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Meningitis

Meningitis


Adapted from the Meningitis and Encephalitis Fact Sheet produced by the National Institute of Neurological Disorders and Stroke and the Bacterial Meningitis Fact Sheet produced by the Directors of Health Promotion and Education.

Key facts
Signs and symptoms
Diagnosis
Treatment
Prevention
School policies
References

Key facts

  • Meningitis is an infection and resulting inflammation of the meninges, the membranes that surround the brain and spinal cord.

  • Meningitis is most commonly caused by bacteria or viruses though it may also be caused by a fungal infection, a reaction to certain medications or medical treatments, an inflammatory disease such as lupus, some types of cancer, or a traumatic injury to the head or spine.

  • Knowing whether or not the infection is caused by a virus or bacteria is important because the severity of the illness and treatment differ depending on what type of meningitis an individual has.

  • Bacterial meningitis is a rare but sometimes fatal disease. Bacterial meningitis is commonly caused by three bacteria:

      Pneumococcal meningitis is the most common form of meningitis and the most serious form of bacterial meningitis. Six thousand cases of pneumococcal meningitis are reported in the U.S. annually. The disease is caused by the bacterium Streptococcus penumoniae which also causes pneumonia, blood poisoning, and ear and sinus infections. Children under age 2 and adults with weakened or depressed immune systems are at higher risk than others. Aftereffects include neurological problems ranging from deafness to severe brain damage.

      Meningococcal meningitis, caused by the bacterium, Neisseria menigitides, affects about 2,600 individuals a year and is common among children ages 2 - 18. Ten to fifteen percent of cases are fatal with another 10-15 percent experiencing brain damage or other serious side effects. High risk groups include infants under age 1, people with suppressed immune systems, travelers to foreign countries where the disease is endemic, and college students, especially freshmen, who live in dormitories.

      Haemophilus meningitis caused by the haemophilus influenzae bacteriaum (Hib) Until introduction of Hib vaccines into routine childhood immunization programs in the 1990s, Hib disease, mainly meningitis and pneumonia in young children, was a significant public health concern in developed as well as developing countries. Since introduction of the Hib vaccines, the Hib-related meningitis has largely disappeared from the United States.

  • Viral or aseptic meningitis is the most common form of meningitis in the U.S. It is rarely fatal in individuals with a healthy immune system. It is frequently not diagnosed because it is thought to be the flu. It is usually caused by enteroviruses -- viruses that enter the body through the mouth and travel to the brain and surrounding tissues. Enteroviruses are present in mucus, saliva, and feces and can be transmitted through direct contact with an infected person or infected object or surface. Individuals infected with viral meningitis usually recover without specific treatment within 7 to 10 days

Signs and symptoms

  • Hallmark signs of meningitis are sudden fever, severe headache, and a stiff neck. In more severe cases, neurological symptoms may include nausea and vomiting, confusion and disorientation, drowsiness, sensitivity to bright light, and poor appetite.

  • Meningitis often appears with flu-like symptoms that develop over 1-2 days.

  • In newborns and infants, typical symptoms of fever, headache, and neck stiffness may be hard to detect. Other signs in babies might be inactivity, irritability, vomiting, and poor feeding.

  • Since the symptoms of viral and bacterial meningitis are often similar, persons who believe they have been exposed should seek medical help as soon as possible.

Diagnosis

  • Early diagnosis and treatment are important. If symptoms occur, the patient should see a doctor immediately. Bacterial meningitis can be treated with a number of effective antibiotics but treatment must start early.

  • The diagnosis of bacterial meningitis is usually made by growing bacteria from a sample of spinal fluid. The spinal fluid is obtained by a spinal tap. A doctor inserts a needle into the lower back and removes some fluid from the spinal canal. Identification of the type of bacteria responsible for the meningitis is important for the selection of correct antibiotic treatment.

Treatment

  • Viral meningitis has no specific treatment at this time. Most patients recover on their own. Physicians may recommend bed rest, plenty of fluids, and medicine to relieve fever and headache. Persons with severe viral meningitis may be hospitalized for supportive care. The physician may prescribe anticonvulsants such as dilantin or phenytoin to prevent seizures and corticosteroids to reduce brain inflammation. If inflammation is severe, pain medicine and sedatives may be prescribed to make the patient more comfortable.

  • Bacterial meningitis: strong doses of general antibiotics may be prescribed first, followed by intravenous antibiotics in more severe cases.

Prevention

  • Good personal hygiene reduces the risk of getting the disease from an infected person. Avoid sharing food, utensils, glasses and other objects with a person who may have or been exposed to the infection.

  • Wash hands often with soap and rinse under running water.

  • People who live, work, or go to school with someone who has been diagnosed with bacterial meningitis may be asked to take antibiotics for a few days as a preventive measure.

  • Several vaccines protect against bacterial meningitis but their effectiveness varies depending on the type of bacteria.

      What should schools do if meningitis cases are reported among students or staff?

      From the Texas Guide to School Health Program
      http://www.dshs.state.tx.us/schoolhealth/pgramguide.shtm



        References:

        P.A. Offit and G. Peter. The Meningococcal Vaccine -- Public Policy and Individual Choices. New England Journal of Medicine. December 11, 2003: 2353-2355.

        NE Rosenstein, BA Perkins, DS Stephens, T Popovic, JM Hughes. Meningococcal Disease: Review Article. New England Journal of Medicine. May 3, 2001: 1378 -1388.

        For more information:

        The Centers for Disease Control and Prevention:
        http://www.cdc.gov/meningococcal/about/index.html

        The National Meningitis Association:
        www.nmaus.org

      • Vaccines against Hib are considered safe and effective. By six months of age an infant should have received three doses of the Hib vaccine. A fourth dose (booster) should be given to children 12 to 18 years of age.

      • The vaccine against meningococcal meningitis (Neisseria menigitides) is ineffective on children under the age of two but considered safe as well as effective against most causes of meningococcal disease in older children and adolescents. The Advisory Committee on Immunization Practices and the American Academy of Pediatrics recommend that students entering college, especially those who will be living in dormitories be informed about the risks of meningococcal disease and the possible benefits of vaccination. New vaccines are also under development.

      • Vaccines against Streptococcus pneumoniae are ineffective against children under the age of two but is recommended for all persons over 65 and younger persons with certain medical conditions. New vaccines are under development. For more information, see Meningococcal Disease and College Students at www.cdc.gov/mmwr/preview/mmwrhtml/rr4907a2.htm
      • Alert local health departments, parents and students.

      • Advise staff and parents of those who were in close contact with the infected student to seek medical attention if symptoms develop.

      • Treatment of all close contacts should be done within the first 2 weeks of diagnosis of the first case, but preferably as soon as possible within the first 24 hours. Defining who might be a "close contact" can be undertaken by consulting with the school nurse, school physician, and/or local board of health.

      • Inform parents and staff that antibodies do not provide absolute protection against disease. Therefore, any student or adult who develops symptoms such as fever or headache requires prompt evaluation by a health care provider.