What you need to know about meningitis

Meningitis is an inflammation of the membranes (meninges) surrounding your brain and spinal cord.

This inflammation typically triggers symptoms such as headache, fever and a stiff neck. It can be caused by a viral, bacterial or fungal infection.

Some cases can improve without treatment in a few weeks. Others can be life-threatening and require hospitalisation and emergency antibiotic treatment.

Consult your doctor immediately if you suspect you have it. Early treatment will prevent serious complications. Delayed treatment increases the risk of brain damage or death.

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

Symptoms

• Fever.
• Severe, nonimproving headache.
• Confusion.
• Vomiting.
• Stiff neck.

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Causes

Viral infections are the most common cause, followed by bacterial infections and, rarely, fungal infections. Because bacterial infections can be life-threatening, identifying the cause is essential.

Bacterial meningitis

Bacteria that enters the bloodstream and travels to the brain and spinal cord cause acute bacterial meningitis. But it can also occur when bacteria directly invade the meninges. This may be caused by an ear or sinus infection, a skull fracture, or after surgery. Several strains can cause acute bacterial meningitis, most commonly:

• Streptococcus pneumoniae (pneumococcus). The most common cause of bacterial meningitis. It more commonly causes pneumonia or ear or sinus infections. There is a vaccine.

• Neisseria meningitidis (meningococcus). These bacteria commonly cause an upper-respiratory infection but can cause meningococcal meningitis when they enter the bloodstream. This is a highly contagious infection that affects teenagers and young adults. It may cause local epidemics in college residences, boarding schools and military bases. A vaccine can help prevent infection.

• Haemophilus influenzae (haemophilus). Haemophilus influenzae type b (Hib) bacterium was once the leading cause of bacterial meningitis in children. Vaccines have helped.

• Listeria monocytogenes (listeria). These bacteria can be found in unpasteurized cheeses, hot dogs and luncheon meats. Pregnant women, newborns, older adults and people with weakened immune systems are most susceptible. Listeria can cross the placental barrier and infections in late pregnancy may be fatal to the baby.

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Viral meningitis

Viral meningitis is usually mild and often clears on its own. Most cases are caused by viruses known as enteroviruses, which are most common in late summer and early fall. Viruses such as herpes simplex virus, HIV, mumps, West Nile virus and others also can cause viral meningitis.

Chronic meningitis

Slow-growing organisms (such as fungi and Mycobacterium tuberculosis) that invade the membranes and fluid surrounding your brain cause chronic meningitis. Chronic meningitis develops over two weeks or more. The symptoms – headaches, fever, vomiting and mental cloudiness – are similar to acute meningitis.

Fungal meningitis

Fungal meningitis is relatively uncommon and causes chronic meningitis. It may mimic acute bacterial meningitis. Fungal meningitis isn’t contagious. Cryptococcal meningitis is a common fungal form of the disease that affects people with immune deficiencies, such as Aids. It’s life-threatening if not treated with an antifungal medication.

Other meningitis causes

Meningitis can also result from noninfectious causes, such as chemical reactions, drug allergies, some types of cancer and inflammatory diseases.

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Treatment

Bacterial meningitis

Acute bacterial meningitis must be treated immediately with intravenous antibiotics and, morerecently, corticosteroids. Your doctor may drain infected sinuses or mastoids.

Viral meningitis

Antibiotics cannot cure viral meningitis and most cases improve on their own. Treatment usually includes:

• Bed rest.
• Plenty of fluids.
• Over-the-counter pain medications to reduce fever and relieve aches.
• Corticosteroids to reduce swelling in the brain.
• Anticonvulsant medication to control seizures.
• An antiviral medication for herpes virus induced meningitis.

Other types of meningitis

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

Antifungal medications treat fungal meningitis and a combination of specific antibiotics can treat tuberculous meningitis. However, these medications can have serious side-effects, so treatment may be deferred until a laboratory can confirm that the cause is fungal.

Noninfectious meningitis due to allergic reaction or autoimmune disease may be treated with corticosteroids. In some cases no treatment may be required, because the condition can resolve on its own.

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