Meningitis is the medical term for inflammation of the tissue (meninges) that surrounds the brain and spinal cord. Most frequently, this is from a variety of viruses that we can commonly encounter in the community. Occasionally, the inflammation can come from a bacteria instead of a virus. The difference between these two types of meningitis is very important in determining the diagnosis, treatment and prevention of the disease.
Causes of Meningitis: Viral and Bacterial
The most common cause of meningitis is viral. Viral meningitis is most commonly caused by a virus called enterovirus. It is seen more frequently from June to October. Enteroviruses are spread by direct contact with feces during activities such as diaper changing or indirectly through contaminated water, food, and surfaces.
Other viruses that cause meningitis can be spread through the air, droplets, direct contact with a person/skin, through birth or through animal (mammals, insects) contact.
Viral meningitis is far more common than bacterial meningitis and is generally less severe.
Of the 2 kinds of meningitis, the bacterial cause is by far the most dangerous. Bacteria such as Streptococcus pneumonia and Neisseria meningitides are two of the most common bacterial meningitis causes
Bacterial meningitis is a serious, life threatening infection that requires rapid, aggressive medical care such as potent IV antibiotics and medical supportive care.
Signs and Symptoms of Meningitis
The signs and symptoms of bacterial and viral meningitis can be similar. The most common symptoms include:
Newborns may develop a fever with nonspecific symptoms (eg, poor feeding, vomiting, diarrhea, rash, irritable, restless, or lethargic).
Older children and adults may develop a sudden fever, headache, nausea, vomiting, confusion, stiff neck, and complain that light bothers their eyes or worsens their headache.
Meningitis can cause seizures, and decreased level of awareness.
Certain types of bacterial meningitis may be associated with a characteristic rash.
In some cases, the onset of symptoms can gradually worsen over a slow progression over one to two days, while in other cases the symptoms worsen rapidly over hours.
Because bacterial meningitis is a serious condition when diagnosed, it is critical to test the spinal fluid. Obtaining this fluid will help decide if you have meningitis or not, as well as give information to help further decide if the meningitis is viral or bacterial.
Obtaining spinal fluid requires a lumbar puncture or spinal tap to retrieve fluid for testing. During a lumbar puncture a clinician uses a needle to remove a sample of spinal fluid from the area below the spinal cord in the lower back. This fluid is then sent to the lab for further testing.
The initial results are available within a matter of hours, and these first tests can decide if someone has or does not have meningitis. Many times, these initial tests can also help decide between viral or bacterial meningitis. Unfortunately, sometimes the tests are inconclusive and the patient must be treated in the most appropriate manner to protect them from possible bacterial infection. Cultures are tests to definitively decide if viral or bacterial meningitis is present but can take 2-3 days to return. Until that time, some patients may need to be observed in the hospital, being treated for the possibility of bacterial infection with IV antibiotics, until these tests return.
The treatment for meningitis depends upon whether the meningitis is viral or bacterial. Sometimes, we cannot decide this until the culture results are available ( as stated above, usually 48 to 72 hours after they are obtained). In these cases, patients are treated as if they have bacterial meningitis until bacterial meningitis is definitively excluded (the culture is resulted).
Requires hospitalization and treatment with intravenous antibiotics. The patient will be monitored closely for signs of complications such as seizures, organ injury, rash, etc. Rarely, patients may need support to breath, blood pressure normalizing medicines, or have bleeding disorders.
Intravenous antibiotics are the only way to treat bacterial meningitis. Oral antibiotics simply cannot achieve the concentration in the spinal fluid to fight the infection.
There is no specific treatment that can eliminate the virus causing viral meningitis. Treatment is generally supportive. In cases where the patient’s pain cannot be controlled with oral medications, they may need IV pain medications. Also, if they are having difficulty staying hydrated, they may require IV fluids as well. Instructions for activity generally include rest, drinking plenty of fluids, and medications to treat fever and pain.
A majority patients with bacterial meningitis recover completely after treatment.
Unfortunately, bacterial meningitis can effect the brain in some irreparable ways leading to deafness, developmental delay or learning disabilities, and seizures. 15 percent of children with bacterial meningitis develop complications. 4 percent of children in the United States with bacterial meningitis died.
Most patients with viral meningitis recover with no long-term complications. Symptoms usually last from 5-7 days. Typical symptoms during the recovery phase include fatigue, irritability, decreased concentration, muscle weakness and difficulty with coordination for several weeks or more. Death is uncommon in children with viral meningitis.
Several measures can help to reduce the risk of developing bacterial and viral meningitis.
Haemophilus influenzae type b (Hib) vaccines.
Other vaccines are also available to prevent certain types of viral infections that may cause meningitis or other central nervous system infections, including polio, influenza, varicella-zoster (chickenpox), measles, and mumps.
Preventative antibiotics are recommended for close contacts of anyone infected with meningococcal infection, even if the contact was previously vaccinated. Close contact is defined as a person who lives with the patient or who spent ≥4 hours with the patient for at least five of the seven days before the patient developed symptoms. Haemophilus influenzae type b (Hib) meningitis is also recommended for preventative antibiotics, but only if the close contact was not previously vaccinated. These preventative antibiotics are not recommended for all bacterial meningitis contacts and none are recommended for viral meningitis.
Families of children with meningitis should take care to avoid becoming infected. This includes washing hands after touching the patient or changing diapers and before eating or preparing food. Utensils and cups should not be shared, the patient’s mouth should be covered during a cough, and the patient should not be kissed on the mouth. These measures should be continued until the patient no longer has symptoms (eg, fever, diarrhea, rash).
WHEN TO SEEK HELP
Anyone who suspects they may have meningitis, or have a family member who may have meningitis, should be evaluated immediately.