What is meningitis?
Meningitis is an inflammatory disease, most often of infectious origin, affecting the meninges – the three coverings of the brain and spinal cord. It is a disease that occurs with the typical symptoms of meningeal syndrome. Depending on the etiology (the specific causative agent), it can be very severe, with lasting consequences for the body, in some cases leading to death.
What causes meningitis?
In most cases, inflammation of the meninges has an infectious cause. 80% of these are viruses, with the most common viral agents being the coxsackie viruses, the herpes virus, the mumps virus, enteroviruses (ECHO viruses), etc. In the rarer cases, about 20%, the bacteria become the causative agent of meningitis.
Typical bacteria in meningitis are meningococci (Neisseria meningitidis), Haemophilus influenzae – mainly causative in infants between 1 and 6 months, pneumococci (Streptococcus pneumoniae) – mainly in children and the elderly, after trauma and hospital treatment, as well as tuberculosis bacteria (Mycobacterium tuberculosis). In some conditions and situations, there may also be typical causes of meningitis, such as streptococci (Streptococcus agalactiae), Escherichia coli, Listeria monocytogenes, in newborns and young children. Meningitis can be a complication after neurosurgery and craniocerebral trauma, as well as after ENT surgery, especially after sinus interventions, as frequent causative agents in these cases are staphylococci (Staphylococcus aureus and others), bacteria that exist as normal flora of the nasopharynx or nosocomial bacteria.
Meningitis can also be caused by non-infectious factors, such as “chemical”, a reaction to certain brain tumors, after chemotherapy, reactions after the use of contrast agents, lead poisoning, and others.
Some parasites and fungi can also cause meningitis, and these are rare cases, mainly in immunocompromised individuals (people with reduced or impaired immunity due to various diseases and conditions).
Meningitis can occur as the main primary disease, and in many cases, it also develops as a secondary complication after surgical intervention or after severe craniocerebral trauma.
What are the symptoms of meningitis?
Symptoms of meningitis include fever (elevated body temperature) and the features of meningeal syndrome, which is seen in diseases of the meninges. The meningeal syndrome is characterized by severe headache, profuse vomiting, constipation (constipation), photo and phonophobia (fear and strong unpleasant sensation caused by light and sounds), neck stiffness (a typical neurological symptom of difficulty moving the neck backward), Kernig’s symptoms and Brudzinski (other neurological symptoms), skin hypersensitivity. In some cases, symptoms of encephalitis (inflammation of the brain substance) can also be observed, such as changes in consciousness up to the onset of coma.
Fever is a typical syndrome, but in some cases, it is absent in the first hours of the disease, which makes diagnosis very difficult. For bacterial meninges, especially meningococcal meningitis, the development of the so-called purpura – a skin rash resembling red spots – is typical. Purpura is a specific symptom that speaks of meningitis and the severity of the infection, which develops very quickly and severely and requires urgent hospitalization (hospital admission and treatment).
The clinical picture may be different and incomplete in newborns, infants, and the elderly. A sudden change in behavior, crying, lowered body tone, very relaxed neck, convulsions, and tense fontanel, are the typical symptoms for infants. In the elderly, the clinical picture of meningitis is often sparse, including symptoms such as severe headaches, convulsions, and behavioral changes.
How is the diagnosis made?
Meningitis is diagnosed after a detailed collection of information about the onset and development of the disease and the performance of some mandatory tests. The examination includes a neurological examination to determine the presence of the typical neurological symptoms. In the presence of symptoms suggestive of meningitis, a mandatory lumbar puncture is performed, and, if necessary, imaging studies such as computed tomography or MRI (nuclear magnetic resonance).
Lumbar puncture is a mandatory examination for meningitis. A lumbar puncture is a procedure in which a needle is used to pierce the sheaths of the spinal cord, most often at the lumbar level (between the sacral vertebrae), in which a small amount of cerebrospinal fluid (cerebrospinal fluid, normally circulating between the sheaths of the brain and spinal cord) is taken ). Examination of cerebrospinal fluid allows the definitive determination of an inflammatory disease of the meninges and the initiation of antibiotic treatment.
Taking cerebrospinal fluid also aims for a specific microbiological examination and the identification of the specific causative agent of meningitis, as well as measuring its sensitivity to the antibiotics used for treatment. Microbiological examination of cerebrospinal fluid requires 48-72 hours. This necessitates the initiation of antibiotic therapy immediately upon diagnosis of meningitis and subsequent possible correction after receiving the microbiology results. Lumbar puncture is an examination that scares patients, but it is mandatory, carries a lot of information, causes discomfort, but has very little risk.
What is the treatment for meningitis?
Meningitis is an emergency that requires early treatment. The treatment is carried out in a hospital, in isolation in infectious disease clinics. In bacterial meningitis, the treatment consists of specific antibiotic treatment, which is started immediately after the diagnosis of meningitis, without waiting for the microbiological results of the lumbar puncture. After receiving the antibiogram, the antibiotic treatment can be adjusted if necessary. Intravenous antibiotic treatment is most often administered. Body temperature is corrected and water and electrolyte needs are replaced.
Viral meningitis is milder and can heal spontaneously. In viral meninges, treatment is symptomatic and supportive. In the case of herpes-meningitis, the specific antiherpes drug acyclovir is indicated.
Meningitis is a serious illness that can lead to death or permanent disability. Complications after experiencing meningitis can be deafness, epilepsy, neuropsychological retardation, impaired memory, or coma.
Vaccines are available against some of the bacterial causes of meningitis such as meningococci and Haemophilus influenzae. Vaccination is also recommended for risk groups of people in contact with sick people, traveling to exotic countries where the disease is common.
