Spinal Meningitis is a disease that causes irritation and/or inflammation of the membranes (also known as meninges) in the nervous system. These membranes are present in the central nervous system to protect the brain and spinal cord. When the body is invaded by bacterial or viral meningitis the meninges are susceptible because there are no white blood cells in the cerebral spinal fluid. White blood cells are the immune system’s major line of defence against infection. The disease is contagious and can be very serious with long-lasting damage to the brain, central nervous system, and the rest of the body occurring in some cases.
Spinal Meningitis Statistics
Every year approximately 3000-5000 people in the US contract bacterial meningitis, the more aggressive form of the disease, with 20-25% of those cases resulting in death. If the disease progresses rapidly over 24hrs then the fatality figure is closer to 50%. The number of people contracting viral meningitis is difficult to establish as it may be dismissed as influenza by some patients and they recover fully without recourse to treatment from a physician. That is not to say that the viral form of the disease is harmless as it can also cause chronic debilitation and death in some people.
Affects of Meningitis
Many people do recover with no long-term damage, but these are usually cases where the meningitis infection was caught and treated early. Some of the long-term effects of meningitis include loss of hearing, impairment of cognitive function (the ability to think and learn), necessary amputation of the limbs, blindness, paralysis, and seizures. Initial symptoms to watch out for are stiffness of the neck, with an inability to touch the chin to the chest, a rash which does not disappear when glass is pressed against it, headaches, light sensitivity, seizures, excessive sleepiness, vomiting and nausea, and lack of thirst or hunger. There are numerous other symptoms of meningitis to watch out for and it is important to be aware of those symptoms that can manifest in children who cannot communicate their symptoms, and are at particular risk of long-term impairment from the disease.
Bacterial and Fungal Spinal Meningitis
Most cases are viral or bacterial in nature, but the disease can be caused by fungal infection and other microorganisms along with certain types of cancer, head injury, other illnesses, and medication reactions. Vaccinations do exist that may protect against the bacterial form of meningitis, and the pneumonia vaccine may also provide some level of protection against the disease. Treatment for viral meningitis is usually home-care with the use of pain relievers and medication to reduce any fever. Antibiotics do not work on this type of meningitis and simple rest and recuperation means that most people recover fully from viral meningitis. Bacterial meningitis however requires immediate treatment with antibiotics injected intravenously and close monitoring of the patient. Steroid injections may also be given to alleviate inflammation, and if the disease progresses the patient may require a breathing tube to be inserted and possible catheterisation. Antibiotic treatment may be commenced prior to the exact diagnosis being given so as to not lose time in the case of an aggressive disease progression. Viral meningitis requires a spinal tap test and the results take time to process, which can delay treatment and significantly effect outcome if the infection turns out to be bacterial. Those diagnosed with viral meningitis and sent home should still be monitored and return for another check-up in two days.
Causes of Meningitis
Meningitis is generally caused by a viral infection in which case the treatment is usually home-care, rest and recuperation. Obtaining an accurate diagnosis is paramount to ensure correct treatment of the disease however, and patients should not risk self-diagnosis with this potentially life-threatening condition. Any rapid progression of symptoms, even if a diagnosis of viral meningitis has already been given, should be brought to the attention of a medical professional immediately for further investigation. Other causes of meningitis include bacterial infection, trauma, fungal infection, and even neck surgery.
Bacterial meningitis is usually caused by the Stereptococcus pneumoniae bacteria but the Neisseria meningitidis bacteria is the one that is connected to outbreaks where crowded conditions occur, such as in college dormitories or army barracks. Another bacteria, Haemophilus influenzae type B (Hib) is also responsible for some cases of meningitis in children and adults but has become less of an issue since children began receiving the Hib vaccine as standard in infancy.
The bacteria that cause meningitis may already live in the body, specifically in the nose and mouth, but it is when they enter the general circulation and reach the meninges of the brain that the problems begin. The brain is usually protected from the body’s immune system, and therefore an autoimmune attack, by the meninges which create a barrier; often referred to as the blood/brain barrier. Unfortunately the bacteria involved in meningitis may occasionally cross this barrier and are then able to attack the brain and central nervous system with little or no initial resistance, spreading rapidly and causing widespread tissue damage, inflammation, and irritation. The problem may actually be exacerbated as the immune system does eventually mount an attack as the blood vessels near the brain can become more permeable than they should be leading to infiltration of white blood cells, fluid and other immune system cells into the central nervous system. This can cause increased swelling of the brain, with resulting decreased blood flow (ischaemia) to some brain cells and more brain damage.
Other Causes of Meningitis
Occasionally meningitis is a result of trauma to the brain, head, or neck, and may occur due to some surgical procedures, such as neck pain surgery. Ear and sinus infections are also potential causes of meningitis. Epidemiological studies show that African Americans contract meningitis at a disproportionally high rate compared to those of other ethnicities. Men and women are affected equally, and the average age for meningitis is 25yrs old. Others who are at high risk include the elderly, children under the age of five, alcoholics, cancer patients (chemotherapy increases the risk of meningitis), those with sickle cell anaemia, diabetics, and recent transplant patients taking immunosuppressive drugs. Further risk factors include living in cramped conditions, such as a college environment, military barracks, or inadequate housing, IV drug use, and the presence of hydrocephalus shunts.
Symptoms of Meningitis
Symptoms of meningitis vary from person to person from mild flu-like symptoms to rapid progression with serious complications and damaging long-term effects. Most people suffer from a stiff neck with an inability to touch the chin to the chest. This is due to swelling and inflammation of the meninges in the cervical spinal cord. Other symptoms commonly include severe headaches with light sensitivity. Nausea and vomiting associated with this head and neck pain may be experienced along with a general lack of hunger or thirst. A reddish rash is often present which does not disappear when rolling a glass over the affected area of skin. Patients may also feel excessively sleepy and have difficulty waking. Some experience seizures which can further damage the brain through acute trauma.
Adult symptoms progress rapidly over 24hrs in about a quarter of patients, with the other sufferers experiencing a gradual progression and abatement of symptoms over a few days to a week. Antibiotic use for an unrelated condition may result in a gradual onset of symptoms that then rapidly progress on cessation of the antibiotics. Those with meningitis caused by a fungal infection may have symptoms developing over a period of weeks rather than days, making it a particularly difficult form to diagnose and treat quickly. AIDS patients are the usual patient group who contract fungal meningitis due to a generally weakened immune system; it is often precipitated by a recent upper respiratory tract infection. Symptoms that are likely to be experienced include headaches and nausea, seizures, confusion, photophobia, a stiff neck, and occasionally, weakness or loss of sensation in localized areas such as the face. Joint swelling, pain, and discomfort may also occur along with a bruise-like rash.
Symptoms in children should be carefully watched for as they may not be able to report feelings of nausea or headache verbally. General irritability, constant crying, vomiting, stiffness of the neck and body rigidity are all signs of meningitis in children. Refusal to eat and unusual tiredness, with long periods of sleep can also indicate the presence of the disease. Children under five are at particular risk and require careful monitoring. Any suspicion of meningitis should be immediately checked with a medical professional as prompt treatment is paramount in limiting the damaging effects of this disease.
Diagnosis of Meningitis
Immediate medical attention is necessary for a prompt diagnosis of meningitis when symptoms are observed. It is advisable to attend the emergency department rather than wait for an appointment at the doctor’s office as meningitis symptoms may progress rapidly and require urgent treatment. Fever, headaches, neck stiffness, abnormal sleepiness and cognitive alterations such as somebody talking gibberish are some of the symptoms of meningitis. If unable to acquire transport to the hospital it is advisable to call out the emergency services, particularly in a case where a child is having difficulty remaining conscious and has stiffness of the neck and body. If seizures are occurring, dial 911 immediately for assistance as the quick commencement of antibiotic treatment can decrease the risk of fatality or serious physical impairment from the disease.
Spinal Tap for Meningitit Diagnosis
The patient will usually be isolated after being recognized as a potential case of meningitis so as to protect other patients and hospital staff. A physical examination will take place where the doctor will check for labored breathing or blood pressure problems. Taking detailed notes on symptoms, intensity, duration and onset will help the physician to evaluate the need for further tests. If the doctor suspects the presence of bacterial meningitis then they are likely to immediately commence antibiotic treatment whilst continuing the evaluation. The physician usually conducts a lumbar puncture (spinal tap) to extract spinal fluid and test it for signs of infection and inflammation. This is the only way of accurately ascertaining the presence of meningitis but may have to wait if the patient is too sick for the procedure, which can be uncomfortable but not usually painful; antibiotics will be given due to the suspicion of meningitis at this point. The results from this test can take a few hours to process, with blood tests for red and white blood cell counts being conducted in the meantime. A CT scan may be performed to check for infection in the brain, any swelling or the presence of an abscess. If breathing appears problematic then a chest x-ray may be carried out in order to check for pneumonia or fluid in the lungs.
Spinal Tap Procedure
A spinal tap is conducted as the patient lies on one side and an anaesthetic is injected locally in the lower back to numb the area. A small needle is then carefully inserted into the area of the spinal column that contains the cerebrospinal fluid. This can be an uncomfortable procedure but is normally not painful. Although the procedure may appear scary there are normally no complications, with some patients experiencing a mild headache after the procedure and very rarely an infection occurring. The fluid is analyzed for the presence of white and red blood cells, protein, and glucose. Results will show whether either viral or bacterial meningitis are present in the system. If tests are inconclusive but the condition continues to progress then a further spinal tap may be conducted after 24-48 hours to ensure an accurate diagnosis.
Treatment of Meningitis
Upon suspecting meningitis in a patient, a physician will generally commence antibiotic treatment whilst waiting for the results of a spinal tap. These results can take a few hours, and a patient’s condition can rapidly degenerate during that time. If the diagnosis comes back as not being meningitis then the antibiotics are likely to be ceased, unless another bacterial infection requires similar aggressive treatment.
Treatment for Viral Meningitis
Viral meningitis cannot be treated with antibiotics and is usually left to run its course naturally with most people recovering fully within seven to ten days without need of further medical intervention. This does not mean that patients should self-diagnose and refrain from obtaining treatment as only a spinal tap can rule out bacterial meningitis, which is potentially fatal. Mild viral meningitis may still need acetaminophen (Tylenol) or other medications to relieve headache and fever. A check-up after two days is warranted to ensure the condition is not worsening. Any change in condition involving seizures, problems speaking or swallowing, weakness or numbness of the limbs and extremities with difficulty walking, heightened fever and worsening headache, excessive vomiting, or difficulty staying conscious requires medical attention immediately.
Treatment of Bacterial Meningitis
Bacterial meningitis requires antibiotic treatment, usually intravenously, and can progress rapidly without adequate treatment. If the patient is unable to get to the hospital themselves, or if friends/family have no transport in which to take them, then an ambulance should be called. Basic home-treatment whilst awaiting the emergency services involves keeping the patient in the recovery position where possible, so as to prevent them from inhaling vomit if they are sick, giving acetaminophen (Tylenol) to reduce their fever and pain, and keeping the person in a quiet area away from light to alleviate their photophobia.
Upon entry to the hospital the patient is likely to be isolated, possibly in an intensive care unit depending on the severity of meningitis symptoms, and an IV inserted for delivery of fluids and antibiotics. A heart monitor is often used, and the patients carefully observed for changes in condition. If breathing is problematic then they may be intubated in order to assist respiratory function. In order to reduce the inflammatory response of the body to the infection and suppress the potential for an autoimmune attack, steroids may be given. Further IV lines (in the groin, chest, or neck) may be used to administer anti-seizure medications and drugs to improve blood pressure. Patients may also be catheterized so as to monitor fluid status.
Prevention of meningitis is helped by ensuring good hygiene habits. It is important to wash hands before contact with food, after using the bathroom, or after contact with dirt, using soap and hot water (not antibacterial/antibiotic hand-washes as these build up antibiotic resistance). Covering the mouth and nose when coughing or sneezing and then washing the hands afterwards also helps prevent the spread of germs. Ensuring vaccinations are up to date for meningitis and Hib can help prevent a person contracting the condition as can preventative antibiotic treatment if they have been in recent close contact with someone diagnosed with bacterial meningitis. Antibiotics may help prevent the disease occurring but anyone who has had recent exposure to the bacterial condition should seek medical attention if they experience a sore throat, headache, a rash, neck stiffness, or fever.