Bacterial meningitis causes and symptoms can be deadly if not monitored. Timely treatment of bacterial meningitis may reduce complications and recovery time.

Bacterial Meningitis

PNS SHIFA

Online Consultation

Syed Intisar Hussain

Overview

<p dir="ltr">Bacterial meningitis is a disease of the central nervous system caused by a certain type of bacteria. It is characterized by inflammation of the meninges. Furthermore, the inflammation is either acute (sudden development) or chronic (gradual development). The symptoms include fever, stiff neck, headaches, aching muscles, nausea, and vomiting.</p>

<p dir="ltr">Bacterial meningitis is a serious infection that can lead to death within a few hours. Although most people recover from bacterial meningitis, they suffer from permanent post-recovery disabilities, for example, brain damage, learning disabilities, and hearing loss.<br />
Meningitis affects the meninges of the brain. Meninges are three layers of membranes that surround the brain and spinal cord. The role of the meninges is to protect the central nervous system.</p>

<p dir="ltr"><br />
According to the World Health Organization, the mortality rate of meningitis is 10%. Moreover, 20% of people who recover from bacterial meningitis develop severe complications<sup><a href="#accordion">[1]</a></sup>.</p>

<p dir="ltr">The CDC says that vaccination is the most effective way of preventing bacterial meningitis. Furthermore, due to the severity of bacterial meningitis, the treatment should be started immediately because death can occur within hours.</p>

<p dir="ltr">&nbsp;</p>

<p dir="ltr">The common types of bacterial meningitis are:</p>

<p dir="ltr">&nbsp;</p>

<ul>
	<li><strong>Meningococcal Meningitis</strong></li>
</ul>

<p dir="ltr">It is referred to as an illness, which is caused by the bacteria Neisseria meningitidis. The illness is often severe and fatal and also includes infection of the spinal cord, brain, and bloodstream.</p>

<p dir="ltr">&nbsp;</p>

<ul>
	<li><strong>Pneumococcal Meningitis</strong></li>
</ul>

<p dir="ltr">It is caused by Streptococcus pneumonia and is the most common type of bacterial meningitis in adults. In addition, it is the second most common cause of meningitis in children older than two. Alcohol use is one of the risk factors in adults.</p>

<p dir="ltr">&nbsp;</p>

<ul>
	<li><strong>Listeria Monocytogenes Meningitis</strong></li>
</ul>

<p dir="ltr">This type of bacterial meningitis affects neonates and the elderly. It is responsible for 20% of bacterial meningitis cases in adults above fifty and neonates. Moreover, 2% of bacterial meningitis cases in the United States are because of Listeria monocytogenes meningitis<sup><a href="#accordion">[2]</a></sup>.</p>

<p dir="ltr">&nbsp;</p>

<ul>
	<li><strong>Hemophilus (Hib) Meningitis</strong></li>
</ul>

<p dir="ltr">A range of illnesses are caused by Hib and the most frequent one is meningitis. It leads to inflammation of the lining of the brain and spinal cord. Moreover, the symptoms are similar to other kinds of bacterial meningitis.</p>

<p dir="ltr">&nbsp;</p>

<ul>
	<li><strong>Neonatal Meningitis&nbsp;</strong></li>
</ul>

<p dir="ltr">Neonatal meningitis causes inflammation of the meninges during the first twenty-eight days after birth. It is classified as early-onset or late-onset meningitis. For early-onset, the clinical features appear in the first few weeks, whereas in late-onset, it occurs postnatally between 8 to 28 days.</p>

<div>&nbsp;</div>

Signs And Symptoms

<p dir="ltr">In adults and children, bacterial meningitis is usually preceded by respiratory illness or sore throat. Moreover, most of the forms are acute and the disorder is characterized by fever, stiff neck, headache, and vomiting in adults. The illness in adults becomes more severe after twenty-four hours. However, in children, the infection has a shorter duration.<br />
&nbsp;</p>

<h5><strong>Adults And Adolescents</strong></h5>

<p>The symptoms in adults and adolescents progress from irritability to drowsiness, confusion, and stupor, which can also lead to coma. Dehydration is also common and other symptoms include the following:</p>

<ul>
	<li>Weakness</li>
	<li>Chills</li>
	<li>Sweating</li>
	<li>Photophobia (cannot tolerate bright light)</li>
	<li>Loss of appetite&nbsp;<br />
	&nbsp;</li>
</ul>

<p dir="ltr">The later symptoms include the following:<br />
&nbsp;</p>

<ul>
	<li>Hydrocephalus (fluid accumulation in the cavity of the brain)</li>
	<li>Hemiparesis (paralysis of one side of the body)</li>
	<li>Hearing loss</li>
	<li>Other neurological abnormalities<br />
	&nbsp;</li>
</ul>

<h5><strong>Infants And Newborns</strong></h5>

<p>The symptoms in infants from three months to two years include the following:<br />
&nbsp;</p>

<ul>
	<li>Fever</li>
	<li>Irritability</li>
	<li>Vomiting</li>
	<li>Refusal to feeding</li>
	<li>Convulsions</li>
	<li>High-pitched cry</li>
	<li>Bulging or tight soft spot (fontanel) on the crown of the head<br />
	&nbsp;</li>
</ul>

<p dir="ltr">The incidence of meningitis is the highest in this age group, so if a child ever has an unexplained fever, it should be investigated. Cerebral fluid can accumulate after several days in the outer membrane covering the brain. The signs of meningitis include persistent fever, seizures, and enlarging head size. Brain abscess and subdural pus accumulation may also occur. Furthermore, hydrocephalus and deafness are also possible effects of bacterial meningitis.</p>

<p dir="ltr">Neonatal bacterial meningitis can happen in babies up to four weeks old and can be due to an infection in other parts of the body, not just the spine and brain. Moreover, some cases are also due to complications during birth. The characteristics of the disorder are nonspecific, which are:<br />
&nbsp;</p>

<ul>
	<li>Jitteriness</li>
	<li><a href="https://merisehat.pk/disease/sleep-apnea-91">Apnea </a>(interruption in breathing)</li>
	<li><a href="https://merisehat.pk/disease/jaundice-65">Jaundice</a></li>
	<li>Infection of the middle ear</li>
</ul>

<p dir="ltr">The CSF is tested for a definitive diagnosis.</p>

<p dir="ltr">Bacterial meningitis, because of Group B pneumococcus, is present during the first ten days of life and also accompanies an illness of the lung frequently. This form of meningitis only occurs after ten days and as an isolated illness with other symptoms. For example, drowsiness and seizures.<br />
&nbsp;</p>

<h4><strong>Bacterial Meningitis Symptoms&nbsp;</strong></h4>

<p>The symptoms of bacterial meningitis develop suddenly and include the following:<br />
&nbsp;</p>

<ul>
	<li>Confusion and altered mental status</li>
	<li>Nausea</li>
	<li>Vomiting</li>
	<li>Irritability</li>
	<li>Sensitivity to light</li>
	<li>Fever</li>
	<li><a href="https://merisehat.pk/disease/migraines-73">Headache</a></li>
	<li>Chills</li>
	<li>Stiff neck</li>
	<li>Purpling of the skin that looks like bruises</li>
	<li><a href="https://merisehat.pk/disease/sleep-apnea-91">Sleepiness</a></li>
	<li>Lethargy<br />
	&nbsp;</li>
</ul>

<p dir="ltr">If you experience these symptoms, seek medical help immediately because bacterial and viral meningitis can be fatal. Although there is no way to know if you have bacterial or viral meningitis by looking at how a person feels, healthcare workers run some tests to confirm the diagnosis.</p>

<p dir="ltr">&nbsp;</p>

<h5><strong>Bacterial Meningitis: Chronic Symptoms</strong></h5>

<p>The symptoms of chronic meningitis last more than four weeks and resemble those of acute meningitis. However, the symptoms develop at a slower rate.</p>

<p dir="ltr">&nbsp;</p>

<h5><strong>Symptoms Of Viral Meningitis</strong></h5>

<p>The symptoms of viral meningitis in infants are the following:<br />
&nbsp;</p>

<ul>
	<li>Irritability</li>
	<li>Decreased appetite</li>
</ul>

<ol>
	<li>Diarrhoea</li>
	<li>Vomiting</li>
	<li>Rash</li>
	<li>Respiratory symptoms<br />
	&nbsp;</li>
</ol>

<p dir="ltr">The symptoms of viral meningitis in adults are the following:<br />
&nbsp;</p>

<ul>
	<li>Fever</li>
	<li>Headaches</li>
	<li>Stiff neck</li>
	<li>Lethargy</li>
	<li>Feeling sleepy all the time</li>
	<li>Decreased appetite</li>
	<li>Nausea</li>
	<li>Vomiting&nbsp;</li>
	<li>Altered mental state<br />
	&nbsp;</li>
</ul>

<h5><strong>Symptoms Of Fungal Meningitis</strong></h5>

<p>The symptoms of fungal meningitis resemble the other infection types, which are the following:<br />
&nbsp;</p>

<ul>
	<li>Nausea</li>
	<li>Vomiting</li>
	<li>Fever</li>
	<li>Stiffness of the neck</li>
	<li>Headache</li>
	<li>Sensitivity to light</li>
	<li>Disorientation and confusion</li>
	<li>Sense of being unwell<br />
	&nbsp;</li>
</ul>

Causes

<p>The most common cause of bacterial meningitis is viral infections, followed by bacterial infections. They are rarely parasitic and fungal. Bacterial infections can be a threat to life; hence, the cause should be identified.</p>

<p>&nbsp;</p>

<h5><strong>Bacterial Meningitis</strong></h5>

<p>Bacteria enter the bloodstream and travel to the brain and spinal cord, causing bacterial meningitis. It can also happen when the bacteria invade the meninges directly. The causative factors can be a skull fracture, an ear infection, a sinus infection, or some surgeries (rare).&nbsp;</p>

<p>The strains of bacteria involved in acute bacterial meningitis are:<br />
&nbsp;</p>

<h5><strong>Streptococcus Pneumonia</strong></h5>

<p>Streptococcus pneumonia is the most common bacterium that causes bacterial meningitis in infants, children, and adults. It causes pneumonia and sinus infection more commonly. However, a vaccine can help in the prevention of these infections.</p>

<p>&nbsp;</p>

<h5><strong>Neisseria Meningitis</strong></h5>

<p dir="ltr">Neisseria meningitis is also a leading cause of bacterial meningitis. It causes an upper respiratory tract infection, though, it can also cause meningococcal meningitis when it enters the bloodstream. This infection is very contagious and can affect adults and teenagers. Moreover, it can also be the cause of epidemics in dorms, boarding schools, and military bases. Getting vaccinated can prevent the infection. However, even if someone is vaccinated and has encountered someone with meningococcal meningitis, they should take oral antibiotics for the prevention of the disease.</p>

<p dir="ltr">&nbsp;</p>

<h5><strong>Haemophilus Influenzae</strong></h5>

<p>Hib (Haemophilus influenza type b) was one of the leading causes of bacterial meningitis in children. Vaccines against Hib have reduced the cases of this type of meningitis in great numbers.</p>

<h5><br />
<strong>Listeria Monocytogenes</strong></h5>

<p>Listeria can be found in cheese that is not pasteurized, hotdogs, and lunch meats. People who are most susceptible to listeria are pregnant women, immunocompromised people, and older adults. Moreover, listeria can cross the placental barrier, and late pregnancy infections can be fatal for the baby.</p>

<p>&nbsp;</p>

Diagnosis

<p dir="ltr">Bacterial meningitis is diagnosed by a healthcare provider through a spinal tap, which is called a lumbar puncture. The fluid is drawn from around the spinal cord and is then tested for the presence of bacteria. Moreover, healthcare providers also perform a physical exam and ask about your symptoms.</p>

<p dir="ltr">&nbsp;</p>

<p dir="ltr">Other tests include:</p>

<ul>
	<li>Urine testing</li>
	<li>Blood test</li>
	<li>A fluid swab from the nose and throat</li>
	<li>CT scan (brain imaging)</li>
</ul>

<p>&nbsp;</p>

<h5><strong>Diagnosis In Children</strong>&nbsp;</h5>

<p dir="ltr">The fastest and most reliable methods to confirm meningitis are laboratory tests and examinations. It consists of multiple blood tests to check for viruses, bacteria, and fungi, in addition to narrowing down the likely agent(s).&nbsp;</p>

<p dir="ltr">&nbsp;</p>

<p dir="ltr">The samples of a child are collected through the following tests:<br />
&nbsp;</p>

<ul>
	<li>Nose or throat swab</li>
	<li>Stool sample</li>
	<li>Finger prick for drawing blood</li>
	<li>Lumbar puncture or spinal tap to draw the fluid around the spinal cord<br />
	&nbsp;</li>
</ul>

<p>However, before the diagnosis and examination are started, parents and guardians should inform healthcare providers if the child is taking any prescription antibiotics or medications which can cause <a href="https://merisehat.pk/disease/allergies">allergies</a>.<br />
&nbsp;</p>

Treatment

<p dir="ltr">Meningitis can cause death in half of the patients, if left untreated, and should be considered a medical emergency. It is necessary to admit patients to a hospital or emergency. Furthermore, isolation is not required 24 hours after the treatment.</p>

<p dir="ltr">The patient should be started on appropriate antibiotic treatment as soon as possible for bacterial meningitis. A lumbar puncture is ideal and should be done before starting treatment since antibiotics can make it difficult to grow bacteria from the spinal fluid. Samples of the blood can also identify the cause of meningitis. The priority should be to start treatment without any delay.&nbsp;</p>

<p dir="ltr">A range of antibiotics is used for the treatment, which includes, penicillin, ampicillin, and ceftriaxone. Moreover, when there is an epidemic of meningococcal and pneumococcal meningitis, the drug of choice is ceftriaxone.</p>

<p dir="ltr">&nbsp;</p>

<h5><strong>Treatment Based On Cause Of Meningitis</strong></h5>

<p dir="ltr">The treatment of meningitis is based on the cause.</p>

<h5><strong>Bacterial Meningitis</strong></h5>

<p>Immediate hospitalization is required for bacterial meningitis. Early diagnosis and treatment can prevent death and damage to the brain. IV antibiotics are prescribed with steroids. Although there is no specific antibiotic for bacterial meningitis, it depends on the bacteria.</p>

<h5><strong>Fungal Meningitis</strong></h5>

<p dir="ltr">Anti-fungal agents are used to treat fungal meningitis</p>

<h5><strong>Parasitic Meningitis</strong></h5>

<p dir="ltr">Parasitic meningitis involves treating either just the symptoms or directly treating the infection.&nbsp;</p>

<h5><strong>Viral Meningitis</strong></h5>

<p dir="ltr">It usually resolves on its own. But in some cases, it is treated with IV antiviral medications.&nbsp;</p>

<h5><strong>Chronic Meningitis</strong></h5>

<p dir="ltr">The underlying cause of chronic meningitis is treated first, for example, fungal infection, or an autoimmune issue like rheumatoid arthritis.</p>

<p dir="ltr">&nbsp;</p>

<p dir="ltr">One out of five people with bacterial meningitis experience chronic side effects<sup><a href="#accordion">[3]</a></sup>. These effects include hearing loss, weakness in the limbs, and seizures. In addition, it causes vision, memory, language, speech, and communication difficulties. It can also lead to scarring and sepsis of the limbs after amputation.<br />
&nbsp;</p>

<h5><strong>After Care And Support</strong></h5>

<p>The sequelae of meningitis can have a tremendous impact on the patients, their families, and their communities, both financially and emotionally. The complications, for example, deafness, <a href="https://merisehat.pk/disease/dissociative-identity-disorder">behavioral problems</a>, or learning impairment may not get recognized early and often go untreated.&nbsp;&nbsp;</p>

<p>People who have survived meningitis require healthcare and long-term medical treatments. The psychosocial impacts are ongoing and this takes a toll on their mental health, while adversely affecting their quality of life.&nbsp;</p>

<p dir="ltr">Although there is a high burden of meningitis sequelae on people who have or had meningitis, there is insufficient access to support in low- and middle-income countries. Individuals and families in these countries should seek guidance from organizations for disabled people. This will ensure that those who are disabled by meningitis live a rewarding life.<br />
&nbsp;</p>

<p dir="ltr">The factors that increase the risk of bacterial meningitis are the following:&nbsp;</p>

<p dir="ltr">&nbsp;</p>

<h5><strong>Age</strong></h5>

<p>Babies are at an increased risk of bacterial meningitis, in comparison with people of other age groups. Although, people of any age can develop bacterial meningitis.<br />
&nbsp;</p>

<h5><strong>Group Setting</strong></h5>

<p>Infectious diseases are contagious, and they spread in large gatherings. For example, college campuses have reported outbreaks of meningococcal disease<sup><a href="#accordion">[4]</a></sup>.<br />
&nbsp;</p>

<h5><strong>Medical Conditions</strong>&nbsp;</h5>

<p>Some medical conditions, surgical procedures, and medications put people at risk of meningitis. For example, HIV infection or a leak in the CSF. In addition, a splenectomy can put people at risk of bacterial meningitis.<br />
&nbsp;</p>

<h5><strong>Meningitis Causing Pathogens</strong></h5>

<p>Microbiologists are exposed to bacteria that may cause meningitis due to their exposure during work, which increases the risk of meningitis.<br />
&nbsp;</p>

<h5><strong>Travel</strong>&nbsp;</h5>

<p>Travelers are at a greater risk of meningococcal disease, which is caused by <em>N. meningitis</em>. This includes the meningitis belt in sub-Saharan Africa during the dry season, and Makkah during the annual Pilgrimage of the Muslims.<br />
&nbsp;</p>

<p dir="ltr">The bacteria that cause meningitis spread through cough, kissing, meal sharing, toothbrushes, or cigarette sharing.</p>

<p dir="ltr">The following steps can be taken for the prevention of meningitis:<br />
&nbsp;</p>

<ul>
	<li>Hands should be washed carefully to prevent the infection from spreading. Children should be taught how to wash their hands before eating food, after using the toilet, after petting animals, or when they come home from some public place. Parents and guardians should show them how to wash their hands properly.</li>
	<li>Never share drinks, straws, food, lip balms, utensils, or toothbrushes with anyone else. Children and teens should be taught to avoid sharing them as well.</li>
	<li>Get enough rest, exercise, and eat a healthy diet comprising fruits and vegetables to maintain a healthy immune system.</li>
	<li>Cover your mouth and nose when you sneeze and cough.</li>
	<li>Pregnant women should eat cooked meat&nbsp;since uncooked meat consumption can cause listeriosis. To avoid listeriosis, cook hot dogs and deli meats at 74&deg;C. They should avoid unpasteurized cheese and choose pasteurized dairy products.</li>
</ul>

<h5><strong>Vaccinations</strong></h5>

<p>The following vaccinations can prevent some types of bacterial meningitis:</p>

<h5><strong>Haemophilus Influenza Type B (Hib) Vaccine</strong></h5>

<p dir="ltr">The vaccine is recommended in children 2 months of age by CDC and WHO. It is also recommended in adults, which also includes those who have sickle cell disease,<a href="https://merisehat.pk/disease/aids"> AIDS</a>, or those who have had a splenectomy.</p>

<p dir="ltr">&nbsp;</p>

<h5><strong>Pneumococcal Conjugate Vaccine (PCV13)</strong></h5>

<p dir="ltr">This vaccine is also recommended by WHO and CDC as a scheduled vaccine for children under two years. Children between two and five are recommended to get additional doses if they are at a high risk of pneumococcal disease, chronic heart disease, cancer, or lung disease.</p>

<p dir="ltr">&nbsp;</p>

<h5><strong>Pneumococcal Polysaccharide Vaccine (PPSV23)</strong></h5>

<p dir="ltr">Adults and adolescents who need to be protected from pneumococcal bacteria can receive this vaccine. CDC recommends the PPSV23 vaccine in adults older than sixty-five. It is also recommended for children older than two years with a weak immune system, or suffering from chronic illnesses, for example, diabetes, sickle cell anemia, and heart disease.</p>

<p dir="ltr">&nbsp;</p>

<h5><strong>Meningococcal Conjugate Vaccine</strong></h5>

<p dir="ltr">It is recommended by CDC that children between eleven to twelve years of age get a single dose of the vaccine and a follow-up booster shot between ages sixteen to eighteen. Furthermore, if the first shot is given at sixteen years or older, a booster is not necessary.</p>

<p dir="ltr">Also, children who have been exposed to a disease, or are at a high risk of bacterial meningitis, can get the vaccine between two months to ten years. It is used for the vaccination of people who have been exposed to the outbreak and aren&rsquo;t previously vaccinated.</p>

<p dir="ltr">&nbsp;</p>

Key Points

<ul>
	<li>Bacterial meningitis is a notification priority disease in Pakistan, and health authorities should be informed immediately of any presenting cases.</li>
	<li>Bacterial meningitis is a fatal infection that can cause long-term complications.</li>
	<li>It is a global challenge to public health.</li>
	<li>Meningitis epidemics are seen all over the world, especially in Sub-Saharan Africa.</li>
	<li>Organisms that cause meningitis include bacteria, fungi, viruses, and parasites.</li>
	<li>1 out of 5 people with meningitis die.</li>
	<li>Affordable and safe vaccines can provide long-term and effective protection.</li>
</ul>

<p>&nbsp;</p>

[1] Runde, T.J., Anjum, F. and Hafner, J.W., 2021. Bacterial meningitis. In StatPearls [Internet]. StatPearls Publishing.

[2] Rogalla, D. and Bomar, P.A., 2021. Listeria Monocytogenes. StatPearls.

[3] Petersen, H., Patel, M., Ingason, E.F., Einarsson, E.J., Haraldsson, Á. and Fransson, P.A., 2014. Long-term effects from bacterial meningitis in childhood and adolescence on postural control. Plos one, 9(11), p.e112016.

[4] Soeters, H.M., McNamara, L.A., Blain, A.E., Whaley, M., MacNeil, J.R., Hariri, S. and Mbaeyi, S.A., 2019. University-based outbreaks of meningococcal disease caused by serogroup B, United States, 2013–2018. Emerging infectious diseases, 25(3), p.434.

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