Meningitis is a rare infection and inflammation of the delicate membranes (meninges) covering the brain and spinal cord and can it occur in children and adults alike

In India, the third most common cause of bacterial meningitis in children < 5 years of age is  N. meningitidis and is responsible for 1.9% of all cases in all age groups.

What are the symptoms of Meningitis?

The symptoms of meningitis may develop within hours or days and this condition may differ in symptoms in adults and babies or children.

Possible symptoms in people older than the age of 2 years include:

• Sudden high fever.
• Stiff neck.
• Severe headache.
• Nausea or vomiting.
• Confusion or trouble concentrating.
• Seizures.
• Sleepiness or trouble waking.
• Sensitivity to light.
• Loss of appetite or thirst.
• Skin rash in some cases (mostly in meningococcal meningitis).

Symptoms in newborn:

• High fever.
• Crying constantly, sometime, crying harder when held.
• Being very sleepy or irritable.
• Trouble waking from sleep.
• Being inactive or sluggish.
• Not wanting to eat
• Not interested in taking feeds.
• Vomiting.
• A bulge in the soft-spot on top of the baby’s head.
• Stiffness in the body and neck.

What are the causes and risk factors of Meningitis?

The different causes of meningitis are also the basis on which they are divided as types of meningitis. These types are:

• Viral meningitis – most common form of meningitis, but generally, if not always, it is less serious form.
• Bacterial meningitis – Caused by bacteria such as Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae, Listeria monocytogenes.
• Fungal meningitis
• Parasitic meningitis
• Chronic meningitis

Non-infectious causes of meningitis:

Meningitis also can result from non-infectious causes such as certain chemical reactions, drug allergies, or some cancer varieties and inflammatory diseases.

Risk factors for meningitis include:

• Skipping vaccinations 
• Age – Most viral meningitis cases occur in children younger than age 5 years of age.
• Living in a community setting such as children in boarding schools, college students living in dormitories, personnel on military bases, and children at child care facilities.
• Pregnancy.
• Weakened immune system in disorders/diseases such as AIDS, alcohol use disorder, diabetes, or organ transplant or removal.

How is Meningitis diagnosed?

A physical exam and medical history is noted by the doctor and further tests are prescribed to confirm the diagnosis. These tests are:

• Blood tests or blood cultures to check for bacteria.
• CT or MRI, X-Ray scans of the head to find swelling or inflammation.
• Spinal tap which collects the cerebrospinal fluid by inserting a needle around spinal cord. It can tell the cause of meningitis.

What are the treatment options for Meningitis?

Treatment depends on type of meningitis that a person or child has.

Bacterial meningitis

Acute bacterial meningitis require urgent treatment with intravenous antibiotics and sometimes corticosteroids.

Viral meningitis

Most cases with viral meningitis improve on their own in few weeks. Treatment of mild cases of viral meningitis usually includes:

• Bed rest.
• Plenty of fluids.
• Pain medicine to help in fever reduction and body ache relief.

In some cases, a class of medicines called corticosteroids may be prescribed to reduce swelling in the brain and a medicine to control seizures.

In case of meningitis caused by herpes virus, an antiviral medicine is available.

Other types of meningitis

Meningitis of unknown cause may require initiation of antiviral and antibiotic treatment

In Chronic meningitis, treatment is based post finding the cause

Noninfectious meningitis due to allergic reaction or autoimmune disease may be treated with corticosteroids.

Can Meningitis be prevented?

Spread of bacteria or viruses may happen by coughing, sneezing, kissing, or sharing eating utensils, a toothbrush, or a cigarette.

These steps can help prevent meningitis:

• Wash hands carefully and teach the children to prevent the spread of germs.
• Practice good hygiene and don’t share drinks, foods, straws, eating utensils, lip balms or toothbrushes with anyone else.
• Stay healthy by getting enough rest, exercising regularly, and eating a healthy diet to keep the immune system at optimal level.
• Cover mouth and nose while coughing or sneezing
• Take care with food in pregnancy to reduce risk of a listeria infection. Cook meat, including hot dogs and deli meat, to higher degrees. Avoid cheeses made from unpasteurized milk and only choose the ones that are clearly labelled as being made with pasteurized milk.

Vaccinations

Some forms of bacterial meningitis are preventable with the following vaccinations:

• MenACWY vaccine is recommended for all teens and preteens. One dose is given at the age of 11 or 12, followed by a booster at age 16. It’s also recommended for adults at high risk.
• MenB vaccine is recommended for children 10 and older who are at increased risk 
• MenABCWY vaccine is a combination of MenACWY and MenB, and if both are to be given at a time, then a combination can be given instead.
• The pneumococcal and Hib vaccines protect against bacteria that can cause bacterial meningitis. The Bacille Calmette-Guerin (BCG) vaccine protects against tuberculosis, which can cause meningitis, is a must for every new born in India.

References:

1. Dutta AK, Swaminathan S, Abitbol V, Kolhapure S, Sathyanarayanan S. A Comprehensive Review of Meningococcal Disease Burden in India. Infect Dis Ther. 2020 Sep;9(3):537-559.
2. Meningitis. Mayo Clinic. May 2024. https://www.mayoclinic.org/diseases-conditions/meningitis/diagnosis-treatment/drc-20350514
3. Meningitis? WebMD. May 2024. https://www.webmd.com/children/understanding-meningitis-basics