Dr Caitlin O’Connor of Tralee Medical Centre in St Brendan’s Park on meningitis…
What is meningitis ?
Meningitis is a disease that causes inflammation of the lining covering the brain and spinal cord (called the ‘meninges’). It can be caused by a bacterial infection or a virus, or more rarely, by a fungal infection.
Viral meningitis is the more common form of the disease and is also much milder – people with viral meningitis rarely die from the disease.
Bacterial meningitis however, while relatively uncommon, is usually a much more severe disease and can be fatal.
While there are no specific drugs for the treatment of viral meningitis, bacterial meningitis requires prompt treatment with antibiotics.
Since the symptoms of viral and bacterial meningitis are often identical however, it is important to contact your doctor immediately if you think you or your child may have either form of the disease.
What is meningococcal septicaemia?
An infection with meningococcal bacteria – the bacteria responsible for most cases of bacterial meningitis in this country – can also lead to a type of blood poisoning known as meningococcal septicaemia.
These two conditions often occur together, and are jointly known as meningococcal disease. Of people who become infected with meningococcal bacteria, half get both meningitis and septicaemia, while 30% get septicaemia alone and fewer than 15% get meningitis alone. Septicaemia is a medical emergency (fatality rates are high) and urgent treatment with antibiotics is necessary.
In meningococcal septicaemia a rash appears under the skin that may start anywhere on the body as a cluster of tiny spots that look like pin-pricks in the skin. If untreated, these blood spots will join to give the appearance of fresh bruises. If the rash is due to septicaemia, the marks will not fade if you press a glass tumbler firmly against it (this is known as the ‘tumbler test’) – you will still be able to see the marks through the glass. If this happens, it is important to get medical help immediately.
The rash may be the last symptom of septicaemia to appear and in cases of meningitis without septicaemia, does not appear at all – it is therefore important to be aware of the other symptoms of meningitis and septicaemia so that treatment can be given promptly.
What are the symptoms of meningitis and septicaemia?
Meningitis (bacterial or viral):
• Stiff neck
• Dislike of bright lights
• Severe drowsiness/confusion
Babies may also show the following symptoms:
• Blotchy or pale skin
• Tense or bulging soft spot on their head
• Blank or staring expression
• Irritable, dislike of being handled
• Refusing to eat
• Body stiffening with involuntary movements, or a floppy body
• Abnormal, high-pitched cry.
• Rash that develops into a bruise-like rash or blood blisters – marks do not fade in the ‘tumbler test’
• Abdominal pain/diarrhoea
• Rapid breathing
• Muscle pain
• Severe drowsiness
• Cold hands and feet
Not everyone will get all of these symptoms. Remember, meningitis and septicaemia can occur separately or together.
If someone has meningitis or septicaemia they could become seriously ill very quickly, and so it is important to contact a doctor as soon as you suspect the disease. If a doctor is not available go immediately to the nearest A&E department and insist on seeing someone.
What are the different types of meningitis?
There are numerous different viruses and at least 50 types of bacteria that can cause meningitis. The most common cause of bacterial meningitis in Ireland is the meningococcal bacteria, which is responsible for up to 90% of cases of bacterial meningitis. There are three main strains of meningococcal bacteria – A, B and C, of which B is the most common in Ireland.
Pneumococcal meningitis is the next most common form of bacterial meningitis. This form of the disease usually occurs in older adults and young children and is associated with a higher risk of permanent neurological damage. Hib (Haemophilus Influenzae Type B) used to be a major cause of meningitis in infants, but has now been almost entirely eliminated in this country following the introduction of the HiB vaccine.
How do you get meningitis or septicaemia?
The viruses that cause meningitis can be spread from person to person through coughing and sneezing or through poor hygiene. In some countries, viruses may be spread via sewage-polluted water. The incubation period can be up to three weeks.
The bacteria that cause both meningococcal and pneumococcal meningitis are very common and live naturally in the nose, throat, sinuses or larynx (the upper respiratory tract). One in 10 people may carry the meningococcal bacteria (this can be as much as one in four in teenagers), however most simply carry the bacteria and will not go on to develop meningitis or septicaemia.
Only in a relative few do the bacteria manage to overcome the body’s immune system leading to meningococcal disease.
Bacteria are spread between people by prolonged close contact and by coughing or sneezing and kissing. It cannot be picked up from water supplies or swimming pools. The incubation period is between two and 10 days and urgent treatment with antibiotics is essential – the sooner the diagnosis and treatment, the greater the chance of full recovery.
How is meningitis treated?
The treatment administered for meningitis will depend on the type of bacteria or virus that has caused the infection.
Antibiotics are ineffective for viral meningitis, and in this case, nursing care is the mainstay of treatment. Most people with viral meningitis make a full recovery, although headaches, tiredness and depression may persist for weeks or months.
Antibiotics are used to treat bacterial meningitis and may also be prescribed for immediate family members or others who have been in very close contact with the patient. The earlier the treatment for bacterial meningitis, the better the prospect of recovery. Doctors will often give treatment even before the person is admitted to hospital.
If infection is diagnosed early and treated promptly, most people who contract bacterial meningitis and meningococcal septicaemia will make a full recovery. However some people may suffer after-effects, which can include headaches, stiffness in the joints, memory loss, co-ordination problems, epileptic fits, deafness and learning difficulties.
It is important to remember that not everyone suffers after-effects and, of those who do, the effects normally improve or completely disappear over time. Various therapies such as cranial osteopathy, physiotherapy or occupational or speech therapy can help recovery from meningitis and septicaemia.
Can meningitis and septicaemia be prevented?
Vaccines are available in Ireland against the C strain of meningococcal bacteria (the MenC vaccine), and against Haemophilus influenzae type b (HiB). The current schedule of childhood immunisation in Ireland includes both of these vaccines.
Protection against haemophilus meningitis is delivered as part of the six-in-one vaccine, which is administered to babies at two, four and six months of age. The meningitis C vaccine is administered at four months, six months and 13 months.
There is also a vaccine to protect against group A meningococcal meningitis but this is not included in the current immunisation schedule. It may be recommended when travelling to areas where epidemics of group A and C infections occur (e.g. in parts of Africa and the Middle East).
A vaccine is available to protect against Group C Meningococcal Disease. This vaccine is included in the Primary Childhood Immunisation Programme offered to all infants. The vaccine is available to all up to the age of 23 years of age.
Since the introduction of the Group C Meningococcal (MenC) vaccine in 2000 there has been a dramatic reduction in Group C disease in Ireland.
If you are under 23 years and have not yet been vaccinated you should contact your GP.
As there is no vaccine to protect against all types of meningitis it is still very important to be aware of, and alert to, the symptoms and signs of meningitis and septicaemia.