Narayana Health Care

According to some Indian Studies conducted by NCBI, meningitis is reported as one of the leading causes of deaths among children below five years of age accounting together to nearly 22.0% deaths. Hospital-based data reports that nearly 40–50% of meningitis result from Hib infection.

The term meninges accurately mean “membrane”. These are the layers that surround the brain and spinal cord. This includes the most outer dura mater (inner to the skull), middle arachnoid mater, and innermost pia mater. The fluid that flows between these meninges is called the Cerebrospinal fluid.

Meningitis is the inflammation of meninges. This may most commonly be due to viral or bacterial infection.

In separate sections, we have already looked into the types and causes of meningitis, today we will discuss the signs and symptoms of meningitis pertaining to their types.

Symptoms may appear immediately within seven days and include:

1. Viral Meningitis

• Diminished appetite – Reduced intake of food
• Irritability
• Sleepiness – more than usual sleeping
• Tiredness or exhaustion
• Fever
• Headaches – as severe as migraines
• Stiff neck – one of the earliest presenting complaints
• Seizures – Delayed symptoms once micro-organisms reach the brain and interfere with the normal neurological processes
• Person act sensitive to bright light – due to interference with neurological processes the person becomes sensitive to light
• Nausea and vomiting

2. Bacterial Meningitis

• Changed mental status due to bacteria reaching the brain and interfere with the normal neurological processes releasing chemicals that cause a state of confusion
• Nausea
• Vomiting
• Sensitivity to light due to meningitis interfered neurological processes
• Irritability
• Headache
• Fever
• Chills
• Stiff neck
• Purple bruised areas of skin
• Sleepiness
• Laziness

Infants and children with Bacterial meningitis present as:

• Breathing short rapidly
• Reject feeds and is irritable
• Scream unreasonably in a high-pitched moan
• Present pale yellow or has jaundice
• Present with an outward fontanelle
• Present stiff, with spasmodic movements
• Is lethargic and tired all the time
• Present with weak sucking while breastfeeding
• Presents following cold or flu

3. Fungal Meningitis

• Nausea
• Vomiting
• Sensitivity to light
• Fever
• Headache
• Confusion or disorientation

Apart from fungal, bacterial, and viral symptoms, signs and symptoms vary with age and sex too.

Adult Meningitis:

• Adults are at a lesser risk than children and elderly
• Young adults sharing the same living space are a higher risk
• Women present with a delayed age of onset than men

Round glass test:

A typical rash is produced by bacterial meningitis due to the involvement of capillaries and resultant blood leaks. It gets severe as the infection spreads. It may spread rapidly and is identified by pressing the side of a glass firmly on the rash. If the rash fades it does not represent a meningeal rash, otherwise, it is.

Prevention:

Prophylactic meningococcal conjugate vaccines are existing for bacterial meningitis. It may have a series of side effects at the time of vaccination but it provides a more widespread and longer protection against meningitis. This vaccine is recommended for a risk population.

• People mass living together like that in dorms, camps and the like
• Adolescents around eleven years
• People travelling to African or middle eastern countries
• Toddlers who are immune-compromised or has no spleen

Complications – if untreated the patient may present with certain severe manifestations presented as:

• Convulsions or seizures
• Loss of hearing
• Loss of vision
• Abnormal gait
• Memory issues
• Migraine
• Kidney failure
• Arthritis
• Brain tissue impairment
• Hydrocephalus
• A subdural empyema or fluid between the brain and the skull
• Sepsis
• Gangrene
• Shock
• Death

I hope the above write-up must have added your knowledge base about the symptoms and clinical presentation of different types of meningitis. Awareness is yet another form of presentation. Stay aware!!

Dr. Amit Shrivastava | Senior Consultant – Neurology | Dharamshila Narayana Superspeciality Hospital, Delhi