24th April is observed as World Meningitis Day every year. The theme for 2020 is “ Defeat Meningitis” with the aim to raise awareness about the condition.
Worldwide, meningitis is one of the major causes of high morbidity and mortality in children below five years of age. In the pediatric population, it accounts for about 180,000 deaths annually[1]. Studies from India have attributed pneumonia and meningitis as the leading causes of deaths among children below five years of age. Together, both these diseases account to around 22% of deaths that occur in kids[2].
This world meningitis day, let’s know a little about this deadly disease including its types, causes, symptoms, and prevention.
What Is Meningitis?
Meningitis is an inflammation of the protective membranes that cover the brain and spinal cord. These delicate membranes are called meninges. It typically triggers symptoms such as headache, fever, and stiff neck.
What Can Cause Meningitis?
The causes of meningitis may be broadly classified as infectious (bacterial, viral, fungal) and noninfectious. Viral and bacterial infections are the most common causes of infectious meningitis whereas health problems such as head injury or cancer belong to the non-infectious causes of inflammation in the brain. Haemophilus influenzae type b(Hib), Streptococcus pneumoniae, and Neisseria meningitidis were reported to be the commonest causes for bacterial meningitis across different parts of the world. Here is more on the types of meningitis
Viral meningitis: It is the most common but least serious type of meningitis and accounts for 85% of the cases[1]. The common causative viruses include enteroviruses (especially the Coxsackie virus). The other viruses that can cause this condition include herpes simplex virus, influenza virus, mumps virus and human immunodeficiency virus (HIV).
Bacterial meningitis: The next common type of meningitis is bacterial meningitis which occurs in about 3 per 100,000 people on a yearly basis[3]. The pathogens that cause this type of meningitis include Streptococcus pneumoniae, Neisseria meningitidis (meningococcus), Haemophilus influenzae, Listeria monocytogenes, and Staphylococcus aureus. The bacteria that causes tuberculosis, Mycobacterium tuberculosis, can also cause the inflammation of the meninges.
N.meningitidis is the leading cause of meningitis worldwide and a dreaded disease in most countries. Meningococcal meningitis most commonly affects individuals from 3 years of age to adolescence. It rarely occurs in individuals older than 50 years. In developing countries, the mortality rate from bacterial meningitis is often higher (20–40%) than in developed countries[4]. The disease is found more in males than in females.
Fungal meningitis: It is relatively uncommon and usually results in chronic meningitis. As the name suggests, it is caused by a fungus which infects the body and spreads through the blood to the brain and spinal cord. Cryptococcal meningitis is a common fungal form of the disease. It affects people with immunodeficiencies, such as the acquired immunodeficiency syndrome or cancer.
Parasitic meningitis: It is less common as compared to viral and bacterial meningitis and mostly caused by parasites present in dirt, feces, grains or poultry. The infection is caused when the eggs of the parasite are ingested and not through mere coughing or touching a person with the condition. Amebic meningitis, a type of parasitic meningitis is one of the most dangerous infections. It is caused when an Ameba (a microscopic parasite not visible by naked eyes) enters the body on inhalation of contaminated water from lakes and rivers.
Noninfectious meningitis: It is basically not an infection but a side-effect or complication of an underlying health problem. The conditions that can lead to an inflammation of the brain tissue include systemic lupus erythematosus, drug-induced, head trauma, brain surgery, and cancer-related problems.
How Does Meningitis Spread?
Fungal, parasitic and non-infectious meningitis is not contagious but viral and bacterial meningitis are highly contagious. Viral and bacterial meningitis are highly contagious and can be spread through:
-Sneezing
-Coughing
-Kissing
-Sharing utensils, cutlery and toothbrushes
The infection is usually spread by people who carry these viruses or bacteria in their nose or throat, but are not sick themselves.
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What Are The Symptoms Of Meningitis?
More than 2/3rd of cases of meningitis occur in infants and mostly in the first 2 years of life. This could be due to decreased immunity and high vascularity of the brain, which puts kids at high risk of infection. Moreover, the symptoms of the infection are also vague due to the immaturity of the central nervous system (CNS) in infants and children. This is the reason why doctors mostly depend on the diagnosis based on blood tests and Cerebrospinal fluid (or CSF which is present in the meninges) rather than the symptoms.
However, there are few signs and symptoms which can help suspect meningitis and aid in the diagnosis of the condition.
-Fever for more than a week
-Neck stiffness
-Headaches
-Nausea and vomiting
-Altered or reduced level of consciousness
-Lethargy
-Rash
-Convulsions
How Is It Treated And Prevented?
The treatment is based on the cause of meningitis. Bacterial meningitis is treated with antibiotics and may require immediate hospitalization. This may help to prevent brain damage and death. Fungal meningitis might require the use of antifungal medications to treat the condition. Viral meningitis may resolve on its own but to know the cause and the right treatment you may need to consult a doctor. Parasitic meningitis can be treated based on the symptoms.
Untreated bacterial meningitis can cause serious neurological complications and is highly fatal. It may result in brain damage, hearing loss or a learning disability in 10–20% of survivors, as well as amputations in some cases[5].
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The Silver Lining
Certain types of meningitis can be prevented with vaccination. The vaccines that can prevent the infection are Haemophilus influenzae type B (Hib) vaccine, pneumococcal vaccine, and meningococcal vaccine. From the year 2012, the Indian Government has introduced the Pentavalent Vaccine (DPT+Hep B + Hib) in the Universal Immunization Programme (UIP) across the country.
Good thing is you can reduce your risk of getting meningitis by ensuring all your vaccinations are up-to-date.
(The article is reviewed by Dr. Swati Mishra, Medical Editor and Dr. Lalit Kanodia, General Physician)
Recommended Reads:
World Immunization Week: 7 Vaccines To Protect Deadly Diseases
Say Yes To Good Health: 10 Ways To Boost Immunity
References:
1. Yerramilli A, Mangapati P, Prabhakar S, Sirimulla H, Vanam S, Voora Y. A study on the clinical outcomes and management of meningitis at a tertiary care centre. Neurol India 2017;65:1006-12.
2. Yadhav Ml K. Study of bacterial meningitis in children below 5 years with comparative evaluation of gram staining, culture and bacterial antigen detection. J Clin Diagn Res. 2014 Apr;8(4):DC04-6.
3. Devi U, Bora R, Malik V, Deori R, Gogoi B, Das JK, Mahanta J. Bacterial aetiology of neonatal meningitis: A study from north-east India. Indian J Med Res. 2017 Jan;145(1):138-143.
4. Verma R, Khanna P. Meningococcal vaccine: a new vaccine to combat meningococcal disease in India. Hum Vaccin Immunother. 2012 Dec 1;8(12):1904-6.
5. Debnath DJ, Wanjpe A, Kakrani V, Singru S. Epidemiological study of acute bacterial meningitis in admitted children below twelve years of age in a tertiary care teaching hospital in Pune, India. Med J DY Patil Univ 2012;5:28-30.
6. Jayaraman Y, Veeraraghavan B, Chethrapilly Purushothaman GK, et al; Hospital Based Sentinel Surveillance of Bacterial Meningitis (HBSSBM) Network Team. Burden of bacterial meningitis in India: Preliminary data from a hospital based sentinel surveillance network. PLoS One. 2018 May 16;13(5):e0197198.