Meningitis

Early symptoms of meningitis may mimic flu-like (influenza) symptoms and can develop over several hours or a few days. You may suspect a meningitis infection if you observe 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 and blotchy skin
• Rashes
• Cold hands and feet
• Headache
• Stiffness in the neck
• Sleepiness and difficulty waking up
• Soft bulging spot on the top of the head (in babies)

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

Bacterial meningitis

This type of meningitis is caused by bacteria such as:

• Streptococcus pneumoniae
• Group B Streptococcus
• Neisseria meningitides
• Haemophilus influenzae
• Listeria monocytogenes
• Escherichia coli

Mycobacterium tuberculosis, which generally causes tuberculosis (TB), is a less common cause of bacterial meningitis (TB meningitis). Bacteria can enter a person’s meninges in various ways:

• 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. It 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 that requires immediate medical attention. It can be life-threatening or cause permanent disabilities, such as brain damage, hearing loss, and learning disabilities, if treatment is delayed.

Viral meningitis

Meningitis caused by a virus is called viral meningitis, which is the most common type. Non-polio enteroviruses are the most common cause of viral meningitis; however, other viruses that cause this disease include:

• 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)
• Lymphocytic choriomeningitis virus

Most people recover on their own without treatment; however, infants and individuals with weakened immune systems are more likely to develop a severe form of the illness.

Fungal meningitis

This type spreads from fungal infections in other parts of the body that infect the brain and spinal cord. Common causes of fungal meningitis include:

• Cryptococcus
• Histoplasma
• Blastomyces
• Coccidioides
• Candida
• Mucormycosis

It is most likely to affect immunocompromised individuals, such as HIV patients, cancer patients, or transplant recipients.

Parasitic meningitis

Various parasites can affect the brain or nervous system 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 or eosinophilic meningoencephalitis (EM). The three main parasites that can cause EM are:

• Angiostrongylus cantonensis (neurologic angiostrongyliasis)
• Baylisascaris procyonis (baylisascariasis and neural larva migrans)
• Gnathostoma spinigerum (neurognathostomiasis)

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 organism that is too small to be seen without a microscope) found in soil and warm freshwater around the world. It grows best at temperatures up to 115°F (46°C) and can survive for short periods at higher temperatures.

Non-infectious meningitis

This type of meningitis is not caused by pathogens that spread between people but due to reasons other than infections, such as:

• Cancers
• Systemic lupus erythematosus (lupus)
• Certain medications
• Head injury
• Brain surgery

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.
• You are immunosuppressed, such as in cases of AIDS, transplant recipients, and congenital immunodeficiencies.
• You live in poorly sanitized crowded conditions.
• You have had a recent trip to endemic areas.
• You have been exposed to vectors such as ticks and mosquitoes.
• You have excessive use of alcohol.
• You have undergone splenectomy (removal of spleen).
• You have bacterial endocarditis.
• You use IV drugs.
• You have sickle cell anemia.

Additionally, different types of meningitis pose a higher risk to certain groups of people:

• 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.

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

• Blood tests: Initial blood tests in cases of suspected meningitis should include:
  • Complete blood count (CBC)
  • Coagulation studies
  • Electrolytes
  • Blood cultures
• Lumbar puncture: A lumbar puncture (spinal tap) is performed to collect cerebrospinal fluid (CSF) and definitively diagnose meningitis. In individuals with meningitis, the CSF typically shows a low sugar level along with an elevated white blood cell count and protein.
• CSF analysis: CSF fluid should also be sent for gram staining, standard culture, and polymerase chain reaction (PCR). CSF analysis helps identify the bacteria causing meningitis. PCR testing is advantageous over culture for diagnosing infection as it is more rapid and can detect a variety of strains, including non-viable bacteria and antibodies against certain viruses.
• Dilated fundus examination: This diagnostic procedure uses eye drops to dilate the pupil, allowing for a better view of the fundus of the eye. The fundus can be examined for signs of papilledema (swelling of the optic nerve), a surrogate marker for raised intracranial pressure. In an immunocompetent patient with no known history of recent head trauma, normal consciousness, and no evidence of papilledema or focal neurological deficits, it is considered safe to perform a lumbar puncture (LP) without prior neuroimaging.
• Imaging tests: If advised by your doctor, imaging tests such as a CT scan of the head can be performed before a lumbar puncture to rule out any hemorrhage and raised intracranial pressure. The criteria for obtaining a CT scan include advanced age (greater than 60), focal neurologic deficits, immunodeficiency, new-onset seizures, altered mental status, and a history of central nervous system disease.

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, toothbrushes, or cigarettes. Meningitis can also spread to individuals who have had close or prolonged contact with a patient. 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 crowded public places, or petting animals, helps to prevent the spread of infections.
• Avoid sharing drinks, foods, straws, utensils, lip balms, or toothbrushes with others.
• Maintain your immunity by getting enough rest, morning sunlight, regular exercise, eating a wholesome, balanced diet, and following sleep hygiene tips.
• Cover your mouth and nose while coughing or sneezing or sneeze into your elbow. Dispose of tissues in the dustbin after use and wash your hands.
• Avoid smoking and excessive alcohol consumption.
• Pregnant individuals 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 preventive antibiotics to decrease your chances of developing the disease.
• Currently, there is no vaccine to prevent viral meningitis. However, vaccination against bacterial meningitis is available and helps in prevention. Some of these vaccines include:
• Haemophilus vaccine (HiB vaccine)
• Pneumococcal conjugate vaccine
• Pneumococcal polysaccharide vaccine
• Meningococcal conjugate vaccine

A. Viral meningitis

Viral meningitis is managed by supportive treatment, which includes:

• Bed rest
• Plenty of fluids and electrolyte balance
• Over-the-counter pain medications to reduce fever and relieve body aches

Oral or intravenous acyclovir may benefit patients with meningitis caused by herpes simplex virus-1 or 2 (HSV-1 or 2) and in severe cases of 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 is a serious condition that requires immediate treatment with antibiotics. Delay in treatment can lead to severe complications and increased mortality. The treatment for bacterial meningitis includes:

1. Antibiotics: If a patient presents with undifferentiated acute bacterial meningitis, broad-spectrum antibiotics are usually prescribed. A seven-day antibiotic therapy is typically sufficient for 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 and penicillin are usually given. Patients who cannot tolerate beta-lactam antibiotics may receive chloramphenicol (IV) as the treatment choice for meningococcal meningitis. For confirmed cases of pseudomonas meningitis, treatment with ceftazidime or meropenem can be administered. 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, such as dexamethasone, usually 20-30 minutes before starting antibiotic therapy to reduce inflammation associated with meningitis.

C. Fungal meningitis

The following medications are advised for the management of fungal meningitis:

• Amphotericin B (IV)
• Flucytosine (orally)

D. Noninfectious meningitis

Non-infectious meningitis due to allergic reactions or autoimmune diseases may be treated with corticosteroids.

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

• Take adequate rest and avoid high-functioning tasks to conserve energy.
• Create an aseptic environment by following simple home infection control procedures.
• Pay extra attention to your diet. Consume 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 if you experience any health discomfort.
• Do not skip or change your medications without consulting your doctor first.

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

• 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 on one side of the body
• Septicemia (if bacteria enter 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, and pancreatitis may be seen, especially in cases of mumps meningitis

The following herbal remedies can be useful as an adjunct to the 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 elimination. Cloves of garlic can be consumed raw for maximum effect.
• Astragalus: Flavonoids and saponins present in the astragalus plant can help in treating the ill effects of an infection. This is a safe remedy suitable for children as well.
• Reishi mushrooms: These bright red mushrooms are beneficial in infectious diseases by boosting the immune system and reducing inflammation caused by the disease.
• Chlorella: Known for its high chlorophyll content, chlorella improves cell production, blood purification, and aids in quicker recovery from infectious agents.
• Ginseng: Ginsenosides in ginseng help eliminate infections by acting directly on cellular membranes. Ginseng can be consumed directly or in tea for maximum effect.
• Hypericum: Also known as St. John’s wort, hypericum contains hyperforin, which can cross the blood-brain barrier and combat certain infectious agents causing the disease.

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

• Severe persistent headaches
• Fatigue
• Memory problems
• Changes in personality
• Depression

If these issues do not improve or if you notice problems with your vision, consult your doctor as soon as possible.

It is advised to take plenty of rest while recovering from the after-effects of meningitis and to avoid exhausting activities.

Children and adolescents who are planning to return to school or work should take it slow, even if they are experiencing a good recovery. Be vigilant for any after-effects and consult your doctor if any of them cause concern.