) and indigenous people.
The viruses or bacteria that cause meningitis are generally spread from one person to another by means of droplets expelled from the nose, throat or lungs when the affected person coughs or sneezes. These are then inhaled by the unaffected person. Usually these germs do not cause any symptoms, but in about 15 percent of people who inhale these viruses and bacteria, an illness develops.
Several different viruses can cause meningitis, including occasionally those that cause herpes and mumps. Other possibilites include the viruses that cause chickenpox, glandular fever, AIDS and cytomegalovirus. Viral meningitis is more commonly a mild disease, with most people recovering reasonably quickly. However, bacterial meningitis is classified as a medical emergency and can be fatal if not treated early enough.
Haemophilus influenza type B (Hib) used to be the most common cause of bacterial meningitis in Australia. But since 1992, vaccination against it has been incorporated into the childhood immunisation schedule for all children from two months of age. Consequently this type of bacteria disease has been virtually eradicated in Australia.
These days the most common strains of bacterial meningitis are caused by the meningococcus bacteria and the pneumococcus bacteria. Along with meningitis, these two bacteria can cause septicaemia (an infection of the blood), which is life threatening. Because these bacteria can cause both septicaemia and meningitis, these diseases are often referred to as invasive pneuococcal disease and invasie meningococcal disease, to include either or both manifestations.
Fungal meningitis is usually caused by the cryptococcus organism and tends to develop slowly, unlike bacterial meningitis.
LIKELY FIRST STEPS
PROCEDURES
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Lumbar puncture Used for diagnosing the cause of meningitis.
MEDICATIONS
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Antibiotics Vital for survival in bacterial meningitis.
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Antivirals Used occasionally for viral meningitis.
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Antifungals Used IV and orally in fungal meningitis.
LIFESTYLE CHANGES
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Rest, fluids Aid recovery, especially in viral meningitis.
A lumbar puncture is the most common procedure performed to help determine the cause of meningitis. This is usually done by a doctor at the hospital under local anaesthesia. If you are to have
this procedure done you will most likely be asked to lie on your side and curl up in the foetal position. The doctor will then numb the area with local aneasthetic before inserting a small, hallow needle into the lower part of your spinal cord, usually between the third and fourth vertebrae, below the point where the spinal cord ends. Cerebrospinal fluid then travels up the hollow needle to be collected in a test tube and sent to the laboratory for examination.
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What is happening
Meningitis is a condition that involves inflammation of the membranes (meninges) that cover the brain and spinal cord. This inflammation is usually caused by a bacterial or viral infection although it can also be caused by a fungal infection, certain neurological conditions and even certain drugs. When the inflammation is caused by something other than bacteria it is sometimes referred to as aseptic meningits.
Meningitis can affect people of any age at any time. However, the disease more commonly occurs during winter and early spring and tends to affect young children (under five years), young adults (15 to 24 years) and indigenous people.
The viruses or bacteria that cause meningitis are generally spread from one person to another by means of droplets expelled from the nose, throat or lungs when the affected person coughs or sneezes. These are then inhaled by the unaffected person. Usually these germs do not cause any symptoms, but in about 15 percent of people who inhale these viruses and bacteria, an illness develops.
Several different viruses can cause meningitis, including occasionally those that cause herpes and mumps. Other possibilites include the viruses that cause chickenpox, glandular fever, AIDS and cytomegalovirus. Viral meningitis is more commonly a mild disease, with most people recovering reasonably quickly. However, bacterial meningitis is classified as a medical emergency and can be fatal if not treated early enough.
Haemophilus influenza type B (Hib) used to be the most common cause of bacterial meningitis in Australia. But since 1992, vaccination against it has been incorporated into the childhood immunisation schedule for all children from two months of age. Consequently this type of bacteria disease has been virtually eradicated in Australia.
These days the most common strains of bacterial meningitis are caused by the meningococcus bacteria and the pneumococcus bacteria. Along with meningitis, these two bacteria can cause septicaemia (an infection of the blood), which is life threatening. Because these bacteria can cause both septicaemia and meningitis, these diseases are often referred to as invasive pneuococcal disease and invasie meningococcal disease, to include either or both manifestations.
Fungal meningitis is usually caused by the cryptococcus organism and tends to develop slowly, unlike bacterial meningitis.
- Discuss a treatment plan with your doctor.
- Take antibiotics if bacterial. If bacterial meningitis is suspected, it is important to have antibiotics straight-away --even if no tests have been done.
- Use strong analgesia. Strong analgesia is often needed for the headache of meningitis.
- Treat close contacts.When the cause of meningitis is infective, close contacts, such as members of your household, should be treated if possible.
QUESTIONS TO ASK
- Am I contagious?
- For how long will I need to take treatment?
- How long will it take me to recover?
- Will I have any long-term complications from my meningitis?
PROCEDURES
---------------------------------------------------------------------------------------------------------------------------------------------
Lumbar puncture Used for diagnosing the cause of meningitis.
MEDICATIONS
------------------------------------------------------------------------------------------------------------------------------------------
Antibiotics Vital for survival in bacterial meningitis.
------------------------------------------------------------------------------------------------------------------------------------------
Antivirals Used occasionally for viral meningitis.
-------------------------------------------------------------------------------------------------------------------------------------------
Antifungals Used IV and orally in fungal meningitis.
LIFESTYLE CHANGES
---------------------------------------------------------------------------------------------------------------------------------------------
Rest, fluids Aid recovery, especially in viral meningitis.
PREVENTION
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Immunisation To prevent against particular strains of bacteria.
It causes headaches and can also be associated with cranial nerve palsies, which means certain muscles of the face can become paralysed. It is more common in people with a poor immune system but it can occur in otherwise healthy individuals as well. Despite its slower onset, fungal meningitis is just as serious, having the potential to cause permanent brain damage or death.
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Immunisation To prevent against particular strains of bacteria.
It causes headaches and can also be associated with cranial nerve palsies, which means certain muscles of the face can become paralysed. It is more common in people with a poor immune system but it can occur in otherwise healthy individuals as well. Despite its slower onset, fungal meningitis is just as serious, having the potential to cause permanent brain damage or death.
Other causes of meningitis include diseases that affect the brain, such as multiple sclerosis, stroke and sarcoidosis; poison such as lead poisioning; reaction to substances injected into the spinal column, such as chemotherapy drugs and X-ray dyes; and rarely, drugs such as azathioprine and carbamazepine.
In babies and young children, symptoms of meningitis include fever, rapid breathing, food refusal, irritability, pale or blotchy skin, drowsiness, purple-red skin rash, sensitivity to light and convulsions. In older children and adults, symptoms include headache, fever, vomiting, neck stiffenss, confusion, rash and light tolerance.
TAKING CONTROL
As of 2003, the vaccine against meningococcal C infection (Meningitec, Menjugate, NeisVac-C) has been available free for all children aged between one and five years and all 15-year olds. Over a series of stages in the next few years, it will be made available free to all people up to age `19 in an effort to reduce the nearly 400 cases of meningococcal disease that occur annually in Australia. Unfortunately the vaccine guards against only one strain of the meningococcal bacteria, and although this strain accounts for only 37% of cases of the disease, it is believed to be the most deadly. It is hoped that vaccines against the other strains of meningococcal bacteria are not too far off.
To diagnose the cause of meningitis doctors at the hospital will usually perform a lumbar puncture (see Procedures opposite) to determine the most likely source. Besides a lumbar puncture the doctors might also culture samples of blood, urine, nasal and throat mucus and pus from skin infections to help make the diagnosis.
Medications
If the doctors suspect bacterial meningitis they will give you a single dose of antibiotics--usually high-dose penicillin--immediately, without waiting for any test results.
Once the diagnosis of bacterial meningitis has been confirmed, antibiotics are usually given intravenously for a period of up to two weeks. Close contacts of a person diagnosed with bacterial meningitis can be offered antibiotics and sometimes vaccination to reduce the risk of further infections.
The majority of people with bacterial meningitis do recover, although the infection has a death rate of about 5 percent, and some people are left with permanent disabilities, such as deafness.
As with most aspects of medicine, prevention is far better than cure. Following the highly effective vaccination program against haemophilus influenza B, there are two new vaccines that are set to reduce the incidence of bacterial meningitis in Australia and New Zealand (user above).
There are also two types of vaccine against the most common strains of pneumococcal bacteria. The conjugate vaccine (Prevenar) protects against seven serotypes of pneumococcus, including those that are most commonly responsible for septicaemia and meningitis. It offers long-term protection and is recommended for all infants under the age of two. It is free for children of Aboriginal or Torres Strait Islander descent and certain other high-risk groups.
The polysaccharide pneumococcal vaccine (Pneumovax) protects against 23 strains of pneumococcal bacteria but is not as long lasting. It is advised that this vaccination be repeated every five years in people for whom it is recommended, namely those aged 65 years and over, Aboriginal and Torres Strait Islander people aged 50 years and over, and people with increased risk, such as HIV patients and those on renal dialysis.
Viral meningitis is usually a mild condition and antibiotics are not needed. Occasionally vital meningitis caused by the herpes virus will be treated with intravenous aciciovir. In most cases, people with viral meningitis get better on their own in seven to ten days. Fungal meningitis is treated with Intravenous and oral antifungal agents.
Most people will make a full recovery from meningitis but it can take time. It is important to be patient and not try to do too much too soon. Possible aftereffects of meningitis include general tiredness, recurring headaches, memory lapses, difficulties in concentration, depression, mood swings, vision or hearing problems and epilepsy.
PROMISING DEVELOPMENTS- Get vaccinated. It is best to be protected against as many causes of meningitis as possible.
- Seek help early if you suspect meningitis. It is important that you get a reason why it isn't meningitis before accepting any reassurance.
- Ensure you drink plenty of fluids and rest if you have viral meningitis.
- Be patient. Trying to do too much too soon after a bout of meningitis will delay recovery.
As of 2003, the vaccine against meningococcal C infection (Meningitec, Menjugate, NeisVac-C) has been available free for all children aged between one and five years and all 15-year olds. Over a series of stages in the next few years, it will be made available free to all people up to age `19 in an effort to reduce the nearly 400 cases of meningococcal disease that occur annually in Australia. Unfortunately the vaccine guards against only one strain of the meningococcal bacteria, and although this strain accounts for only 37% of cases of the disease, it is believed to be the most deadly. It is hoped that vaccines against the other strains of meningococcal bacteria are not too far off.
Treatments
If you suspect that you or someone that you are caring for has symptoms of meningitis, the most important thing you can do is to get to a doctor or a hosptial as soon as possible. In the case of bacterail meningitis, every minute counts.To diagnose the cause of meningitis doctors at the hospital will usually perform a lumbar puncture (see Procedures opposite) to determine the most likely source. Besides a lumbar puncture the doctors might also culture samples of blood, urine, nasal and throat mucus and pus from skin infections to help make the diagnosis.
Medications
If the doctors suspect bacterial meningitis they will give you a single dose of antibiotics--usually high-dose penicillin--immediately, without waiting for any test results.
Once the diagnosis of bacterial meningitis has been confirmed, antibiotics are usually given intravenously for a period of up to two weeks. Close contacts of a person diagnosed with bacterial meningitis can be offered antibiotics and sometimes vaccination to reduce the risk of further infections.
The majority of people with bacterial meningitis do recover, although the infection has a death rate of about 5 percent, and some people are left with permanent disabilities, such as deafness.
As with most aspects of medicine, prevention is far better than cure. Following the highly effective vaccination program against haemophilus influenza B, there are two new vaccines that are set to reduce the incidence of bacterial meningitis in Australia and New Zealand (user above).
There are also two types of vaccine against the most common strains of pneumococcal bacteria. The conjugate vaccine (Prevenar) protects against seven serotypes of pneumococcus, including those that are most commonly responsible for septicaemia and meningitis. It offers long-term protection and is recommended for all infants under the age of two. It is free for children of Aboriginal or Torres Strait Islander descent and certain other high-risk groups.
The polysaccharide pneumococcal vaccine (Pneumovax) protects against 23 strains of pneumococcal bacteria but is not as long lasting. It is advised that this vaccination be repeated every five years in people for whom it is recommended, namely those aged 65 years and over, Aboriginal and Torres Strait Islander people aged 50 years and over, and people with increased risk, such as HIV patients and those on renal dialysis.
Viral meningitis is usually a mild condition and antibiotics are not needed. Occasionally vital meningitis caused by the herpes virus will be treated with intravenous aciciovir. In most cases, people with viral meningitis get better on their own in seven to ten days. Fungal meningitis is treated with Intravenous and oral antifungal agents.
Most people will make a full recovery from meningitis but it can take time. It is important to be patient and not try to do too much too soon. Possible aftereffects of meningitis include general tiredness, recurring headaches, memory lapses, difficulties in concentration, depression, mood swings, vision or hearing problems and epilepsy.
- Presently researchers in Australia are trialling a new vaccine that combines protection against the meningococcus C strain as well as the Y strain of meningococcus. Meningococcal Y is thought to be responsible for about 2% of all cases of meningococcal disease.
- New Zealand researchers are conducting a trial of a new vaccine that will protect against meningococcal B, the commonest cause of meningococcual disease. In 2000 there were 388 reproted cases of meningococcal disease. In 2000 there were 388 reported cases of meningococcal disease in Australia. Of these, approximately 56% had contracted meningococccal B.
A lumbar puncture is the most common procedure performed to help determine the cause of meningitis. This is usually done by a doctor at the hospital under local anaesthesia. If you are to have
this procedure done you will most likely be asked to lie on your side and curl up in the foetal position. The doctor will then numb the area with local aneasthetic before inserting a small, hallow needle into the lower part of your spinal cord, usually between the third and fourth vertebrae, below the point where the spinal cord ends. Cerebrospinal fluid then travels up the hollow needle to be collected in a test tube and sent to the laboratory for examination.
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