Meningitis is acute or chronic inflammation of the spinal cord, collectively called the meninges. The most common symptoms are fever, headache, and neck stiffness. Other symptoms include confusion or altered consciousness, nausea, vomiting, and an inability to tolerate light or loud noises. Young children often exhibit only nonspecific symptoms, such as irritability, drowsiness, or poor feeding. A non-blanching rash (a rash that does not fade when a glass is rolled over it) may also be present.
The inflammation may be caused by infection with viruses, bacteria or other microorganisms. Non-infectious causes include malignancy (cancer), subarachnoid haemorrhage, chronic inflammatory disease (sarcoidosis) and certain drugs. Meningitis can be life-threatening because of the inflammation’s proximity to the brain and spinal cord; therefore, the condition is classified as a medical emergency. A lumbar puncture, in which a needle is inserted into the spinal canal to collect a sample of cerebrospinal fluid (CSF), can diagnose or exclude meningitis.
Some forms of meningitis are preventable by immunization with the meningococcal, mumps, pneumococcal, and Hib vaccines. Giving antibiotics to people with significant exposure to certain types of meningitis may also be useful. The first treatment in acute meningitis consists of promptly giving antibiotics and sometimes antiviral drugs. Corticosteroids can also be used to prevent complications from excessive inflammation. Meningitis can lead to serious long-term consequences such as deafness, epilepsy, hydrocephalus, or cognitive deficits, especially if not treated quickly.
In 2019, meningitis was diagnosed in about 7.7 million people worldwide,[9] of whom 236,000 died, down from 433,000 deaths in 1990. With appropriate treatment, the risk of death in bacterial meningitis is less than 15%. Outbreaks of bacterial meningitis occur between December and June each year in an area of sub-Saharan Africa known as the meningitis belt. Smaller outbreaks may also occur in other areas of the world. The word meningitis comes from the Greek μῆνιγξ meninx, “membrane”, and the medical suffix -itis, “inflammation”.
The symptoms of meningitis in very small children and babies include:
- Fever
- a bulge in the soft spot on top the head (the fontanelle)
- yellow skin (jaundice)
- unusual or high-pitched crying
- inactivity or floppiness
- irritability
- feeding problems
- holding their head back and arching their back
- being difficult to wake
- purple-red skin rash or bruising
- pale or blotchy skin
- seizures (fits)
The most common symptoms of meningitis in older children and adults are:
- fever
- sensitivity to light
- very bad headache and stiff or sore neck
- nausea or vomiting and loss of appetite
- tiredness and drowsiness
- irritability
- confusion
- purple-red skin rash or bruising
- muscle and joint pains
- seizures (fits)
The signs and symptoms do not appear in a definite order and some may not appear at all. Not all cases of meningitis will cause a rash. This symptoms list does not include every possible sign and symptom of meningitis.
People with meningitis will usually be admitted to hospital, although some people with viral meningitis can be cared for at home with close medical supervision.
Treatment will depend on the type of infection that has caused the meningitis.
Viral meningitis
There is no specific treatment for viral meningitis and patients usually get better with plenty of rest and fluids alone. Paracetamol can be used to ease any symptoms of headache and fever. Children with viral meningitis should stay home from school or day care until they feel well. Viral meningitis is not treated with antibiotics because antibiotics are not effective against viral illnesses.
Bacterial meningitis
Bacterial meningitis is a medical emergency and can be fatal if not treated quickly. If bacterial meningitis is diagnosed, antibiotics (often injectable or intravenous) will be used. They may be given for up to 3 weeks. Other medicines such as corticosteroids may also be given to help reduce the risk of complications, such as brain swelling or seizures.
People in close contact are sometimes given antibiotics to reduce their risk of developing the illness.
Fungal meningitis
Meningitis that’s caused by a fungus is treated with intravenous and oral anti-fungal medicine.
There is a lower risk of catching viral or bacterial infections if you follow good hygiene.
- Wash your hands regularly.
- Don’t share drink bottles, cups or cutlery.
- Sneeze into your elbow.
- Throw tissues into the bin straight after use and wash your hands.
Several of the viruses and bacteria that cause meningitis can be largely prevented by the routine childhood immunisation, so staying up to date with childhood vaccinations is the best way to prevent meningitis. Extra optional vaccines are also available against some of strains of meningococcus bacteria that can cause bacterial meningitis.
Vaccination is your best protection against meningococcal disease. Vaccination with meningococcal B and meningococcal ACWY can be done from 6 weeks of age. Meningococcal immunisation is recommended for:
- babies and young children under 2 years old
- teenagers and young adults aged 15-19 years
- teenagers and young adults aged 15 to 24 who live in crowded conditions
- Aboriginal and Torres Strait Islander people aged 2 months to 19 years
- teenagers and young adults aged 15 to 24 years who are current smokers
- travellers to places where meningococcal disease is more common\
- people who have medical conditions that increase their risk meningococcal disease, such as people with some blood disorders or weakened immune systems
- laboratory workers who work with the bacterium that causes meningococcal disease
Meningococcal meningitis remains a public health concern with a high case fatality rate and leading to serious long-term complications. Preventing meningitis through vaccination is the most effective way to reduce the burden and impact of the disease by delivering long-lasting protection. The rollout of multivalent meningococcal conjugate vaccines is a public health priority to eliminate bacterial meningitis epidemics in the African meningitis belt. Introduction into routine immunization programmes and maintaining high coverage will be critical to avoid the resurgence of epidemics.
Antibiotics for close contacts of meningococcal cases, when given promptly, decrease the risk of transmission. Outside the African meningitis belt, chemoprophylaxis is recommended for close contacts within the household. Within the meningitis belt, chemoprophylaxis for close contacts is recommended in non-epidemic situations. Ciprofloxacin is the antibiotic of choice, and ceftriaxone an alternative.
Admission to a hospital or health centre is necessary. Isolation of the patient is not usually advised after 24 hours of treatment.
Appropriate antibiotic treatment must be started as soon as possible. Ideally, lumbar puncture should be done first as antibiotics can make it more difficult to grow bacteria from the spinal fluid. However, blood sampling can also help to identify the cause and the priority is to start treatment without delay. A range of antibiotics is used to treat meningitis, including penicillin, ampicillin, and ceftriaxone. During epidemics of meningococcal and pneumococcal meningitis, ceftriaxone is the drug of choice.
The response to epidemics consists of appropriate case management, active community-based case-finding and reactive mass vaccination of affected populations. Surveillance, from case detection to investigation and laboratory confirmation is essential to the control of meningitis.
Reactive vaccination campaigns have been implemented in Zinder region, and monitoring the spread to new areas is crucial to guide further response activities, including considering further vaccine requests if appropriate. Timeliness of the reactive campaign is critical, ideally within four weeks of crossing the epidemic threshold.
WHO does not recommend any restriction on travel and trade to Niger on the basis of the information available on the current event.
