Meningitis is an infection of the meninges, the protective membranes surrounding the brain and spinal cord. It can affect anyone, but is most common in infants, young children, adolescents and young adults

This disease can be very serious if not treated quickly.

In fact, it can cause septicaemia (a life-threatening acute infectious blood process) and permanent brain and/or nerve damage.

Fortunately, numerous vaccinations are available that offer protection against various forms of meningitis.

Meningitis Symptoms

The first symptoms of meningitis can mimic those of influenza and can develop within several hours or a few days.

Possible signs and symptoms in adults and children over two years of age include:

• sudden high fever;
• neck pain;
• severe headache that feels different from a ‘normal’ headache;
• nausea or vomiting;
• confusion and/or difficulty concentrating;
• convulsions;
• drowsiness and/or difficulty waking up;
• hypersensitivity to light;
• lack of appetite and/or thirst;
• rash (especially in meningococcal meningitis).

Symptoms in infants

In infants and children under two years of age, signs and symptoms of illness may be:

• high fever
• constant crying;
• excessive sleepiness or irritability;
• difficulty waking from sleep;
• inactivity or sluggishness;
• lack of appetite or poor nutrition;
• vomiting;
• swelling of the fontanelles;
• stiffness of the body and neck.

In addition, one should be aware that infants with meningitis can be difficult to comfort and may even cry louder when held.

Meningitis, when to call for help

If the following signs or symptoms appear, call for help or otherwise seek immediate medical attention: fever; severe and relentless headache; confusion; vomiting; stiff neck.

Bacterial meningitis is serious and without prompt antibiotic treatment can be fatal.

Delayed treatment increases the risk of permanent brain damage or death.

It is also important to talk to your doctor if a family member or someone you live or work with has meningitis because you may need to take medication to prevent the infection.

Bacterial meningitis

In most cases, meningitis is triggered by viral infections.

However, bacterial infections and, more rarely, fungal and parasitic infections can also cause illness.

The most dangerous are bacterial infections, which is why they should be identified as early as possible.

Acute bacterial meningitis is caused either by bacteria entering the bloodstream and travelling to the brain and spinal cord or by bacteria invading the meninges directly.

Underlying the disease may be an ear or sinus infection, a skull fracture or, more rarely, some surgery.

Several strains of bacteria can cause acute bacterial meningitis.

The most common culprits are:

– Streptococcus pneumoniae or pneumococcus: this is one of the most common causes of bacterial meningitis in infants, young children and adults. It commonly causes pneumonia, ear infections and sinus infections. There is a vaccine that can prevent pneumococcal infections;

-Neisseria meningitidis or meningococcus: this is another major cause of bacterial meningitis. There are several serogroups of it. Of these, the most common are five: A, B, C, Y, W135. The most dangerous is meningococcus C, which together with B is also the most frequent in Italy and Europe. These microorganisms commonly cause an upper respiratory tract infection, but can cause meningococcal meningitis when they enter the bloodstream. This is a highly contagious infection that mainly affects adolescents and young adults. A vaccine also exists against meningococcus;

-Haemophilus influenzae type b (Hib): this used to be the main cause of bacterial meningitis in children. Now, thanks to new vaccines, the situation is much better;

-Listeria monocytogenes (listeria): these are bacteria that can be present in certain foods, such as unpasteurised cheese. Pregnant women, infants, the elderly and people with weakened immune systems are the most vulnerable to listeria infections.

Meningitis, the other causes

In addition to bacterial meningitis, there are other forms of meningitis.

Viral meningitis is generally mild and often resolves on its own.

It can be triggered by different types of viruses, such as enteroviruses, HIV, mumps virus, West Nile virus.

The herpes simplex virus can cause an extremely severe form with involvement of brain structures.

Slow-growing organisms (such as fungi and Mycobacterium tuberculosis) that invade the membranes and fluid surrounding the brain can cause chronic meningitis.

This is a form of the disease that develops over a period of two weeks or more and can manifest itself with headaches, fever, vomiting and mental numbness.

Fungal meningitis is relatively rare

It can mimic acute bacterial meningitis and is often contracted by breathing in fungal spores that may be present in soil, decaying wood and bird droppings.

Fungal meningitis is not contagious.

Cryptococcal meningitis is a fungal form that affects people with immune deficiencies, such as AIDS.

It is life-threatening if not treated with an antifungal drug.

Parasites can cause a rare type of meningitis called eosinophilic meningitis.

The main parasites that cause meningitis typically infect animals; people usually become infected by eating contaminated food.

Parasitic meningitis is not transmitted from person to person and can also be caused by a tapeworm infection in the brain (cysticercosis) or cerebral malaria.

Amoebic meningitis is a rare type of disease that is sometimes contracted by swimming in fresh water and can quickly become life-threatening.

Sometimes, meningitis can also result from non-infectious causes, such as chemical reactions, drug allergies, certain types of cancer and inflammatory diseases such as sarcoidosis.

Risk factors for meningitis

Risk factors for meningitis include:

• lack of vaccination: the risk increases for anyone who has not completed the recommended childhood or adult vaccination programme;
• age: most cases of viral meningitis occur in children under the age of five. Bacterial meningitis is common in individuals under the age of 20;
• living in a community setting: university students living in dormitories, military base personnel and children in boarding schools and childcare facilities are at higher risk of meningococcal meningitis. This is probably due to the fact that the bacteria responsible spread via the respiratory route and spread rapidly in large groups;
• pregnancy: gestation increases the risk of listeriosis, the infection caused by listeria bacteria, which can also cause meningitis. Listeriosis increases the risk of miscarriage, foetal death and premature birth;
• compromised immune system: those with compromised defences are more susceptible to the disease;
• removal of the spleen: this is a procedure that increases the risk. Therefore, anyone without a spleen should be vaccinated to minimise this risk.

Complications of meningitis can be serious

The longer the disease goes untreated, the greater the risk of permanent neurological damage, including: hearing loss; memory difficulties; learning disabilities; brain damage; gait problems; seizures; kidney failure; shock; and death.

With timely treatment, even people with severe meningitis can have a good recovery.

Treatment depends on the type of meningitis

Bacterial meningitis requires immediate hospitalisation.

The first intervention consists of administering a cocktail of various drugs, including antibiotics and sometimes corticosteroids.

Often the danger to health is so great that doctors are required to administer antibiotics immediately even when there is a well-founded suspicion and before definitive diagnostic confirmation; they may also recommend a broad-spectrum antibiotic until they are able to determine the exact cause of the meningitis.

This helps ensure recovery and reduce the risk of complications.

The doctor may also drain any infected sinuses or mastoids, the bones behind the outer ear that connect to the middle ear.

Generally, people who have been in close contact with the sick person are also given antibiotic prophylaxis just in case.

In most cases, viral meningitis improves on its own within several weeks.

In any case, it cannot be cured with antibiotics.

Treatment of mild cases usually includes: bed rest; hydration; use of over-the-counter painkillers to help reduce fever and relieve muscle pain.

The doctor may also prescribe corticosteroids to reduce swelling in the brain and anticonvulsant drugs to control convulsions.

If the cause of meningitis is unknown, the doctor may start an antiviral and antibiotic treatment while the cause is determined.

Treatment for chronic meningitis is based on treating the underlying cause.

Antifungal drugs can be used to treat fungal meningitis and a combination of specific antibiotics can be used for tuberculous meningitis.

However, these drugs can have serious side effects, so treatment can be postponed until tests confirm that the cause is fungal.

Non-infectious meningitis due to allergic reaction or autoimmune disease can be treated with corticosteroids.

In some cases, no treatment may be necessary because the condition may resolve on its own.

Cancer meningitis requires specific therapy.

Vaccines available

The most effective form of prevention is vaccination.

Six vaccines are currently available:

-the Haemophilus vaccine, which is almost always administered with the single vaccine called hexavalent, which contains six different vaccines in a single syringe (DTPa, which protects against tetanus, diphtheria and pertussis; IPV or anti-polio, which protects against poliomyelitis; anti-Hib, which protects against Haemophilus influenza type B; and anti-hepatitis B, which protects against hepatitis type B). It provides for three doses: generally, at the 3rd, 5th and 11th-13th months;

-the pneumococcal vaccine PVC13, which is the most widespread, is also effective in young children and protects against the 13 most common types of pneumococcus in industrialised countries. It has three doses, which experts recommend administering at the same time as the hexavalent vaccination, but at different anatomical sites: usually at 3, 5 and 11-13 months of age;

-the 23-valent polysaccharide pneumococcal vaccine, which can only be used in children over two years old (not yet vaccinated) and adults;

-the serogroup C meningococcal conjugate vaccine (MenC), which is most commonly used in infants. It should be administered as a single dose around the age of 13 months. A dose in adolescence may then be recommended, preferably with the conjugate vaccine, which also protects against strains spread elsewhere in the world;

– the tetravalent conjugate vaccine, which protects against serogroups A, C, W and Y, to be administered in a single dose around the 13th month. It is also used for booster shots in adolescence;

– the meningococcal B vaccine, which has different dosages depending on age. Ideally, the first dose should be given at two months, followed by two more doses in the first year of life.

Adults who were not vaccinated as infants can take precautions at any time.

Vaccination is recommended in non-immunised adults at risk because they suffer from certain diseases (such as thalassaemia, diabetes, severe chronic liver disease, congenital or acquired immunodeficiencies), because they are subject to special conditions (e.g. live in boarding schools, attend discos and/or sleep in dormitories, are military recruits) or because they have to travel to areas where meningitis is common.

It is also important to observe basic rules of hygiene, such as washing hands and keeping a safe distance from those displaying suspicious symptoms.

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