VOL: 98, ISSUE: 47, PAGE NO: 30AETIOLOGY
- Meningitis is an inflammation of the meninges (membranes around the brain and spinal cord). There are two main types of meningitis in the UK: viral and bacterial.
- The two main types of bacterial meningitis are meningococcal and pneumococcal; Haemophilus influenzae type b (Hib) has been almost eliminated by a vaccine.
- Meningococcal septicaemia often occurs with meningococcal meningitis but can occur without meningitis.
- People of any age can contract meningitis/septicaemia but it is most common in babies, children under four and teenagers.
- The organism that causes meningococcal meningitis and septicaemia is present naturally in the nose and throat in 10 per cent of the population. It can be passed on by fluid droplets spread by the nose and mouth, for example by coughing, sneezing and kissing.
- Nearly all meningococcal disease is caused by groups A, B, C, W-135 and Y. Group B causes around 60 per cent of cases in the UK.
- In children under four, the most common type of meningitis used to be Hib. This is now rare due to the routine use of the Hib vaccine.
SIGNS AND SYMPTOMS
- Symptoms can be similar to flu, do not appear in a particular order and some may not appear at all.
- First symptoms in people with the bacterial form of the illness are shown two to 10 days after invasion of the bacteria.
- In babies: high-pitched/moaning cry; difficult to wake; refusal to feed or vomiting; pale or blotchy skin; red or purple spots that do not fade under pressure (see glass test below).
- In older children and adults: red or purple spots that do not fade under pressure (see glass test below); neck stiffness (has difficulty touching chin to chest); drowsiness or confusion; a severe headache; vomiting; pyrexia; photophobia.
- The glass test: press the side of a glass tumbler firmly against the rash and observe whether the rash fades or loses colour under pressure. If it does not change colour, contact medical staff immediately.
- Neurologic assessment.
- Blood test.
- Lumbar puncture may be needed to obtain a sample of cerebrospinal fluid. The sample is examined to detect the presence of micro-organisms and identify the infecting organism.
- Bacterial meningitis: strong antibiotics - these may be altered according to sensitivity and culture results.
- There are no effective drug treatments for viral meningitis.
- Health education: knowledge of the signs and symptoms of meningitis is a good form of defence as it helps to ensure crucial early treatment.
- Isolation precautions may be needed to protect other patients, relatives and staff.
- Recent developments include a vaccine for the meningococcal group C meningitis and septicaemia. This can be given to people up to and including the age of 24. Research is ongoing to develop a vaccine that is effective against the more common meningococcal B strain of the illness.
Meningitis Research Foundation: www.meningitis.org
Meningitis Trust: www.meningitis-trust.org.uk
The MRF is happy to advise health professionals via its 24-hour freephone helpline. Tel: 080 8800 3344
The Public Health Laboratory: www.phls.co.uk/topics_az/meningo/backgrd.htm