Meningitis: symptoms, signs and treatment

Expert advice on meningitis (cerebrospinal meningitisis) diagnosis, treatment and vaccinations.

Meningitis
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Worried about meningitis? You are not alone. The very mention of meningitis strikes fear into the heart of most parents in the UK.

Such fears are understandable because meningitis is an inflammation of the lining of the brain and spinal cord and can be a very serious illness. GP Dr Gillian Rice looks at the symptoms, signs and vaccination options for the rare infection.



What is meningitis?

Meningitis is often associated with septicaemia, otherwise known as blood poisoning, which can also be extremely serious. Although most people recover from the disease, some are left deaf or blind, and in others it may prove fatal.

One of the biggest problems with meningitis is that it can develop very quickly. A child (or adult) can seem perfectly well and then, just a few hours later, be extremely ill with the disease. Another problem is that the symptoms can be difficult to distinguish from other, less serious infections.

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What are the symptoms of meningitis?

It is important to know that not everyone will develop the symptoms below and that they can appear in any order.

If someone gets some of the symptoms listed below, seek medical help immediately because the disease can become extremely serious in just a few hours.

⚠️ If you cannot get in touch with your doctor, or are still worried after getting advice, trust your instincts and take your child to the emergency department of your nearest hospital. You know your child best.

➡️ In babies and young children, meningitis can cause fever, vomiting, refusal to feed, a high-pitched or moaning cry and irritability.

➡️ Babies may also develop a tense or bulging fontanelle (the soft spot on the top of the baby's head), blotchy or pale skin, rapid breathing, a floppy body or stiffness with jerky movements.

➡️ Older children and adults may experience a severe headache, stiff neck and aversion to bright lights as well as fever and vomiting. Eventually, the person may become drowsy or unconscious.

➡️ If septicaemia (blood poisoning) is also present, a rash may develop that starts off looking like tiny red pinpricks. Later, the rash changes to purplish red blotches. If you press on the rash with a glass tumbler, the spots will not fade.

➡️ Older children and adults with septicaemia may complain of cold hands and feet, aching muscles and joints, and stomach pain (sometimes with diarrhoea).

⚠️ Research has found that key early warning signs of meningitis and septicaemia in children under 17 years old often include cold hands and feet, abnormal skin colour (pale, bluish or mottled), and leg pains. These symptoms often occur hours before other classic symptoms, such as a rash and dislike of bright light.

Septicaemia is a medical emergency that requires urgent treatment with antibiotics. If your child has these early warning signs and you suspect they have septicaemia or meningitis, do not wait for a rash to appear but seek medical advice immediately.

What causes meningitis?

A number of different viruses and bacteria can cause meningitis. Vaccination programmes have reduced the number of cases of certain types of meningitis around the world. But there are still a number of bacteria for which no effective vaccine has yet been developed. We also lack vaccines to prevent most viral causes of meningitis.

Viral meningitis: is the most common form of the disease, but fortunately it's less severe than the bacterial type. However, it can still be serious and very rarely can progress from headache, fever and drowsiness, to deep coma.

Bacterial meningitis: is less common, but it's always a severe and serious illness. Babies in the UK are now offered vaccination against four of the main causes of bacterial meningitis: meningococcal group C, Hib (Haemophilus influenzae type B) and pneumococcus (Streptococcus pneumoniae) and from September 2015 a Men B vaccine was also offered to babies as part of the NHS childhood vaccination programme.

Hib meningitis: was the most common form in children before the introduction of the Hib vaccine in 1992, but since then has been virtually eliminated.

Meningococcal group B bacteria now cause the most number of cases of meningitis in Britain. There has been an alarming rise in a particularly deadly strain of group W disease.

Pneumococcal meningitis is the second most common form of meningitis in the UK. With this form of meningitis, people do not usually get the rash that is associated with meningococcal meningitis, though the other symptoms are similar.



How do you get meningitis?

The bacteria that can cause bacterial meningitis are very common and don't usually cause any harm. They are found naturally in the nose and throat, particularly in teenagers and young adults. The bacteria can be spread through prolonged close contact, coughing, sneezing and kissing.

However, only in a small number of people do the germs overwhelm the body's immune system to cause meningitis or septicaemia.

How is meningitis diagnosed?

If someone is suspected of having meningitis or septicaemia, they should be admitted to hospital urgently and a number of investigations will then be carried out.

Several blood tests will be performed looking for markers of inflammation in the body and trying to identify any bacteria causing the infection.

A lumbar puncture may be carried out. This involves a needle being inserted through the lower part of the back in order to obtain a sample of cerebrospinal fluid (the fluid surrounding the brain and spinal cord), which is then tested in the laboratory.



How is meningitis treated?

Bacterial meningitis and septicaemia are treated with antibiotics intravenously (through a vein in the arm). Corticosteroid drugs, such as dexamethasone, may also be used to reduce inflammation in the brain.

➡️ If there are signs of dehydration the person may need fluids. These may need to be given intravenously or directly into the stomach or small intestine via a thin tube inserted through the nose.

➡️ If the person is suspected of having septicaemia, the doctors will look for signs of shock. Clinical shock occurs when blood doesn't circulate round the body properly, preventing the body's tissues and organs from functioning correctly.

➡️ Severe shock eventually causes low blood pressure and both fluids and drugs may be needed intravenously to improve the circulation and stabilise blood pressure.

➡️ A person with septicaemia may need some help to breathe – either using a face mask attached to an oxygen supply or a machine called a ventilator. If they need to be put on a ventilator, or their condition is very serious, they may be transferred to an intensive care unit in the hospital.

➡️ People who have been in close contact with someone who has been diagnosed with meningitis may also need antibiotics. Viral meningitis cannot be helped by antibiotics and treatment usually consists of rest and painkillers for symptoms such as headache.



Long-term effects of meningitis

Most people recover well after meningitis, but it may take some time to return to normal. The after effects of meningitis vary from person to person but may include:

  • emotional and psychological problems
  • minor learning difficulties which may require extra help at school.

    More severe cases of meningitis and septicaemia may cause:

    • hearing loss
    • blindness
    • learning impairment
    • behavioural problems
    • epilepsy
    • problems with movement and coordination
    • scarring of the skin
    • amputations
    • damage to bones and joints
    • kidney failure.


      Meningitis vaccinations

      Vaccinations introduced in recent years have gone a long way to reducing the number of cases of meningitis seen in this country.

      The four major vaccines that can help protect your child from getting meningitis now form part of the childhood immunisation schedule.

      ✔️ Meningitis C vaccine

      The meningitis C vaccine is made from a small inactivated part of the meningococcal group C bacteria. It stimulates the body's immune system to produce antibodies that act as a defence against group C meningococcal disease (meningitis and septicaemia).

      If an immunised person comes into contact with the real group C bacteria, the antibodies will prevent their body from becoming infected by the bacteria and will protect the person from developing group C meningococcal meningitis or septicaemia.

      The Men C vaccine is given to babies when they are between 12 and 13 months old (combined with the Hib vaccine as Menitorix). A booster dose is given at school to teenagers aged around 14 years as the ACWY vaccine (see below), this began in autumn 2015. The aim of this was to increase the protection against meningitis C among teenagers and young adults.

      If you are aged under 25 years and have never been immunised against meningitis C, it's recommended that you have this vaccination, particularly if you are going to university for the first time.

      ✔️ Hib vaccine

      The Hib vaccine is made from a small inactivated part of the Haemophilus influenzae type B bacteria and works in a similar way. It protects the person from developing Hib meningitis or septicaemia.

      The Hib vaccine is part of the six-in-one combination vaccine that also protects against whooping cough, diptheria, tetanus, polio and hepatitis B.

      The six-in-one vaccine is given in three doses, at two, three and four months of age and a fourth dose of Hib vaccine is given between 12 and 13 months, combined with a meningitis C booster.

      ✔️ Pneumococcal vaccine

      A pneumococcal conjugate vaccine (PCV) was added to the routine child immunisation programme in 2006. It prevents the body being infected with Streptococcus pneumoniae and will protect the person from developing pneumococcal meningitis or septicaemia.

      The original PCV used in the UK protected against seven different strains of pneumococcal bacteria and it has been estimated that in the first two and a half years after this vaccine was introduced up to 959 cases of serious illness and 53 deaths caused by invasive pneumococcal disease were prevented.

      In 2010 the original pneumococcal vaccine was replaced by another vaccine (Prevenar 13) in the routine child immunisation programme. This provides protection against 13 strains of pneumococcal bacteria.

      Babies born after on or after the 1st January 2020 will have this vaccination at 12 weeks and again at 12 months old. Babies born prior to this date will continue to have three vaccinations at two, four and 12 to 13 months.

      ✔️ Meningitis B vaccine

      From September 2015 a new Meningitis B or Men B vaccine (Bexsero) was introduced and offered to babies at 2, 4 and 12 months of age.

      ✔️ Men ACWY vaccine

      Because of the worrying rise in cases of group W disease, government advisors recommended that from 2015, 14 to 18 year olds should be given the ACWY vaccine (Nimenrix) to protect them and to try to limit the number of cases in the rest of the population.

      A programme was rolled out to make sure that eligible people in this age group were offered the vaccination. Currently:

      • Children age 13 to 15 are routinely offered the ACWY vaccine at school.
      • If you were born after September 1996 and were eligible for the ACWY vaccine but didn't receive it, you can have it up until you are 25 years old. You can check your eligibility using the UKMenACWY Eligibility Checker.

        These vaccines do not prevent infection with other viruses or bacteria. Because these vaccines do not contain any 'live' bacteria, they cannot give anyone meningitis or septicaemia.


            Resources

            A number of organisations can offer advice and support to people affected by meningitis including:


              References

              • Department of Health, Vaccine Update June 2015.Department of Health,Green Book Chapter 22 Meningococcal, August 2015.
              • Thompson MJ, Ninis N, Perera R, et al. Clinical recognition of meningococcal disease in children and adolescents. Lancet 2006; 367:(9508)397-403.
              • Peltola H. Worldwide Haemophilus influenzae type b disease at the beginning of the 21st century: global analysis of the disease burden 25 years after the use of the polysaccharide vaccine and a decade after the advent of conjugates" Clinical Microbiology Reviews 2000;13(2): 302–17.
              • Logan SA, MacMahon E. Viral meningitis. BMJ (clinical research ed.) 2008; 336(7634); 36-40.
              • Segal S, Pollard AJ. Vaccines against bacterial meningitis. Brit Med Bull 2004;72: 65-81.
              • Report of the Director of Immunisation, April 2009, p.17.
              • Meningococcal ACWY (MenACWY) vaccination programme, Public Health England at www.gov.uk/government/collections/meningococcal-ac...

                    Dr Gillian Rice is a Freelance GP working in the Bristol area.
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