Bacterial Meningitis
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Bacterial Meningitis

(Spinal Meningitis)

En Español (Spanish Version)

Definition

Bacteria first cause an upper respiratory tract infection. Then it travels through the blood stream to the brain.

The meninges are the membranes that surround the brain and spinal cord. Bacterial meningitis is an infection and inflammation of the meninges. It can cause death within hours. A quick diagnosis and treatment is vital.

Bacterial Meningitis

Meningitis

© 2008 Nucleus Medical Art, Inc.

Causes

Worldwide, three types of bacteria cause the majority of cases of acute bacterial meningitis:

  • Streptococcus pneumoniae (the bacteria that causes pneumonia)
  • Neisseria meningitidis
  • Haemophilus influenzae b (Hib)
    • In the US, widespread immunization has almost eliminated meningitis due to Hib

Other forms of bacterial meningitis include:

  • Listeria monocytogenes meningitis
  • Escherichia coli meningitis
  • Mycobacterium tuberculosis meningitis

A variety of other bacteria can also cause meningitis. Newborn babies and the elderly are at more prone to get sick.

Some forms of bacterial meningitis are spread by direct contact with fluid from the mouth or throat of an infected person (eg, kissing). In general, meningitis is not spread by casual contact.

Risk Factors

A risk factor increases your chance of getting a disease or condition.

If you have any of these risk factors for meningitis, tell your doctor:

  • Age: infancy and early childhood; over 60 years of age
  • People in close and prolonged contact with patients with meningitis due to Hib or Neisseria meningitidis
  • A weakened immune system due to HIV infection or other conditions
  • Alcoholism
  • Smoking (for meningitis due to Neisseria meningitidis)
  • Living in proximity to others, such as dormitories and military barracks (for meningitis due to Neisseria meningitidis)

Symptoms

Classic symptoms can develop over several hours, or may take 1 to 2 days:

  • High fever
  • Headache
  • Very stiff, sore neck

Other symptoms may include:

  • Red or purple skin rash
  • Cyanosis (bluish skin color)
  • Nausea
  • Vomiting
  • Photophobia (sensitivity to bright lights)
  • Sleepiness
  • Mental confusion

In newborns and infants, symptoms are difficult to see. As a result infants under three months old with a fever are often checked for meningitis. Symptoms in newborns and infants may include:

  • Inactivity
  • Unexplained high fever or any form of temperature instability, including a low body temperature
  • Irritability
  • Vomiting
  • Jaundice (yellow color to the skin)
  • Feeding poorly or refusing to eat
  • Tautness or bulging of soft spots between skull bones
  • Difficulty awakening

As the illness progresses, patients of all ages may have seizures and/or hearing loss.

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done.

Tests may include the following:

  • Spinal tap—removal of a small amount of cerebrospinal fluid to check for bacteria
  • Other cultures—testing of samples of blood, urine, mucous, and/or pus from skin infections
  • MRI scan—a test that uses magnetic waves to make pictures of structures inside the body (to be sure the inflammation is not from some other cause, such as a tumor)
  • CT scan—a type of x-ray that uses a computer to make pictures of structures inside the body

Treatment

More than 90% of all people with bacterial meningitis survive with immediate care. Antibiotics and corticosteroids are often given together to treat meningitis. Fluids may also be given. Talk with your doctor about the best treatment plan for you. Treatment options include:

Antibiotics

Antibiotics are given through an intravenous line as soon as the meningitis is suspected. The antibiotics may be changed once tests name the exact bacterial cause. Patients usually stay in the hospital until fever has fallen and the cerebrospinal fluid is clear of infection.

Corticosteroids

Intravenous corticosteroids are usually given early in the course of treatment. They control brain pressure and swelling. They also reduce the body’s production of inflammatory substances that can cause further damage.

Fluid Replacement

Fluids lost due to fever, sweating, or vomiting are cautiously replaced to avoid complications of fluid overloading.

Other Medications

Pain medications and sedatives may be used to reduce pain and fever. Anticonvulsants may also be prescribed to prevent seizures.

Prevention

To help reduce your chances of getting bacterial meningitis, take the following steps:

  • Vaccines against Hib, which are very safe and highly effective, given to young children
  • Pneumococcal polysaccharide vaccine against Streptococcus pneumoniae, given to:
    • All people over age 65
    • People ages 2 to 64 with certain chronic medical problems
  • Pneumococcal conjugate vaccine against Streptococcus pneumoniae, given to:
    • Infants
    • All children older than 2 years old
  • Preventative antibiotics given to healthcare workers or family members in close contact with infected patients
  • Pasteurization of milk and milk products to prevent meningitis due to Listeria monocytogenes
  • Monitoring for maternal infection during and before labor to prevent meningitis in newborns

RESOURCES:

Centers for Disease Control and Prevention
http://www.cdc.gov/

Meningitis Foundation of American
http://www.musa.org/

National Institute of Neurological Disorders and Stroke
http://www.ninds.nih.gov/

CANADIAN RESOURCES:

Health Canada
http://www.hc-sc.gc.ca/

Meningitis Research Foundation of Canada
http://www.meningitis.ca/

References:

Beers MH, Berkow R. The Merck Manual of Diagnosis and Therapy. 17th ed. Hoboken, NJ: John Wiley & Sons;1999.

Diagnosis of acute meningitis in adult patients. American Family Physician website. Available at: http://www.aafp.org/afp/20000115/tips/9.html. Accessed June 24, 2008.

Meningitis and encephalitis fact sheet. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/encephalitis_meningitis/detail_encephalitis_meningitis.htm. Accessed June 24, 2005.

Meningococcal disease. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/ncidod/dbmd/diseaseinfo/meningococcal_g.htm#Are%20there%20vaccines%20against%20meningitis. Accessed November 27, 2005.



Last reviewed January 2008 by David Horn, MD, FACP

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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