Perhaps the most devastating event a family can endure is the death or permanent disability of a child or otherwise healthy loved one due to an unexpected, rapidly progressing infection. As a pediatric infectious diseases specialist, I have unfortunately seen this happen too many times. One specific type of infection is particularly notorious for doing this: bacterial meningitis.
April 24 is World Meningitis Day. Let’s review what meningitis is and what you can do to protect your children and loved ones.
Meningitis: What is it?
Meningitis is inflammation of the membranes that line the surface of the brain and spinal cord (the meninges).
What are the signs and symptoms?
What makes identifying meningitis challenging is that many symptoms are very non-specific. The most commons symptoms include high fever, severe headache, and neck stiffness. Some patients may have vomiting, severe sensitivity to lights and sounds, altered consciousness or seizures, or a diffuse rash consisting of purple dots or blotches. In infants or children too young to describe their symptoms, signs include:
- Refusal to feed;
- Severe irritability;
- Severe lethargy; or
- A child who is very difficult to rouse.
Any person who has these symptoms should seek medical attention immediately!
Why does meningitis matter?
Meningitis can be an absolutely devastating illness. It is often fatal, and a significant number those who survive experience permanent neurological damage. The most common long-term side effect is hearing loss. However, more severe cases can lead to seizures, blindness, and brain damage resulting in permanent intellectual, emotional, and physical impairment. Certain bacteria may cause widespread disease throughout the rest of the body, causing severe disease of the arms and legs, often requiring amputation.
What causes it?
The most feared cause of meningitis is bacterial infection of the meninges (bacterial meningitis).
There are several bacteria that are notorious for causing meningitis. These include Streptococcus pneumoniae, (a.k.a. pneumococcus) which also is the most common cause of ear infections and pneumonia, Haemophilus influenzae type B (HiB), and Neisseria meningitides (a.k.a. meningococcus). Certain strains of meningococcus, known as serotype B, are the bacteria that made recent headlines for causing several outbreaks of meningitis on college campuses.
Certain viral infections may cause meningitis, but fortunately, with a few exceptions, most forms of viral meningitis are not as serious and rarely lead to long-term side effects. Some viruses can cause direct infection of the brain or spinal cord themselves, known as encephalitis, which is also very dangerous but slightly different from meningitis.
In Vermont, Lyme disease can also cause meningitis, but this usually responds well to treatment.
Who is at risk?
Anybody can get meningitis. However, we know that certain groups are at much higher risk.
The very young (infants and toddlers) and the elderly are at greatest risk, particularly for bacterial meningitis due to pneumococcus. HiB tends to affect only young children. Meningococcus is most common in children, adolescents, and young adults, oftentimes in patients who would otherwise be the picture of good health. Persons traveling to certain regions of Africa and those participating in the Hajj will also be at higher risk due to increased prevalence of the disease in those specific regions. Of course, anybody who is immunocompromised is at higher risk for many bacterial infections, including meningitis.
How do we diagnose it?
The best way to diagnose bacterial meningitis is by testing the cerebrospinal fluid (CSF), which is the fluid that surrounds the brain and spinal cord. We perform a lumbar puncture (also known as a spinal tap), in which we use a needle to withdraw CSF to test for signs of inflammation and to culture for bacteria.
How do we treat it?
Depending on the cause, we can treat bacterial meningitis with various antibiotics, almost always used intravenously. However, bacterial meningitis is a very difficult infection to treat. Why? Because bacteria manage to infect a region of the body designed to keep out foreign material, including medications. Therefore, even if we use the right antibiotics, significant damage can still occur before the infection can be brought under control. In some instances, we use steroids to try to limit the amount of damage. So, while treatment is available, a far better approach is PREVENTION.
What can I do to prevent bacterial meningitis?
Fortunately, the incidence of bacterial meningitis in children has plummeted in recent years, for one specific reason: vaccination.
Effective vaccines to prevent infections caused by pneumococcus, HiB, and meningococcus have been developed and are approved for use. In the United States, all of them are included in the standard pediatric immunization schedule recommended by the Centers for Disease Control and Prevention, and similar vaccines are also available for adolescents and adults with certain conditions that may put them at higher risk, including against serotype B meningococcus, or for those traveling to high-risk regions.
So, the single most important thing each of us can do to prevent meningitis is to ensure that all of our loved ones are up-to-date with all recommended vaccinations. While this will not prevent all forms of meningitis, these vaccines are safe and effective in preventing the majority of these horrific infections. There is no greater tragedy than to lose a loved one to a completely preventable disease: meningitis is no exception! And don’t just take my word for it: click here to read personal accounts of those whose lives have been directly affected by meningitis.
Benjamin Lee, MD, is a pediatric infectious diseases physician at the University of Vermont Medical Center.