Meningitis infection, symptoms
Feb 20 2016 by
Ray Sahelian, M.D.

Meningitis is an infection of the thin lining that surrounds the brain and the spinal cord. Meningitis kills up to 10 percent of those affected, typically within 24-48 hours, even when it is diagnosed early and treated. Microbiologic causes of meningitis include bacteria, viruses, fungi, and parasites. Before routine use of pneumococcal conjugate vaccine, bacterial meningitis affected almost 6000 people every year in the United States, and about half of all cases occurred in children 18 years old or younger. Prompt and accurate diagnosis and adequate treatment of bacterial meningitis in children remains a major challenge, as reflected by the continued high morbidity and case-fatality rates of the disease worldwide. Appropriate use of antibiotics, along with adjunctive therapies, such dexamethasone, has proved helpful in the prevention of neurologic sequelae in children with bacterial meningitis.

Meningococcal disease is caused by Neisseria meningitidis and is an infection which rapidly progresses to multiorgan failure. It was a major killer in the epidemics of the 1980's in the United States. With the advent of Haemophilus influenzae type b (Hib) vaccine in the 1990s, Streptococcus pneumoniae and Neisseria meningitidis have become the most common causes of bacterial meningitis in the United States.

Meniningitis caused by Neisseria meningitidis has an average annual incidence of one case per 100,000 in the United States. The disease can be rapidly fatal or result in severe neurologic and vascular sequelae despite antibiotic therapy. Antibiotic chemoprophylaxis with rifampin, ciprofloxacin, or ceftriaxone is required for household and other close contacts. Although the majority of cases of meningococcal disease are sporadic, outbreaks can occur, and vaccination of the affected population often is necessary.

Przegl Epidemiol. 2013. Bacterial meningitis - principles of antimicrobial treatment. Bacterial meningitis is associated with significant morbidity and mortality despite the availability of effective antimicrobial therapy. The management approach to patients with suspected or proven includes emergent cerebrospinal fluid analysis and initiation of appropriate antimicrobial and adjunctive therapies. The choice of empirical antimicrobial therapy is based on the patient's age and underlying disease status; once the infecting pathogen is isolated, antimicrobial therapy can be modified for optimal treatment. Successful treatment requires the knowledge on epidemiology including prevalence of antimicrobial resistant pathogens, pathogenesis of meningitis, pharmacokinetics and pharmacodynamics of antimicrobial agents. The emergence of antibiotic-resistant bacterial strains in recent years has necessitated the development of new strategies for empiric antimicrobial therapy.

Symptoms
Meningitis symptoms are a stiff neck, high fever, headaches and vomiting.

Long term consequences
Children who survive meningitis in infancy are less likely to pass school-graduation exams compared with their counterparts without this serious infection. Even meningitis survivors who seem to be normal at age 5 are at increased risk for poor academic performance.

Infect Disord Drug Targets. 2014. Complications of serogroup B meningococcal disease in survivors: a review. This systematic review evaluates the prevalence of long-term complications of serogroup B meningococcal disease (MD) in light of the recent licensure of a vaccine against meningococcal B disease. Twelve appropriate studies were identified by searching available databases from 1946 to July 2014. The average prevalence of hearing impairment was 4.2% among serogroup B MD survivors; 2.3% suffered amputation and 2.3% developed seizures. When compared with complications due to non-meningococcal B bacterial meningitis, physical impairment and seizures were more common in survivors of meningococcal B disease but hearing impairment had similar prevalence. Few studies quantified less frequent complications such as visual impairment and cognitive dysfunction. Better comprehensive reporting of the complications and costs of serogroup B MD in survivors and their families is needed to inform vaccination policy.

Meningitis vaccine
Serogroup B accounts for the highest incidence of disease in young infants but is not contained in any vaccine licensed in the United States. Adolescents and young adults 15 to 24 years of age have a higher incidence of disease and a higher fatality rate than other populations. Because 70 to 80 percent of these infections in the United States are caused by meningococcal serogroups C, Y, and W-135, which are contained in the tetravalent meningococcal vaccines, they are potentially preventable. The U.S. Food and Drug Administration recently approved a meningococcal conjugate vaccine containing serogroups A, C, Y, and W-135. This T-cell-dependent vaccine induces bactericidal antibody production and promotes immunologic memory that should result in a longer duration of immunity. The Advisory Committee on Immunization Practices recommends that this vaccine be given to 11- and 12-year-old adolescents, to adolescents entering high school, and to college freshmen living in dormitories. The vaccine also may be given to persons 11 to 55 years of age who belong to certain high-risk groups.

Meningitis from kissing
In adolescents, intimate kissing with multiple partners, attending college, and a history of preceding illness are independent risk factors for meningococcal disease, whereas religious observance and meningococcal vaccination are tied to reduced risks. Meningococcal disease -- a bacterial infection of the fluid within the tissues surrounding the brain and spinal cord -- is largely a disease affecting children younger than 5 years, although in recent years both the US and UK have seen rising rates among teens.This trend served as a major stimulus for the development of the meningococcal vaccine, which has proven highly successful. Exactly why the incidence of meningococcal disease peaks again around the adolescent years is unclear. Several studies have looked at risk factors for this disease in teenagers, but most have been limited to certain subgroups or included subject numbers. Dr. Joanna Tully, from the University of London, and colleagues compared sociodemographics, lifestyle, and medical factors in 144 teenagers with menincogoccal disease and an equal number of healthy controls of similar age. Blood samples as well as throat and nasal swabs were obtained from all subjects. Overall, 114 of the 144 "case patients" were confirmed as having meningococcal disease with microbiologic tests. Intimate kissing with multiple partners and preterm birth were the strongest independent risk factors for meningococcal disease, each raising the risk 3-fold. Being a college student and a history of preceding illness increased the odds 3-fold. Attending one or more religious ceremonies in the 2 weeks before illness was associated with a 90 percent reduced risk of meningococcal disease. Similarly, receipt of the meningococcal vaccine cut the risk of disease by 88 percent. Source: British Medical Journal, 2006.

Meningitis diagnosis
Doctors can follow a set of guidelines to diagnose sick children who might have a deadly form of meningitis, sparing young patients days in the hospital. Meningitis produces swelling of the membranes surrounding the brain and spinal cord. The bacterial form that occurs in one in 25 cases can produce a more severe illness than the viral form. Doctors often cannot determine which type of meningitis a patient has until a bacterial culture is produced in the laboratory - requiring up to a three-day wait. Just in case, most patients are admitted to the hospital and treated with powerful antibiotics. Guidelines developed four years ago and tested in a trial of 3,300 patients aged 29 days to 19 years correctly classified all but two patients, both of whom were younger than 2 months and more difficult to diagnose. The criteria include routine tests of blood and fluids and a checklist, including whether the child has had seizures since falling ill. "The ability to identify those children who are at very low risk of bacterial meningitis and can be considered for management on an outpatient basis will avoid unnecessary hospitalization and aggressive antibiotic therapy," said study author Dr. Nathan Kuppermann of the University of California-Davis Medical Center. A vaccine to combat bacterial meningitis has been recommended in the United States for at-risk children younger than 2 since 2000, reducing the incidence of the disease.

Meningitis and Travel
International travel and migration facilitate the rapid intercontinental spread of meningococcal disease. Serogroup A, and to a lesser extent serogroup C, have been responsible for pandemics in the past (mainly in Africa), but in recent years there was an international outbreak due to W135 related to the Hajj pilgrimage. The high carriage rates, persistence and transmissibility, in combination with the high case fatality rate of the Hajj-associated W135 outbreak clone, certainly raise considerable concern about the public health consequences of widespread dissemination of this organism and the potential for future epidemics. Indeed, the now evolving W135 epidemic in Africa mandates that the bivalent meningococcal vaccine should be replaced by the tetravalent meningococcal vaccine, covering A, C, Y and W135 serogroups.

Burkina Faso
Health officials in the west African country of Burkina Faso are worried about an increase in deaths from meningitis which has killed 246 people so far (Feb 2010), up from 203 in the same period last year. Meningitis, a disease that inflames the lining of the brain and can be transmitted by mosquitoes, tends to strike countries in the Sahel region during the dry season which typically runs from November to June.

West Africa
One third of the world's stockpiled meningitis vaccine doses have been dispatched to West Africa where an outbreak has killed more than 1,100 people since January, the World Health Organization (WHO) said in March 2009.

Update April 2009 - Meningitis has killed more than 2,500 people so far in 2009 in West and Central Africa in what could become the worst epidemic for five years, UNICEF reports. Infection rates in Africa rise during the dry and hot period from January to May and the "meningitis belt" stretching from Senegal to Ethiopia is especially prone.

Aseptic form
GlaxoSmithKline Plc's anti-seizure drug Lamictal can cause a brain inflammation known as aseptic meningitis.

Meningitis treatment and prevention questions
Are there any herbs such as saw palmetto, andrographis, mangosteen, graviola, astragalus, andrographis, or curcumin that can prevent meningitis?
   I am not aware of any herbs that can prevent meningitis infection from occurring.