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The Facts About Meningitis: Bacterial, Viral and Fungal

WHAT IS MENINGITIS?There are three different types of meningitis:  bacterial, viral and fungal.  This article explores the signs and symptoms, causes, transmission, and treatments for all three types.  Meningitis refers to inflammation and swelling of the tissue that covers the brain (the meninges). The most common and worrisome cause of this is an infection within the cerebrospinal fluid (the fluid enclosed by the meninges) from a virus or bacteria. Sometimes the infection is within the substance of the brain too (meningoencephalitis). Bacterial meningitis can be fulminant, meaning, the infection can escalate within a few hours to rapidly become life threatening. If the cause is a virus it is generally much less severe and rarely life-threatening. There are chronic forms of meningeal infection that are not as immediately dangerous but that still require evaluation and treatment.

WHAT ARE THE SIGNS AND SYMPTOMS OF MENINGITIS?

General:  Meningitis infection is characterized by a sudden onset of fever, headache, and stiff neck, and may be accompanied by other symptoms, such as:

• Nausea
• Vomiting
• Photophobia (sensitivity to light)
• Altered mental status

Bacterial meningitis:  The symptoms of bacterial meningitis can appear quickly or over several days.  Typically they develop within 3-7 days after exposure.  Infants younger than one month old are at a higher risk for severe infection. In newborns and infants, the classic symptoms (fever, headache, and neck stiffness) may be absent or difficult to notice. Instead the infant may appear to be slow or inactive, irritable, vomiting or feeding poorly. In young children, doctors also look at the child’s reflexes, which can also be a sign of meningitis.

Although the early symptoms of viral meningitis and bacterial meningitis may be similar, later symptoms of bacterial meningitis can be very severe (e.g., seizures, coma).

Meningococcemia:  This is the more dangerous and deadly of bacterial meningitis and is caused by bacteria called Neisseria meningitidis. When these bacteria enter the bloodstream and multiply, they damage the walls of the blood vessels and cause bleeding into the skin and organs.   Symptoms may include fever, fatigue, vomiting, cold hands and feet, cold chills, severe aches or pain in the muscles, joints, chest or abdomen, rapid breathing, diarrhea — and, in the later stages, rashes.  Meningococcemia is very serious and can be fatal. In fatal cases, deaths can occur in hours.

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Viral meningitis:
  Viral meningitis is an infection of the meninges (the covering of the brain and spinal cord) that is caused by a virus. Enteroviruses are the most common cause of viral meningitis.  It is usually less severe than bacterial meningitis and normally clears up in 7 to 10 days without specific treatment.

The symptoms of viral meningitis are similar to those for bacterial meningitis, which can be fatal. Because of this, it is important to see a healthcare provider right away if you think you or your child right have meningitis.  Symptoms of viral meningitis in adults may differ from those in babies and children.

Common symptoms in babies and children:

• Fever
• Irritability
• Poor eating
• Hard to awaken

Common symptoms in adults:

• High fever
• Severe headache
• Stiff neck
• Sensitivity to bright light
• Sleepiness or trouble waking up
• Nausea, vomiting
• Lack of appetite

Fungal Meningitis:  Symptoms of fungal meningitis are similar to symptoms of other forms of meningitis but often they appear more gradually. In addition to typical meningitis symptoms, like headache, fever, nausea, and stiffness of the neck, people with fungal meningitis may also experience:

• Dislike of bright lights
• Changes in mental status, confusion
• Hallucinations
• Personality changes

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WHAT ARE THE RISK FACTORS AND CAUSES?

Below is a partial list of the risk factors for meningitis:

Age:

o Viral meningitis occurs mostly in children younger than age 5.

o Before the availability of effective vaccines, bacterial meningitis was most commonly diagnosed in young children. Now, as a result of the protection offered by current childhood vaccines, bacterial meningitis is more commonly diagnosed among pre-teens and young adults.

Community setting:

o Infectious diseases tend to spread quickly wherever larger groups of people gather together. As a result, college students living in dormitories, military personnel and children in childcare facilities are at an increased risk.

o Working with animals. Dairy farmers, ranchers, and other people who work with domestic animals are at an increased risk of contracting listeriosis.

Pregnancy:

o Pregnant women are at an increased risk of catching listeriosis. The bacteria that cause listeriosis, listeria bacteria, can also cause meningitis. The unborn baby of a pregnant woman with listeriosis is also at risk.

Weakened immune system:

o There are certain diseases, medications and surgical procedures that may weaken the immune system and increase the risk.

Causes of bacterial meningitis can include:

• Neisseria meningitidis
• Streptococcus pneumoniae
• Haemophilus influenzae serotype b (Hib)
• Group B streptococcus (GBS)

Causes of Viral Meningitis include:

• Enterovirus—In the United States (especially during the summer months) most viral meningitis cases are caused by enteroviruses.
o Hand, Foot, and Mouth Disease
• Measles
• Influenza
• Mumps
• Herpesvirus, such as
o Epstein-Barr virus
o Herpes simplex viruses
o Varicella-zoster virus—the cause of chickenpox and shingles
• Arboviruses—These viruses, which are spread by mosquitoes and other insects, can also cause infections that can lead to viral meningitis
• Lymphocytic Choriomeningitis Virus—This virus, which is spread by rodents, is a rare cause of viral meningitis.

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CAN I CATCH MENINGITIS?  HOW IS IT TRANSMITTED? IS IT CONTAGIOUS?

Bacterial Meningitis:  Bacterial meningitis is contagious. The bacteria are spread through the exchange of respiratory and throat secretions (i.e., coughing, kissing). Sometimes the bacteria that cause meningitis have spread to other people who have had close or prolonged contact with a patient with meningitis caused by N. meningitidis (also called meningococcal meningitis) or H. influenzae serotype b (also called Hib meningitis).  People in the same house, school, daycare center or work, or anyone with direct contact with a patient's oral secretions (such as a boyfriend or girlfriend) would be considered at increased risk of getting the infection. People who qualify as close contacts of a person with meningitis caused by N. meningitidis should receive antibiotics to prevent them from getting the disease.

Viral Meningitis:  Enteroviruses, the most common cause of viral meningitis, are most often spread from person to person through fecal contamination (which can occur when changing a diaper or using the toilet and not properly washing hands afterwards). Enteroviruses can also be spread through respiratory secretions (saliva, sputum, or nasal mucus) of an infected person. Other viruses, such as mumps and varicella-zoster virus, may also be spread through direct or indirect contact with saliva, sputum, or mucus of an infected person. Contact with an infected person may increase your chance of becoming infected with the virus that made them sick; however you will have a small chance of developing meningitis as a complication of the illness.

Fungal Meningitis:  Fungal meningitis is not contagious. It is not transmitted from person to person. People get fungal meningitis usually by inhaling fungal spores from the environment. People with certain medical conditions like diabetes, cancer, or HIV are at higher risk of fungal meningitis. You may also get fungal meningitis after taking medications that suppress your immune system. Examples of these medications include steroids (such as prednisone), medications given after organ transplantation, or anti-TNF medications, which are sometimes given for treatment of rheumatoid arthritis or other autoimmune conditions.

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HOW IS MENINGITIS DIAGNOSED?

Early diagnosis and treatment are very important. If meningitis is suspected, samples of blood or cerebrospinal fluid are collected using a simple lumbar puncture, and sent to the laboratory for testing. It is important to know the specific cause of meningitis because the severity of illness and the treatment will differ depending on the cause. In the case of bacterial meningitis, for example, antibiotics can help prevent severe illness and reduce the spread of infection from person to person.

Bacterial Meningitis:  If bacteria are present, they can be grown (cultured). Growing the bacteria in the laboratory is important for confirming the presence of bacteria and for identifying the specific type of bacteria that is causing the infection.

Viral Meningitis:  The specific causes of meningitis may be determined by tests used to identify the virus in samples collected from the patient.

Fungal Meningitis:  To confirm fungal meningitis, specific lab tests are performed depending on the type of fungus suspected.

CAN MENINGITIS BE TREATED?

Bacterial Meningitis:  Bacterial meningitis can be treated with a number of effective antibiotics. It is important that treatment be started early in the course of the disease. If bacterial meningitis is suspected, initial treatment with ceftriaxone and vancomycin is recommended. Appropriate antibiotic treatment of the most common types of bacterial meningitis should reduce the risk of dying from meningitis to below 15%, although the risk is higher among the elderly.
Viral Meningitis:  There is no specific treatment for viral meningitis. Antibiotics do not help viral infections, so they are not useful in the treatment of viral meningitis. Most patients completely recover on their own within 7 to 10 days. A hospital stay may be necessary in more severe cases or for people with weak immune systems.

Fungal Meningitis:  Fungal meningitis is treated with long courses of high dose antifungal medications. This is usually given using an IV line and is done in the hospital. The length of treatment depends on the status of the immune system and the type of fungus that caused the infection. For people with immune systems that do not function well because of other conditions, like AIDS, diabetes, or cancer, longer treatment is needed.

Contact Experienced Medical Malpractice Attorneys at Berger & Lagnese, LLC for a Free Consultation

In our times of need, we turn to medical institutions to care for and heal us of our ailments. Unfortunately, you cannot always depend on our doctor and nurses to be correct 100% of the time. Even the best medical facilities in Pittsburgh, PA can make mistakes, including Jefferson Hospital, Forbes Hospital and Allegheny General Hospital. If you or a loved one has been victimized by medical malpractice in Pittsburgh, PA or the surrounding areas, contact the skilled medical malpractice lawyers at Berger & Lagnese, LLC. Our office is located at 310 Grant St #720, Pittsburgh, PA and you can schedule your free consultation either online here or by calling (412) 471-4300.

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