Meningitis is a viral or bacterial infection of the cerebral spinal fluid that causes inflammation of the membranes that cover the brain and spinal cord. Viral meningitis is usually caused by a common intestinal virus, but can be caused by a number of viruses. Less frequently, it can be associated with mumps, herpes, or other viral diseases. A number of bacteria including haemophilus influenza type B (haemophilus meningitis), streptococcus pneumonia (pneumococcal meningitis) and Neisseria meningitis (meningococcal meningitis) can cause bacterial meningitis. Viral meningitis is much more common but bacterial meningitis causes much more severe illness. It is important to distinguish between the two types, as bacterial meningitis requires rapid diagnosis and treatment.
Signs and Symptoms:
The signs and symptoms for both viral and bacterial meningitis are the same and include:
• High fever
• Severe headache
• Stiff neck (nuchal rigidity)
• Nausea and vomiting
• Sore throat
• Petechiae (advanced sign)
• Seizures (advanced sign)
Modes of Transmission:
Meningitis spreads from person-to-person through respiratory droplets from coughing and sneezing. Procedures such as suctioning can also cause droplet spread. Droplets can be travel through the air approximately 3 feet. Patients with meningitis are most likely to spread the infection at the time they are diagnosed.
Bacterial meningitis is very serious and can be deadly. Death can occur in as little as a few hours. Most people recover from meningitis. However, permanent disabilities (such as brain damage, hearing loss, and learning disabilities) can result from the infection. Symptoms of bacterial meningitis can appear quickly or over several days. Typically, they develop within 3 to 7 days after exposure. Symptoms will vary depending on the person but may include: fever, headache, vomiting, stiff neck, rash (red pin point), drowsiness, and confusion. Later symptoms of bacterial meningitis can be very serious (e.g., seizures, coma).
Having meningitis does not always mean you have meningococcal disease. In addition, having meningococcal disease does not necessarily mean you have meningitis. Meningococcal Disease is an inflammation of the meninges, which is caused by the bacteria Neisseria Meningitides. Although approximately 10% of healthy people have the bacteria in their throat, it is more likely to be transmitted by people who are actively sick with the disease. Exposure to these bacteria can result in meningitis.
There are several other types of bacteria besides Neisseria that can cause meningitis, the other leading causes in the United States include:
Group B Streptococcus
Common causes of bacterial meningitis vary by age group:
Newborns: Group B Streptococcus, Streptococcus pneumoniae, Listeria monocytogenes, Escherichia coli
Babies and children: Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae type b (Hib), group B Streptococcus
Teens and young adults: Neisseria meningitidis, Streptococcus pneumonia
Older adults: Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae type b (Hib), group B Streptococcus, Listeria monocytogenes
Mode of Transmission: Respiratory droplets or direct and prolonged contact with the secretions from the throat or nose of an infected person.
Examples of Transmission:
Mouth to mouth
Intubation or suctioning a patient without proper protection and contact with the secretions
Projectile vomiting or coughing in the face
The good news is that meningitis is not as contagious as the common cold or influenza. It cannot be spread through casual contact or by breathing the air where someone who has meningitis has been, it requires direct contact with respiratory secretions.
Prevention: There are vaccines available against some of the bacteria that cause bacterial meningitis. These include vaccines for haemophilus influenza (Hib), Neisseria meningitis and streptococcus pneumonia. These vaccines have been shown to be as much as 90% effective in protecting against meningitis and the introduction of the Hib vaccine as a routine childhood vaccine in 1986 has virtually eliminated this form of meningitis. The Hib vaccine is not recommended for those over five years of age. There are no current recommendations for routine vaccination for EMS personnel.
Bacterial meningitis is much more serious with some case progressing to death in 24 to 48 hours. Early identification and treatment is important but even with the correct treatment there is a 5 to 10% fatality rate. Of the survivors, 10 to 15 % will have permanent side effects such as hearing loss, learning disabilities, or brain damage. Bacterial meningitis can also advance to a more serious condition called meningococcal invasive disease. This results in an infection of the blood that will affect other areas of the body and can be fatal in 20 to 30% of cases.