WHAT IS MENINGITIS?

Meningitis means inflammation of the meninges, the membranes covering the brain. It is caused by several different types of germs, some called bacteria and other viruses.

WHAT IS THE DIFFERENCE BETWEEN BACTERIAL AND VIRAL MENINGITIS?

Bacteria meningitis is more serious than viral meningitis. In about one in ten cases it will be fatal, in about one in seven cases it will cause long term after-affects such as deafness and brain damage. Bacterial Meningitis will respond to antibiotics, but to be effective these must be given as quickly as possible, making early diagnosis essential. Viral Meningitis is less serious than Bacterial Meningitis, only in exceptional circumstances is it fatal. Normally recovery is complete, but symptoms such as tiredness, headache and depression may persist or recur.

HOW MANY DIFFERENT FORMS OF BACTERIAL MENINGITIS ARE THERE?

There are many different forms of bacteria which cause meningitis but most of them are quite rare. The three main types which account for about 75% of all cases in the U.K. are: Meningococcal, Pneumococcal and Haemophilus influenzae.

• Pneumococcal - Usually seen in older adults and small children. It is not prevalent as the Meningococcal or Haemophilus strains, but has a high mortality rate of approximately 20%.
• Haemophilus influenzae - Haemophilus influenzae meningitis is rare above the age of 5. Most cases occur between 3 months and 3/4 years of age. It has a lower death rate but higher complication rate than Meningococcal strains.
• Neonatal Meningitis - Means Meningitis in newborn babies. Fatality rates can be as high as 50%. Streptococcal and E.coli are the most common.
• Streptococcl and E.Coli - These types of meningitis can cause difficulty in feeding. These can also be fever, convulsions and rapid breathing in the newborn. The bacteria usually comes from the mother during delivery. Infection from the nursery environment can occur but is less common.
• Listeria - Meningitis due to Listeria Monocytogenes is rare. It can occur in adults with low resistance to the disease although new born babies are most at risk. Listeria is widespread in the environment e.g. soil. The germs are found in animals and birds as well as humans and, more recently there have been reports of Listeria in some food products, such as salads, soft cheese and pate.
• Tuberculosis - Tuberculosis is no longer a common disease in the U.K. Tuberculosis Meningitis is rare.
• Leptospirosis - Seen sporadically throughout the country as a result of contact with lake, river or canal water. Infection often causes Flu like illness and occasionally Meningitis and/or Jaundice.
• Septicaemia - Bloodstream infection often preceeds meningitis. Patients with Meningitis may die from the Septicaemia rather than from the Meningitis itself.

HOW MANY DIFFERENT FORMS OF VIRAL MENINGITIS ARE THERE?

There are many different types of viruses which cause Meningitis. The majority are rare in the U.K. The most common are: Mumps,Coxsackie and Echoviruses. Meningitis can sometimes complicate infection by Herpes Simplex, Measles, Polio and Chickenpox. The different forms are:

• Mumps Meningitis - Mumps Meningitis is a common complication of Mumps. It is generally not serious but does sometimes cause permanent deafness.
• Coxsackie and Echovirus Meningitis - With the Mumps type these two groups of viral Meningitis are the most common.
• Herpes Simplex - Herpes Simplex can occasionally cause Viral Meningitis. The virus is spread by contact with infected skin sores and saliva. Rarely does the virus cause more severe complications.

HOW IS MENINGITIS SPREAD?

The way Meningitis spreads depends on the organism involved. Droplet infection is most common. The young baby may be infected by its mother, while rare infections such as Leptospirosis are caused by contact with contaminated water. People can carry the germ for days, weeks or months without feeling unwell. Being a carrier actually helps to boost natural immunity. Only rarely do the bacteria overcome the body's defences and cause Meningitis. The incubation period of the disease is between two and ten days after infection.

WHERE DOES THE MENINGOCOCCAL BACTERIUM COME FROM?

It's around all the time. One of the strange things about it is that it can live happily in the back of people's throats without doing any harm at all. Then, when circumstances change, it can invade the body, infect the Meninges and cause Meningitis. One person in every ten carries the bacterium in their throat. What we don't understand clearly yet is what causes the change from a harmless bacterium in your throat to a bacterium causing a very severe illness. It seems likely there needs to be some additional factor that encourages the bacterium to cause illness in certain people at certain times, what this factor is we don't yet know - but we will.

WHO GETS MENINGOCOCCAL MENINGITIS?

Most commonly it is children aged under 5 years, there is also a quite high attack rate in teenagers and early twenties. It is most dangerous to young children.

HOW LONG DOES THE ILLNESS TAKE TO DEVELOP?

The illness may progress over one or two days but it can sometimes develop in a matter of hours. Not all of the signs and symptoms mentioned above may occur at once, but someone with Meningitis will become VERY ILL.

HOW WOULD SOMEBODY KNOW THEY WERE GETTING MENINGOCOCCAL MENINGITIS?

In the early stages it is very like getting Flu - the person feels off colour; then they develop a high temperature, a fever. In babies they may become irritable, hey don't take their food and may vomit. As the disease develops the patient gets a headache and often a stiff neck - this is because of inflammation involving the lining around the brain. One of the things about Meningococcal Meningitis is that it can produce a rash. It is a very important symptom to look out for. The rash is typically like groups of little purple dots just under the skin, anywhere on the body. They can be very faint and barely noticeable, sometimes the dots merge into bruise-like marks.

WHAT HAPPENS THEN?

The worrying thing about the Meningococcus is that it can kill. Sometimes the bacteria grows very very rapidly in the blood - even before it gets to the brain lining - and this is called septicaemia (blood poisoning). This septicaemia causes damage to many internal organs in the body and the patient can collapse and die in a matter of hours, if not treated properly.

This is why Meningococcal Meningitis is so very frightening, and why we must take it so very, very seriously.

WHAT CAN WE DO ABOUT IT?

The important thing, for parents especially, is to be vigilant and get medical help quickly. If your chid becomes unwell with a temperature, and you don't think it's like the usual cold or snuffles the child gets, then ask the doctor to see him quickly or take him to a casualty department. It may be that the child has to go to hospital for tests but, if it is Meningitis, acting quickly may save his life. Meningitis can be cured with Antibiotics if they aer given early enough; so, if you're worried about your child - don't wait, get help immediately.

CAN OTHER PEOPLE GET MENINGOCOCCAL MENINGITIS FROM CONTACT WITH A PATIENT? IS IT CONTAGIOUS?

Because the bacteria lives in the back of the throat it can be spread by droplets from coughs and sneezes. In fact, though, the Meningococcus doesn't travel well, you need to be in very close and regular contact with a case before you become at risk of picking it up. Usually only members of the same family living in the same house are at risk.

SHOULD EVERYBODY WHO HAS BEEN IN CONTACT WITH MENINGOCOCCAL MENINGITIS RECEIVE ANTIBIOTICS?

No. The only people who are at risk are the immediate family and "kissing contacts", and they are the only people who need Antibiotics. If you think you have been in contact with a Meningitis case, talk it over with your GP.

IS THIS DISEASE BECOMING MORE COMMON?

Most infectious diseases, like Flu, Measles and Whooping cough run in cycles with peaks occuring every few years. Meningococcal Meningitis is the same, it has been building up again over the last three years.