Meningitis it is the inflammation of the meninges, i.e. the membranes that surround and protect the central nervous system (brain, spinal cord). It is a severe infection with high morbidity and mortality that requires prompt diagnosis and treatment.

It is caused by various causes (germs, viruses, parasites, drugs, malignancies, autoimmune diseases, etc.).
Germs (bacteria) usually cause meningitis (infection of the meninges) while the other causes mainly cause encephalitis (impaired level of consciousness).

Non-microbial causes (with the typical exception of severe herpetic encephalitis) usually have a mild and often self-limiting clinical course. In contrast, microbial meningitis is a highly urgent and serious condition. Besides, for microbial meningitis there is a special treatment (antibiotics) and effective prevention (vaccines). For this reason, in the following we will refer almost exclusively to microbial meningitis.

What are the most common symptoms?

The most common symptoms are headache, neck stiffness, fever, violent (“rocket-like”) vomiting, and intolerance to light and noise. Sometimes it is accompanied by a characteristic microspotted rash, when the cause is meningococcus which requires special attention because it can quickly develop into a severe septic condition. If the clinical picture is accompanied by drowsiness and disturbances in the level of consciousness, then we are talking about meningoencephalitis. As it can be seen, most of the symptoms are not specific, but when they are unusual and intense, they should raise the clinical suspicion of doctors towards the diagnosis (or exclusion) of meningitis.

What are the common pathogens?

The most important causes are pneumococcus, meningococcus and Haemophilus influenzae.

Diagnosis – treatment

Early diagnosis is crucial for treatment. The most important examination (after the clinical examination) is the lumbar puncture. Early diagnosis is required because the disease can develop rapidly and cause:

• Immediate death (rot, infection of the stem, bleeding, etc.)
• Later chronic neurological complications (after treatment).

Treatment is with appropriate antibiotics. Again we emphasize the importance of their timely administration. If the patient with suspected bacterial meningitis is to be transferred to a health facility (hospital, health center), the antibiotic must be administered immediately (within 20-30′) and before the patient leaves for the hospital.

Preventions and precautions

1. Vaccination. With modern National Immunization Commission vaccination programs, the incidence and mortality of bacterial meningitis have decreased dramatically in recent years. Available vaccines cover Haemophilus influenzae (b) and all strains of meningococcus (B,A,C,W,Y).

2. Prophylaxis of the environment of a confirmed case.

It concerns measures for people who came into close contact with a confirmed case. The transmission is not airborne but from the nasopharynx which is colonized by the microbe and can under certain conditions cause the disease. Transmission and spread requires close contact and socialization, such as in barracks, classmates in the same class, family environment, medical and nursing staff in close contact with the patient, etc.
Prophylaxis consists of giving short courses of oral antibiotics to close contacts to eliminate nasopharyngeal carriage. Disinfection of premises and environment is not required.

In conclusion, bacterial meningitis, one of the most serious infections, can be controlled and effectively treated with proper vaccination coverage and correct and timely diagnosis.

Vaccination saves lives.