Spinal meningitis, also called meningitis, is an inflammation of the membranes (protective layer) around both the brain and spinal cord. Infectious and non-infectious agents can cause this type of inflammation, leading to severe consequences up to death. This disease is so fatal that the CDC has made the 24th of April the world meningitis day. The aim of this day has many purposes. Still, the most important is to teach people how to deal with the after-effects of meningitis, which varies according to the severity of the case. It also increases awareness about the importance of vaccination and enhances the recognition of the signs and symptoms of meningitis. Meningitis is more common than you think; this devastating disease affects more than 2.8 million people every year.
Causes of meningitis
Infectious causes are the most frequent cause of spinal meningitis. Infection means that there is an external agent that caused it to happen. This infectious agent might be bacteria, viruses, fungus, parasites, or even amebic meningitis.
The most serious is bacterial meningitis because the bacteria that cause meningitis are virulent, meaning that it has many biological weapons coded in its DNA and is ready for usage when it starts the infection. Most of the bacteria that cause meningitis harbor in the respiratory tract, allowing them to spread more rapidly and infect many others. Bacteria that cause meningitis can spread with close contact; this leads to the rapid turning of the situation into an epidemic (it is the case when there are many cases than usual in a specific period).
The most common type is viral meningitis because viruses are even easier to spread, mainly in the autumn and winter seasons. Although viral meningitis is the most common form with incidence rate reaching up to 11 people in every 100,000 people in some reports, it is less severe than bacterial meningitis, and the patients can even recover without medical treatment.
Other rare forms of infectious meningitis are fungal and parasitic meningitis. Inhaling spores of specific types of fungus can cause fungal meningitis in the susceptible population. Because fungal meningitis mainly affects the individual with a weak immune system, it mostly leads to death in those individuals. The treatment of fungal meningitis is also unspecific and, by itself, causes a lot of damage to the patient; all of those reasons increase the rate of mortality of fungal meningitis. The even more rare type of meningitis is parasitic meningitis. It requires particular circumstances, mainly eating infected animal meats with those parasites.
Amebic meningitis is a select category because the ameba that causes it lives mainly soil and warm freshwater. This limits the infection to happen only during swimming in the water, and even not any water. Naegleria fowleri, the ameba that causes amebic meningitis, does not live in salt water, so you will not get infected if you swim in any ocean. Even drinking contaminated water with Naegleria fowleri will not cause an infection. For all of those reasons, the rate of infection by amebic meningitis is shallow. From 1962–2018, there were not more than eight cases per year, and the total number does not exceed 145 cases in all of the United States.
The most surprising causes of meningitis are non-infectious. Many of us think that you can only get meningitis only when you are infected by one of the agents mentioned above. However, for your surprise, you can get inflammation in your meningitis by cancer, head injury, immune disease like systemic lupus erythematosus, and even some medications can cause meningitis. All the signs are the same as the classically known meningitis that will have its paragraph.
Risk factors
We talked a lot about the cause of meningitis in the previous paragraph. It is now time to talk about the secret ingredient that mainly determines the course of the disease and, even in many cases, whether the infection will occur or not. The risk factors are specific features present in the individual that make him or her more susceptible to infection.
Here are the famous risk factors for meningitis:
» Age: This is the famous risk factor for any disease; being too old or too young makes your immune system not qualified to stop the infection from occurring. Babies still have not a well-developed immune system, and older adults with fragile health have a weakened immune system for many reasons. Getting old, T lymphocytes’ function decreases, the number of antibodies decreases, affects all of the aspects of the immune system, and macrophages become slower. Old age also comes with a disease that contributes to the state of low immunity like diabetes.
» Certain medical conditions: Being free from disease will make your immune system available and ready for any upcoming infection; this will lower your risk of getting an infection, in this case, by meningitis. On the other hand, the risk is higher if you have a medical condition that affects your immune system like diabetes or take a particular medication that has the same effect of lowering your body’s ability to fight the infection like chemotherapy. It is also higher if you have a medical condition that by itself can cause inflammation in different parts of your body which includes the meninges.
» Proximity: Staying near an infected person with meningitis will increase the probability of getting meningitis. Many people do not choose to be near an infected person, but they are obliged to do. This is especially true for low-socioeconomic people who live in very crowded slums, facilitating the spread of meningitis. Low income and social insecurity will also cause your immune system to become vulnerable, as you do not get enough nutrients to work in the optimal condition. Low awareness also increases the risk of infection, as people will not have a clue about the cause of the symptoms their child has. Even worse, they will start to treat the symptoms with very primitive and unscientific methods, so the mortality rate for meningitis is very high in African countries.
The spread of meningitis
Most of the agents that cause infectious meningitis spread through close contact. Many of them live in the respiratory tract; this makes it easy to travel from one person to another very rapidly, causing epidemics. Some people carry the bacteria that cause bacterial meningitis in their nose and throat without getting an infection. Carriers those carrying the infectious agent but without showing any signs or symptoms of the disease. Carriers are very dangerous; they can spread the infection without being noticed or getting treatment.
There are still particular types of meningitis that spread in unique ways. Pregnant mothers can infect their babies with Group B Streptococcus and E. coli during delivery. Eating contaminated food with E. coli or L. monocytogenes can lead to meningitis. The infection can even start from inside the body, as in the case of Candida, a special type of fungus that lives inside the body peacefully when you have a normal immune system. When your immune system becomes compromised, Candida starts to be fatal and may cause fungal meningitis. As previously mentioned, you can get meningitis by swimming in water contaminated with Naegleria fowleri, which will take your nose as a way to your brain, where it will cause amebic meningitis. You can get meningitis by non-infectious causes mentioned before. Non-infectious meningitis cannot spread from one person to another.
Symptoms and signs
The symptoms are what the patient feels when he has the disease, and the signs are what the doctor finds when he examines the patient.
The symptoms of meningitis are almost the same whatever its type, and it is similar to the symptoms of the common cold and other respiratory diseases, especially at the beginning. This is why many patients delay seeking medical care until the alarming symptoms or signs of the disease appear.
The common symptoms and signs include:
- Fever
- Headache
- Poor eating
- Sleepiness
- Lethargy
- Nausea
The alarming symptoms and signs of meningitis include:
- Stiff neck
- Projectile vomiting
- Photophobia (sensitivity to light)
- Confusion
- Seizures
- Hallucinations
The doctor will take the symptoms and signs, and the history provided by the patient or his family into account while forming a differential diagnosis list. The differential diagnosis list is the diseases that may have the same signs and symptoms and history that the patients are showing. Doctors will begin thorough examination and tests to determine the definitive diagnosis for the case.
Make sure to provide the doctor with accurate information to get the best medical care possible.
Diagnosis and treatment
Diagnosis usually requires samples from the blood and spinal cord. The doctors may also ask for the respiratory swab to exclude bacterial meningitis from the diagnosis.
According to the diagnosis, the treatment will be determined.
If you have bacterial meningitis, the doctor will order the appropriate antibiotics for your case and prophylactic antibiotics to all the people who have had contact with you. This is very important to prevent the spread of the meningitis bacteria and stop the epidemics before beginning.
If you have viral meningitis, you will usually require no treatment, and the doctors will ask you to rest for around a week until complete recovery. If the case is severe, the doctors may order antiviral therapy; to help your body fight the infection.
If you have fungal meningitis, doctors will immediately start you with a long antifungal treatment course by intravenous access. The duration of the treatment will depend mainly on your immune system status.
There is no specific treatment for parasitic meningitis; the doctors will order you symptomatic treatments for your system until your body recovers.
Amebic meningitis is fatal in almost all cases; the treatment present until today is not effective against the disease’s fatality. Among the 34 infected persons with the condition in the United States, only three survived.
The treatment of non-infectious meningitis mainly aims to treat the disease or improve the condition that leads to this inflammation.
Prevention
Prevention is better than cure. This is especially true in meningitis; the disease is fatal in a very short time. For this, the WHO does its best to spread the vaccines for bacterial meningitis because it is the most lethal and very common worldwide.
There are three types of the vaccine in the case of bacterial meningitis:
- Meningococcal vaccine effective against Neisseria meningitis
- Pneumococcal vaccines effective against S. pneumonia
- Hib vaccines effective against Hib
These vaccines do not work against all of the strains; this is why you can still get bacterial meningitis even if you are fully vaccinated. Nevertheless, this chance is low compared to non-vaccinated individuals.
Pregnant females take antibiotics against group B streptococcus if they are positive during pregnancy.
Pregnant females should be aware of eating certain types of foods to avoid infection by listeria.
There are vaccines against many viruses that may cause viral meningitis like mumps, measles, and influenza.
There are no specific precautions against other types of meningitis, but you can generally protect yourself by:
- Avoid close contact with any sick patient
- Stay clean and hygienic
- Take appropriate precautions when swimming in warm water
- Eat healthy food
- Take care of your immune system
- Make sure to visit the doctor if you have any concerns about the state of your body