MENINGITIS
«In acute bacterial meningitis, a delay in diagnosis and in the beginning of antibiotic treatment can involve serious sequels and even death,» «In meningitis, especially in bacterial ones, every minute counts.» Hence the importance of detecting this disease in time.
Signs that warn of meningitis
Piñeiro describes the symptoms of meningitis according to the stage of the disease:
The initial signs and symptoms of meningitis are common to many other banal pediatric diseases: fever, vomiting, headache, diarrhea, chills, and malaise, muscle aches … Symptomatology so nonspecific in its early stages makes this serious disease virtually indistinguishable from any other current clinical picture.
Subsequently, as meningitis develops, the classic meningeal signs appear, mainly expressed by a stiff neck with intense pain when mobilized, and vomiting ‘in shotguns’, that is, projective and without previous nausea.
Progressively lethargy, stupor, serious involvement of the general condition and seizures may appear. The famous petehiae, tiny reddish spots that do not disappear when stretching the skin, are not specific to meningitis. In fact, the most frequent cause of the appearance of these small spots is a viral infection. However, if these lesions increase rapidly, they are suggestive of the development of bacterial meningitis.
Other clinical manifestations that can alert us to meningitis, such as photophobia (excessive sensitivity to light), altered level of consciousness, seizures and other neurological symptoms and signs.
In infants (children under two years old), the clinical manifestations may be high fever, excessive drowsiness or irritability, inactivity, constant crying and feeding rejection.
The elderly can only present altered level of consciousness, without fever or neck stiffness.
Infectious meningitis can be viral, bacterial and fungal
“Meningitis consists of an inflammation of the membranes (meninges) that surround the brain and spinal cord. It usually, but not always, they have an infectious cause. ”
Within meningitis of infectious cause we can distinguish between those produced by viruses, those of bacterial origin and those caused by fungi (more rare). Viral meningitis are benign and usually resolve spontaneously in a matter of days, leaving, in general, a lower rate of complications.
Bacterial meningitis are serious and require urgent antibiotic treatment. Those that enter the bloodstream and travel to the brain and spinal cord can cause acute bacterial meningitis. Meningitis can also manifest itself when bacteria directly invade the meninges from a location located in the neighborhood, such as an ear or sinus infection, a skull fracture or, in rare cases, after some surgeries.
“Pneumococcus and meningococcus are the bacteria responsible for more than half of the acute meningitis in Spain. Pneumococcus is the most common cause of bacterial meningitis in infants, young children and adults. Meningococcal meningitis is a very contagious infection that mainly affects adolescents and young adults. It can cause a local epidemic in schools, residences, boarding schools and similar centers. ”
“The prognosis of bacterial meningitis also depends on the causative bacteria and the host response, but the overall mortality and morbidity figures are high, often regardless of the treatment used. Depending on the age of the child, mortality can vary between 10 and 30 percent, and the sequel among survivors can be as severe as, for example, limb amputation, neurological problems or kidney failure. ”
The importance of detecting meningitis in time
In the case of acute bacterial meningitis, a delay in diagnosis and in the establishment of antibiotic treatment can involve serious sequel and even death. That is why, “in the case of suspicion of an acute meningitis of bacterial origin, we must initiate urgent intravenous antibiotic treatment, even before performing diagnostic lumbar puncture. At first, broad-spectrum antibiotics are used and, subsequently, when the results of the culture and antibiogram are available, the treatment is adjusted to the identified agent.
Meningitis is a difficult disease to diagnose in its initial stages – where treatment would be much more effective, and easy to diagnose once it has developed – a time when therapy is already less effective. In meningitis, especially in bacteria ones, every minute counts.
For this reason, the pediatrician continues, the vaccines that exist today are so important that they constitute the most effective preventive measure to avoid the development of bacterial meningitis. Among them, the ones financed in Spain stand out: pneumococcus, Haemophilus influenzae and meningococcus C. In addition, “there are others not funded that pediatricians will never tire of recommending and fighting to be included in the funded calendar. The latter would be the vaccine that protects against meningococcus B and a tetravalent vaccine that protects against four other meningococcal serotypes: A, C, W and Y. None of them has demonstrated a hundred percent protection, but currently they constitute the measure most effective preventive”.
Risks and complications of a delay in diagnosis
“Bacterial meningitis is serious and can be fatal in a few days without proper antibiotic treatment. The delay in diagnosis and treatment increases the risk of permanent brain damage or death. ”
Complications of meningitis include cerebral edema, hydrocephalus, venous sinus thrombosis, cranial nerve paralysis, epileptic seizures, septic shock, and kidneys failure, among others.
With proper treatment, administered on time, even patients with potentially serious meningitis can have a good recovery without sequel.
The fundamental problem of bacterial meningitis is that during the first hours of the disease the child can present excellent general condition and simulate any banal disease. However, in a matter of hours, the clinical picture worsens sharply, developing a serious illness. Early diagnosis is complex, even by the best pediatricians in our country. These paintings are called fulminant because they are like that, of sudden and unexpected evolution. And nobody is usually to blame; neither the pediatrician who failed to see him on time, nor the family he consulted too late. ”
What other diseases can be confused with?
“The first symptoms of meningitis can be nonspecific and be confused with those that can occur at the onset of a flu, for example. However, the appearance of severe headache – different from the usual – vomiting ‘in shotguns’ and the stiffness of the neck muscles should alert us that it can be a meningitis. Before the appearance of these symptoms we must consult in the Emergency Department of our nearest center, “ Fernández Matarrubia says.
Piñeiro adds that in the initial stages of meningitis it can be confused with anyone: upper respiratory tract infection (cold), flu, gastroenteritis … In advanced stages, the diagnosis usually offers no doubt.
Measures to prevent the transmission
Should we take measures of some type in the family or school to avoid contagion when a case of meningitis is diagnosed? “Only in the case of bacterial meningitis. Depending on the number of cases diagnosed and whether or not they belong to the same class, there are a number of antibiotic prophylaxis guidelines to try to prevent the spread or development of the disease. In cases of viral meningitis, the only possible preventive measure is hand washing. For viral, there are no vaccines available either. ”
«The prevention of bacterial meningitis is done through two main measures: vaccination and chemoprophylaxis.»
With vaccination, the individual is immunized against a germ and thus avoid acquiring the infection. The inclusion of conjugate vaccines against pneumococcus, meningococcus C and type b Haemophilus influenzae in systematic vaccination schedules has caused a significant decrease in the incidence of these diseases.
Chemoprophylaxis consist of the administration of an antibiotic for short periods of time to people who have been in contact with a patient diagnosed with meningitis. Not all types of meningitis require antibiotic prophylaxis for contacts, specifically pneumococcal meningitis (the most common type of meningitis) does not require chemoprophylaxis. However, close contacts of patients with invasive meningococcal disease are more likely to contract the disease within the next seven days, so chemoprophylaxis will be indicated in certain cases.
In the event that a case of meningococcal meningitis has been diagnosed, all those who have had close contact with the “index case” in the previous seven days should take antibiotic prophylaxis.
What is meant by close contact?
Having had a prolonged contact (eight hours or more) and also close (90 cm is the general limit established for the spread of large droplets) with the case of meningococcal meningitis or who have been directly exposed to the patient’s oral secretions (for example, when kissing in the mouth, performing mouth-to-mouth resuscitation maneuvers, etc.) during the week before the onset of symptoms and up to 24 hours after the start of antibiotic treatment.
This group would include all members of the household (or comparable contexts such as shared flats), classmates, members and nursery classrooms or nursery schools.
«It would not be justified, however, to administer chemoprophylaxis to all students who attend the same class or Primary, High School and university education Center, unless they have had close contact with the case.»
For more information, visit your doctor; not self-medicate; or write us.