Ask the Doctor: Meningitis

Q. What is meningitis?
A. Meningitis is an inflammation of the membranes (meninges) that envelope the brain and the spinal cord. This inflammation most often represents a serious infection that has a high potential for long-term complications. The particular infectious agents involved tend to vary depending upon age groups, with the most common etiologies being bacterial or viral in nature. Bacterial infection tends to be the more severe and notorious form. In younger children, the most common causes had been Streptococcus pneumoniae and Haemophilus influenzae prior to our current immunization schedule for children and can still be a concern among unimmunized individuals. Currently, however, Neisseria meningitidis is the most common bacterial agent and is the primary agent normally involved in the above situations.

Q. How does someone get it?
A. Our bodies normally carry many bacteria with which we are considered to be "colonized." This colonization goes unnoticed because the bacteria do not breach the body's natural defense. Certain bacteria are more aggressive and better able to breach the body's defenses. When these bacteria enter the nose and throat, some individuals carry the bacteria for a while without ill effect while others will be affected quickly. Once the bacteria penetrates the initial barrier, it can invade the blood stream and from there has access to multiple places in the body. Once a person has meningitis, it is possible to spread it by person-to-person contact through respiratory droplets or secretions (saliva included). This requires close contact, not just a casual encounter, with that individual.


Q. Are there vaccines against meningitis?
A. There are vaccines available that help to reduce the incidence of bacterial meningitis. For infants and young children, routine vaccinations for Streptococcus pneumoniae and Haemophilus influenzae type B starting at the two-month check-up have helped to reduce the incidence of meningitis as well as severe invasive disease caused by these two agents. There is also a vaccine available against Neisseria meningitidis that can be administered starting at age eleven in the general population and in high-risk patients over the age of two. These vaccines provide coverage against the majority of strains that cause the most severe disease by these bacteria. However, it is not possible for all strains to be covered by a vaccine, and so even with appropriate vaccination, there is still a risk of acquiring the disease.

Q. What are the symptoms of meningitis?
A. Many of the individual symptoms and signs associated with meningitis are nonspecific and can be associated with many illnesses. It is the combination of these symptoms that is important, such as headache, nausea/vomiting, altered personality, irritability, altered level of interaction or state of consciousness, neck pain with rigidity, fever, and poor feeding. There can also be a rash associated that can appear red and pinpoint or purple/black and splotchy in nature. The rash tends to occur more commonly on the legs and lower trunk and can progress quickly. Among these symptoms, neck pain with rigidity, change in personality/consciousness, and the aforementioned rash are more specific and concerning.

Q. How is it treated?
A. Treatment depends on the cause of meningitis. Bacterial meningitis is a serious illness and can be rapidly progressive. Prompt recognition of concerning symptoms and seeking care as quickly as possible are essential. Bacterial meningitis is treated with IV antibiotics and supportive care in an appropriately equipped facility. The total duration of therapy as well as the antibiotic used depends on the bacteria involved. Those who should receive prophylactic treatment based on contact are household contacts, daycare/nursery school contacts, and healthcare workers who may have come into contact with the infected individual's saliva. The key to optimal treatment is prompt recognition of concerning symptoms and seeking immediate medical attention.