Meningitis

Causes of Meningitis

There are various causes of meningitis depending on the type of meningitis.

1. Bacterial meningitis

This type of meningitis is caused by bacteria like Streptococcus pneumoniae, Group B Streptococcus, Neisseria meningitides, Haemophilus influenzae, Listeria monocytogenes, and Escherichia coli. Mycobacterium tuberculosis, which generally causes tuberculosis or TB, is a less common cause of bacterial meningitis (called TB meningitis).

Bacteria can enter a person’s meninges in various ways as follows:

• Via the bloodstream

• Ear, throat or sinus infections

• Defect in the dura mater (dense outer layer of meninges)

• Skull fracture

• Neurosurgical procedures

The spread of bacterial meningitis generally depends on the type of bacteria that causes it. Bacterial meningitis can spread from person to person and also via certain foods such as unpasteurized dairy or deli meats. A person can be a carrier for bacterial meningitis and pass it on to others without getting sick themselves.

Bacterial meningitis is a serious condition and requires medical attention right away. It can be life threatening or cause permanent disabilities, such as brain damage, hearing loss, and learning disabilities, in case the treatment is delayed.

2. Viral meningitis

Meningitis caused by a virus is called viral meningitis and it is the most common type. Non-polio enteroviruses are the most common cause of viral meningitis however, other viruses that cause this disease are mumps virus, herpes viruses (Epstein-barr virus, herpes simplex viruses, cytomegalovirus, and varicella-zoster virus), measles virus, influenza virus, arboviruses (west nile virus and zika virus), and lymphocytic choriomeningitis virus.

Most people get better on their own without treatment however infants and people with a weakened immune system are more likely to get a severe form of illness.

3. Fungal meningitis

It spreads from fungal infections at any other part of the body that goes and infects the brain and spinal cord. Some causes of fungal meningitis are Cryptococcus, Histoplasma, Blastomyces, Coccidioides, Candida, and Mucormycosis. It is most likely to affect immunocompromised individuals such as HIV patients, cancer patients or transplant recipients.

4. Parasitic meningitis

Various parasites can affect the brain or nervous system in many ways and cause meningitis. Overall, parasitic meningitis is much less common than viral and bacterial meningitis. Some parasites can cause a rare form of meningitis called eosinophilic meningitis, eosinophilic meningoencephalitis, or EM.

The three main parasites that can cause EM are Angiostrongylus cantonensis (neurologic angiostrongyliasis), Baylisascaris procyonis (baylisascariasis and neural larva migrans), and Gnathostoma spinigerum (neurognathostomiasis).

5. Amebic meningitis

Primary amebic meningoencephalitis (PAM) is caused by Naegleria fowleri and is a rare brain infection that is usually fatal. Naegleria fowleri is a free-living ameba (a single-celled living organism that is too small to be seen without a microscope).

Naegleria fowleri is found in soil and warm freshwater around the world. It grows best at higher temperatures up to 115°F (46°C) and can survive for short periods at higher temperatures.

6. Non-infectious meningitis

This type of meningitis is not caused due to pathogens that spread between people but due to reasons other than infections like cancers, systemic lupus erythematosus (lupus), certain medications, head injury, and brain surgery.

Symptoms Of Meningitis

Early symptoms of meningitis may mimic the flu-like (influenza) symptoms and may develop over several hours or over a few days. You may suspect a meningitis infection, if you see one or more of the following symptoms:

• A high grade fever

• Vomiting 

• Confusion 

• Rapid breathing 

• Decreased level of consciousness

• Seizures

• Muscle and joint pain

• Pale & blotchy skin

• Rashes 

• Cold hands and feet

• Headache 

• Stiffness in the neck

• Sleepiness & difficulty waking up

• Soft bulging spot on the top of the head (in babies)

Risk Factors For Meningitis

You are at a higher risk of meningitis if:

• You recently had surgery on your brain or spinal cord

• You have a birth defect of your skull or spine

• You have a chronic condition such as kidney failure, diabetes, adrenal insufficiency or cystic fibrosis

• Advanced age

• Poor vaccination

• Immunosuppressed condition in case of AIDS, transplant recipients, and congenital immunodeficiencies

• Living in poorly sanitized crowded conditions

• A recent trip to endemic areas 

• Exposure to vectors such as ticks and mosquitoes

• Excessive use of alcohol 

• Splenectomy (Removal of spleen)

• Bacterial endocarditis

• IV drug use

• Sickle cell anemia

Also, different types of meningitis pose a higher risk to certain groups of people such as: 

• Newborns are most often affected by group B streptococcus meningitis

• Adolescents are at greater risk for meningococcal meningitis

• Adults with bacterial meningitis are most likely to have pneumococcal meningitis

• Older adults (50 and older) and pregnant women are more susceptible to listeria meningitis

Diagnosis Of Meningitis

The clinical diagnosis of meningitis is based on the symptoms. Meningitis can be confirmed by one or more of the following diagnostic tests:

1. Blood tests

Initial blood tests in the case of meningitis suspicion should include:

• Complete blood count (CBC)

• Coagulation studies

• Electrolytes

• Blood cultures

2. Lumbar puncture

A lumbar puncture (spinal tap) is done to collect cerebrospinal fluid (CSF) and definitively diagnose meningitis. In people with meningitis, the CSF often shows a low sugar level along with an elevated white blood cell count and protein.

3. CSF analysis

CSF fluid should also be sent for gram staining, standard culture, and polymerase chain reaction (PCR). CSF analysis helps to pinpoint which bacteria caused meningitis. PCR testing is more advantageous than culture for the diagnosis of infection as this technique is more rapid and is able to detect a variety of strains of even non-viable bacteria and antibodies against certain viruses

4. Dilated fundus examination

Dilated fundus examination is a diagnostic procedure that employs the use of eye drops to dilate or enlarge the pupil of the eye to obtain a better view of the fundus of the eye. The fundus can be examined to look for signs of papilledema (swelling of the optic nerve, which connects the eye and brain), a surrogate marker for raised intracranial pressure. In an immunocompetent patient with no known history of recent head trauma, normal level of consciousness and no evidence of papilledema or focal neurological deficits, it is considered safe to perform lumbar puncture (LP) without prior neuroimaging.

5. Imaging tests

If your doctor advises, imaging tests such as CT scan head can be performed before a lumbar puncture to rule out any hemorrhage and raised intracranial pressure. The criteria for getting a CT scan include advanced age (greater than 60), focal neurologic deficits, immunodeficiency, new-onset seizures, altered mental status, and central nervous system disease in the past. 

Prevention Of Meningitis

Some forms of viral and bacterial meningitis are contagious. The organisms can spread through the exchange of secretions like coughing, sneezing, kissing, or sharing utensils, toothbrush or cigarette. Sometimes, meningitis can spread to other people who have had close or prolonged contact with a patient with meningitis.

The following steps can be taken to prevent meningitis:

• Regular and thorough hand washing especially before eating and after using the toilet, spending time in a crowded public place or petting animals helps to prevent the spread of infections.

• Avoid sharing drinks, foods, straws, utensils, lip balms or toothbrushes with anyone else.

• Maintain your immunity by getting enough rest, morning sunlight, regular exercise, eating a wholesome, balanced and healthy diet and following sleep hygiene tips.

• Cover your mouth and nose while coughing or sneezing or sneeze into your elbow. Throw tissues into the dustbin after use and wash your hands.

• Avoid smoking and excessive alcohol.

• Pregnant ladies should reduce their risk of listeriosis by thoroughly cooking food and avoiding cheese made from unpasteurized milk. 

• Avoid contact with sick patients. If you have been in close contact with someone who has had a bacterial meningococcal infection, your doctor can prescribe you preventive antibiotics to decrease your chances of developing the disease.

Till date, there is no vaccine to prevent viral meningitis. However, vaccination against bacterial meningitis is available and helps in preventing meningitis. Some of them are as follows:

• Haemophilus vaccine (HiB vaccine) 

• Pneumococcal conjugate vaccine 

• Pneumococcal polysaccharide vaccine

• Meningococcal conjugate vaccine 

Specialist To Visit

If you suspect you have any symptoms of meningitis, you can consult these specialists:

• Infectious disease specialist

• Emergency physician

• Neurologist

• Neurosurgeon

• Rheumatologist 

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Treatment Of Meningitis

A. Viral meningitis

Viral meningitis is managed by supportive treatment. Bed rest, plenty of fluids and electrolytes balance along with over-the-counter pain medications to help reduce fever and relieve body aches are the mainstay for treatment for viral meningitis. However, oral or intravenous acyclovir may be of benefit in patients with meningitis caused by herpes simplex virus-1 or 2 (HSV-1 or 2) and in cases of severe Epstein Barr Virus (EBV) or varicella zoster virus (VZV) infection. Patients with HIV meningitis are administered highly active antiretroviral therapy (HAART).

B. Bacterial meningitis

Bacterial meningitis on the other hand, is a serious condition and requires immediate treatment with antibiotics. Delay in the treatment can lead to severe complications and increased mortality. Following is the treatment for meningitis:

1. Antibiotics
If a patient comes with undifferentiated acute bacterial meningitis, broad-spectrum antibiotics are usually prescribed. Antibiotic therapy of seven days is usually enough to treat suspected cases of meningococcal meningitis.

The treatment for adults usually begins with the administration of the following antibiotics:

• Cefotaxime 

• Ceftriaxone 

• Cefepime

• Vancomycin 

• Ampicillin

For meningitis caused by N. meningitidis, third-generation cephalosporins & penicillin are usually given. Patients who cannot tolerate beta-lactam antibiotics, chloramphenicol (IV) is the treatment choice for meningococcal meningitis.

For confirmed cases of pseudomonas meningitis, treatment with ceftazidime or meropenem can be given. For anaerobic bacteria like bacteroides and fusobacterium, metronidazole may be added.

2. Corticosteroids
Patients suffering from meningitis due to S. pneumoniae and H. influenzae are given corticosteroids like dexamethasone usually 20-30 minutes before starting antibiotic therapy to reduce the inflammation associated with meningitis.

C. Fungal meningitis

The following medications are advised in management of fungal meningitis:

• Amphotericin B (IV)

• Flucytosine (orally)

D. Noninfectious meningitis 

Non-infectious meningitis due to allergic reaction or autoimmune disease may be treated with corticosteroids.

Home-care For Meningitis

If you had meningitis in the past and have been discharged from the hospital, you need to keep in mind the following home care tips in mind:

• Take adequate rest and do not indulge in high-functioning tasks to conserve energy

• Create an aseptic environment by following simple home infection control procedures

• Pay extra attention to your diet. Take foods that are healthy and safe

• Avoid drinking alcohol and smoking

• Do not go to high altitudes

• Always be with someone at all times

• Consult your doctor immediately in case you face any health discomfort 

• Do not skip or change your medications without consulting your doctor first

Complications Of Meningitis

With appropriate treatment, symptoms like headache and fever improve. However, if this condition is ignored, you may have a more severe infection and inflammation. Common complications of meningitis include the following:

• Hearing problems (due to damage to the nerves)

• Seizures or epilepsy

• Hydrocephalus (a build-up of CSF in and around the brain)

• Memory problems, changes in personality and behavior

• Learning disorders

• Speech problems

• Weakness in one side of the body

• Septicemia (if bacteria enters the bloodstream and cause blood poisoning) 

• Amputation of limbs, if the infection spreads to other parts of the body (including the bloodstream)

• Parotitis, orchitis, oophoritis, pancreatitis may be seen, especially in cases of mumps meningitis 

Alternative Therapies Of Meningitis

The following herbal remedies can be useful as an adjunct to treatment of bacterial infections such as meningitis:

• Garlic (lahsun): Garlic is an easily available superfood that is effective in various infectious conditions including meningitis. Allicin present in garlic is effective against various bacteria and viruses and helps in their effective elimination. You can take cloves of garlic in a raw form for its maximum effect. 

• Astragalus: Flavonoids and saponins present in the astragalus plant can help in treating the ill effects of an infection. This is an extremely safe remedy that can be taken by kids as well. 

• Reishi mushrooms: These mushrooms are bright red in appearance and are useful in infectious diseases by boosting your immune system and reducing the inflammation caused by this disease. 

• Chlorella: Due to the high chlorophyll content present in this plant, it is known to improve cell production, blood purification, and quicker recovery from infectious agents. 

• Ginseng: Ginsenosides present in ginseng are useful in eliminating the infection from the body by acting directly on the membranes. You can consume ginseng directly or in tea for its maximum effect. 

• Hypericum: Hypericum or St. John’s wort contains hyperforin as the main active ingredient, which has the capacity to cross the blood-brain barrier and work against certain infectious agents causing the disease. 

Living With Meningitis

Most people tend to recover quickly from meningitis with timely treatment. However, for some people, life after meningitis is tough as they struggle to perform everyday activities such as:

• Some people complain of severe persistent headaches, fatigue, memory problems, changes in personality, and depression after meningitis. If these problems do not get better or you notice problems with your vision, consult your doctor as early as possible.

• It is advised to take plenty of rest while recovering from the after-effects of meningitis and not indulge in activities that are exhausting. 

• Children and adolescents who are planning to return to their school or work should take it slow, even if they are having a good recovery. Look out for any after-effects and consult your doctor if any of them bothers you.