I C O A K S

AUTHOR: PROFESSOR JOHN MURTAGH

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Copyright of Professor John Murtagh and Australian Doctor. This patient handout may be photocopied or printed out by a doctor free of charge for patient information purposes.
Bacterial meningitis
What is meningitis?
Meningitis is inflammation of the
meninges, which are the thin membranes that
cover the brain and spinal cord.
Infection can be caused by viruses, which is
more common, or by bacteria, which is more
serious and life-threatening.
Bacterial meningitis is an infection of chil-
dren and young adults. Children aged 6-12
months are at the greatest risk, although it
can occur in any person.
What is the cause?
Many of the infecting bacteria are present
normally in the nose and throats of people.
When a persons natural resistance is low
these bugs can break through the so-called
brain barrier and infect the meninges. They
can spread via the bloodstream or through the
cavities in bone from an infected ear or sinus.
What is meningococcal meningitis?
Particular bacteria called meningococcus
can cause a particularly deadly infection,
especially in children and adolescents.
The affected person rapidly becomes sick
and develops a rash. Early diagnosis and treat-
ment with antibiotics is essential.
What are frequent symptoms and
signs?
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Fever.
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Headache.
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Nausea and vomiting.
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Pallor.
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Lethargy/tiredness.
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Increasing irritability.
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Drowsiness.
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Neck stiffness.
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Photophobia.
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Altered conscious state, for example, confu-
sion.
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Delirium.
In infants the signs may not be obvious but
neck stiffness, vomiting and headache are
noticeable in children older than three. These
symptoms may be masked and confuse the diag-
nosis, especially if the child is on antibiotics.
What are the risks of bacterial meningi-
tis?
The sooner treatment is started, the better
the result. Untreated cases may be fatal.
Permanent brain damage resulting in dis-
abilities such as deafness, blindness, paraly-
sis, epilepsy and intellectual impairment can
occur. In rare cases a cerebral abscess can
develop.
When is urgent attention necessary?
If your child develops any of the following
signs, report immediately to your doctor or
hospital emergency department:
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Becomes flat quite rapidly.
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Cold, pale skin, especially of the limbs.
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Change in conscious state.
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Drowsiness, confusion or delirium.
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Rapid heart rate.
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Rapid, difficult or noisy breathing.
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Convulsion.
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Red rash, especially if it looks like flecks of
blood.
We all worry about meningococcal infec-
tion and a major sign is a rash or bruising. It
can have a dramatic onset but early antibi-
otic injections can result in a cure.
When you reach medical attention the diag-
nosis will be made by blood tests, lumbar
puncture (in particular), cultures of infected
sites and scans of the brain and meninges.
What is the treatment?
Patients will be admitted to hospital ini-
tially to confirm the diagnosis and identify
the causative bug. Treatment is by large doses
of antibiotics which are usually fed directly
into a vein by means of an IV drip. This may
be necessary for up to two weeks.
Meningitis caused by tuberculosis, which is
more prevalent in tropical countries, requires
a longer course of treatment.
The patient will need strict bedrest, plenty
of fluids and analgesics for any pain. Barrier
nursing to prevent spread of infection will be
required.
What are preventive measures?
Seek medical care for any persistent infec-
tion, especially in the upper respiratory tract.
Oral antibiotics may be prescribed for the fol-
lowing contacts of a person with meningo-
coccal disease. Those who:
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Live in the household and are younger than
24 months.
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Have kissed the patient in the previous 10
days.
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Have attended the same day care centre,
kindergarten or school class.
A new meningococcal vaccine is available.
Your doctor can provide appropriate advice
about this.
Skin
Skull
Front View
Cranial
meninges
Spinal
meninges