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Meningitis causes, symptoms and treatments

The meningitis is an inflammation of s brain: the envelopes of the spinal cord and brain in which circulates the cerebrospinal fluid.

In most cases, meningitis is caused by a virus (viral meningitis). Meningitis can also be caused by a bacterium (bacterial meningitis). Bacterial meningitis is usually much more serious than viral meningitis and requires extreme emergency care.

In very rare cases, the disease may be due to certain types of cancer, an inflammatory disease such as lupus , an infection from a fungus or an allergic reaction to a drug , for example Motrin, Advil or the antibiotic ciprofloxacin (Cipro).

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Meningitis of viral origin

This form of meningitis resembles, in the beginning, a flu and rarely causes complications. Generally, symptoms of colds appear and then signs of meningitis. These signs disappear on their own after 2 weeks. But as at the beginning, it is not known if the meningitis is benign (due to a virus) or maybe serious (due to a bacterium); we hospitalize the child a time.

Viral meningitis most commonly affects children and young adults. As with most viral diseases, this meningitis cannot be treated with antibiotics. This leaflet focuses on bacterial meningitis.

Meningitis of bacterial origin

The bacterial meningitis is more severe. It can progress extremely rapidly, lead to serious complications (deafness, brain damage, epilepsy, mental disability, attention deficit or learning disorders) and sometimes lead to death (5% of cases) if it is not detected and treated in time. It’s an emergency. It affects mostly children, adolescents and young adults.

There are several types of bacterial meningitis, depending on the bacterium involved:

  • Pneumococcal meningitis ( Streptococcus pneumoniae ) . The pneumococcus bacterium is the st causes of meningitis in North America, both in adults than in children. It can also cause pneumonia and otitis media. Natural immune protection against pneumococcus is acquired only around the age of 5 years. Susceptibility to infections of this type is maximal before the age of 2 years. Streptococcus pyogenes or Streptococcus agalactiae also have meningitis.
  • Hib Meningitis ( Haemophilus influenzae type B) . Before the 1990s, it was the main form of bacterial meningitis in children under 5 years old. The widespread use of Hib vaccine has significantly reduced scope. The H. influenzae is a common cause of ear infections , sinusitis and bronchitis . However, note that the Hib vaccine does not protect against these other conditions, rarely caused by the “type B” strain of this virus;
  • Meningococcal meningitis ( Neisseria meningitidis ) . This bacterium is the only one that causes epidemics of meningitis . It is known that it is present in the back of the throat or nose from 10% to 25% of the population, according to the World Health Organization, without causing disease. In rare cases, it overwhelms the body’s natural defenses and causes meningitis;

    a more serious form of infection occurs if bacteria reach the bloodstream and organs; we then speak of meningococcemia . There are 13 strains of Neisseria m . Strains  A, B and Care most often involved in epidemics. Type B and C strains currently predominate in America and Europe, while type A strains predominate in Africa and Asia;

  • Listeria meningitis ( Listeria monocytogenes ) . Listeria monocytogenes infection , or listeriosis , is usually benign in an adult but can be transmitted to infants and young children, in whom it can cause meningitis. The pregnant women are particularly at risk (20 times more than the general population) and can transmit the infection to the unborn. This bacterium found in water and soil can contaminate plants and animals and enter the food chain.

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Contagion

Bacterial meningitis can be transmitted through close and prolonged contact with an infected person. Most people exposed to the bacteria do not become infected . Moreover, in most of those who contract it, meningitis does not develop.

The bacteria are carried by saliva and secretions from the nose and throat. It can be contracted by breathing saliva particles in the air when the person has coughed, sneezed or bled, the bacterium is also transmitted by the saliva present during kisses on the mouth, sharing utensils, glasses, bottles of water, cigarettes, lipstick, etc.

Frequency and epidemics

The bacterial meningitis is a relatively rare disease with an overall incidence maintained at or below 2 per year per 100 000 population in Canada.

However, with regard to meningococcal meningitis , which is responsible for epidemics , the number of new cases increases and decreases according to irregular cycles, without being able to identify trends. In Canada, periods of increased meningococcal activity occur approximately every 10 to 15 years. The winter and spring are the periods conducive to epidemics in the temperate regions of the world, while in the tropics, the dry season is the most affected.

Due to routine immunization in infants and young children, the median age of Americans with bacterial meningitis increased from 15 months in 1985 to 25 years in 1995.

In France, in 2014, 1220 meningitis were observed, ie 1.9 cases per 100 000 people.
(with 57 meningitis to haemophilus influenzae, 330 meningitis to Neisseria meningitidis (meningococcus), 550 to streptococcus pneumoniae, 41 to streptococus pyogenes, 139 to streptococcus agalactiae 103 to Listeria monocytogenes).

Possible complications

The infections meningitis is a medical emergency, they  require early diagnosis, hospitalization and immediate treatment with antibiotics. The longer the treatment, the greater the risk of neurological sequelae or death . Hearing loss, vision problems (which can lead to blindness), speech difficulties, learning disabilities, epilepsy are some of the possible consequences. Infection can even cause paralysisor gangrene of hands or feet that may require amputations. Studies indicate that 15% to 20% of infants and young children who survive bacterial meningitis have permanent neurological sequelae .

When a bacterial infection affects the central nervous system, it can cause death in a few days and sometimes even in a few hours. Meningococcal disease is fatal in 5 to 15% of cases.

Symptoms of meningitis

The symptoms of meningitis are related to the abnormal inflammation of the brain envelopes, the so-called meninges membranes and cerebrospinal fluid contained between two of the three meninges.

Symptoms of meningitis in newborns and babies

Cases may be difficult to detect because babies do not always have the classic symptoms of bacterial meningitis:

  • The fever ,
  • The stiff neck
  • The headache (difficult to detect in a very small!): He cries a lot,
  • Vomiting,
  • The sleepiness,
  • Convulsions,
  • Red or blue spots on the skin.
  • The constipation

Symptoms of meningitis in children aged 2 years and older, adolescents and adults

Meningitis usually manifests itself in three typical signs, to which may be added other less constant signs depending on the cause of meningitis. Here are the 3 signs of meningitis:

  • A headache that is the fastest sign to appear and the most constant. They are intense, diffuse, violent and continuous with exacerbations. They prevent sleep, are increased by noise and light, and by movement. They are not soothed by pain medications and are often accompanied by pain in the spine and increased sensitivity of the skin. Thus, the sick person remains motionless in the darkness and silence.
  • Vomiting that appears early enough, but they are not systematic. These are so-called easy vomiting (without significant effort to vomit), classically jet, not related to meals and facilitated by changes in posture.
  • A stiff neck. It is due to the involuntary contraction of the muscles of the neck which aims to avoid movements and to calm the pain. This contracture can be painful and is often manifested by a head a little back with a body in the posture of a rifle. Lateral movements are possible, but they accentuate the headache.

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Other signs may point to an infectious cause of meningitis:

  • A fever at 30 ° or 40 ° which began gradually. But fever is not always present especially as a drug could be taken to lower the fever (paracetamol or acetaminophen for example).
  • Sweats,
  • Chills,
  • Muscle pain
  • Associated rhinopharyngitis, or sinusitis or otitis,
  • A rash of the skin

Signs of severity may occur and if so, call the UAS:

purpura who must call the emergency EMS if it is associated with signs of meningitis disorders of consciousness (abnormal drowsiness), to coma,

  • Respiratory disorders,
  • An epileptic fit

People at risk for Meningitis

Meningitis can occur at any age . However, the risk is higher in the following populations:

  • Children under 2 years old;
  • Teenagers and young adults aged 18 to 24;
  • Old people ;
  • College students living in dormitories (boarding school);
  • The personnel of the military bases;
  • Children who attend day care (nursery) full time;
  • People whose immune system is weakened. This includes older people with chronic health problems (diabetes, HIV-AIDS, alcoholism, cancer), people in remission of a disease, those taking medications that weaken the immune system.

Risk factors for meningitis

  • Have intimate contact with an infected person .

Bacteria are transmitted by saliva particles in the air or by direct contact with saliva exchange by kissing, an exchange of utensils, glass, food, cigarette, lipstick, etc. ;

  • Stay in countries where the disease is widespread .

Meningitis is present in several countries, but the largest and most frequent epidemics are taking shape in the semi-desert regions of sub-Saharan Africa , known as the “African meningitis belt”. During epidemics, the incidence reaches 1,000 cases of meningitis per 100,000 population. Overall, Health Canada estimates that the risk of contracting meningitis is low for most travelers. Of course, the risks are higher for long-term travelers or for those who have close contact with the local population in their living environment, public transport or workplace;

  • Smoking or being exposed to second-hand smoke .

Smoking increases the risk of meningococcal meningitis1. In addition, according to some studies,  children  exposed to second-hand smoke are at higher risk of meningitis2,8. Researchers at the University of Edinburgh have observed that cigarette smoke facilitates the adhesion of meningitis bacteria to the walls of the throat8;

  • Being often tired or stressed .

These factors weaken the immune system, as do diseases leading to immune fragility (diabetes, HIV-AIDS, alcoholism, cancer, organ transplant, pregnancy, treatment with corticosteroids …)

  • Having a splenectomy (removal of the spleen) for meningococcal meningitis
  • Have a cochlear implant
  • Have an infection of the ENT sphere (Otitis, sinusitis)

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Prevention of meningitis

Polysaccharide vaccine or conjugate vaccine?

 

Polysaccharide vaccine. Vaccine composed of polysaccharides (carbohydrates formed of several simple sugars) from bacteria (pneumococcus, Hib, meningococcus, etc.).

Conjugate vaccine. These vaccines combine bacterial polysaccharides with carrier proteins. This technique provides a stronger and more durable immune response in young children.

 

Basic preventive measures in the event of an epidemic
Hygiene measures

  • If washing hands frequently;
  • Wear a mask
  • Do not share food, drinks, toothbrushes, cigarettes, lipsticks, etc;
  • In public places, such as schools, wash common surfaces, especially in washrooms, once a day with a solution of 1 part of bleach to 10 parts of water.

Way of life

  • Adopt a healthy lifestyle so as not to weaken the immune system;
  • Treat respiratory tract infections and ear infections of young children as soon as they arise.

 

Other measures to prevent meningitis
Vaccination

Some types of bacterial meningitis can be prevented by vaccination, but not all. In recent years, there is a vaccine against meningococcal meningitis type B: Bexsero. However, no vaccine can offer protection against all strains of bacteria that can cause meningitis:

  • Pneumococcal vaccine. Vaccines containing polysaccharides from 23  pneumococcal serotypes (Pneumovax, Pneumo and Pnu-Immune) have been on the market since 1983. They confer immunity against each of these serotypes. Those who respond best to these vaccines are healthy young adults. The Prevnar vaccine, the only pneumococcal conjugatevaccine , protects young children to 90% against this type of meningitis and offers a slight protection against ear infections caused by pneumococcus. The Canadian Pediatric Society recommends its administration to all children aged 2 months to 4 years;
  • Vaccine against Haemophilus (Hib).  In Canada, routine Hib vaccination is recommended for all infants as young as 2 months of age. Three conjugate vaccines are registered in Canada: HbOC, PRP-T and PRP-OMP, which is a vaccine that combines vaccination against haemophilus influenzae with vaccination of other diseases.
    In France, ACTHIB is available.
    The number of doses varies according to the age at the first dose.
    This Hib vaccine is also present in multi-disease vaccines (Infanrix quinta, Pentavac, Hexyon, Infanrix hexa)
  • Vaccines against meningococcus.  In France, it is supported at 65%. There are 2 types of meningococcal vaccines in Canada:
  • Conjugate vaccines . Three vaccines offer protection against meningococcal serotype C  : Menjugate, NeisVac and Meninvact. The degree of protection is high (more than 90%) in babies (from the age of 2 months) and young children. This vaccine has been included in the vaccination calendar since 1999; A vaccine offers relationship protection against invasive meningococcal B infections (mainly meningitis and sepsis), Bexsero.
  • Polysaccharide vaccines . MenAC-Ps protect against meningococcus serotype A and C . MenACYW-Ps (Menactra, Nimenrix, Mencevax, Menveo) confers immunity against 4 serotypes: A, C, Y and W135 . These vaccines are not used for the routine immunization of children. They are used especially during epidemic periods, for travelers traveling to an area affected by an epidemic of meningitis and to people at high risk of infection. They can be administered from the age of 2 years.

In case of contact with a sick person, treatment should be provided if:
– the patient has been exposed directly to the patient’s nasopharyngeal secretions within 10 days of the onset of symptoms (persons who live / are kept under the care of the patient); same roof as the index case during its contagious period)
– Or if not, the doctor assesses risk situations. It is considered important if there is a proximity of less than 1 meter with the sick person, a face-to-face situation, a meeting lasting more than one hour, mouth-to-mouth contact .

  • antibiotics

As a precaution, the relatives of the person with Rifampicin (oral route of treatment for 2 days) are also treated with antibiotics. In case of contraindication or known resistance of this bacterium to rifampicin: Ceftriaxone (injectable) or ciprofloxacin (oral), single dose. This should be started as soon as possible before 24 to 48 hours if possible. This treatment is useless more than 10 days after contact with the sick person.

Medical treatments for meningitis

Treat viral meningitis

In case of meningitis, even before having the results of the analyzes, the person must be treated as if it were a bacterial meningitis, emergency, by injectable antibiotics and brought to the emergency to realize examinations allowing a diagnostic.
If it is a viral meningitis, the sick person will be able to go home, because there is no mortal risk, or sequelae. It will then be treated only with paracetamol (acetaminophen).
Rest, plenty of fluid and good nutrition, as well as the usual measures to relieve fever.

Attention . In case of fever in children, avoid giving aspirin. Prioritize acetaminophen to lower fever. Aspirin is not recommended.

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Treat bacterial meningitis

Antibiotics .
The key is the speed of treatment. If the treatment is taken more than 6 hours after onset of symptoms, there is a mortality rate of 8.4% in adults. One should not wait to know the bacterium involved to give antibiotic treatment.
The antibiotic given immediately in extreme urgency is intravenous Ceftriaxone. If this is not possible, it is injected intramuscularly. In case of unavailability, Cefotaxime is injected or in case of unavailability of Amoxicillin. Only then will the treatment be adapted to the bacteria in question.
Antibiotics for early treatment of meningitis are effective in ending the disease and reducing the mortality rate. According to the US Agency Centers for Disease Control and Prevention, appropriate antibiotic treatment reduced to less than 15% risk of dying from meningitis, although the risk is higher in older people.

The person will sometimes be treated with corticosteroids to help prevent hearing loss due to neurologic damage from the inflammatory reaction, one of the most common complications.

Cerebral edema is treated by avoiding overhydration and raising the headboard to 30 degrees. Sometimes, in cases of significant intracranial hypertension, mannitol or barbiturates are prescribed.

Rest and recovery

During the acute period of meningitis , it is recommended to rest in a quiet, dimly lit room to relieve headaches.

It is also recommended to take the sick children in his arms and massage them gently to soothe their anxiety.

Convalescence following meningitis can be long, since it is a sometimes very serious disease that draws a lot of energy reserves of the body. Some people will take several months to recover.

Hearing problems , if they are not permanent, can last for a while and cause dizziness.

Post-meningitis depression is also quite common. It is recommended not to rush the return to work and to return gradually, if necessary.

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