Meningitis and Meningococcal Disease · Meningitis Origins Meningitis outbreaks date back to...

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Meningitis and Meningococcal Disease Essential Information

Transcript of Meningitis and Meningococcal Disease · Meningitis Origins Meningitis outbreaks date back to...

Meningitis and Meningococcal Disease Essential Information

Meningitis

OriginsMeningitis outbreaks date back to ancient times, but were first formally recorded in 1805 in Geneva. All meningitis disease is, by definition, an inflammation of the meninges, which is the thin protective membrane covering the brain and spinal cord. Most meningitis is caused by an infection in the fluid surrounding the brain and spinal cord. The infection is usually caused by bacteria, viruses, fungi, or amoeba, but the same inflammation can be caused by cancer, physical injury or certain drugs without any accompanying infection.

Meningitis is unusual in that it has so many causes. It is diagnosed primarily based on examination of the cerebral-spinal fluid (CSF) for the presence of inflammation of the meninges and the presence of microorganisms on smear and culture. Also used in the diagnosis are accompanying symptoms. Since many things can cause this inflammation, there are a wide range of investigations also for non-microorganism causes. Irrespective of the cause, meningitis is always serious, requiring immediate medical care, and can be fatal even with medical care.

Many of the microorganisms that cause meningitis are also associated with other infections/conditions. A person could have an influenza infection and be diagnosed with influenza with no meningitis. If they subsequently develop meningitis, they will be additionally diagnosed with the new condition (meningitis) even though they already have been diagnosed with influenza as the source of the infection. Because of the range of causes, there are a wide range of treatments as well, which is why it is so important for a trained physician to diagnose the cause of the meningitis, rather than just treating the symptoms. There is uncertainty as to why some microorganisms may cause meningitis in some people who are exposed, but not in others who are similarly exposed. This makes meningitis a complicated disease to understand, diagnose, and treat.

The most common bacterium to cause meningitis is Neisseria meningitidis, which is a bacterium that approximately 10% of people carry in the back of their nose and throat without having illness (colonized). When this bacterium invades the body causing infection, the person would be diagnosed as having meningococcal disease caused by Neisseria meningitidis. If this bacterial infection also caused meningitis, the patient would be diagnosed with meningococcal meningitis to show that they had meningitis caused by a meningococcal infection. Meningococcal meningitis is an illness that is often severe and includes infections of the lining of the brain, spinal cord, and/or bloodstream (meningococcemia). Because a person may be infected with Neisseria meningitis and develop illness without meningitis, having a meningococcal infection and having meningitis should always be considered as two separate conditions, making this a very serious infection.

Meningitis can be caused by a number of strains of bacteria, fungi, viruses, and at least one amoeba. The table shows organisms commonly understood to be capable of causing meningitis. However, as explained earlier, these same organisms can cause infections without presenting with meningitis.

Primary Disease Disease Subtype Organisms causing meningitis

Neisseria meningitidisStreptococcus pneumoniaeGroup B StreptococcusEscherichia coliListeria monocytogenesHaemophilus influenzae type b

Non-polio enteroviruses including enteroviruses, coxsachieviruses and echoviruses”Mumps virusHerpesviruses including herpes simplex virus, varicella zoster virus, and Epstein-Barr virusMeasles virusInfluenza viruxArboviruses including West Nile virusLymphocytic choriomeningitis virus

CryptococcusHistoplasmaBlastomycesCoccidiodesCandida

Naegleria fowleri

Men

ingi

tis

dise

ase

Bacterial Meningitis

Viral Meningitis

Fungal Meningitis

Primary Amoebic Meningoencephalitis

Organisms

Symptoms and Diagnosis Bacterial meningitis is usually severe. Complications such as brain damage, hearing loss or learning disabilities are common among survivors. Meningococcal or bacterial meningitis initial symptoms include:

Often the initial symptoms are similar to influenza (flu) and can also include additional symptoms:

Risk factors include age (infants and children <1 year of age, and young adults (16-23) are most at risk), being in a large group of people with close contact, certain medical conditions, and travel to certain areas (sub-Saharan Africa). The symptoms of meningococcal meningitis can appear suddenly or over several days, but typically develop within 3-7 days of exposure.

Many of the initial symptoms likely to present early in the illness are often seen in patients with other commonly occurring diseases, such as influenza, or can be hard to detect (especially with newborns and infants.) Newborns and infants may appear to be slow or inactive, irritable, have vomiting, or not feeding properly.

Because of the seriousness of meningitis (and a number of the complications associated with meningitis) and its ability to be fatal in as little as a few hours, medical attention should be sought immediately if there’s a concern of a person having the symptoms above, especially if it involves an infant or child. Even in non-fatal cases, permanent disabilities can occur from meningitis. Diagnosis and treatment should only be performed by a trained physician who can rule out other potential diseases.

Meningococcal disease occurs frequently in Africa, especially in sub-Saharan Africa where vaccinations are inconsistent by country (but are increasing rapidly due to WHO efforts) and outbreaks occur frequently during the dry season (between December and June.) Epidemics in Africa occur irregularly, but typically every 5-12 years.

Viral Meningitis: Similar to bacterial meningitis, viral meningitis causes an inflammation of the tissue that covers the brain and spinal cord. While viral meningitis is the most common type of meningitis, it is usually less severe than bacterial meningitis and most people recover without treatment in 7-10 days. Infants <1 year of age and the elderly are more likely to have severe illness, but children <5 years of age and persons of any age with weakened immune systems are more likely to get viral meningitis.

Common symptoms of viral meningitis in infants includes:

Common symptoms of viral meningitis in adults includes:

Initial symptoms of viral meningitis are similar to those of bacterial meningitis. Since viral meningitis is more common and generally less severe than bacterial meningitis, this may encourage people to avoid seeking medical care. However due to the potential seriousness of meningitis and meningococcal infections, it is better to seek medical care if there is a concern of meningitis and let the physician determine whether additional care or treatment is required.

• Fever• Irritability• Poor feeding

• Sleepiness or trouble waking from sleep

• Lethargy (lack of energy)• Sudden onset fever

• Headache• Stiff neck

• Fever• Headache• Stiff neck• Increased

sensitivity to light (photophobia)

• Sleepiness or trouble waking from sleep

• Nausea• Vomiting• Lack of appetite• Lethargy (lack of

energy)

• Nausea• Vomiting• Increased sensitivity

to light (photophobia)

• Rash• Confusion (altered

mental state)

Fungal Meningitis: Meningitis caused by a fungus is rare. When it does occur, it is usually because of a fungal infection in the blood that reaches the spinal cord. Cryptococcus is the most common cause of fungal meningitis and is one of the most common causes of adult meningitis in Africa.

Common symptoms of fungal meningitis in adults includes:

• Fever• Headache• Stiff neck

Because of the seriousness of fungal meningitis, medical attention should be sought immediately if a person has the symptoms above. Diagnosis should only be performed by a trained physician.

Primary amebic meningoencephalitis (PAM): PAM is a very rare form of parasitic meningitis that causes a brain infection which is usually fatal. The most common parasite causing meningitis, Naegleria fowleri, enters the body through the nose, which typically occurs when people go swimming in lakes and rivers in warmer areas. Initial symptoms of PAM start 1-7 days after infection. Initial symptoms include:

Later symptoms include:

PAM is rare, but generally fatal within 5 days (range of 1 to 12 days after the start of symptoms.) Medical attention should be sought immediately if a person has the symptoms above, especially if they have been in freshwater recently.

Non-Infectious Meningitis: This type of meningitis is not spread at all from person to person and can develop as a result of:

Common symptoms of non-infectious meningitis includes: • Fever• Headache• Stiff neck

These symptoms are often accompanied by:

• Nausea and vomiting• Increased sensitivity to light (photophobia)• Altered mental state (confusion)

Method of Transmission/ContagiousnessBecause there are many causes of meningitis, the method of transmission varies. Note that person to person transmission can occur for some of the bacterial microorganisms that cause meningitis, but this is not the case for all microorganisms that cause meningitis. Since meningitis is a complication for a number of infectious diseases (meaning meningitis occurs with a low frequency), a person with meningitis can infect a person with whom they have had close personal contact and for this second person to develop an infection but to not develop meningitis as well. However after any close personal contact with a person diagnosed with meningitis, the second person should consult their physician to see if further care or treatment is recommended.

Bacterial meningitis: Neisseria meningitidis can be spread from person to person through respiratory secretions and throat secretions (saliva, sputum, etc.), but other bacteria that can cause meningitis are rarely spread this way. As many as 10% of people carry the bacteria Neisseria meningitidis in their nose or throat without becoming sick. Close lengthy contact, such as living in the same house, increases the chance of passing Neisseria meningitidis from person to person, but this bacteria is not spread by casual contact, such as breathing the same air. Shared dishware, poor respiratory hygiene, and sexual contact (such as kissing) increase the risk of person to person transmission of Neisseria meningitidis. According to the CDC, viruses that cause colds and the flu are considered much more contagious and cause more meningitis than the bacteria that can cause meningitis, but bacterial meningitis is generally more severe than viral meningitis.

• Nausea and vomiting• Increased sensitivity to

light (photophobia)• Altered mental state

(confusion)

• Fever• Headache

• Stiff neck• Nausea and vomiting

• Altered mental state (confusion)

• Lack of awareness of people and surroundings

• Loss of balance• Seizures• Hallucinations

• Certain cancers• Systemic lupus

erythematosus (lupus)

• Certain drugs• Head injury• Brain surgery

References and useful websites

PreventionVaccination: Vaccines for meningococcal disease caused by Neisseria meningitidis are widely available and are the best defense against meningococcal disease. While no vaccine is 100% effective, being vaccinated significantly reduces the chances of getting meningococcal disease. Because the immunity decreases over time, people should receive boosters at regular intervals. Vaccinations are available for some of the viral infections that can cause meningitis, but not for non-polio enteroviruses, which are the most common cause of viral meningitis.

Antibiotics: People that have been in close personal contact with a person with meningococcal disease and certain other bacterial causes (i.e. Streptococcus pneumoniae and Haemophilus influenzae type b) will generally be given antibiotics to provide protection (prophylactic antibiotics). Prophylaxis is not indicated for all bacteria that might cause meningitis. Antibiotics provide no benefit if the person has viral meningitis. Seek out your physician’s advice if someone you have had closer personal contact with is diagnosed with meningococcal disease or meningitis irrespective of the source.

Reduce Contact: Non-immunized people should avoid or minimize contact with people who have an active meningococcal/bacterial meningitis infection. If around an infected person, avoid coming in contact with their respiratory secretions (saliva) or touching your eyes, nose, and mouth. Frequent hand hygiene can help prevent infection for some of the microorganisms that can cause meningitis.

Transmission Based Precautions: Use of transmission based precautions in a hospital when a person infected with meningitis is being treated will be based on the pathogen involved. If the pathogen is bacterial, the person may be placed on contact precautions. If the pathogen is viral, the person may be placed on contact and droplet precautions. In some cases, only standard precautions will be used if the microorganism is not believed to be spread by person to person contact.

Hand Hygiene: While the microorganisms that cause meningitis and meningococcal disease are not all believed to be primarily spread through “hand to hand” or “hand to surface to hand” contact, it can be a route of other infections for a number of these microorganisms. Frequent hand washing with soap and water or the use of alcohol hand gel reduces the risk of this type of transmission. For viral meningitis, performing hand hygiene frequently is believed to help prevent transmission of viruses that can cause infections leading to meningitis, especially after changing diapers, using the toilet, or coughing or blowing your nose.

Respiratory Hygiene: People with meningitis or meningococcal disease should cover their mouth with a tissue or use their elbow when they cough or sneeze. Dispose of the tissue once used. They should wash their hands or use alcohol hand gel after sneezing or coughing. As the bacteria and viruses that cause meningitis can be transmitted via respiratory droplets for certain microorganisms, infected people should take steps to protect those around them, especially if the source of the meningitis is not known (do not kiss or share eating utensils, cigarettes, or common drinking vessels).

Surface Cleaning/Disinfection: Whether the microorganisms that are most associated with meningitis are transmitted via environmental surfaces varies by organism, but for certain organisms, environmental surfaces are a potential source of transmission of the causative microorganisms, most commonly for viral meningitis. An environmental hygiene program should always include regular cleaning and disinfection of commonly touched environmental surfaces (door handles, light switches, elevator buttons, keyboards, phone, etc.) because the microorganisms can live for several hours on environmental surfaces and the risk posed by environmental surfaces can be reduced through proper cleaning and disinfection. When cleaning and disinfecting, avoid spraying or splashing as this can further spread microorganisms.

Protocol for Sick Staff Members: Staff members with meningitis or meningococcal infections should stay away from work until cleared by a doctor to return.

Good Health Practices: Practicing good health is also helpful in preventing the development of many illnesses. The strength of a person’s immune system is often related to their overall health. Get plenty of sleep, eat healthy, avoid smoking or being around cigarette smoke, be physically active, manage stress, and drink plenty of fluids to keep your immune system strong.

Vector Control: Mosquitoes and other insects can transmit pathogens from person to person. Avoid bites from mosquitoes and other insects. Mice and rats can also contribute to the spread of some microorganisms that can cause infections resulting in meningitis. Control rodents in the home or in public buildings, using a professional pest control company if needed.

Much of the Information used in the development of this brochure was taken from the sites listed below.

http://www.cdc.gov/meningitis/index.htmlhttp://www.who.int/mediacentre/factsheets/fs141/en/

This brochure is intended for informational purposes only. This brochure is not a substitute for medical advice or medical care from a trained physician. Consult your physician for more information.

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