Table of Contents
What is meningitis?
Meningitis is an inflammation of the meninges, which should not be confused with encephalitis. Meningitis affects the membranes covering the brain, while encephalitis affects the brain itself. However, it is possible for both inflammations to occur at the same time. Bacterial meningitis can become life-threatening within a few hours.
Meningitis: general symptoms
Meningitis begins with symptoms similar to those of the flu. These include headaches and body aches , high fever , as well as vomiting and nausea . As the disease progresses, painful neck stiffness occurs , which is a typical symptom of meningitis. Since the meninges are equipped with pain receptors, they react to inflammation and irritation with pain. This pain is particularly noticeable when the head moves, for example when the chin is tilted away from the chest. This is due to the stretching of the lining of the brain and spinal cord.
Typical symptoms of meningitis:
- Flu-like symptoms such as fever, headache and body aches, vomiting, nausea
- expressed feeling of illness
- high sensitivity to light (photophobia)
- increased sensitivity to noise
Symptoms, course & causes of viral meningitis
Symptoms & course
Viral meningitis is milder than bacterial meningitis. Typical signs after about two to 14 days of incubation are:
- flu-like symptoms
- neck stiffness
| Virus | transmission | illness |
| Coxsacksie A & B | droplet infection | Hand, foot and mouth disease, summer flu, herpangina |
| FSME | Bite of blood-sucking ticks | Tick-borne encephalitis |
| Herpes Simplex Typ 1 & 2 | direct body contact, droplet and smear infection | Lip and genital herpes |
| Varicella-Zoster | Direct contact with the rash | chickenpox, shingles |
| Epstein-Barr | Saliva, body fluids, blood | glandular fever |
| Mumps | Droplet infection through coughing & sneezing, saliva | Mumps |
| measles | Droplet infection through coughing & sneezing, saliva | measles |
| HIV | blood, semen, vaginal secretions and breast milk | HIV (immunodeficiency disease) |
| Polio | Contaminated drinks, droplet infection from coughing & sneezing | poliomyelitis |
| rubella | Droplet infection from coughing, sneezing and speaking | rubella |
| Parvo-B19 | Droplet infection from coughing, sneezing and speaking | ringworm |
Treatment and consequences of viral meningitis
In the case of viral meningitis, only the symptoms are usually treated. If herpes viruses or the HI virus are the trigger, they can be treated with antivirals (antivirus drugs). Bed rest as well as pain-relieving and antipyretic medications also help.
A viral meningitis is less life-threatening than a bacterial one. If the patient survived the first few days well, the chances of recovery are very good and the meningitis heals completely within several weeks without any consequential damage.
Vaccination against viral meningitis
To prevent viral meningitis, children are recommended to be vaccinated against measles , mumps and rubella , and against tick-borne encephalitis (TBE). The Standing Vaccination Commission (STIKO) recommends vaccination against TBE for all people who live or vacation in tick-risk areas. Three vaccine doses are required for the basic immunization. This should be refreshed after three years. In the subsequent five-year cycle, vaccinations against TBE are given regularly.
Symptoms & causes of bacterial meningitis
In the case of bacterial meningitis, the symptoms can massively worsen within a few hours, so that the disease can lead to death! The incubation period is two to five days, with meningococci two to ten days. If you experience the following symptoms, you should react quickly and call the emergency doctor or go to the emergency room!
- flu-like symptoms such as fever, headache and body aches, nausea and vomiting
- extremely pronounced neck stiffness
- very bad headache
- neurological deficits: dimming of consciousness and/or slurred speech
- fever
- poor drinking
- noticeable tiredness
- highly irritable and listless
- stomach pain
- seizures
- shrill screaming
- convex fontanel
Bacterial meningitis is most commonly transmitted by pneumococci. However, meningococci, staphylococci, enterobacteria and Haemophilus influenzae type B etc. can also trigger the disease.
| bacteria | transmission | illness |
| Pneumococci | Droplet infection from coughing and sneezing | Meningitis, pneumonia, middle ear and sinus infections |
| meningococci | Droplet infection through coughing, speaking and sneezing | meningitis and blood poisoning |
| Staphylokokken | Droplet infection and use of contaminated objects | Meningitis, food poisoning, blood poisoning, wound infections |
| Enterobacterien | smear infection | Diarrheal diseases, intestinal inflammation, meningitis, pneumonia |
| Haemophilus influenzae Typ B | Droplet infection from coughing and sneezing | Meningitis, pneumonia, blood poisoning, heart muscle inflammation |
| Streptococcus agalactiae | Droplet transmission through coughing and sneezing | Meningitis, blood poisoning, urinary tract infections, wound infections |
| Listeria monocytogenes | red meat, cold smoked fish, raw milk and raw milk cheese | Listeriosis: diarrhea and vomiting, blood poisoning, meningitis, encephalitis |
effect of the bacteria
The meningococci flood the patient’s blood, causing blood poisoning (sepsis). In severe cases, Waterhouse-Friedrichsen syndrome develops:
Meningococci carry sugar chains (endotoxins) on their surface, which release toxins when the bacteria break down. These toxins trigger an uncontrolled blood clotting disorder, causing numerous blood clots to form and clogging smaller vessels. The necessary coagulation factors are used up, so that bleeding can occur in the skin, mucous membranes and organs. So-called petechiae appear on the skin as pin-sized, red-brown spots that grow larger and larger as the disease progresses. This can also happen in the adrenal glands. If they are severely damaged, they can no longer produce hormones. The profuse bleeding in the skin and organs can cause blood pressure to drop, putting the patient in shock and, in the worst case, in a coma. Mortality is very high!
Meningitis: investigation, treatment & consequences
Investigations In order to diagnose
bacterial meningitis , the medical history (anamnesis) is first examined. During the physical examination, the doctor tries to move the patient’s head towards the breastbone, which allows the neck stiffness to be determined. Due to the stretching of the membranes of the brain and spinal cord and the associated pain, patients also automatically pull their legs up ( Brudzinski sign ). Another sign of the disease is that patients cannot straighten their leg while sitting because it is too painful ( Kernig’s sign ). The third sign ( Lasègue sign) is recognized by the doctor by guiding a stretched leg of the lying patient upwards and flexing the hip joint. Shooting pain indicates irritation of the meninges.
During further examinations, the doctor takes blood to determine the pathogens with certainty and to select a suitable antibiotic. The doctor can also remove nerve fluid from the spinal cord canal, which is also examined in the laboratory for pathogens. In addition, computed tomography (CT) or magnetic resonance imaging (MRI) can be done to see the condition of the brain. Sometimes it can also be proven where the pathogen comes from, for example from purulent sinuses.
Treatment
Regardless of whether the meningitis is viral or bacterial, the doctor will prescribe an antibiotic . Only with early therapy can bacterial meningitis be treated as quickly as possible and prevent further complications. The antibiotic is usually given as an infusion into a vein so that it works quickly. Once the laboratory confirms the disease, the doctor adjusts the treatment and may give other antibiotics that target the bacteria more effectively.
Develops Waterhouse-Friedrichsen syndrome, is treatment in the intensive care unitnecessary in a single room. The patient is treated in isolation. Contact persons may receive antibiotics as a preventive measure. Anyone with whom the patient has been in contact in the seven to ten days prior to the onset of the disease should also be treated. A meningococcal vaccination may also be useful.
Consequences
Since bacterial meningitis is life-threatening , the chances of survival depend on which pathogen caused the meningitis and how quickly it was treated. With timely treatment, an adult has a good chance of making a full recovery. Babies and the elderly usually have less of a chance because of their weaker immune systems.
In some cases, neurological damage such as hearing damage, signs of paralysis or impairment of the psyche or behavior can occur. This often happens when the inflammation also affects the brain.
Vaccination against bacterial meningitis
The Standing Vaccination Committee (STIKO) recommends vaccinations against meningococci, pneumococci and Haemophilus influenzae type B, especially for children, since their immune system is not yet very good at fighting off the pathogens.
Meningococcal vaccination
Group B and C meningococci most commonly cause meningitis. The C group is responsible for this much less frequently than the B group. However, group C is difficult and often associated with complications, which is why children in their second year of life should be vaccinated against this form. The vaccination can be made up for up to the age of 18. Group C also includes vaccines against groups A, W and Y.
The B group , against which there has been a vaccine since 2013, is administered in four vaccine doses for children and two vaccine doses for adults.
Pneumococcal vaccine
This vaccine is given in three doses to children: the first dose at two months of age, the second at four months of age, and the third between eleven and fourteen months of age.
Haemophilus influenzae type B vaccination
This vaccination is also recommended for all children and is administered in four doses – one each from the age of 2, 3 and 4 months, and at the end of the first year of life.
