It is undeniable that our brain and spinal cord are essential to our daily normal function. Like everything else that is important, there is an extra protection layer that covers our brain and spinal cord for additional support and to prevent external harm. This membranous coverings of the brain and spinal cord is known as the meninges, and it is composed of three sub-layers: dura mater, arachnoid, and pia mater. Meninges protect the brain and spinal cord from mechanical injury, to support the blood vessels and to house cerebrospinal fluid (CSF). 

Image credit: https://www.scientificanimations.com/wiki-images

However, when things go south, the meninges can be infected by bacteria, virus or other microorganisms, which lead to an inflammation of meninges, known as meningitis. (-itis means inflammation in medical terms) Meningitis can also be caused by non-infectious origin. 

Symptoms of meningitis

Symptoms of meningitis develop suddenly and can include:

• a high temperature (fever) of 380C or above

• being sick

• a headache

• a rash that does not fade when a glass is rolled over it (but a rash will not always develop, so NEVER wait for a rash if meningitis is suspected) It can be harder to see a rash on dark skin, check the soles of the feet, palms of hands, roof of mouth and inside eyelids.

Image credit to https://www.meningitis.org/

• a stiff neck, which is characterised by a reduced ability or painful sensation when you try to flex your neck towards your chest. 

Image credit: https://www.spine-health.com/conditions/neck-pain/when-neck-stiffness-may-mean-meningitis

• a dislike of bright lights/a pain or discomfort in eyes when exposed to light

• drowsiness or unresponsiveness

• seizures (fits)

• Vomitting 

These symptoms can appear in any order. You do not always get all the symptoms.

Who does meningitis mainly affect?

Meningitis can affect anyone, but is most common in babies, young children, teenagers and young adults. More than 90% of the cases involve children under 5 years old and 50% were among infants under 6 months old. It is important that doctors figure out if a child has bacterial or viral meningitis. This is because bacterial meningitis is a medical emergency. If bacterial meningitis is not treated quickly, it can lead to brain problems such as deafness or learning problems. Bacterial meningitis can even lead to death as a result of sepsis, i.e. the immune system overreacts to an infection and starts to damage the body’s own organs. Viral meningitis is usually less serious, and does not usually lead to long-term brain problems or death.

Meet the germs that cause meningitis

Common causes of bacterial meningitis vary by age group:

• Newborns: Group B Streptococcus, S. pneumoniae, L. monocytogenes, E. coli

• Babies and children: S. pneumoniae, N. meningitidis, H. influenzae type b (HiB), group B Streptococcus

• Teens and young adults: N. meningitidis, S. pneumoniae

• Older adults: S. pneumoniae, N. meningitidis, Hib, group B Streptococcus, L. monocytogenes

Image shows N.meningitidis. Image credit to: https://www.britannica.com/science/meningitis ©Ilexx/Dreamstime.com

In Malaysia, the HiB vaccine is provided for free to all Malaysian children in 4 doses through the National Immunisation Programme (NIP), which has helped to drastically cut down rates of meningitis caused by HiB. Starting from December 2020, NIP saw another addition of free vaccines to be provided by the Ministry of Health, which is the pneumococcal vaccine. The pneumococcal vaccine protects children from S. pneumoniae. You can visit any nearby klinik kesihatan to make an appointment for your child to receive the vaccination.

Another vaccine, the meningococcal vaccine, prevents the threat posed by N.meningitidis. Although meningococcal vaccine is not mandatory under NIP, it is a mandatory vaccination for all Muslims who wish to embark on their holy pilgrimages during Hajj or Umrah. This is the Saudi Arabian government’s response to extensive outbreaks of meningococcal disease among pilgrims in the past decade.

Viral meningitis is most commonly caused by non-polio enteroviruses, mumps virus, herpesvirus, measles virus, influenza virus and many more. The NIP provides vaccines that cover some of these viruses that can cause meningitis.

In rare cases,meningitis can also be caused by fungi, parasites and amoeba. These types of meningitis are more commonly seen in immunocompromised individuals (weakened immunity).

Image credit: https://www.arabnews.com/node/973501/saudi-arabia

How does one get meningitis?

Meningitis is an infectious disease and can be passed from one person to another. Here’s how it is spread:

• It usually results from a bloodstream infection after one contracted the offending microorganisms, which usually enter the body via the respiratory/breathing tract through sneezing, coughing, kissing or sharing utensils, cutlery and toothbrush. Fortunately, not everyone who gets a respiratory tract infection will go on to develop a blood stream infection. That is because the brain is protected by a ‘special gate’ called blood-brain barrier. It is when the blood-brain barrier is compromised that the offending microorganisms gain the opportunity to enter into the brain or spinal cord. 

• Sometimes, meningitis can also develop due to direct spread of severe infection from the ear (otitis media) or nasal cavity (sinusitis).

• Injury or surgical procedure around the skull and face also may increase the risk of meningitis.

Interestingly, how people spread the germs often depends on the type of bacteria. It is also important to know that people can have these bacteria in or on their bodies without being sick. These people are “carriers.” Most carriers never become sick, but can still spread the bacteria to others. For example, in the case of meningitis caused by HiB or S.pneumoniae, people spread by coughing or sneezing while in close contact with others, who breathe in these bacteria. Whereas in the case of N.meningitidis, people spread these bacteria by sharing respiratory or throat secretions (saliva or spit). This typically occurs during close (coughing or kissing) or lengthy (living together) contact.

Treatment of meningitis

People with suspected meningitis will usually have tests in hospital to confirm the diagnosis and check whether the condition is the result of a viral or bacterial infection.

Bacterial meningitis usually needs to be treated in hospital for at least 7 days. The treatment usually involved an infusion of antibiotic drip, saline drip and oxygen through a face mask. 

Viral meningitis tends to get better on its own within 7 to 10 days and can often be treated at home. Taking painkillers, fever medicines and getting plenty of rests can help to relieve the discomforts. 

Image credit to https://www.verywellhealth.com/meningitis-overview-2632037 (Emily Roberts)

References:

1. NHS - Meningitis. https://www.nhs.uk/conditions/meningitis/

2. CDC - Meningitis. https://www.cdc.gov/meningitis/index.html

3. UpToDate - Patient education: Meningitis in children (The Basics)

4. Immunise4Life - Our Three Vaccine Defenders Against Bacterial Meningitis. https://www.immunise4life.my/diseases/our-three-vaccine-defenders-against-bacterial-meningitis/

5. Portal MyHealth - Meningitis. http://www.myhealth.gov.my/en/meningitis/

6. Portal MyHealth -Penyakit Meningitis (Meningococcal). http://www.myhealth.gov.my/penyakit-meningitis/

Written by

Ms Joyce Toh