Meningitis is an infection of the cerebrospinal fluid. People sometimes refer to it as spinal meningitis. Meningitis is usually caused by a viral or bacterial infection. The severity and treatment depends on whether it is caused by a virus or bacterium.

Viral meningitis is generally less severe and resolves without specific treatment, while bacterial meningitis can be quite severe and may result in brain damage, hearing loss, learning disability, or death if not treated in the early stages.

For bacterial meningitis, it is also important to know which type of bacteria is causing the meningitis because antibiotics can prevent some types from spreading and infecting other people. Before the 1990s, Haemophilus influenzae type b (Hib) was the leading cause of bacterial meningitis, but new vaccines being given to all children as part of their routine immunizations have reduced the occurrence of invasive disease due to H. influenzae. Today, Streptococcus pneumoniae and Neisseria meningitidis are the leading causes of bacterial meningitis.

What are the signs and symptoms?

The symptoms may include any of the following: severe headache, nausea, vomiting, stiff neck, pain in the shoulders and back, and a red pinpoint rash are the most common signs of this disease. If the condition is meningococcemia, then a purplish skin rash that looks like bruising may occur. These symptoms can develop over several hours, or they may take 1 to 2 days. Other symptoms may include nausea, vomiting, discomfort looking into bright lights, confusion, and sleepiness. As the disease progresses, patients may have seizures.

How is it diagnosed and treated?

Early diagnosis and treatment are very important. If symptoms occur, the patient should see a doctor immediately. The diagnosis is usually made by growing bacteria from a sample of spinal fluid. The spinal fluid is obtained by performing a spinal tap, in which a needle is inserted into an area in the lower back where fluid in the spinal canal is readily accessible. Identification of the type of bacteria responsible is important for selection of correct antibiotics.

Bacterial meningitis can be treated with a number of effective antibiotics. It is important, however, that treatment be started early in the course of the disease. Appropriate antibiotic treatment of most common types of bacterial meningitis should reduce the risk of dying from meningitis to below 15%, although the risk is higher among the elderly.

Presently, there is a vaccine that will protect against 4 of the strains of meningococcal disease. The use of the vaccine is recommended in outbreak situations, for individuals with specific medical conditions, or for those traveling to areas where the illness is hyperendemic or epidemic.

Rifampin, Ciprofloxin, Sulfisoxazole, Sulfadiazine, or Ceftriaxone are antibiotics which may be used for prophylactic treatment of high-risk contacts.

How is it transmitted?

The bacteria are spread through the exchange of respiratory and throat secretions (i.e.,coughing, kissing). Fortunately, none of the bacteria that cause meningitis are as contagious as things like the common cold or the flu, and they are not spread by casual contact or by simply breathing the air where a person with meningitis has been.
People who qualify as close contacts of a person with meningitis caused by N. meningitidis should receive antibiotics to prevent them from getting the disease. A person may pass the bacteria from the time he/she is first infected until the germ is no longer present in discharges from the nose and throat. Persons are usually no longer infectious after 24 hours of effective antibiotic treatment.

Close contacts are those who are likely to have been exposed to the nasopharyngeal secretions of the sick person. This exposure can result in the spread of the disease only if it occurred 10 days or less before the individual became ill and up to 1 day after treatment begins. Close contacts include, but are not limited to the following:

Those living in the same house as the ill person,
Those sharing sleeping arrangements with the ill person,
Children sharing toys, such as in the same day care or nursery school, as the ill person,
Those who shared cigarettes, food, drinks, or other things that contain saliva with the ill person,
Those who have kissed the ill person,
Those who have given mouth-to-mouth resuscitation to, intubated, or suctioned the nasopharyngeal secretions of the ill person.
Casual contact, such as being in the same classroom, workplace, or sitting at the same table with an infected person does not increase the risk of infection.

What should I do if I suspect I have it, or have been in close contact with someone who has been diagnosed?

In either case, you should see your physician immediately. Meningococcal disease can be rapidly progressive, early recognition and treatment are crucial to recovery. Beginning preventive treatment more than 2 weeks after exposure would be too late to prevent secondary cases.