Meningitis refers to inflammation of protective membranes covering the brain and the spinal cord, known as meninges. This can occur after a bacterial invasion of the fluid surrounding the brain and spinal cord, causing a characteristic swelling of these membranes.
Neisseria meningitides (meningococci) are one of the bacteria that cause meningitis and septicemia (known as an invasive meningococcal disease), which is often life-threatening and can lead to outbreaks or epidemic attacks.
There are five common serogroups of Neisseria meningitides (meningococci): A, C, W, Y, and B. Until 2013, meningococcal vaccines were only available against the first four serogroups but not the later one, B. In consequence, millions of teenagers and adults are not vaccinated against serogroup B. According to the Centers for Disease Control and Prevention (CDC), about 30% of meningococcal disease cases reported in the United States in 2012 were caused by serogroup B. Currently, meningococcal vaccines against serogroup B are available through the national routine immunization programs in Ireland, Italy, the US, and the UK (Bexsero and Trumenba vaccines).
How do you catch the infection?
Meningococcal disease is a droplet infection, meaning that they spread when healthy individuals breathe in the tiny droplets of saliva splashed from an infected person via coughing, sneezing, intimate kissing, or even speaking during close contact with those infected ones. This is similar to the transmission of common cold and flu by droplets; however, it’s much more difficult.
Still, not everyone transmitting the infection is a patient. Meningococci can live in certain body parts, such as the back of the nose (the nasopharynx), without harming those carrying them. Those people can transmit the infection to the others, and, in this case, they are called asymptomatic carriers. One in 10 people worldwide is a meningococcal carrier either in the back of the nose or in the throat.
After entering the body, meningococcal bacteria migrate to the fluid around the brain and spinal cord, the CSF, to reach the meninges. They may circulate in the bloodstream, causing a widespread infection known as meningococcal septicemia. This often has awful outcomes.
What makes someone at a higher risk of getting meningitis B?
As vaccines are available for these infections, it is of utmost importance to identify high-risk people to prevent the disease.
• Age: Meningococcal B infection can affect anybody, but young children (<5 years) and the elderly (>65 years) are at higher risk.
• Genetic variation: Genetic factors control immunity and susceptibility to invasive bacterial infections. Certain molecules can alter bacterial adhesion to human tissues, recognize the immune system, and respond accordingly. Some studies outlined the association of genetic variation and total disease outcomes regarding severity and death rates.
• Underlying medical conditions: Medical conditions that weaken the immunity can increase the risk. HIV infection, primary immunodeficiency conditions, cancer, or the use of immunosuppressive drugs are all risk factors.
Patients who underwent splenectomy (surgical removal of the spleen) are at a significantly higher risk.
• Behaviors: Living in crowded community settings, for instance, overcrowded houses and dormitories, smoking, and intimate kissing with multiple partners, increase the risk of catching the infection.
What are the early signs of meningitis?
Headache: Headache is one of the earliest symptoms of acute meningitis. Patients describe it as severe, persistent, and different than usual. Headache in meningitis patients is a key sign of compression, meaning that the nerves, arteries, veins, and other structures inside the skull are under high pressure from the inflammation. It’s usually associated with blurred vision and changes in consciousness and not relieved by usual analgesics.
Fever: High-grade fever (>103°F – 39.4°C) is characteristic. In infants and young children, it may result in febrile seizures and transient loss of consciousness.
Vomiting: Projectile vomiting in meningitis is also a sign of compression. The patient propels the stomach contents far away in severe violent bursts without the usual sense of nausea usually experienced prior to the other types of vomiting.
Confusion: Unexplained confusion associated with loss of concentration and disorientation to time, place, or persons. In neonates and infants, its seen as inactivity or sluggishness.
Stiff neck: This specific sign usually appears early. The patient cannot flex the neck forward all the way, possibly due to neck muscle spasm to avoid painful stretching of the spinal cord meninges within the spine.
Sleepiness: Unexplained sleepiness or inability to wake up is usually reported, especially in neonates and young infants.
Photophobia or photosensitivity (Dislike of bright lights): This is manifested by favoring dim light and covering the eyes in bright sunlight. Infected babies may sleep prone (lying on the abdomen) to avoid bright lights. However, this sign is not as common in young children.
Skin rash: It starts as small, red spots before spreading quickly and turning into red or purple blotches. It is a sign of meningococcal septicemia (bacterial spread in the bloodstream). The rash is easier to see in the palms of hands, the soles of feet, the roof of the mouth, and inside the eyelids.
The tumbler test is a simple method to confirm the meningococcal septicemic rash if you suspect the condition. Applying a glass tumbler firmly against the rash and observing the rash through it. If it is a meningococcal septicemic rash, it will appear clearly.
Seizures: Seizures occur as an early sign in 20% of infected children either from the brain swelling or the bacterial toxins. They may be persistent and need urgent management. Several studies reported the association of poor outcomes of meningitis in adults and seizures.
Anticonvulsant therapy may be needed to prevent their recurrence.
Early Signs in newborns and Infants:
Neonates and infants show additional symptoms as refusing feeds, irritability, loud crying, unresponsiveness, and bulging soft spot on the top of their head (bulging fontanelles).
If you think you or someone you know might have meningitis, seek medical help immediately or call the emergency numbers.