Meningitis is a disease that can be fatal if not treated promptly. Recognizing its symptoms and seeking medical help immediately are keys to limiting the devastating effects of the disease.
Christina usually woke up long before her parents’ alarm clock sounded. But on this morning, the 2-year-old girl lay sleeping in her bed even after her mother tried to rouse her for breakfast. When she wouldn’t wake up for her mother, her father picked her up out of bed and carried her into the kitchen. Christina, who normally loved to be held and cuddled, kicked and hit her father and let out a high-pitched cry. She continued to whimper as she sat in her high chair and she refused to eat her breakfast.
Christina was rarely fussy. The last time she behaved in this manner she was suffering from the flu. Christina’s mother took her temperature and discovered that the girl had a slight fever. She put the child back into bed and called the daycare center to report that Christina would be staying at home.
After an hour passed, Christina’s mother returned to the bedroom to check on the girl. She found her daughter lying on her side with her back arched, staring blankly at the wall. She had a high temperature and her skin was blotchy. Her mother called Christina’s pediatrician and reported the symptoms. The doctor instructed her to bring the child to a hospital emergency room immediately. The pediatrician said that Christina may be experiencing an illness much more serious than the flu. Christina was, in fact, exhibiting the classic symptoms of meningitis, a disease that can be fatal if not treated promptly.
A dangerous disease
Meningitis is among the world’s most feared diseases because it has one of the lowest cure rates and highest complication rates of any disease. According to the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, about 13,000 people in the United States contract meningitis each year and approximately 70 percent of these cases occur in the first five years of life. If meningitis is diagnosed early and treated promptly, most people make a full recovery. However, because symptoms of meningitis resemble the flu, diagnosis and treatment can come too late to stop the most damaging effects of the disease. About 10 percent of people with meningitis die. The disease can also cause serious disability, such as deafness and brain damage.
Although deadly outbreaks of meningitis on college campuses and in grammar and high schools generate media attention, meningitis is not highly contagious and outbreaks rarely occur. The bacteria and viruses that cause the disease cannot live for long periods of time outside of the body. In most instances, close personal contact is needed to spread the disease from one person to another. According to health experts, the most important way to prevent the harmful effects of meningitis is to be aware of its symptoms and to seek immediate medical attention when these symptoms appear.
What is meningitis?
Meningitis is a general name for inflammation of the meninges (sheaths that cover the brain and spinal cord). The most frequent cause of meningitis is the entry of a microorganism—such as a bacterium or a virus—from an infection elsewhere in the body. The microorganisms travel through the blood and into the meninges and cerebrospinal fluid (the fluid that circulates in the spaces in and around the brain and spinal cord). The infection most frequently begins in the respiratory system. Rare sources of microorganisms that cause meningitis include infections of heart valves, bones, ears, nose, or teeth.
In the bloodstream, infection-causing microorganisms are fought off by white blood cells, an important part of the immune system. However, there are no white blood cells in cerebrospinal fluid to fight infectious agents. Once infectious organisms have entered the cerebrospinal fluid, the body’s defenses cannot control their rapid growth and the disease races through the delicate surfaces and fluids of the central nervous system. As a result of this, meningitis can cause brain damage in just a few hours and can kill in 24 hours.
There are two main forms of meningitis—bacterial meningitis and viral meningitis. Bacterial meningitis affects fewer people than the viral form, but it often results in more serious health consequences. Bacterial meningitis is fatal in 1 in 10 cases and it leaves 1 in 7 survivors with a severe disability caused by brain injury.
There are several types of bacterial meningitis. Two types—meningococcal and pneumococcal—represent the majority of bacterial meningitis cases. The bacteria that cause these cases are common and live in the back of the nose and throat, or in the upper respiratory tract. They are spread among people by coughing, sneezing, and kissing. These bacteria cannot live outside the body for long, so they cannot be picked up from water supplies, swimming pools, or a building’s air-conditioning system.
Individuals can carry these bacteria for days, weeks, or months without becoming ill. In fact, about 25 percent of the population carries the bacteria. Only rarely do the bacteria overcome the body’s defenses and invade the cerebrospinal fluid, causing meningitis.
Meningococcal meningitis accounts for more than half of all cases of bacterial meningitis in the United States. This form of meningitis is caused by three strains of meningococcus bacteria—A, B, and C. Strain B causes about 75 percent of all meningococcal cases in the United States and has the highest fatality rate of all types of meningitis. Strain C causes about 25 percent of the meningococcal cases. Strain A is rare in the United States, but kills thousands of people annually in the “meningitis belt” spanning sub-Saharan Africa.
A telltale rash
Nearly half the people who develop meningococcal meningitis also develop a form of septicemia (infection in the bloodstream) known as meningococcal septicemia, a potentially fatal condition. Disease occurs when the meningococcus bacteria multiply uncontrollably in the bloodstream. The bacteria release toxins into the blood that break down the walls of the blood vessels, allowing blood to leak into the skin. This leaking causes a characteristic rash, called a hemorrhagic rash. The rash can appear anywhere on the body—even behind the ears or on the soles of the feet.
The rash starts as a cluster of tiny blood spots, which look like pin pricks in the skin. If untreated, these spots gradually grow and become multiple areas of bleeding, resembling fresh bruises under the skin surface. These bruises continue to grow and form large areas of skin damage and discoloration. The spots or bruises do not blanch (turn white) when pressed. Septicemia reduces the amount of blood reaching vital organs, such as the liver and kidney, and can result in extensive skin damage. It is fatal in about 20 percent of cases.
Pneumococcal meningitis is caused by pneumococcus bacteria, which also cause several diseases of the respiratory system, including pneumonia. Pneumococcal meningitis has a fatality rate of about 20 percent. It also results in a higher incidence of brain damage than other forms of the disease. Pneumococcal meningitis tends to affect young children, older people, or anyone with a chronic illness, such as heart or liver disease or diabetes.
Meningitis in babies
Neonatal meningitis, another type of bacterial meningitis, affects mostly newborn babies. This form of the disease can be caused by Group B streptococcus bacteria, commonly found in the intestines. These bacteria also cause urinary tract infections and diarrhea.
Ten to 30 percent of all women are asymptomatic carriers of Group B streptococcus, harboring the bacteria in their genital tracts. During childbirth, the bacteria is transmitted to about half of all infants born to these women. Nearly 2 of every 1,000 infants in the United States develop Group B streptococcus infections, which can cause meningitis, pneumonia, and other serious illness, usually within the first three months of life. Half of all infants who develop meningitis from Group B streptococcus bacteria experience long-term central nervous system problems, including seizure disorders and mental retardation. About 10 percent of infected infants die from the disease.
Other types of bacterial meningitis
Staphylococcal meningitis is a rare, but deadly form of bacterial meningitis. It is caused by staphylococcus bacteria, which also cause skin infections and pneumonia. Staphylococcal meningitis usually develops as a complication of a diagnostic or surgical procedure. The infection spreads through blood to the cerebrospinal fluid from an infected part of the body. People with shunts, brain abscesses, and invasive head injuries are especially at risk of developing this form of meningitis. Even with early treatment, most people die or are severely disabled by staphylococcal meningitis.
Haemophilus influenza type B (Hib) is caused by haemophilus bacteria, which also cause respiratory infections and conjunctivitis, an inflammation of the membrane covering the eye. Hib was once the most common form of bacterial meningitis. Before 1985, when an Hib vaccine was introduced into the routine immunization program for U.S. children, Hib meningitis infected between 16,000 and 25,000 children annually, killing about 1 in every 20 infected children and leaving 1 in 4 survivors with permanent brain damage. About 90 percent of the cases were in children under 5 years of age, making it one of the deadliest childhood diseases. By 1998, the Hib vaccine had virtually eliminated Hib meningitis in the United States, according to the CDC.
Viral meningitis is far more common than the bacterial form and, in most cases, much less debilitating. Most people exposed to viruses that cause meningitis experience mild or no symptoms and fully recover without complications.
The disease can be caused by many different viruses. Some of the viruses are transmitted by coughing or sneezing or through poor hygiene. Other viruses can be found in sewage polluted waters. Occasionally, viral meningitis will develop following the mumps or chicken pox. Mosquito-borne viruses also account for a few cases each year. Approximately half of the viral cases in the United States are due to common intestinal viruses, or enteroviruses. These viruses are shed in the feces and in discharges from the mouth and nose. Most people who become infected with the virus contract it through hand-to-mouth contact.
Symptoms of meningitis
The symptoms of meningitis are similar for both bacterial and viral forms of the disease. Adults and older children typically experience vomiting, headache, drowsiness, seizures, high temperature, joint aching and pain, stiff neck, and aversion to light. Infants and younger children with meningitis will often whimper and cry in a high-pitched tone, be difficult to wake and very lethargic when awake, dislike being held and cuddled, arch their back and retract their neck, stare blankly at their surroundings, have a high fever and cold hands and feet, refuse food, vomit, and appear pale or blotchy.
According to health experts, anyone exhibiting all or some of these symptoms—or experiencing the characteristic rash of septicemia—should be taken immediately to a doctor. Because the disease spreads so rapidly, people with meningitis or septicemia require aggressive efforts at diagnosis and treatment.
Diagnosis and treatment
Diagnosis of meningitis almost always requires a lumbar puncture (spinal tap) in order to obtain spinal fluid for examination and culture. Diagnosis cannot be made through imaging tests, such as x rays or ultrasound. Test results take up to two days. Since death can occur within 24 hours of the first signs of bacterial meningitis, doctors isolate patients with possible meningitis and immediately start them on intravenous antibiotics. Patients with bacterial meningitis receive intravenous antibiotics for a week or more.
If the diagnosis turns out to be viral meningitis, the antibiotic treatment is stopped, because antibiotics have no effect on the viruses. In fact, there is no treatment for viral meningitis—the illness must simply run its course. Rest, fluids, and good nutrition, as well as measures to control fever and relieve pain, will ease discomfort and aid in recovery. Doctors do not prescribe aspirin as a pain reliever, however, because the combination of aspirin and viral infection has been linked to the development of Reye’s syndrome, a disease affecting the brain and liver.
Complications of meningitis
Although many people make a swift and complete recovery, meningitis—particularly the bacterial form—can result in a variety of after effects. Some of these effects are permanent and physically disabling and some are less obvious, affecting the patient emotionally. According to the National Meningitis Trust in England, young children often face minor complications following meningitis. These include babyish behavior, temper tantrums, forgetting recently learned skills, reverting to bed-wetting, and insomnia. Older children and adults may experience lethargy, recurring headaches, difficulty in concentration, short-term memory loss, clumsiness, balance problems, depression, bouts of aggression, mood swings, and learning difficulties.
One of the most common problems resulting from meningitis is hearing loss. Temporary or permanent deafness affects about 1 in 10 people following meningitis. Medical experts advise anyone who has had meningitis to take a hearing test. A hearing exam is especially important for young children whose hearing loss is often more difficult to detect. Other serious complications can include brain damage, epilepsy, and changes in eyesight. Behavioral difficulties—such as violent temper tantrums, aggression, and mood swings—can also be long-term problems.
Common after effects of meningitis
Source: Meningitis Foundation of America, Inc.
In young children:
- Babyish behavior/extra clingy
- Temper tantrums
- Forgetting recently learned skills
- Demanding attention
- Reverting to bed-wetting
In all children and adults:
- Recurring headaches
- Forgetting recently learned skills
- Difficulty in concentration
- Short-term memory loss
- Balance problems
- Violent temper tantrums
- Bouts of aggression
- Mood swings
- Learning difficulties
- Hearing loss
- Tinnitus (ringing in ears)
- Sore, stiff joints
- Eyesight difficulties
- Brain damage
Some forms of meningitis can be prevented through immunization. The Hib vaccine, which has reduced Hib meningitis cases by 95 percent since 1985, is given to American children in three doses—at 2, 3, and 4 months old. The vaccine also protects against other problems caused by the Hib bacteria, such as epiglottitis (a swelling of the epiglottis—a leaf-shaped structure in the throat that prevents food and drink from entering the windpipe) and cellulitis (infection in the tissue under the skin).
Vaccines also exist for meningococcal meningitis strains A and C. Doctors recommend that people in close contact with patients suffering from A or C meningococcal meningitis receive a vaccination. The vaccine is also recommended for people traveling to Africa or other parts of the world where these types of meningitis are prevalent. The vaccine is not very effective in young children. Protection for adults lasts three to five years. In 1998, scientists were developing more effective vaccines for A and C, as well as working on a vaccine to prevent strain B meningococcal meningitis.
Scientists were also developing a vaccine to prevent infections caused by Group B streptococcus bacteria. According to researchers at the National Institute of Allergy and Infectious Diseases, an experimental vaccine developed in 1997 prevented infection in newborn mice exposed to Group B streptococcus bacteria. The vaccine may protect infants from the bacteria by stimulating the production of antibodies in pregnant women. The maternal immunity generated by such a vaccine would cross the placental membrane and protect the newborn for the first few months of his or her life.
Antibiotics and sanitization
Apart from vaccination, however, there is no known way to protect against meningitis. Fortunately, because the disease is not highly infectious, a patient’s family is usually not at any significant risk of becoming ill. Doctors offer antibiotics to people who have been in close contact with individuals infected with meningococcal meningitis. Other contacts, such as school friends or colleagues, are rarely at high risk and do not normally need treatment. Doctors advise people who have viral meningitis to wash their hands with soap and water after using the toilet, changing diapers, touching food, or sneezing and coughing to limit the risk of spreading the disease.
Although there is little people can do to prevent meningitis, they can limit its devastating health effects by recognizing the symptoms of the disease and seeking immediate medical treatment. Meningitis is a serious, but a treatable disease. People who promptly receive medical attention have an excellent chance of full recovery.