Meningitis (Brain Inflammation)

Brief overview

What is meningitis? An inflammation of the skins that surround the brain – not to be confused with inflammation of the brain (encephalitis). However, both inflammations can occur at the same time (as meningoencephalitis).
Signs & Symptoms: Flu-like symptoms (such as high fever, headache and pain in the limbs, nausea and vomiting), painful neck stiffness, sensitivity to noise and light, possibly clouding of consciousness up to unconsciousness, possibly neurological deficits (such as speech and walking disorders) and epileptic seizures.
Treatment: In bacterial meningitis, antibiotics and possibly dexamethasone (a cortisone). For viral meningitis, symptomatic treatment (antipyretics and analgesics) and possibly antiviral drugs (antivirals).
Prognosis: If left untreated, meningitis can become life-threatening within hours, especially bacterial meningitis. However, with early treatment, it can often be cured. However, some patients suffer permanent damage (such as hearing impairment).

Meningitis: symptoms

Meninges and the brain itself can also be inflamed at the same time. This combination of meningitis and encephalitis is called meningoencephalitis.

Below is an overview of all the major meningitis symptoms in adults:

Meningitis: symptoms in adults

painful stiffness of the neck (meningismus)

Fever

pronounced feeling of illness with aching limbs

increased sensitivity to noise (phonophobia)

Nausea and vomiting

Confusion and drowsiness

possibly dizziness, hearing disorders, epileptic seizures

Meningitis: symptoms of bacterial meningitis

Complications

A possible complication of meningococcal infection is “blood poisoning” (sepsis): The bacteria flood the patient’s blood in large numbers. High fever, weakness and a severe feeling of illness with circulatory problems are the result. In severe cases, this meningococcal sepsis (meningitis sepsis) can develop into the so-called Waterhouse-Friderichsen syndrome (especially in children and people without a spleen):

Waterhouse-Friderichsen syndrome can occur in various bacterial diseases. However, it is most commonly the result of meningitis caused by meningococci.

Meningitis: symptoms of viral meningitis

In people with a healthy immune system, the symptoms usually subside on their own over the course of a few days. However, the recovery phase can be quite long. In younger children, the illness can also be severe. The same applies to people with a weakened immune system (for example, due to medication, cancer or infections such as HIV).

Meningitis: Symptoms in infants and young children

Tip: Since meningitis symptoms develop quickly and can become dangerous, especially in young children, you should see a doctor even if you have a vague suspicion of the disease.

Meningitis: Symptoms in special forms of meningitis

Overall, these two special forms are very rare. However, they should be considered if the course of the disease is prolonged.

Meningitis: Causes and risk factors

In meningitis, the meninges are inflamed. These are connective tissue sheaths that lie against the brain inside the skull. There are three of them (inner, middle and outer meninges).

On the other hand, meningitis can also occur in the context of various diseases, such as sarcoidosis or cancer. In these cases, meningitis is not contagious. Read more about the possible causes of meningitis below.

Meningitis that is not caused by bacteria is also called aseptic meningitis (abacterial meningitis).

Viral meningitis

Virus	Diseases primarily caused by the virus
Coxsackie virus A and B	Hand-foot-and-mouth disease, herpangina, summer flu
Herpes simplex virus type 1 and 2 (HSV-1, HSV-2)	Labial herpes, genital herpes
TBE virus	Early summer meningoencephalitis
Varicella zoster virus (VZV)	Chickenpox and shingles
Epstein-Barr virus (EBV)	Pfeiffer glandular fever (infectious mononucleosis)
Mumps virus	Mumps (goat mumps)
Measles virus	Measles
Many other viruses: HIV, polio virus, rubella virus, parvo B19 virus, etc.

Meningitis infection occurs in a different way, for example with TBE viruses: the pathogens are transmitted by the bite of bloodsucking ticks.

The time that elapses between infection and the appearance of the first symptoms of the disease (incubation period) also depends on the type of virus. In general, the meningitis incubation period here is usually about two to fourteen days.

Bacterial meningitis

Frequency of meningococcal disease

There are different subgroups of meningococci, so-called serogroups. Most meningococcal diseases are due to serogroups A, B, C, W135 and Y. These serogroups are not equally widespread throughout the world. In Africa, for example, meningococci of serogroup A are the main cause of major epidemics. In Europe, on the other hand, it is mainly serogroups B and C that cause infections.

Children under the age of five are the most likely to contract meningococcal disease (especially in the first two years of life). A second, smaller peak of the disease is seen in the age group of 15 to 19 years. In principle, however, meningococcal infections can occur at any age. People with a weakened immune system are particularly at risk.

Pathogens of bacterial meningitis and other diseases

Bacterium	caused diseases
Pneumococcus	v.a. meningitis, pneumonia, middle ear and sinusitis etc.
Meningococcus	v.a. meningitis and blood poisoning (sepsis)
Staphylococcus	Meningitis, food poisoning, wound infections, blood poisoning (sepsis), etc.
Enterobacteriaceae incl. Pseudomonas aeruginosa	Diarrheal diseases, enteritis, pneumonia, meningitis, etc.
Haemophilus influenzae type B
Streptococcus agalactiae (B streptococci)	Meningitis, blood poisoning (sepsis), urinary tract infections, wound infections
Listeria monocytogenes	“Listeriosis” (diarrhea and vomiting, blood poisoning, meningitis, encephalitis, etc.)

Also depending on the causative bacterium is how meningitis is transmitted (usually droplet infection).

Other causes of meningitis

Specific bacteria: Tuberculosis (tuberculous meningitis), neuroborreliosis.

Fungal infection: candidiasis, cryptococcosis, aspergillosis

Parasites: Echinococcosis (tapeworm)

Protozoa (single-celled organism): Toxoplasmosis

Cancers: Meningeosis carcinomatosa, meningeosis leucaemica

Inflammatory diseases: Sarcoidosis, lupus erythematosus, Behçet’s disease

Meningitis: examinations and diagnosis

An experienced physician can already make the meningitis diagnosis on the basis of the symptoms and the physical examination. However, it is essential to clarify whether the meningitis is bacterial or viral. This is because the treatment depends on it.

The most important steps for meningitis diagnosis are:

Medical history (anamnesis).

During the consultation, the doctor will first take your medical history or that of your sick child (anamnesis). Possible questions the doctor may ask are:

Do headaches, fever and/or painful neck stiffness occur?
Are any underlying or pre-existing conditions known (HIV, sarcoidosis, Lyme disease, etc.)?
Do you or does your child take any medications on a regular basis?
Do you or does your child have any allergies to medications (for example, antibiotics)?
Have you or has your child had contact with others with headaches, fever and neck stiffness?

Physical examination

Another sign of meningitis is when the sufferer cannot straighten the leg while sitting because it is too painful (Kernig’s sign).

The Lasègue sign is also positive in the case of a herniated disc.

Further investigations

The first steps of further investigations in case of suspected meningitis are:

1. drawing blood for blood cultures: so-called blood cultures can be used to try to detect and identify a pathogen – especially bacteria. The physician can then select an appropriate antibiotic for bacterial meningitis therapy that is effective against the type of bacteria in question.

3. computed tomography (CT) or magnetic resonance imaging (MRI): these imaging procedures provide further information about the condition of the brain. They can sometimes also provide clues about where the pathogen originally came from (for example, from ulcerated sinuses).

Meningitis: Treatment

As soon as blood and cerebrospinal fluid have been drawn, the doctor starts antibiotic therapy – even if it is not yet known whether bacterial meningitis is actually present. The early administration of antibiotics is a precautionary measure, because bacterial meningitis can quickly become very dangerous.

Once the actual pathogen has been determined from the blood and cerebrospinal fluid sample, the doctor adjusts the meningitis treatment accordingly: If it is indeed a bacterial meningitis, the patient may be switched to other antibiotics that better and more specifically target the causative bacterium. However, if it turns out that a virus is responsible for the meningitis, usually only the symptoms are treated.

Bacterial meningitis: therapy

If the dreaded Waterhouse-Friderichsen syndrome develops, treatment in the intensive care unit is necessary.

Special measures in meningococcal meningitis

Viral meningitis: Therapy

In the case of viral meningitis, usually only the symptoms are treated. Only against a few viruses are there special drugs (antivirals) that can mitigate the course of the disease. This applies, for example, to the group of herpes viruses (herpes simplex virus, varicella zoster virus, Epstein-Barr virus, cytomegalovirus) and the HI virus (HIV).

Meningitis of other cause: Therapy

If meningitis has causes other than bacteria or viruses, the trigger is treated accordingly if possible. For example, fungicides (antifungals) are prescribed for meningitis caused by fungi. Anthelmintics (anthelmintics) are used against tapeworms. If sarcoidosis, cancer or another underlying disease is behind the meningitis, it is treated specifically.

Meningitis is a potentially life-threatening disease. The prognosis depends, among other things, on which pathogen causes the meningitis and how quickly the patient is treated professionally.

Viral meningitis is usually much less life-threatening than bacterial meningitis. But here, too, the prognosis depends on the particular virus and the general physical condition. The first few days are particularly critical. If the affected person has survived these well, the chances of recovery are usually good. Viral meningitis then generally heals within several weeks without secondary damage.

Meningitis: Consequences

Meningitis: Prevention

If you want to prevent meningitis, you should, if possible, protect yourself from infections with the most common pathogens (viruses and bacteria).

Bacterial meningitis: prevention through vaccination

Meningococcal vaccination

There are different subgroups (serogroups) of meningococci. In Europe, meningococcal meningitis is mostly caused by serogroups B and C.

In addition, quadruple vaccines against meningococci of serogroups A, C, W and Y are available for infants, children, adolescents and adults at increased risk of infection (see below). Depending on the vaccine, these are licensed from the age of six weeks, twelve months and from two years.

Pneumococcal vaccination

Pneumococcal vaccination is recommended for all children from the age of two months. Three vaccination doses are provided: the first dose should be given at the age of two months, the second dose at the age of four months. The third vaccine dose is recommended at eleven months of age.

Haemophilus influenzae type B vaccination

Viral meningitis: prevention through vaccination

Some forms of viral meningitis can also be prevented with vaccination. The mumps vaccination, measles vaccination and rubella vaccination (usually given in combination as MMR vaccination) are recommended as standard for all children.

For a longer vaccination protection, a basic immunization with three vaccination doses is recommended. After three years, the TBE vaccination can be boosted with another dose. Thereafter, booster vaccinations are recommended at five-year intervals for people under 60 years of age, and every three years after age 60. In this way, combined meningitis and encephalitis caused by TBE viruses can be prevented.