According to the Confederation of Meningitis Organisations, over 1 million people worldwide are affected by meningitis every year. Here is everything you need to know about meningitis, reviewed by paediatrician Dr. Eddie Cheung.
What is meningitis?
Meningitis is an inflammation of the meninges (tissues surrounding the brain and the spinal cord). It affects people of all ages, but children under the age of 5, and those with a weakened immune system are at greater risks.
Plenty of pathogens can cause transmissible meningitis, including bacteria (e.g. Neisseria meningitidis, Streptococcus pneumoniae and Haemophilus influenzae type B, viruses (e.g. enterovirus, herpes simplex virus and mumps), parasites and fungi.
Viral infection is more common and many of them resolve spontaneously. Bacterial meningitis is rarer but potentially deadly. It requires immediate medical attention. Your doctor diagnoses it by performing blood tests, a spinal tap (lumbar puncture) to collect cerebrospinal fluid for analysis and a brain imaging test (CT or MRI scan).
Complications can occur, for example: hearing loss, visual impairment, seizures. Other complications like memory and concentration problems, which can affect learning, are commonly seen in bacterial cases. More than 1 in 5 patients with bacterial meningitis has permanent problems.
Incubation period: Varies depending on whether it’s caused by bacteria or virus.
Infectious period: Varies depending on whether it’s caused by bacteria or virus.
How is meningitis transmitted?
Infectious meningitis is mainly spread via contact with respiratory secretions and/or saliva of an infected person, for example from kissing, coughing, sneezing, and sharing eating utensils and toothbrushes.
Other ways of transmission include eating contaminated food, bacteria travelling from a site of head trauma or severe infection to the meninges.
It is important to know that having this bacteria or virus does not always lead to meningitis.
Signs and symptoms of meningitis
Below are general and common symptoms for verbal kids
- Stiff neck
- Lack of energy
- Nausea or vomiting
- Photophobia (increased sensitivity to light)
- Confusion or difficulty waking up
Symptoms specific to Meningococcal bacterial meningitis include
- A rapidly progressive red or purple rash of spots that do not go away when pressed (Purpura fulminans) may appear on limbs and body. This represents blood stream involvement of the bacterial infection and is a dreadful complication
Signs and symptoms in infants include
- Fussiness or irritability
- Being more sleepy or lacking in energy
- Refusing feeding
- A bulging soft spot on the head
- A high-pitched cry
When should you see a doctor?
Meningitis is a medical emergency. You should visit your doctor immediately if your child shows symptoms- particularly a fever, headache and neck stiffness. Do not wait until a rash appears.
Babies with a fever, irritability and poor feeding should also be given medical attention right away.
If you think your child has been exposed to an infected person, check with your doctor to see if they need antibiotics for prevention.
How is meningitis treated?
Your child is treated in the hospital with
- intravenous antibiotics as soon as possible. Examples include vancomycin and ceftriaxone. They are very effective in killing the causative bacteria;
- intravenous steroids (dexamethasone) for 4 days in some cases. They reduce brain inflammation and complications such as hearing loss;
- fluids to prevent dehydration and shock;
- oxygen through a face mask if they have difficulty breathing.
Majority of the patients develop a mild infection that goes away on its own without treatment. Viral meningitis usually ends in 7-10 days. Some may require antiviral medications or supportive medical treatment,
One point to note is that if a child is suspected to suffer from meningitis, empirical use of antibiotics +/- antiviral medications may be used after initial investigations are performed. Further and definitive treatment will then be guided by the test results.
Meningitis vaccination in Hong Kong
Immunization is the key to preventing both bacterial and viral meningitis. Several of them are available under the Hong Kong Childhood Immunisation Programme, such as measles, mumps, polio, varicella-zoster virus (chickenpox) and Pneumococcus.
Vaccines against influenza, Haemophilus influenzae type B and Meningococcal types A, C, W and Y are available in private clinics.
Your doctor may recommend antibiotics (e.g. rifampicin and ciprofloxacin) as a precautionary measure for:
- close contacts (including contact with oral secretions) with someone with meningitis caused by N. meningitidis;
- family members or people living in the same household, dormitory or university residence hall if someone has meningitis caused by H. influenzae.
Good hygiene and health practices
- Wash your hands with soap and water for at least 20 seconds regularly.
- Cover mouth and nose with a tissue when coughing and sneezing.
- Clean and disinfect frequently touched surfaces and objects.
- Adopt a healthy lifestyle to strengthen your immune system.
- Avoid close contacts with people who are sick.
- Avoid mosquito and other insect bites as they may carry disease-causing viruses.
- Avoid sharing eating utensils, cutlery and drinking glasses.
Testing for Group B Streptococcus
Group B Streptococcus is one of the most common bacterial causes for meningitis in newborns, and spreadable during labor from mothers to babies. Women are therefore advised to screen for this type of bacteria when they are 36-37 weeks pregnant. Antibiotics may be given during childbirth to those who are positive.
Dr. Eddie Cheung 張蔚賢醫生 is a specialist in paediatrics. He received his paediatric training in Queen Mary Hospital and post-fellow paediatric cardiology training in Grantham Hospital/ Queen Mary Hospital. He is a Fellow of the Hong Kong College of Cardiology, the Vice President of Hong Kong Society of Paediatric Cardiology and Consultant of Hong Kong Association of Cleft Lip and Palate. He is currently working as Director of Paediatric Centre of HK Medical Consultants and serves as Infection Control Officer at the Hong Kong Adventist Hospital.