Meningitis - Symptoms & Treatment

In meningitis, the brain and the spinal cord meninges become inflamed, usually as a result of bacterial infection. Such inflammation may involve all three meningeal membranes - the dura mater, arachnoid, and pia mater.

Meningitis can be a serious infection, and it can be contagious - which is why outbreaks make the news. However, it's also pretty rare, and it can be treated.

The prognosis is good and complications are rare, especially if the disease is recognized early and the infecting organism responds to antibiotics. However, mortality in untreated meningitis is 70% to 100%. The prognosis is poorer for infants and elderly people.

Causes

Meningitis is almost always a complication of another bacterial infection­bacteremia (especially from pneumonia, empyema, osteomyelitis, and endocarditis), sinusitis, otitis media, encephalitis, myelitis, or brain abscessusually caused by Neisseria meningitidis, Haemophilus influenzae, Streptococcus pneumoniae, and Escherichia coli.

Meningitis may also follow skull fracture, a penetrating head wound, lumbar puncture, or ventricular shunting procedures. Aseptic meningitis may result from a virus or other organism. Sometimes no causative organism can be found.

Meningitis often begins as an inflammation of the pia-arachnoid, which may progress to congestion of adjacent tissues and destroy some nerve cells.

Signs and symptoms

It's easy to mistake the early signs and symptoms of meningitis for the flu. They may develop over a period of one or two days, but some types of meningitis can prove fatal in a matter of days.

If you or your child has bacterial meningitis, delaying treatment increases the risk of permanent brain damage. Seek medical care right away if you or anyone in your family has any of the following signs or symptoms:

• Fever and chills
• Severe headache
• Nausea and vomiting
• extreme sleepiness
• confusion
• photophobia (low tolerance to bright light)
• seizure
• joint aches or pains

Diagnosis

• Lumbar puncture with CSF glucose measurement and CSF cell count
• Gram-stain and culture of CSF (cerebral spinal fluid)
• Chest x-ray to look for other sites of infection
• Head CT scan looking for hydrocephalus, abscess or deep swelling

Treatment

Treatment may include:

• bacterial meningitis - Treatment for bacterial meningitis usually involves intravenous (IV) antibiotics. The earlier the treatment is initiated, the better the outcome.
  While steroid administration has been shown to be helpful in treating bacterial meningitis in infants and children, this treatment is used less frequently in adults. Dexamethasone, a type of steroid, may be given in more acute cases of bacterial meningitis, to decrease the inflammatory response caused by the bacteria.
• viral meningitis - Treatment for viral meningitis is usually supportive (aimed at relieving symptoms). With the exception of the herpes simplex virus, there are no specific medications to treat the organisms that cause viral meningitis.
• fungal meningitis - An intravenous anti-fungal medication may be administered to treat fungal meningitis.
• tuberculous (TB) meningitis - A long course (one year) of medications is recommended for persons who develop TB meningitis. The therapy usually involves treatment with several different medications for the first few months, followed by other medications.

Prevention

• Washing your hands really well and often is one way to defend against meningitis and other infections.
• It is highly recommended that household contacts and people with close contact with individuals with meningococcal meningitis receive preventative antibiotics to avoid becoming infected themselves.
• Children should routinely be immunized with the Hemophilus influenzae type B vaccine, which can help prevent a common type of childhood meningitis.
• The American Academy of Pediatrics and the American College Health Association encourage college students (particularly freshmen living in dormitories) to consider being vaccinated with the meningococcal vaccine.