What is Meningitis?

According to NICE (the National Institute for Health and Care Excellence), in the United Kingdom, one in every 100,000 people develops acute bacterial meningitis every year.

Of these, between 4% and 10% of children and 25% of adults will die. There are frequent complications after pneumococcal meningitis (30% of people) but with those with meningococcal meningitis, only 7% go on to have complications.

The World Health Organization (WHO) estimates that there are around 82 million cases of meningitis each year and the Centers for Disease Control and Prevention (CDC) estimates that there are more than 1.2 million people experiencing bacterial meningitis around the world every year.

This article will tell you everything you need to know about this disease, including how to spot it and how it is treated.

What is meningitis?

Meningitis means the membranes around the brain and spinal cord are infected or inflamed. The meninges consist of three protective layers with cerebrospinal fluid (CSF) between each layer to nourish the brain. The suffix –itis simply means ‘inflammation’.

Meningitis is a disease that can affect anyone. However, it is most common in the young (babies, children, teens and young adults). If it is not treated quickly, it can become very serious and can cause life-threatening complications like sepsis (blood poisoning). If not treated, it can result in permanent brain or nerve damage, amputations and death.

What are the types of meningitis?

There are several different types of meningitis infections.

These are:

• Viral meningitis.
• Bacterial meningitis.
• Fungal meningitis.
• Parasitic meningitis.
• Amoebic meningitis.
• Non-infectious meningitis.

Let’s take a look at the different types in more detail:

Viral meningitis

Viral meningitis is rarely life-threatening though people can become extremely unwell with it. There can also be life-changing after-effects. This type of meningitis is the most common. There are several different viruses that can cause viral meningitis.

These include:

• Enterovirus.
• Varicella zoster virus (the one responsible for chickenpox).
• Herpes simplex virus.
• Mumps.
• West Nile virus.
• Epstein-Barr virus.

If you have any one of these viruses, you can develop viral meningitis as a complication. However, most people don’t go on to have this.

Viral meningitis can affect anyone but it is more common in children. It can sometimes be diagnosed clinically without a lumbar puncture being performed.

Most people who are in good health will have a quick recovery from this form of meningitis. However, if people have a poor immune system, it can cause complications.

When someone has viral meningitis, they can pass on the virus to others but anyone who gets the virus likely won’t develop meningitis.

Bacterial meningitis

After viral meningitis, this is the most common form and it can be extremely dangerous. There are different bacteria known to cause bacterial meningitis.

These are:

• Streptococcus pneumonia.
• Neisseria meningitidis.
• Haemophilus influenzae.
• Listeria monocytogenes.
• Group B Streptococcus.

These are all organisms that are contagious and prevalent in our environment.

When Neisseria meningitidis is the cause of meningococcal meningitis, it is likely to cause an outbreak in people who live in close proximity.

Symptoms of bacterial meningitis can progress quickly and it’s important to target the infection quickly. Usually, the specific bacteria is identified by a lumbar puncture.

Though any person can develop this disease, it is much more common when people have a poor immune system or if they have experienced head trauma or brain surgery.

Fungal meningitis

This is not a common form of meningitis and those with a poor immune system are most at risk. Typically, this type of meningitis is caused by Candida – a fungus naturally present on the skin – as well as Histoplasma, Cryptococcus, Coccidioides and Blastomyces.

All of the fungi that cause fungal meningitis are present naturally in the environment. It is quite common for people to come into contact with them but it isn’t common to get an infection in healthy people. Treatment includes antimicrobials.

Parasitic meningitis

Parasites are organisms that invade a person’s body after contamination in the environment or by eating food that hasn’t been cooked properly. The most common meningitis-causing parasites are Baylisascaris procyonis, Angiostrongylus cantonensis, and Gnathostoma spinigerum.

An infection involving a parasite can cause inflammation in the brain but it can also appear as though there is a growth or a mass inside the brain too. When parasites invade the body they can remain in the body, reproduce, or die and remain, which means they look like a brain mass.

Sometimes the parasite is removed with surgery.

Amoebic meningitis

This is an extremely rare form of meningitis. Amoebae are single-celled organisms that usually live in soil, rivers, lakes, contaminated sewer water, and freshwater. Two organisms that can cause this form of meningitis are Acanthamoeba and Naegleria fowleri.

Due to the rarity of this condition, it isn’t recognised easily. Brain imaging can be used to identify inflammation patterns.

This type of meningitis is often referred to as meningoencephalitis as the inflammation and infection affect the brain as well as the meninges. Symptoms tend to worsen and there can be complications should the condition get worse.

Treatment includes antimicrobials (those used to treat a fungal infection) and surgery to reduce the pressure from fluid around and in the brain.

Non-infectious meningitis

Inflammation of the CSF and meninges can happen when no infection is present. This is often called aseptic meningitis and it can occur with autoimmune conditions like rheumatoid arthritis, sarcoidosis and lupus.

Just because someone has one of these conditions doesn’t mean they will get meningitis. When non-infectious meningitis does occur, it is infrequent and causes problems like confusion, poor concentration and fatigue.

This type of meningitis can also happen due to brain radiation or medications for treating cancer.

Cancer is one of the most serious causes of this type of meningitis because it can lead to leptomeningeal carcinomas. Essentially, this is when cancerous cells spread through the spinal cord and meninges. With this type of non-infectious meningitis, treatment includes intrathecal chemotherapy. This is injected directly into the CSF.

What causes meningitis?

As mentioned above, meningitis is most often caused by a bacterial or viral infection. Viral meningitis is much more common and less serious. Bacterial meningitis is quite rare but it’s usually serious if it isn’t treated.

Many different bacteria and viruses can cause this disease.

This includes:

• Pneumococcal bacteria.
• Meningococcal bacteria (of which there are different types: A/B/C/W/X/Y/Z).
• Hib bacteria (Haemophilus influenzae type b).
• Enteroviruses – these are usually responsible for mild stomach infections.
• The mumps virus (MuV).
• The herpes simplex virus (HSV) – the one that causes genital herpes and cold sores.
• West Nile virus.
• Influenza.
• HIV.
• Echo viruses.
• Coxsackie viruses.
• Streptococcus pneumonia.
• Neisseria meningitidis.
• Listeria monocytogens.
• Haemophilus influenza.

How meningitis is spread

The bacteria and viruses responsible for meningitis can be spread in typical ways like the common cold or Covid-19.

For example:

• Coughing.
• Sneezing.
• Kissing.
• Sharing utensils.

Infections are usually spread by people carrying the bacteria or virus in their throat or nose, even though they are not necessarily ill themselves.

The infection can be spread by someone who has meningitis but this isn’t as common.

People can get meningitis on more than one occasion.

What are the signs and symptoms of meningitis?

Usually, meningitis has non-specific symptoms. However, occasionally, it does cause focal neurological symptoms. This means that the symptoms affect a specific part of the body or bodily function.

Meningitis symptoms can happen in any order and you don’t always get all of them. In the first stages of the disease, you might not see a rash or the rash could fade with pressure and the ‘glass test’. However, you should always go with your instincts and don’t wait for the rash before seeking advice.

In general, non-infectious meningitis and viral meningitis cause mild to moderate symptoms but these can become severe and lead to complications sometimes.

With bacterial meningitis, the symptoms usually worsen rapidly and you can experience generalised symptoms as well as focal symptoms. There is a high risk of people experiencing complications.

With parasitic meningitis, amoebic meningitis and fungal meningitis, it is also possible to have focal symptoms and seizures.

Common meningitis symptoms

• Having cold feet and hands.
• A fever.
• Confusion.
• Vomiting.
• Nausea.
• Rapid breathing.
• Joint and muscle pain.
• Blotchy, pale and mottled skin (this is easier to see on white skin compared to darker skin).
• A rash or spots (again, this is easier to see on white skin).
• A stiff neck.
• A headache.
• Dizziness.
• Back pain.
• Being averse to bright lights (photophobia).
• Being difficult to wake or being extremely sleepy.
• Seizures.

In babies, there might also be the following signs:

• Irritability.
• Refusing feeds.
• A high-pitched cry.
• Being unresponsive, floppy or stiff.
• A bulging anterior fontanelle (soft spot on the top of the head at the front of the skull).
• Decreased alertness.
• Reduced physical activity.

The meningitis rash

Most people are aware to look out for a rash with meningitis. This rash will not fade with the ‘glass test’. Essentially, the glass test means rolling a glass over the skin and putting the skin under pressure. If the rash fades, it’s likely not to be a meningitis rash (though in the early stages it might fade).

The rash is a petechial rash. It looks like small purplish dots in clusters. It usually occurs with bacterial meningitis, more specifically meningococcal meningitis.

Less common symptoms

Though it is not common, meningitis can cause symptoms that suggest the brain is involved.

These include:

• Leg, arm or face weaknesses.
• A person experiencing sensory changes just on one side of their body.
• Changes to vision.
• Loss of hearing.
• Seizures.

How is meningitis diagnosed?

If meningitis is suspected a person will undergo tests in the hospital to confirm the diagnosis and its cause. It’s important to know whether it is caused by a bacteria, virus, or other reason so that the treatment can be tailored accordingly.

Hospital tests often include:

• A physical examination. This might include looking at neck movements to check for stiffness, looking at the eyes to detect photophobia, taking of temperatures, etc.
• A blood test to look for meningitis-causing viruses or bacteria.
• A lumbar puncture. This takes a sample of fluid from the spine, which is then checked for viruses or bacteria.
• A CT scan. This checks whether there are problems in the brain like swelling.

Due to the severity of bacterial meningitis and the complications the condition can have, all suspected meningitis cases are given antibiotics before the diagnosis is confirmed. If tests show that the meningitis is a viral strain, the antibiotics will cease.

How is meningitis treated?

There are some vaccinations that provide protection against meningitis.

The MenB vaccine protects against meningococcal group B bacteria. This is given to babies aged 8 weeks, 16 weeks, and one year.

The 6-in-1 vaccine is given at 8 weeks, 12 weeks and 16 weeks. This protects against Haemophilus influenzae type b (Hib) as well as diphtheria, tetanus, whooping cough, hepatitis B, and polio.

The pneumococcal vaccine protects against meningitis caused by pneumococcal bacteria. This is given to babies at 12 weeks old and one year old. It is also offered to those over 65 as a single dose.

The Hib/MenC vaccine is given at one year of age and protects against meningococcal C bacteria that can cause meningitis.

Though not specifically for meningitis, the MMR vaccine (the one that protects against measles, mumps and rubella) can help protect against meningitis that results as a complication of these diseases (e.g., the mumps virus). This is given to babies aged one and then when they are 3 years and 4 months old.

The MenACWY vaccine is given to teenagers when they are 14 years old (as well as anyone up to 25 who has never received a MenC-containing vaccine). It protects against four types of meningitis-causing bacteria: meningococcal A, C, W and Y.

Hospital treatment

All occurrences of bacterial meningitis will be treated in hospital. This is due to the severity of the condition and its potential complications. Severe cases of viral meningitis might also require a stay in hospital for observation and treatment.

Treatments for the disease include:

• Antibiotics given intravenously.
• Intravenous fluids to prevent the patient from becoming dehydrated.
• Oxygen via a face mask if breathing difficulties occur.
• Steroids to reduce swelling of the area around the brain.

Depending on the type and severity of the meningitis, patients might stay in the hospital a few days or a few weeks. Even after discharge, it can take time to be back to full health.

Further treatment may be required depending on whether complications are present, for example, hearing loss.

Treatment at home

If it is proven that the meningitis has been caused by a viral infection, the patient might be able to go home to recover. In most cases of viral meningitis, the patient will get better on their own without any treatment needed or serious complications. The majority of patients feel better within a week to ten days.

If this is the case, it is advised that people:

• Ensure they have plenty of rest.
• Take pain relief medication for aches and headaches.
• Take anti-sickness medication for associated nausea and vomiting.

Preventing the infection from spreading

Meningitis doesn’t spread very easily from person to person. However, with bacterial meningitis, some close links might be given antibiotics as a precaution.

This could be:

• Those living in the same house.
• Pupils who share a dormitory.
• University students in the same halls of residence.
• A girlfriend or boyfriend.

If someone has only had brief contact with a person who has developed bacterial meningitis then they will not typically be required to take a course of antibiotics.

Recovery from meningitis

The majority of people who contract meningitis will make a full recovery. The condition can, however, cause serious and life-threatening complications and long-term problems.

Complications after a bout of viral meningitis are very rare.

It is believed that one-third to half of all patients who survive bacterial meningitis end up with at least one permanent problem as a result.

The most common complications of meningitis

There are problems that occur as a complication of the disease.

These include:

• Partial or total hearing loss. Usually, patients will take a hearing test a few weeks after they have recovered.
• Recurrent seizures – i.e., epilepsy.
• Problems with concentration or memory.
• Problems with balance, movement and coordination.
• Partial or total loss of vision.
• Learning difficulties and behaviour problems.
• Amputation – loss of limbs. Sometimes this is necessary in order to stop the spread of infection.
• Joint and bone problems, like arthritis.
• Kidney problems.

It is estimated that 10% of bacterial meningitis cases are fatal.

Treatment and support for complications as a result of meningitis

Long-term support or additional treatment is often needed when someone has experienced meningitis complications.

This could be in the form of:

• A cochlear implant or hearing aid for hearing loss.
• Prosthetic limbs.
• Rehabilitation support.
• Counselling or psychological support. Parents of children who have gone through meningitis might also need support like CBT (cognitive behavioural therapy) or help with associated PTSD (post-traumatic stress disorder).

Final thoughts

Meningitis is a challenging disease but one that is treatable, especially if the signs and symptoms are spotted early. Most cases of meningitis are viral and this can often be left to be treated at home.

When meningitis is caused by a bacterial infection, it is often worse and there can be complications. Around one in ten people who contract bacterial meningitis die and so it is important to get treatment as soon as possible.