Meningitis

Meningitis is an inflammation of the meninges (the membranes surrounding the brain and spinal cord). It is most often caused by a viral or bacterial infection. Distinguishing between a viral and a bacterial cause is difficult; however, in the case of meningitis it is extremely important. Viral meningitis usually clears up on its own and does not cause any permanent harm. However, bacterial meningitis may lead to brain damage, learning disabilities, hearing loss, or death without treatment for the specific type of bacteria. There are approximately 12,500 cases of viral meningitis and 25,000 cases of bacterial meningitis reported annually in the United States, resulting in 2,200 deaths. Meningitis can also be caused by fungal infections (cryptococcus), tuberculosis, or chemicals.

Signs and Symptoms

Signs and symptoms of meningitis may differ by age and may differ somewhat by the cause or type of organism that causes it.

In newborns, signs and symptoms include the following:

• Irritability
• High-pitched cry
• Poor feeding
• Vomiting
• Fever
• Seizures
• Bulging fontanelle ("soft spot" in the skull) and/or stiff neck (less common)

In children and young adults, signs and symptoms include the following:

• Fever
• Headache
• Vomiting
• Stiff neck
• Upper respiratory tract infection
• Sensitivity to light
• Drowsiness
• Tiny red or purple spots on the skin (petechiae) or other bleeding in the skin (in cases of meningococcal meningitis—see section entitled What Causes It?)
• Confusion
• Seizures
• Clouding or loss of consciousness

The elderly may have no signs or symptoms other than altered mental state and lethargy. Often they have no fever, and the signs of meningitis are less predictable.

What Causes It?

Several types of bacteria can cause meningitis:

• Neisseria meningitidis causes meningococcal meningitis, currently the most common form of meningitis in children and young adults, and the only type that occurs in outbreaks.
• Haemophilus influenzae was the most common cause in infants and children under 6 years old prior to 1986 when an H. influenza vaccine (HiB) was introduced. The vaccine has virtually eradicated this form of meningitis in countries where the vaccine is administered.
• Streptococcus pneumonia may occur following an ear or sinus infection, pneumonia, or injury to the head.
• Listeria monocytogenes tends to affect extremes of ages (newborns and the elderly).
• Group B streptococcus occurs in newborns.
• Gram-negative bacilli (such as Escherichia coli, Proteus, Pseudomonas aeruginosa, Klebsiella pneumoniae, Salmonella spp., Enterococcus spp.) can cause meningitis following a head injury or brain surgery.
• Staphylococcus aureus may be seen following a head injury or brain surgery.

Viral meningitis can be caused by several types of viruses, including:

• Enteroviruses (which multiply in the intestinal tract)—common in infants and small children
• Arboviruses—carried by arthropods, such as ticks; seen in children
• Mumps virus—seen in children between the ages of 5 and 9 who have not had the MMR vaccine
• Lymphocytic choriomeningitis virus—seen in workers who have contact with hamsters, rats, or mice
• Herpesviruses
• Human immunodeficiency virus (HIV)—meningitis may be the first sign a person is infected with HIV

Who's Most At Risk?

These conditions and characteristics increase the risk for bacterial meningitis:

• Crowded urban areas or dormitories (for meningococcal disease)
• Otitis media (middle ear infection), mastoiditis (infection of one of the bones around the ear), sinusitis (inflammation of sinuses), or pneumonia
• Significant head injury, skull trauma, or cerebrospinal rhinorrhea (flow of cerebrospinal fluid from the nose after a head injury)
• Sickle-cell anemia (in children)
• Alcoholism
• A suppressed immune system (for pneumococcal disease)
• Brain surgery
• Endocarditis (inflammation of the lining of the heart's chambers)
• Cancer
• Never receiving the H. influenza (HiB) vaccine (see section entitled What Causes It?)

These conditions and characteristics increase the risk for viral meningitis:

• Not being immunized with the measles, mumps, and rubella (MMR) vaccine (in children)
• Daycare centers (for children)
• Lack of safe-sex practices and therefore being at risk for contracting herpesviruses and HIV
• Laboratory work that requires handling rats, hamsters, and mice or their wastes

What to Expect at Your Provider's Office

Early diagnosis is the key to treating meningitis successfully. Healthcare providers will ask for detailed information about preexisting conditions and any exposure to possible causes. When providers suspect meningitis, they perform a lumbar puncture (removal of cerebrospinal fluid from the spine through a needle) as soon as possible so that the fluid can be examined and tested for infection. Antibiotics are started right away, even before the lumbar puncture results are available. The provider may also perform blood tests and use computed tomography, magnetic resonance imaging, or other techniques to image the brain.

Treatment Options

Prevention
To help prevent meningitis, children should be vaccinated against H. influenzae and mumps; the elderly and those who are debilitated should receive a pneumococcal vaccine. A meningococcal vaccine is administered to control epidemics or for travel to areas where meningococcal disease is widespread. Those who live with a person who has meningococcal infection should take the drug rifampin to prevent spread of the disease.

Drug Therapies

The length of treatment varies with the organism being treated, ranging from one to three weeks. If bacterial meningitis is suspected, antibiotics must be started immediately, even before results from the lumbar puncture, blood tests, and imaging studies have been completed or returned. The following categories of medications will be used or considered in the case of bacterial meningitis:

• Antibiotics, often in combination, including ampicillin, cephalosporins, gentamicin, vancomycin, and/or trimethoprim-sulfamethoxazole
• Corticosteriods to reduce neurologic complications
• Diazepam and/or phenytoin if seizures occur
• Rifampin is given to household contacts of those with meningococcal meningitis to reduce their risk of contracting the disease.
• There is no specific antiviral therapy for infection with enteroviruses, arboviruses, mumps virus, or lymphocytic choriomeningitis virus.
• Herpes simplex virus type 2 may be treated with acyclovir, but it is not clear that this changes the course of the illness.
• HIV meningitis may be treated with antiretroviral drugs.
• Intravenous gamma globulin to boost immunity may be used for those with meningitis caused by an enterovirus.

Surgical and Other Procedures

Surgery may be needed to close an abnormal opening that allows cerebrospinal fluid to leak outside its usual area; such a leak could allow bacteria or viruses to enter the brain or spinal cord.

Complementary and Alternative Therapies

Bacterial meningitis has severe consequences if not recognized and treated aggressively with antibiotics and other standard medical approaches as described. Nutritional and herbal therapies should be used only in support of conventional treatment, not in place of it, and only with the guidance of a health professional. Some studies suggest herbs may fight microbes and regulate the immune system to assist in the treatment of certain kinds of meningitis. Homeopathic remedies may help relieve symptoms that accompany meningitis.

Nutrition

Several nutrient deficiencies seem to possibly play a role in the development of certain types of meningitis. Much more research is needed, though, to determine if taking these nutrients in either dietary or supplement form will impact the course of the disease.

Vitamin B12
One small-scale study suggested that people with meningitis from tuberculosis had decreased levels of vitamin B12. More research is needed to determine whether measures to increase vitamin B12 can help treat tuberculous meningitis.

Vitamin A
A study investigating meningococcal disease in sub-Saharan Africa found that vitamin A deficiency may play a role in this type of meningitis. Again, though, it is not known whether taking vitamin A supplements would be beneficial for this condition.

Herbs

Garlic
In laboratory tests, garlic (Allium sativum) has been shown to stop the growth of and even kill the fungus Cryptococcal neoformans. When combined with the antifungal medication amphotericin B, garlic seemed to augment the effects of the medicine against cryptococcus. A subsequent study of five patients with cryptococcol meningitis suggested that the antifungal effects of garlic may be conferred to people, although more extensive research is needed.

Echinacea
In animals with suppressed immune systems infected with L. monocytogenes, echinacea (Echinacea purpurea) improved immune function, significantly reduced the amount of bacteria, and increased survival rate. It is not known whether echinacea will help treat meningitis caused by L. monocytogenes in humans.

Homeopathy

Although very few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies to help alleviate symptoms of meningitis in addition to standard medical care to treat this condition. Before prescribing a remedy, homeopaths take into account a person's constitutional type. A constitutional type is defined as a person's physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for each individual.

• Apis Mellifica — for meningitis in children with such intense head pain that they bore their heads into a pillow
• Arnica Montana — for meningitis following surgery or an injury to the head; this remedy is most appropriate for individuals who often insist that there is nothing wrong with them
• Belladonna — for a sudden onset of high fever which accompanies meningitis; this remedy is most appropriate for individuals who are hot and flushed with wide pupils, and may have nightmares and delusions
• Bryonia — for meningitis with impaired consciousness and a characteristic movement of the mouth in which the jaw moves side to side quite rapidly in a somewhat contorted manner
• Helleborus — for meningitis with impaired consciousness and stupor; individual may also be anguished and pleading for help; shaking or rolling of the head may also occur
• Hyoscyamus — for meningitis with violent spasms that occur with shrieking and grinding of the teeth

In the case of meningitis, these treatments must not be used without direction and supervision by an appropriately trained and certified homeopathic doctor.

Prognosis/Possible Complications

About 25% of adults who contract bacterial meningitis die from it. Sixty percent of infants who survive bacterial meningitis have long-term neurologic complications or developmental difficulties. Most people who get viral meningitis recover completely without consequences.

Complications of meningitis may include hearing loss, seizures, cerebral edema (brain swelling), weakness on one side of the body, impaired speech, visual impairment or blindness, intellectual deficits, difficulty coordinating movements, breathing difficulty, respiratory arrest, and recurring meningitis.

Following Up

For the first one to two days after treatment begins, patients should be monitored in the intensive care unit to be sure that the medication is working, to watch for any seizures, and to prevent aspiration. If signs and symptoms do not improve after one to two days, healthcare providers should check the cerebrospinal fluid again.

Special Considerations

Pregnant women often carry L. monocytogenes and S. agalactiae in their genital tract or rectum without having symptoms and may transmit these infections to their children during birth. Pregnant women should not take rifampin to prevent meningitis because it is not clear whether this drug may harm the fetus.

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