Headache and high fever often go hand in hand. But occasionally a simple infection turns out to be an insidious disease. Meningitis is an inflammation of the meninges caused by bacteria or viruses. Learn more about the causes, symptoms and treatment of meningitis here.
What is meningitis?
The brain is surrounded and protected by three meninges. Between the inner and middle meninges is a gap filled with a watery fluid that protects the gray matter from shock. Viruses or bacteria can cause inflammation of the meninges. This attacks the tissue and impairs the function of the brain. The infection causes swelling of the brain tissue and impairs blood flow, so paralysis similar to a stroke can occur. The life-threatening disease begins suddenly with high fever, severe headache and stiff neck. In some cases, it is even impossible to rest the head on the chest. Convulsions, paralysis and vomiting may also occur. Spotty skin hemorrhages, clouding of consciousness and circulatory collapse are indications of a life-threatening course of the disease. In severe cases, the disease can lead to death within hours.
Three bacterial species are the main culprits
More than 80 percent of all meningitis cases are caused by three types of bacteria:
- Meningococcus
- Pneumococcus
- Haemophilus influenzae, which is responsible for severe disease, especially in children under 4 years of age
All three pathogens are also present in healthy people without causing any harm. But occasionally they infect the brain for no apparent reason.
People at increased risk of meningitis.
Young children up to two years of age and people with immune disorders are much more susceptible to meningitis. Patients with chronic ear and nose infections are at risk for the bacteria entering the brain, causing inflammation. There is also an increased risk of meningitis after brain or spinal cord surgery.
Typical symptoms of meningitis
In children up to two years of age, meningitis is noticeable by the following symptoms:
- High fever
- Difficulty feeding
- Vomiting
- Irritability
- Shrill screaming
Therefore, infants under one year of age must always be presented to the doctor if they have a fever, so that meningitis is excluded. Unlike adults and older children, neck stiffness is not necessarily present. Older children and adults often react in an irritable and confused manner and become increasingly dazed. Coma and death may follow. Meningococcal meningitis quickly causes skin bleeding (petechiae) on the upper body and hands and feet. A blue and blotchy skin is also one of the typical identifying signs.
Lumbar puncture brings clarity
Meningitis is diagnosed with the help of a lumbar puncture. For this purpose, fluid is taken from the spinal cord. A thin hollow needle is inserted into the lower part of the spinal canal, usually between the third and fourth lumbar vertebrae below the point where the spinal cord ends. This allows the spinal fluid to be collected and examined. A portion of the punctate is examined directly under the microscope for bacteria. The remainder is used to grow bacterial cultures to accurately determine the pathogen.
Immediate treatment with antibiotics
Suppurative, or bacterial, meningitis must be treated immediately with antibiotics. Cortisone may be given to improve the patient’s general condition. In addition, the loss of fluids suffered by the patient due to fever, sweating, vomiting and loss of appetite must be compensated. Meningococcal meningitis can be complicated by a severe drop in blood pressure, which is also treated with additional fluid administration or medication.
Meningitis due to viruses.
Meningitis caused by viruses cannot be treated with antibiotics. Viruses do not respond to antibiotics because of their structure and metabolism. However, the symptoms of the disease are very similar and do not allow differentiation without microbiologic testing.The viruses that can cause meningitis include herpes and mumps viruses. The herpes virus often triggers seizures in the early stages of the disease. With the help of magnetic resonance imaging, swelling of the temporal lobes can be detected early in herpes-related meningitis. If a herpes virus is the cause of the inflammation, the herpes-specific agent aciclovir can be used to treat it, but it does not help with other viruses.
Severe brain damage may be left behind
Viral meningitis also often passes without symptoms and just as often causes no damage. According to recent research, the severity of the disease apparently depends on the type of virus, but this cannot be determined in every case with immunologic tests. Severe damage is more likely to occur in infants than in older children and adults. Late effects of bacterial meningitis can include seizures and permanent brain damage such as mental impairment and paralysis.
Vaccination against meningitis
Vaccination is available against certain bacterial pathogens, particularly various species of meningococcus. Several vaccines are available that essentially contain fragments of the bacterium. Vaccine protection lasts between three and ten years, depending on the type of vaccine, and can usually be given to children as young as 2 years. For some time, there has also been a vaccine that can be used in children as young as 2 months. In principle, vaccination against the Haemophilus bacterium (HiB) is part of the vaccination schedule established by the permanent vaccination commission at the Robert Koch Institute (STIKO). The HiB vaccination is usually given to children four times. The first vaccination is given after the child reaches two months of age, the second and third vaccinations are each given one month later, and the final vaccination is given between 11 and 14 months of age. It can be given individually or together with the combination vaccination against diphtheria, pertussis and tetanus. After 5 years of age, HiB vaccination is recommended only in certain cases.
Meningitis vaccination before travel
Meningitis vaccination is also important for travelers. Basically, any country with difficult hygiene conditions can be considered a possible meningitis area. At the same time, there is a temporal relationship between season and global spread of the disease. Between December and June, for example, meningococcal epidemics occur more frequently south of the Sahara from Sudan to Zambia. From November to May, the risk of disease is also particularly high in northern India and Nepal. In England, Ireland, the Netherlands, the USA and Spain, vaccination against meningococcus C has been part of the vaccination schedule for some time: The pathogen is extraordinarily common there. Exchange students, au pairs and all those who would like to live there for a longer period of time should bear this in mind. But also who goes to the Bavarian Forest, should be vaccinated against the early summer meningoencephalitis, which can be transmitted as a virus variant by tick bites.
Antibiotics for meningitis outbreaks
In Germany, there are also repeated cases of meningitis illnesses, which often occur in clusters in certain places. Schools and kindergartens in particular are sites of infection because the bacteria are passed on through coughing and sneezing as a so-called “droplet infection.” In this case, people with close contact to the infected person are treated with antibiotics as a precaution and observed. To prevent such outbreaks, it is particularly important to observe simple basic rules of hygiene. Keeping your hand in front of your mouth when coughing, turning away from the other person when coughing or sneezing should be as much a matter of course as washing your hands frequently. In 2015, 287 people in Germany contracted a serious meningococcal infection, and 28 cases were fatal.
