MENINGITIS AND SEPTICAEMIA

It Affects Everyone

Every year there are thousands of cases of bacterial meningitis in England and Wales.  A number of children and  adults in our community have died or suffered serious brain damage recently as a result.

Meningitis means inflammation of the lining of the brain (meninges).  It can be caused by several different germs.  Some are bacteria and some are virus.  The bacterial germs can also cause septicaemia - blood poisoning or infection of the blood.  Meningitis caused by a virus (viral meningitis) is generally less serious.

Bacterial meningitis can be very serious.  There are three main types of bacterial meningitis.  They are named after the germ that cause the infection.  They are:-

-Meningococcal
-Pneumococcal
-Haemophilus influenza type b (known as Hib)

Since the introduction of Hib vaccine the incidence of this particular bacterial meningitis is falling.

SYMPTOMS

Recognising the symptoms could mean the difference between life and death.  Meningitis is not easy to identify at first because the symptoms are similar to those of "flu".

In bacterial meningitis, the onset of the illness is usually sudden and acute sometimes in just a few hours characterised by the following sequence:-

- High fever
- Vomiting
- Headache
- Stiffness of neck
- Pains in the back or joints
- Intolerance to light, preference for darkness
- Rash on body which looks purplish and blotchy
- Convulsions (especially in children)
- Stupor
- Coma
- Death

In viral meningitis the symptoms are not as sudden and acute as in bacterial meningitis.  It is characterised by:-

- Fever
- Backache
- Neck stiffness
- Drowsiness

DIAGNOSIS

The signs and symptoms are not sure indications of bacterial or viral meningitis until a lumber puncture is done (fluid around the brain and the spinal cord is removed for examination through a needle passed into the spine around the lower back).  Occasionally rashes of cold sore or swellings of mumps can indicate that the meningitis is viral.

The symptoms may be different in young babies, children and adults.

Babies may have a staring expression and fever.  They may refuse feeds or they may vomit.  They may be distressed and make a shrill or moaning cry when you pick them up.  Babies with meningitis can be very difficult to wake up.  The fontanel - the soft spot on baby's head - may be tense or bulging and the skin may be pale and blotchy.  There may also be a rash of red or purple spots or bruises anywhere on the body.

Anyone of any age can get meningitis or septicaemia.  The most common type of meningitis in children under four used to be Hib.  This germ could also cause septicaemia.

Immunisation against Hib infection is now possible.  Children are now immunised at two, three and four months at the same time as diphtheria, whooping cough, tetanus and polio.  If you do not remember your child being immunised and he or she is under four, you should contact your doctor.

MENINGOCOCCAL MENINGITIS

Now, the meningococcal germ is the most common cause of meningitis and septicaemia in all age groups.

Meningococcal meningitis is the most dangerous type of meningitis too.  It is caused by a germ called Neissiria Meningitides.  This germ exists in five forms ABCY and W135. B is responsible for two thirds of cases and C for one  third in UK.  It is endemic throughout the world and in UK, it mainly occurs in winter months.  Epidemics occur from time to time usually in residential and other institutions e.g. military barracks, schools, children's homes, etc.

The infection is acquired by droplet transfer from close contacts.  After incubation period of two-three days, the  illness starts suddenly, often with shivering attacks followed by fever.

Young people and adults also get the pneumococcal form of meningitis.  Both forms can be very serious and must be treated immediately.

HOW IS MENINGITIS TREATED?

If this illness is diagnosed early and treated quickly, most people recover quickly.  But in some cases, the infection can kill or lead to a permanent disability such as deafness or brain damage.  Antibiotics are used to treat bacteria meningitis.  They are also given to immediate family members and anyone else who is in close contact with the person who has the disease.  Antibiotics are often given direct into cerebro-spinal space by infusion in the spine (intra-thecal) or through a drip in a vein.  Before a patient is discharged from hospital, they are given Rifampicin antibiotics for two days, if they have had meningococcal meningitis or for four days if they have had Hib meningitis.  Antibiotics are not used for viral meningitis.

CAN YOU GET MENINGITIS BY COMING INTO CONTACT WITH SOMEONE WHO HAS IT?

The germs that cause bacterial meningitis are very common and live naturally in the back of the nose and throat.  People of any age can carry these germs for weeks or months without becoming ill.  It is only rarely that they overcome the body's defences and cause meningitis or septicaemia.

Coughing, sneezing and kissing spread the germs, but they do not live for more than a few seconds outside the body and are not easily passed from one person to another.  You cannot get meningitis from water supplies, swimming pools, factories or buildings.

WHAT IS SEPTICAEMIA?

Septicaemia often occurs with meningococcal meningitis.  The germ enters the body from the throat and travels through the blood.  In some cases, the germs multiply in the bloodstream and cause blood poisoning.  This may happen on its own or with an attack of meningitis.

People with septicaemia usually have a rash which can be anything from tiny spots to large blotchy bruises.  Their skin may be pale and clammy, even though they have a fever.

WHERE DO YOU GET THE RASH?

The rash can appear anywhere on the body and in the early stages may be little more than small red spots in the skin.  It can develop very quickly, and in a matter of hours the spots can grow to red or purple bruises.  It may be more difficult to see the rash if you have dark skin.  The spots or bruises must be taken seriously - call your doctor immediately.  (A rash is not necessarily present in every case of meningitis).

HOW SOON SHOULD YOU CALL A DOCTOR?

The meningococcal germ that causes meningitis or septicaemia can be very serious.  But you can prevent the consequences by acting quickly.

If you think you or your child might have meningitis, call your doctor immediately.  Explain why you are concerned.  Describe the symptoms carefully and ask for advice.  If your doctor is not available, go straight to the nearest hospital casualty department.  Bacterial meningitis or septicaemia must be treated early.

CAN ACUPUNCTURE AND/OR ACUPRESSURE HELP?

No definitely no.  No such antiques should be attempted otherwise valuable time will be wasted and the patient's life will be put in more danger.

IMMUNISATION

Researchers around the world are working to produce more effective vaccines against these infections.  Hib vaccine is already in routine use and is very successful, but as yet there is no vaccine against the most common strain of the meningococcal germ.  For travellers abroad to countries like, India, Pakistan, Saudi Arabia, Kenya, Tanzania, etc., it is recommended to be immunised against meningitis type A and C which is common in these countries.  It is available as Mengivac A+C or AC Vax.  However, it gives no protection against type B which is common in UK.  Hence routine immunisation against type A+C is not necessary in UK.

PROGNOSIS AND SEQUELAE

This depends on duration of illness before treatment is begun and the sensitivity of ineffective agent to the available drug.  Most patients do well.  In 10% of the cases, death or serious brain damage occurs like:-

- Cranial nerve palsy e.g. deafness
- Paralysis of some part of the body
- Epilepsy
- Mental retardation (dementia)
- Disproportionate increase in the size of head (hydrocephalus)

PORPHYLAXIS (FOR PREVENTION OF CONTACTS GETTING MENINGITIS)

Contacts means immediate family of the patient or those people who have been in physical contact with the patient for 2-3 hours just before or during the illness.

For meningococcal meningitis - Rifampicine for adults and children - twice a day for two days OR Ciprofloxacin as a single dose for adults OR Ceftriaxone especially in pregnancy.

For Hib meningitis - Rifampicine for adults and children once a day for four days. If you have any questions/need further clarification/need more information please do not hesitate to contact the Medical Advisory Board.

The following literature is available from the Medical Advisory Board office free-of-charge.

1. Meningitis Fact Sheet
2. Meningitis - Schools Policy
3. Meningitis - The Facts
4. Meningitis Poster - The Symptoms to Look Out For
5. What is Meningitis?
6. About Meningitis
7. Knowing about Meningitis and Septicaemia
8. Information on National Meningitis Trust
9. After Meningitis
10. Meningitis Symptoms Card
11. National Meningitis Trust Annual Report
12. Meningitis Research Order Form
13. National Meningitis Trust Magazine - Headlines
14. Meningitis Symptoms Checklist Card
15. Meningitis - The Way Forward
16. Meningitis - The After Effects
17. Meningococcal Meningitis and Septicaemia
18. Meningitis Research Donation Form
19. Meningitis - A Race Against Time
20. Meningitis - A Race Against Time - Poster
21. Meningitis in Your Community
22. Understanding Meningitis Video - £6.00 to buy Free to loan