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Meningitis is a condition where the protective membranes (meninges) covering the brain and spinal cord becomes inflamed (swollen). This usually occurs when the fluid surrounding the brain gets infected.
Meningitis usually occurs due to viral or bacterial infection. This can affect anyone but is more common in children, teenagers, or young adults.
The person typically shows symptoms of fever, headache, and stiff neck.
This is usually a serious condition which if not treated early, can lead to multiple complications affecting the brain and the body.
Encephalitis is different from meningitis– where the brain itself becomes inflamed, whereas in meningitis the protective layer covering the brain becomes inflamed.
Encephalitis is usually caused by a virus, whereas, meningitis can be caused by bacteria, virus, fungus, or by some non-infectious causes.
It was estimated that about 28 lakh people suffered from meningitis (25–33 lakh) in 2016.
It was also found that around 3.2 lakhs died from it in 2016.
India was found to have the maximum number of deaths due to the condition.
Meningitis more commonly occurs as a result of infection. It can be caused by a number of micro-organisms. If these micro-organisms enter the bloodstream and break the blood-brain barrier, they reach to the fluid surrounding the brain and the spinal cord. There, these micro-organisms multiply and result in inflammation of meninges. This leads to the development of symptoms.
These organisms can also directly enter into the brain due to head injury or surgeries and result into meningitis.
Below are the following types of meningitis caused by respective micro-organisms:
1. Bacterial meningitis: this is a common and serious condition which if left untreated can often lead to death. Bacterial infection is one of the leading causes of meningitis in India. A number of bacterias may cause this which typically affects a certain age group:
• Streptococcus pneumonias: also called pneumococcus, is the commonest bacteria to cause meningitis in infants, young children and young adults. This bacteria more often is responsible for upper and lower respiratory tract infections. When it gets access to meninges it results in meningitis. Pneumococcal vaccine can help to prevent this infection in most of the people.
• Meningococcus: is also a common type of bacteria which may cause this condition. It usually causes upper respiratory tract infection, but when it gets access to meninges it results in meningitis. This is usually common in teenagers and young adults. The bacteria is highly infectious and may also result in epidemics in places where multiple people stay together such as boarding schools, etc. This has been found to be the commonest cause in sub-Saharan Africa which is called as “meningitis belt”
• Listeria monocytogens (listeria): this bacteria commonly affects people with low immunity such as newborns, pregnant women, and old adults. The bacteria can also cross the placenta and enter the developing fetus.
• Tubercular bacteria: the bacteria (Mycobacterium tuberculosis) that causes tuberculosis in the lung if it reaches the meninges results in tubercular meningitis. This is a serious condition that causes death in 20-50% of the patients and significant neurological problems in many others. It is still one of the common infections to affect the brain affecting about 1.5 per 100000 people in India.
2. Viral meningitis: has been found to be the commonest type of meningitis. It is typically, a milder form which, mostly resolves on its own. However, viral meningitis affecting newborns (less than a month of age) and people with low immunity tends to be more serious. The commonest virus to cause meningitis in India is enteroviruses.
3. Fungal meningitis: is a rare type of meningitis and usually affects people with decreased immunity suffering from diseases like diabetes, HIV, or cancer. This condition could become life-threatening and needs anti-fungal treatment.
4. Parasitic meningitis: this type is very rare. It can be caused parasites namely angiostrongylus cantonensis, baylisascaris procyonis, and gnathostoma spinigerum. Another very rare but usually fatal type is amebic meningitis which is caused by Naegleria fowleri. This can occurs by swimming in lakes, rivers, or poorly maintained swimming pools.
Some of the following non-infectious causes may also lead to meningitis. This type of meningitis is less common than the one caused by the infection. The following are the causes:
• Systemic lupus erythematosus (lupus)
• Sarcoidosis- a long-standing inflammatory disease
• Certain medicines
• Head injury
• Brain surgery
The micro-organisms that cause meningitis usually spread from people who carry these bacterias and viruses, but themselves are not ill. Less commonly, the disease can spread from a person who is suffering from the infection.
These micro-organisms can spread through saliva, feces, nasal discharge, throat secretion by following means:
• Sharing drinks or glasses
• Sharing utensils, or cutlery
People sharing classroom, house, rooms, hostel, elevators may get infected from people carrying these micro-organisms.
Anyone can develop meningitis however certain groups of people are more prone than others.
Age: amongst children, kids below 5 years of age are more prone. It is also common in teenagers and young adults. It can also occur in elderly people due to associated multiple factors.
People with low immunity: conditions that lower immunity such as HIV, diabetes, cancer, chemotherapy, chronic alcoholism, and others.
Non vaccinated people: studies have found a higher risk in people who have not received or completed vaccination.
People living in group settings: students in boarding schools and dormitories or soldiers in military bases are at higher risk of getting meningococcal infection.
Pregnant females: are more prone to get infected from listeria due to reduced immunity.
There can be a number of signs and symptoms associated with meningitis which can appear to be similar to symptoms of common flu (influenza virus infection).
Following symptoms could be present in patients more than 2 years old.
• High fever
• Headache- severe headache or headache with nausea or vomiting
• Stiffness in the neck
• Altered sensorium- difficulty concentrating or to think clearly or altered consciousness.
• Increased sensitivity to light
• Being highly sleepy or difficult to wake
• Seizures (fits)
• Skin rashes- tiny red/pinkish rashes seen on the skin that don’t fade away on pressing with clear glass against the skin. On darker skin, these can be observed on lighter areas of the body such as palms, soles, tummy, or whites of eyes.
Amongst all the symptoms the first four symptoms namely, fever, headache, neck stiffness, and altered sensorium has been found in most of the patients of meningitis (83%).
Signs and symptoms in babies and newborns:
• Constant or high pitched cry
• Inactivity or excessive sleepiness
• Poor feeding
• Having a stiff or loose body posture or being unresponsive
• Bulging present in the soft spot on the top of the head.
A person or if someone known experiences these signs and symptoms should prompt immediate medical help as meningitis could be deadly if not treated early.
The diagnosis is done on the basis of clinical history, physical examination, lab investigations, and imaging tests:
The doctor would take a detailed history and would suspect meningitis on its basis especially if the above-discussed risk factors are present and the patient belongs to or has traveled to an endemic area.
The treatment depends on the type of meningitis and the presence of complications if any. The following treatment is generally given according to the underlying cause.
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