What is Meningitis and how can you spot the symptoms?
Meningococcal disease can kill a healthy person of any age within hours of their first symptom. Whilst meningitis occurs in people of all ages, those most vulnerable include infants, young children and the elderly. In Ireland, four cases of meningitis and septicaemia present in hospitals each week. One out of ten of these cases are fatal, while one in three are left with the disease's life altering effects.
Meningitis is caused by inflammation of the meninges which is the lining that covers the brain and spinal cord, as well as inflammation of the cerebrospinal fluid (CSF) - the fluid that surrounds the brain and spinal cord. The infection may be caused by bacteria or viruses. Bacterial meningitis is less common than viral meningitis but all cases of suspected meningitis should be treated as bacterial until proven otherwise.
Meningitis may present with any of the following features: fever, headache, neck stiffness, back rigidity, bulging anterior fontanel (soft spot on top of a baby's head) and photophobia (sensitivity on looking at light).
Other presenting features of meningitis include: altered mental state or unconsciousness, as well as signs of shock including tachycardia (fast heart rate), hypotension (low blood pressure) and respiratory distress (laboured breathing with shortness of breath).
The onset of symptoms develops quickly, usually over hours and can occur in any particular order. It is important to note that the symptoms as mentioned above are often not so obvious in the elderly and infants.
Red Flag Symptoms
Symptoms which often occur early on, before the more classic symptoms appear, include severe leg pains which can prevent children from walking, as well as cold hands or feet, and dusky or blue colour of the skin around the lips.
A typical rash is common with meningococcal infection. It is important to note that a rash does not always occur in cases of meningitis but is characteristic when it does.
This rash, which is caused by haemorrhage (bleeding) underneath the skin's surface, involves small spots that are red or purple in colour. These spots do not fade when pressed and are demonstrated using a glass test - a clear glass is placed on one of the spots or blotches and should not disappear.
Treatment & Prognosis
The mainstay of hospital treatment involves treating the causative organism, as well as any complications incurred such as seizures, septic arthritis (invasion of a joint by an infectious agent) and pericardial effusion (an abnormal accumulation of fluid around the heart). Also, included in this group are subdural effusions (a collection of fluid beneath the outer lining of the brain), which young children are particularly vulnerable to.
Delayed complications include hearing loss or deafness, intellectual deficits and blindness as well as peripheral gangrene (death of tissue in part of the body).
The prognosis depends on the patient's age, the severity of the illness as well as the causative organism.
Patients who present with rapid onset of illness or those with severe neurological impairment on presentation have a 50-90% mortality rate. The organism with the highest mortality rate (21%) is pneumococcal meningitis.