"In the case of an acute bacterial meningitis, a delay in the diagnosis and in the establishment of the antibiotic treatment may imply serious sequels and even death".
DR. PABLO IRIMIA SIEIRA
SPECIALIST. NEUROLOGY DEPARTMENT
Meningitis is the inflammation of the membranes (meninges) that surround the brain and spinal cord. Usually, but not always, they have an infectious cause.
Within the meningitis of infectious cause, we can distinguish between those produced by virus, those of bacterial origin and those caused by fungi, which are more rare.
Viral meningitis are benign and usually resolve spontaneously; however, bacterial meningitis are serious and require urgent antibiotic treatment.
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What are the symptoms of meningitis?
In addition to the typical clinical manifestations, they may be accompanied by altered level of consciousness, epileptic seizures and other neurological symptoms and signs.
In infants (children under two years), clinical manifestations may include high fever, excessive sleepiness or irritability, inactivity, constant crying, and refusal to feed. The elderly may present only altered level of consciousness, without fever or stiffness of the neck.
Although some symptoms suggest the cause of the infection, such as the presence of a rash in the meningococcy, clinical data cannot deduce the responsible agent.
The clinical manifestations that can alert us of a meningitis are:
- Nausea and vomiting.
- Photophobia (excessive sensitivity to light).
- Stiffness of the neck.
What other diseases can meningitis be confused with?
The first symptoms of a meningitis can be non-specific and confused with those that can occur at the beginning of a flu, for example (general malaise, fever...). However, the appearance of intense headache, different from the usual one, "shotgun" vomiting, and stiffness of the neck muscles should alert us that it may be a meningitis.
If these symptoms appear, we should consult the Emergency Department of our nearest center.
Do you have any of these symptoms?
You may have meningitis
What are the causes of meningitis?
The most frequent are meningitis of infectious cause, produced by three different infectious agents:
- Viruses: viral meningitis are benign and usually resolve spontaneously within a few days. It is necessary to distinguish them from viral encephalitis (e.g. herpes encephalitis), which not only produce inflammation of the meninges but also of the brain and have a more serious prognosis.
- Bacteria: Bacterial meningitis is serious and requires urgent antibiotic treatment. Bacteria that enter the bloodstream and travel to the brain and spinal cord can cause acute bacterial meningitis. Meningitis can also occur when bacteria invade the meninges directly from a nearby focus, such as an ear or sinus infection, a skull fracture or, in rare cases, after some surgeries.
- Pneumococcus and meningococcus are the bacteria responsible for more than half of the acute meningitis in our country. Pneumococcus is the most frequent cause of bacterial meningitis in infants, young children and adults.
- Meningococcal meningitis is a very contagious infection that mainly affects adolescents and young adults. It can cause a local epidemic in schools, residences, boarding schools and similar centers.
- Fungi: they are rarer and occur mainly in immunosuppressed persons, such as people receiving chemotherapy or immunosuppressive treatment (transplants, etc.).
How can it be prevented?
The prevention of meningitis is done through two main measures: vaccination and chemoprophylaxis.
Vaccination immunizes the individual against a germ and thus prevents him/her from acquiring the infection. The inclusion of conjugated vaccines against pneumococcus, meningococcus serogroup C and Haemophilus Influenzae type b in the systematic vaccination calendars has caused a significant decrease in the incidence of these diseases.
Chemoprophylaxis consists in the administration of an antibiotic during short periods of time to people who have been in contact with a patient diagnosed with meningitis. Not all types of meningitis require antibiotic prophylaxis for contacts. Pneumococcal meningitis (the most common type of meningitis) does not require chemoprophylaxis.
However, close contacts of patients with meningococcal meningitis are more likely to get the disease in the next 7 days, so chemoprophylaxis will be indicated in certain cases.
In case a case of meningococcal meningitis has been diagnosed, all those persons who had close contact with the index case in the previous 7 days shall take an antibiotic prophylaxis.
Close contact is defined as having had prolonged (8 hours or more) and close (90 cm is the general limit established for the dissemination of large droplets) contact with the case or having been directly exposed to the oral secretions (for example, by kissing on the mouth, performing mouth-to-mouth resuscitation maneuvers, etc.) of the patient during the week prior to the onset of symptoms and up to 24 hours after the beginning of the antibiotic treatment.
This group would include all members of the household (or comparable settings such as shared floors, etc.), fellow students, members and staff of the nursery or kindergarten classroom... It would not be justified, however, to administer chemoprophylaxis to all students attending the same primary, secondary, or university class or center, unless they have had close contact with the case.
How is meningitis diagnosed?
For the diagnosis of meningitis, it is necessary to study the cerebrospinal fluid, which is extracted by means of a lumbar puncture. It should be done as soon as possible if there are no contraindications.
In some cases, the lumbar puncture is postponed until a neuroimaging test (CT or brain MRI) is obtained.
The examination of the cerebrospinal fluid allows the identification of the agent causing the meningitis in most patients.
Other complementary samples that can help the diagnosis are blood cultures, otorhinopharyngeal samples or stool samples (particularly if enteroviruses are suspected).
How is meningitis treated?
Meningitis is a medical emergency
In the case of acute bacterial meningitis, a delay in the diagnosis and in the establishment of the antibiotic treatment may imply permanent brain damage with severe sequelae and even death.
That is why, in case of suspicion of an acute bacterial meningitis, we must start urgent intravenous antibiotic treatment, even before performing the diagnostic lumbar puncture. At first, broad-spectrum antibiotics are used, and later, when the results of the culture and antibiogram are available, the treatment is adjusted to the identified agent.
With appropriate treatment, administered in time, even patients with potentially serious meningitis can have a good recovery without sequelae.
Where do we treat it?
IN NAVARRA AND MADRID
The Department of Neurology
of the Clínica Universidad de Navarra
The Neurology Department has extensive experience in the diagnosis and multidisciplinary treatment of neurological diseases.
We offer a diagnosis in less than 72 hours, along with a proposal for personalized treatment and post-consultation follow-up of the patient by our specialized nursing team.
We have the most advanced technology for an accurate diagnosis with cutting-edge equipment such as HIFU, deep brain stimulation devices, video EEG, PET and epilepsy surgery, among others.
Why at the Clinica?
- State-of-the-art diagnostic assistance with great work in research and teaching.
- Specialized nursing team.
- We work together with the Sleep Unit.