MENINGITIS

MENINGITIS
Meningitis is a serious infection of the layer of tissue surrounding the
brain and spinal cord. The condition may be caused by a variety of in-
Brai
fectious agents including bacteria, viruses, parasites, and fungi, or it
Brain
may have a physical origin such as environmental heavy metals, or
medications. In response to invading pathogens, the body produces
infection-fighting factors, which are released to the site of injury. In the
case of meningitis, these anti-infection particles gather around the
Spinal
brain and spinal cord causing dangerous swelling in these delicate
closed spaces. The result is a potentially life-threatening disease caus-
ing symptoms of headache, painful stiff neck, and sensitivity to light.
Swelling may decrease blood flow to the brain making it difficult for
treatments to reach the infection, and complicating recovery.
Usually meningitis is caused by spreading of infection from locations
close to the brain such as ears and sinuses. It also may occur from "seeding" of infection from
normal pathogens in the nose and mouth. Occasionally infection results from complications of
surgery to the head or neck.

The most serious cases of meningitis are those caused by bacterial infection. Even when recog-
nized and treated with antibiotics, the rate of death in bacterial meningitis is near 20%. Viral men-
ingitis is usually less serious than bacterial, and can often be treated safely at home. Since vi-
ruses do not respond to antibiotic treatment, viral meningitis is treated by symptom relieving
measures and observation.

While it may strike all ages, the group most frequently afflicted with meningitis is the 20-30 year
old cohort. Recent development of a vaccination for the bacteria that once was a frequent cause
of meningitis in children has significantly decreased the number of yearly cases in the youngest
age groups. In addition, the most common causes of viral meningitis, measles, mumps, and polio,
can all be prevented by immunization. This is one of the many reasons that it is so important to
keep children up to date on their vaccination schedules. While there is a vaccination available for
the bacteria that most often results in meningitis in individuals past childhood, it’s use remains
controversial.

Bacterial meningitis strikes men and women equally, and is more common in African Americans
than in people of other races. Any person with depressed immunity is at increased risk for devel-
opment of meningitis, and is more likely to suffer serious complications. Individuals particularly
susceptible are people who have Diabetes or Cancer (especially those on chemotherapy), are IV
drug users or alcoholics, have shunts for hydrocephalus, have been exposed to meningitis, or are

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TRANSMISSION OF DISEASE
Meningitis is passed by exchange of bodily fluids such as kissing, and sharing utensils, glasses,
and toothbrushes. It is not highly contagious and is usually only spread through prolonged expo-
sure to an infected individual. However, the germs are able to travel through the air, and may be
contracted from a sneezing or coughing at a distance of 3 feet, therefore it is important to practice
extremely good hygiene and use great caution when dealing with an individual known to be in-
fected.

SYMPTOMS OF MENINGITIS
Symptoms of meningitis may develop quickly becoming significant over a period of hours, or may
take weeks to become noticeable. Classic symptoms include:
• Headache
• Rash
• Lethargy
• Stiff neck (also called nuchal rigidity)
• Fever and chills
• Vomiting
• Discomfort on exposure to bright lights (also called photophobia)
• Confusion
• Seizures (in about a third of people)
• Recent upper respiratory infection (a cold or sore throat, for example)

Some less common symptoms of meningitis are
• Localized weakness or loss of strength or sensation, especially in the face.
• Joint swelling and pain in one or more joints.
• A new rash that often looks like bruises.

Anyone exhibiting these symptoms should be evaluated by a medical professional immediately.
The most appropriate arena for this exam is the emergency department, as a doctor’s office is not
usually equipped with the proper tools for diagnosing meningitis. While awaiting medical attention,
Tylenol can be used to help relieve pain and fever. If vomiting occurs, the person should be posi-
tioned on his or her side to avoid choking or inhalation of gastric contents.

DIAGNOSIS
The physician’s work-up for meningitis may include tests targeted at revealing a source of infec-
tion such as pneumonia or abscess. If the doctor feels that there is a strong possibility of meningi-
tis, the patient will likely undergo blood tests, chest x-rays, and a CT scan. The cornerstone to di-
agnosis of meningitis is evaluation of a small portion of the spinal fluid by means of lumbar punc-
ture, or "spinal tap". In performing the lumbar puncture, the physician or healthcare provider with-

draws some fluid from the spinal canal, and
evaluates it for evidence of infection. The pa-
tient lies on his or her side in a curled position
while the examiner injects anesthetic into a
small area of the back, and then inserts a sy-
ringe into the cerebrospinal fluid, between 2
vertebrae. The needle does not touch the spi-
nal cord, as it is inserted at a level well below
the end of the cord its self. While this proce-

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dure may seem frightening, it is quite safe when performed by a trained pro-
fessional, and is essential in the diagnosis of meningitis. Rare complications
include:
Spinal cord
Epidural
Space
• Post–spinal tap headache
• Nerve root trauma (eg, previous surgery in the area, scar tissue).
• CNS infection (more likely in immunocompromised patients).
Subarachnoid Space
• Intraspinal hematoma (eg, in patients on anticoagulation therapy).

TREATMENT
If the diagnosis of bacterial meningitis is made, the patient will be admitted to the hospital for in-
travenous antibiotic treatment and close observation. If the infection is viral, the patient may be
sent home with strict instructions to return for any new or worsening symptoms, including:
• Profuse or uncontrollable vomiting
• Worsening headache or fever
• Seizures
• Weakness or numbness of any extremities
• Difficulty speaking, swallowing, or walking
• Confusion or excessive sleepiness

COMPLICATIONS
Bacterial meningitis is more likely to lead to complications than are the other forms of disease.
Seeking immediate treatment can greatly reduce the risk of complications, which include:
• Permanent brain damage
• Kidney failure
• Learning disability
• Hearing loss, blindness
• Limb damage (fingers, toes, arms, legs) that requires amputation
• Gangrene
• Coma
• Convulsions
• Death

PROGNOSIS
Prognosis depends largely upon the causative agent, and the severity of disease. Bacterial men-
ingitis results in death in up to 20% of cases, and survivors may suffer long term disability after
prolonged periods of recovery. Viral cases often resolve within two weeks with few or no lasting
side effects.

CONCLUSION
Prompt diagnosis and treatment of meningitis is essential. If you or someone in your care suffers
from symptoms of the disease, seek medical attention immediately. If you are unable to obtain
transportation to the emergency department, call 911.

Some cases of meningitis can be prevented. Keeping children’s immunizations up to date, and
maintaining good hygiene can go a long way in maintaining a safe environment for everyone.

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