BACKGROUND TO MENINGITIS

Introduction

Meningitis means inflammation of the meninges, the brain lining. It can be caused by several different germs, mainly bacteria and viruses.

Bacterial meningitis is quite rare, but it can be very serious and needs urgent treatment with antibiotics. There are about 2,000 reported cases of meningitis each year in the UK. There are two main bacterial forms, meningococcal and pneumococcal. The names represent the different organisms that cause meningitis, i.e. cause the meninges to become inflamed.

Effect and prevalence

If bacterial meningitis is diagnosed early and treated promptly, most people make a full recovery. However, in some cases it can be fatal, or lead to permanent handicaps (for example, deafness and brain damage).

Meningococcal meningitis, and in particular the group B strain, is the most common bacterial form in the UK. Meningococcal meningitis accounts for more than half the cases. Some forms of bacterial meningitis affect new-born babies. The most common are E Coli and group B streptococcus. These forms are rare, and often referred to as Neonatal meningitis.

Hib (Haemophilus influenzae type b) meningitis used to be the most common bacterial form in infants. This type of meningitis is now very rare, and has almost been eliminated by the Hib vaccine, which was introduced into the routine immunisation programme in 1992.

Viral meningitis is more common than bacterial. Although rarely life-threatening, it can be severely weakening. Viral meningitis can be caused by many different viruses. Some are spread between people by coughing or sneezing, or through poor hygiene. Other germs can also be found in sewage-pollute water.

Viral meningitis cannot be helped by antibiotics, and treatment is based on good nursing care. Recovery is normally complete, but headaches, tiredness, and depression may persist. In mild cases of viral meningitis, people would not even go to their doctor. However the symptoms are similar to the bacterial form. Someone with severe symptoms needs to be admitted to hospital for tests to find out if it is bacterial or viral meningitis. If worried, get medical advice.

Infection

Anyone of any age can get meningitis. The germs that cause bacterial meningitis are very common, and live naturally in the back of the nose and throat. People of any age can carry these germs without becoming ill. It is only rarely that they overcome the body's defences and cause meningitis. They spread by coughing, sneezing, and kissing, but they cannot live outside the body for long. Hence, they cannot be picked up from water supplies, swimming pools, buildings, or factories.

Symptoms

Meningits is not easy to identify at first because the symptoms are similar to those of flu. Recognising the symptoms early enough could mean the difference between life and death. Someone with meningitis becomes very ill. The illness may progress over one or two days, but it can develop quickly, and sometimes in just a few hours the patient becomes seriously ill. Not all the symptoms show at once:

• vomiting
• high temperature or fever
• violent or severe headache
• neck stiffness
• dislike of bright lights
• drowsiness and lethargy
• joint pains
• fits

Babies

Babies with meningitis may have a staring expression, and a fever, and they may vomit or refuse feeds. They can often be fretful, and make a shrill or moaning cry when handled. Babies can be very difficult to waken, and their fontanelle (the soft spot on the top of their head) may be tense or bulging. They may suffer with neck retraction, and their extremities (e.g. fingers, toes) may feel cold even though they may have a high temperature. Common symptoms are:

• fever, which can be accompanied by the hands and feet feeling cold
• refusing feeds or vomiting
• high pitched moaning cry, or whimpering
• dislike of being handled, fretful
• neck retraction with arching back
• blank and staring expression
• difficult to wake, lethargic
• pale, blotchy complexion

Septicaemia

Some bacteria that cause meningitis can also cause septicaemia (blood poisoning) as well as meningitis. Septicaemia is particularly associated with the meningococcal form. The bacteria enter the body from the throat, and travel via the blood. In some cases the germs multiply uncontrollably in the bloodstream, and this results in septicaemia before the bacteria can infect the meninges. In other cases, infection in the bloodstream and in the meninges develops at the same time, causing both septicaemia and meningitis.

Septicaemia can develop quickly. A rash appears under the skin. This starts as a cluster of tiny blood spots, which look like pin-pricks in the skin. If untreated, they get bigger and become multiple areas of obvious bleeding under the skin surface, like fresh bruises. The rash can appear anywhere on the body, even behind the ears or on the soles of the feet. It is more difficult to see the rash on darker skin. The spots or bruises do not turn white when pressed. The rash must be taken seriously; call a doctor immediately.

Septicaemia can affect both adults and children. Diarrhoea can accompany septicaemia, often discoloured.

Treatment

Antibiotics are used to treat bacterial meningitis. They are also prescribed for immediate family members, or any others who are in very close contact with a patient with the meningococcal strain. Antibiotics are not used for viral meningitis.

Prevention

Apart from vaccines there is no known way to protect against meningitis. However, only very close family contacts of the patient are at an increased risk of contracting meningitis. Other contacts, such as school friends and workmates, are only very rarely at higher risk, and do not normally need special treatment or investigation.

Stopping smoking improves health generally, and research has indicated that it may reduce the chances of getting meningitis in the family.

If you think you have meningitis, call a GP immediately. Explain your concern, describe the symptoms carefully, and ask for advice. If the GP is not available, then go straight to the nearest casualty department. Be insistent - if it is bacterial meningitis, then early treatment with antibiotics is vital.

Immunisation

As yet, there is no vaccine against the most common strain of the meningococcal germ, group B. The Hib vaccine is already in routine use and is very effective, but it does not protect against the other types of germs.

There is also a vaccine against some of the rare types of the meningococcal germ, groups A & C. When there are connected cases of meningococcal or C infection in a school, college, or university, some people may be offered this. Unfortunately, at the moment the vaccine does not work in small children, who are most at risk from the rarer strains.