What is spinal meningitis?
Meningitis is an infection that causes inflammation of the membranes covering the brain and spinal cord. Non-bacterial meningitis is often referred to as "aseptic meningitis." Bacterial meningitis may be referred to as "purulent meningitis."
Causes, incidence, and risk factors
The most common causes of meningitis are viral infections that usually resolve without treatment. However, bacterial infections of the meninges are extremely serious illnesses, and may result in death or brain damage, even if treated. Meningitis is also caused by fungi, chemical irritation, drug allergies, and tumors.
Types of Memingitis include:
- Meningitis - cryptococcal
- Syphilitic aseptic meningitis
- Meningitis - H. influenza
- Meningitis - meningococcal
- Meningitis - pneumococcal
- Meningitis - staphylococcal
- Meningitis - tuberculous
- Aseptic meningitis
- Meningitis gram negative
- Carcinomatous meningitis (meningitis due to cancer)
- Acute bacterial meningitis is a true medical emergency, and requires immediate hospital-based treatment. Bacterial strains that cause meningitis include Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis (meningococcus), Listeria monocytogenes, and many other types of bacteria. In the U.S. almost 20,000 cases of bacterial meningitis occur yearly.
Viral meningitis is milder and occurs more often than bacterial meningitis. It usually develops in the late summer and early fall, often affects children and adults under 30. Seventy percent of the infections occur in children under the age of 5. Most viral meningitis is associated with enteroviruses, which are viruses that commonly cause intestinal illness.
However, many other types of viruses can also cause meningitis. For example, viral meningitis may occur as a complication in people with genital herpes. Recently, West Nile virus spread by mosquito bites has become a cause of viral meningitis in most of the U.S. In addition to causing viral meningitis, West Nile virus may cause encephalitis in some patients and a polio-like syndrome in others.
Symptoms of spinal meningitis
- Fever and chills
- Severe headache
- Nausea and vomiting
- Stiff neck (meningismus)
- Sensitivity to light (photophobia)
- Mental status changes
Additional symptoms that may be associated with this disease:
- Decreased consciousness
- Rapid breathing
- Agitation
- Opisthotonos (severe neck stiffness, ultimately resulting in a characteristic arched posture-seen in infants or small children)
- Bulging fontanelles (the soft spots in a baby's skull may bulge)
- Poor feeding or irritability in children
- Meningitis is an important cause of fever in newborn children. For this reason, a lumbar puncture is often done on newborns who have a fever of uncertain origin.
Signs and tests
- Lumbar puncture with CSF glucose measurement and CSF cell count
- Gram-stain and culture of CSF (cerebral spinal fluid)
- Chest x-ray to look for other sites of infection
- Head CT scan looking for hydrocephalus, abscess or deep swelling
Treatment of spinal meningitis
Antibiotics will be prescribed for bacterial meningitis; the type will vary depending on the infecting organism. Antibiotics are not effective in viral meningitis. Treatment of secondary symptoms including brain swelling, shock, and seizures will require other medications and intravenous fluids. Hospitalization may be required depending on the severity of the illness and the needed treatment.
Expectations (prognosis) of spinal meningitis
Early diagnosis and treatment of bacterial meningitis is essential to prevent permanent neurological or spinal damage. Viral meningitis is usually not serious, and symptoms should disappear within 2-weeks with no residual complications.
Complications of spinal meningitis
- Hearing loss or deafness
- Brain damage
- Loss of vision
- Hydrocephalus
Calling your health care provider
If you feel that you or your child have symptoms suggestive of meningitis, you must seek emergency medical help immediately. Early treatment is key to a good outcome.
Prevention of spinal meningitis
Haemophilus vaccine (HiB vaccine) in children will help prevent one type of meningitis.
The pneumococcal conjugate vaccine is now a routine childhood immunization and is very effective at preventing pneumococcal meningitis.
It's highly recommended household contacts and people with close contact with individuals with meningococcal meningitis receive preventative antibiotics to avoid becoming infected themselves.
Some communities conduct vaccination campaigns following an outbreak of meningococcal meningitis. Military recruits are routinely vaccinated against this form of meningitis because of its high rate of occurrence.
The American Academy of Pediatrics and the American College Health Assn encourage college students (particularly freshmen living in dorms) to consider being vaccinated with the meningococcal vaccine.
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