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Meningitis
What is meningitis?
Meningitis is an inflammation of the membranes that cover the brain and spinal cord. There are two main types of meningitis. One is caused by bacteria and is a serious disease, often needing emergency medical treatment; the other is caused by a virus, is a milder disease and usually goes away by itself. Occasionally meningitis can be caused by fungal infections, but this is quite rare and mainly affects people with weakened immune systems.
Viral meningitis is more common than bacterial meningitis.
Bacterial meningitis
Bacterial meningitis is caused by a range of different bacteria, but most commonly by the meningococcal germ. Most cases of bacterial meningitis (and septicaemia) in the United Kingdom are caused by the meningococcal bacteria.
Septicaemia is blood poisoning caused by the bacteria entering the bloodstream and multiplying uncontrollably. It is the reason why, in some cases, a purple-red spotty rash appears on the body during the latter stages of bacterial meningitis. Septicaemia is a medical emergency and can kill in hours. This condition needs immediate intervention and treatment with antibiotics.
The earlier people with bacterial meningitis are diagnosed and treated, the greater the chance they will make a full recovery.
Bacterial meningitis is more common during the winter.
Viral meningitis
Many people who have viral meningitis may not realise it, assuming their illness is a bad cold or flu. The most common viruses causing viral meningitis are the coxsackie and echoviruses (often known as enteroviruses). Although most people are exposed to these viruses at some point in their lives, few actually develop the meningitis illness fully, experiencing mild symptoms, or none at all.
Viral meningitis is more common in the summer months.
Who is at risk from meningitis?
Viral and bacterial meningitis can infect people of any age, although bacterial meningitis more often affects children whilst viral meningitis more commonly affects young adults. Eighty per cent of bacterial meningitis cases occur in children aged sixteen years and under, with the majority occurring in those aged five years and under. Viral meningitis tends to affect older children and adults.
People of any age can be carriers of bacterial meningitis, harbouring the bacteria for days, weeks or months without becoming ill. Approximately ten to twenty-five per cent of the population are estimated to be carriers of the meningococcal bacteria.
What is the incubation period?
The incubation period for bacterial meningitis is between two and ten days. The incubation period for viral meningitis can be up to three weeks.
What are the symptoms of meningitis?
Early signs of meningitis are similar to many other types of illness, such as bad colds and flu. Meningitis is, therefore, not always easy to recognise initially. The illness often develops slowly over one or two days, but people can suddenly become very ill, very quickly, sometimes only in a matter of hours. In some cases, acting quickly to get medical help can be the difference between life and death.
Symptoms do not appear in any order and people may not develop all of them.
1. Symptoms of bacterial meningitis in adults and older children include:
- Severe headache
- Stiff neck (unable to touch chin to chest)
- Dislike of bright lights
- Fever
- Vomiting
- Drowsy/less responsive
- Sometimes diarrhoea
- Sore throat
- Joint or muscle pain
- Stomach cramps
- Fits
- Confusion and disorientation
- Rash (anywhere on the body)
In young children and babies also look for:
- Vacant staring expression
- Refusing feeds
- High pitched moaning
- Whimpering cry
- Floppiness
- Dislike of being handled
- Fretful
- Neck retraction and arching back
- Difficult to wake
- Convulsions
- Tense or bulging fontanelle (soft spot on top of head)
- Lethargy
- Pale, blotchy complexion
- Altered breathing pattern
The presence of a rash in someone with meningitis means that the disease has reached a very serious stage and is suffering from septicaemia (blood poisoning). A fever with a rash that does not fade under pressure is a medical emergency.
The rash is caused by blood leaking into the tissues under the skin. It starts as tiny pinpricks anywhere on the body and can spread quickly to look like fresh bruises.
This rash is more difficult to see on darker skin. In this case look in the paler areas of the skin such as around the feet and hands, and under the eyelids.
The glass test
If a transparent drinking glass is pressed firmly against a septicaemic rash, the marks will not fade from view. You will be able to see the marks through the glass. If this occurs; seek medical attention immediately. In a small number of cases, the rash may fade at first but may later change into one that does not fade.
2. Symptoms of viral meningitis
Most cases of viral meningitis are relatively mild, with symptoms including:
- Headache
- Fever and generally malaise
- Drowsiness
In severe cases of viral meningitis symptoms can also include:
- Weakness of the muscles
- Paralysis
- Speech disturbances
- Double vision or partial loss of the field of vision
- Epileptic fits
- Coma
How do you catch meningitis?
Bacterial meningitis – by regular, prolonged, close contact with an infected person; and by coughing, sneezing and intimate kissing (saliva exchange). The bacteria do not live for long outside the body so they cannot be picked up from water supplies, swimming pools, buildings or factories. You cannot catch bacterial meningitis by casual contact or by simply breathing the air where a person with meningitis has been.
Viral meningitis – Viral meningitis can be caused by many different viruses, either caught from other people via coughing and sneezing, through poor personal hygiene (such as not washing your hands after going to the toilet), or through sewerage-polluted water. Occasionally, viral meningitis is acquired through an infection of herpes simplex virus, measles, polio or chickenpox. It also used to be a complication of mumps, but due to the effectiveness of the measles, mumps and rubella (MMR) vaccine, mumps and its complications are very rare.
How contagious is meningitis?
Bacterial meningitis – Most people can carry the bacteria that cause meningitis without getting ill, their risk of actually contracting meningitis very small. Only very infrequently do the bacteria overcome the body's defences and cause meningitis.
Carriers of bacterial meningitis gain a boost in resistance to getting the disease, a natural immunity. The bacteria are not as contagious as many common infections, such as colds or flu, and are isolated cases. Occasionally, outbreaks do occur but they tend not to linger very long..
Viral meningitis – is not categorised as very contagious. Although some of the viruses are contagious and a person with meningitis may easily pass the virus to someone else, it is unlikely to cause them to actually develop the illness.
What is the treatment for meningitis?
Bacterial meningitis – treatment should be administered as early as possible to prevent complications and the development of any long-term effects. A range of antibiotics are effective in treating bacterial meningitis. People with this disease are usually hospitalised.
Viral meningitis – does not normally need any treatment, clearing up on its own. Most people recover within five to fourteen days. Antibiotics are not given for viral meningitis because they do not get rid of the disease. Painkillers and anti-emetics can be used to combat discomfort and nausea. Recovery from viral meningitis can be very slow, but is usually complete. However, sufferers can continue to experience headaches, tiredness, depression, memory loss and concentration problems.
How can I prevent getting meningitis?
There is no known way to prevent meningitis. Vaccines are available for certain types of bacterial meningitis (meningococci groups A and C) and for haemophilus influenzae (HiB), which can also cause meningitis. The vaccine against meningitis C is offered to all children and young people aged twenty five years and under. People in contact with someone diagnosed with types A or C bacterial meningitis should be vaccinated against that particular type. Vaccination for type B bacterial meningitis is not recommended.
There is also a quadrivalent (4 type) vaccine available to protect against group A, group C, group W135 and group Y meningococcal disease. This is recommended for people travelling abroad to Saudi Arabia during the Hajj and Umrah pilgrimages.
People who have had close contact with someone infected with bacterial meningitis may require medical treatment. “Close contact” means living with, or intimately kissing, someone who has meningitis. Contact your GP to find out what you need to do.
School friends and colleagues of someone with bacterial meningitis are deemed causal contacts and are, therefore, not at high risk of catching the disease. There is no need to avoid people who have been in contact with a case of meningitis.
How long should a person with meningitis remain absent from work/school?
Bacterial meningitis – you must avoid social situations for the duration of the illness. Return to work/school when your doctor gives approval. There is no reason to exclude siblings and other contacts of a case from school.
Viral meningitis – stay away from work/school until you feel well enough to attend.