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Meningitis

What is meningitis?

Meningitis is an infection of the coverings around the brain and spinal cord.
The infection occurs most often in children, teens, and young adults. Also at risk are older adults and people who have long-term health problems, such as a weakenedimmune system.

There are two main kinds of meningitis:

  • Viral meningitis is fairly common. It usually does not cause serious illness. In severe cases, it can cause prolonged fever and seizures.
  • Bacterial meningitis is not as common but is very serious. It needs to be treated right away to prevent brain damage and death.

The two kinds of meningitis share the same symptoms. It’s very important to see a doctor if you have symptoms, so that he or she can find out which type you have.

What causes meningitis?

Viral meningitis is caused by viruses. Bacterial meningitis is caused by bacteria.

Meningitis can also be caused by other organisms and some medicines, but this is rare.

Meningitis is contagious. The germs that cause it can be passed from one person to another through coughing and sneezing and through close contact.

What are the symptoms?

The most common symptoms among teens and young adults are:

  • A stiff and painful neck, especially when you try to touch your chin to your chest.
  • Fever.
  • Headache.
  • Vomiting.
  • Trouble staying awake.
  • Seizures.

Children, older adults, and people with other medical problems may have different symptoms:

  • Babies may be cranky and refuse to eat. They may have a rash. They may cry when held.
  • Young children may act like they have the flu. They may cough or have trouble breathing.
  • Older adults and people with other medical problems may have only a slight headache and fever.

It is very important to see a doctor right away if you or your child has these symptoms. Only a doctor can tell whether they are caused by viral or bacterial meningitis. And bacterial meningitis can be deadly if not treated right away.

How is meningitis diagnosed?

Your doctor will ask questions about your health, do an exam, and use one or more tests.

Lumbar puncture is the most important lab test for meningitis. It is also called a spinal tap. A sample of fluid is removed from the spine and tested to see if it contains organisms that cause the illness.

Your doctor may also order other tests, such as blood tests, EEG, CT scan, or an MRI.

How is it treated?

Treatment depends on the cause. See your doctor right away if you or your child has symptoms, because bacterial meningitis can be deadly if not treated right away.

Bacterial meningitis is treated in a hospital. You or your child will get antibiotics. And you will be watched carefully to prevent serious problems such as hearing loss, seizures, or brain damage.

Meningitis – Topic Overview

But viral meningitis is more common, and most people with this form of the illness get better in about 2 weeks. With mild cases, you may only need home treatment. Home treatment includes drinking lots of fluids and taking medicine for fever and pain.

Can meningitis be prevented?

The best way to protect your child from meningitis is to make sure he or she gets all the standard immunizations for children. These include shots for measles, chickenpox,Haemophilus influenzae type B (Hib) disease, and pneumococcal infection.

Talk to your doctor about whether you or your child also needs the meningococcal vaccine, which is a shot to prevent bacterial meningitis. It is recommended for:

  • Adolescents ages 11 and 12.
  • Teens ages 13 to 18 who haven’t had the shot yet. (They should get it as soon as possible.)
  • College freshman living in dormitories.
  • People who plan to travel to countries known to have meningitis outbreaks.
  • People without a spleen.
  • People with HIV.

Meningitis – Treatment Overview

Treatment for meningitis depends on the organism causing the infection, your age, the extent of the infection, and the presence of other medical conditions or complications of meningitis.

Most people with viral meningitis usually start getting better within 3 days of feeling sick and recover within 2 weeks. But it is important to see your doctor if symptoms ofmeningitis develop so that he or she can rule out bacterial meningitis, which is more serious. With mild cases of viral meningitis, you may only need home treatment, including fluids to prevent dehydration and medicine to control pain and fever. If you do not get better or if symptoms get worse, you may need further testing to check for other causes of illness.

Bacterial or severe viral meningitis may require treatment in a hospital, including:

  • Antibiotics. These medicines usually are given through a vein (intravenously, or IV) to treat meningitis. Antibiotics are given only when bacteria are causing the infection. Giving antibiotics when they are not needed may cause drug resistance.
  • Measures to reduce pressure within the brain. If meningitis is causing pressure within the brain, corticosteroid medicines such as dexamethasone may be given to adults or children.
  • Measures to reduce fever. Medicines such as acetaminophen (Tylenol), fluids, and good room ventilation reduce fever. If you have a high fever, you also may need a device such as a cooling pad placed on the bed.
  • Measures to prevent seizures. If you have seizures, your surroundings will be kept quiet and calm. Medicines such as phenobarbital or dilantin can help stop seizures. For more information, see the topic Seizures.
  • Oxygen therapy. Oxygen may be given if you have trouble breathing and to increase the amount of oxygen in all parts of the body. Oxygen may be delivered by a hood or tent placed over the body, a face mask placed over the nose and mouth, a nose piece (nasal cannula) held loosely under the nose, or, in severe cases, a tube through the mouth into the trachea (windpipe).
  • Monitoring fluids. You may need to drink extra liquids because infections increase the body’s need for fluids. Increasing liquids also reduces the possibility ofdehydration. Liquids are given into a vein (IV) if you have an infection and arevomiting or are not able to drink enough. Doctors control the amount of fluids given because people with meningitis may develop problems if they have too much or not enough fluid.
  • Monitoring blood chemicals. Frequent blood tests are done to measure essential body chemicals, such as sodium and sugar in the blood.

A person who has severe meningitis may need to be treated in the intensive care unit (ICU) of a hospital. Doctors watch the person closely and provide care if needed. See the Other Treatment section of this topic for more information on intensive care in a hospital.

What To Think About

Most healthy adults who have recovered from meningitis do not need follow-up care. But adults who have existing medical conditions that make them more likely than others to develop long-term complications or get meningitis again should see their doctors after recovery. Babies and children treated for meningitis always need follow-up care after recovery and need to be checked for long-term complications such as hearing loss.

Antibiotics for bacterial meningitis

Examples

Generic Name          Brand Name

ampicillin
cefotaxime                Claforan
ceftriaxone                Rocephin
gentamicin sulfate
penicillin G
vancomycin               Vancocin

How It Works

Antibiotics kill bacteria.

Why It Is Used

Antibiotics may be prescribed alone or in combinations to treat bacterial meningitis.

How Well It Works

Ampicillin and penicillin G are effective against many bacteria that cause meningitis, including Listeria monocytogenes, certain strains of Streptococcus pneumoniae, Neisseria meningitidis, and group B streptococcus.

Ceftriaxone and cefotaxime also are effective against many bacteria that cause meningitis, including most Streptococcus pneumoniae, Haemophilus influenzae type b, andEscherichia (E.) coli.

Gentamicin sulfate is effective against E. coli. It often is used with ampicillin to treat people who have bacterial meningitis caused by group B streptococci.

Vancomycin is effective against many bacteria that are not killed by other antibiotics.

Side Effects

The most common side effects of antibiotics include:

  • Nausea and vomiting.
  • Diarrhea.
  • Allergic reactions including skin rash, fever, and sometimes difficulty breathing.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Antibiotics used to treat bacterial meningitis usually are given into a vein (intravenous, or IV), 1 to 4 times a day. The number of days the medicine is given (between 7 and 21) depends on the bacteria causing the infection, the severity of the illness, the person’s age, and whether the person is likely to develop severe meningitis or complications.

Penicillin and cefotaxime are two of the antibiotics most frequently used to treat meningitis. But some bacteria (particularly Streptococcus pneumoniae) are becoming increasingly resistant to penicillin. So doctors often combine different types of antibiotics to try to kill all bacteria. For infants older than 1 month, treatment may include vancomycin and cefotaxime or ceftriaxone. For infants younger than 1 month, vancomycin may be added to the usual treatment of ampicillin and cefotaxime or ceftriaxone.

Ciprofloxacin and rifampin are often effective at preventing infection when they are given to people who have been exposed to certain bacteria that cause meningitis. Rifampin is the preferred medicine for children.

Some people may be allergic to ampicillin and penicillin G.

People who receive gentamicin sulfate or vancomycin need to be checked for hearing problems, low back pain, or less-than-expected amounts of urine. These medicines can cause hearing loss and kidney damage. Kidney damage usually clears up after the medicines are stopped.

People should take antibiotics only when they have a bacterial infection. Antibiotics do not kill viruses and other organisms. Because of the problem of resistance, people who take antibiotics when they do not have a bacterial infection may require stronger antibiotics for future bacterial infections.

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