PM Pediatrics
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Dr. Christina Johns
Senior Medical Advisor, PM Pediatrics

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Demystifying Meningitis

We’ve all heard the frightening reported stories: a teenager away at summer camp says she has a stiff neck and a headache one minute, then in what seems like the next she’s dead. From meningitis.

There are few words in the lexicon of medical terminology that get everyone’s attention like the word MENINGITIS. Not unreasonable, since it CAN be a critical illness and can even be fatal. Serious business. It has sufficient cache that many people don’t even know what it really means; all they know is that it is BAD. But there’s more to the story than just BADNESS. So before our kids leave for camp and college, let’s dial down the scary unknown meter just a little and demystify this illness a bit.

Why am I doing this now, right at the end of the school year and the start of summer? You’ll see…in just a few paragraphs from now.

Let’s first talk about what meningitis is anyway.

The word meningitis refers to inflammation (“itis” means inflammation) of the meninges, or the tissues lining the brain. Meningitis is an infectious disease that can have multiple different causes: from bacterial to viral to the more obscure (like tuberculosis). People who have meningitis typically complain of some combination of the following symptoms:

symptoms of meningitis may include: fever, stiff neck, headache, light sensitivity, nausea and vomiting, fatigue, confusion, poor appetite, irritability, & even seizures

 

In many instances there is a short “flu like prodrome” where at first it just seems like a run of the mill viral illness or stomach bug, but then the symptoms hang around and get worse. By the time I see most patients with meningitis, they have an inkling that something is going on that’s probably more than just a 2-3 day sickness. They may not come in with every single symptom wearing a sign around their neck that says “I have meningitis,” but they have enough of a combination to raise suspicion. The hallmarks of this illness are clinical signs that we call “meningeal signs.” These include “nuchal rigidity” (25 cents), also known as stiff neck, and stiffness throughout the neck and spine when undergoing a straight leg raise. Light sensitivity, called photophobia, is also a big clue that really gets my attention.

Clinicians diagnose meningitis by obtaining a sample of the fluid that surrounds the brain and spinal fluid called the cerebrospinal fluid, or CSF.

This is done by performing a spinal tap, or lumbar puncture, where a small needle is introduced into the spinal column below the level where the spinal cord ends and only fluid exists. A small amount of fluid is drawn off and sent to the lab for analysis. Based on the cell count and level of glucose and protein in the fluid we can make a fairly solid preliminary guess whether or not the infection is due to a viral or bacterial cause. Sometimes a head CT scan and blood tests are also performed. It’s common to treat with broad spectrum antibiotics until the CSF culture incubates in the lab for 48 hours. After that time, if the culture is positive, then the antibiotics are continued and ultimately tailored to the exact infecting organism. If the culture is negative, the assumption is that the infection is viral meningitis, and then what is required is symptom management. Not antibiotics. The extent of that treatment includes pain management, adequate hydration, and rest. Sometimes this is no small task, with IV fluids and pain medicine and monitored hospitalization the appropriate course of treatment. People who have viral meningitis typically recover well.

Spinal Lumbar Puncture Illustration on old Paper

If I’m generalizing, I’d say that bacterial meningitis is usually more dangerous than viral meningitis.

(Of course there are exceptions like infants who get Herpes Simplex meningitis.) Bacterial meningitis is often associated with rapid clinical decline whereas most of the time viral meningitis is more indolent. I’m speculating here but I think there are likely plenty of patients with viral meningitis who never get a medical evaluation, who just tough it out and get better on their own. I don’t recommend this. If your child has symptoms that are concerning for possible meningitis, an urgent medical evaluation is important. The earlier the diagnosis is made, the sooner we can make your child feel more comfortable, regardless of final etiology.

 

This is a timely topic NOW because one of the most common culprits of viral meningitis is the class of germs called enteroviruses, which circulate around during the warmer weather months. While meningitis is rare overall, thankfully; we tend to see more viral meningitis in the summer. Knowing about this infection in the early innings is key since the sooner it is diagnosed the better the outcome will be, even if that means improved supportive care (note I’m repeating myself on this J).

It’s important to note that the overwhelming majority of people who get VIRAL meningitis recover very well (play it again, Sam). While I can’t stress enough the importance of awareness of symptoms and diagnosis right away, I do want to emphasize the point about recovery so that there might be a little less panic if the word meningitis is stated as a possibility for someone you know this summer.

 

What can be done to prevent meningitis?

For meningitis due to a bacterial cause, getting all the recommended immunizations on time is a smart move, as there are now several vaccines against germs that are known to cause meningitis: H. Influenza type b, Neisseria Meningitidis, and the Pneumococcal conjugate vaccine. Start there for sure. Some of these vaccines are given during infancy, and some are given in the pre-teen/teenage years.

Viral meningitis is typically transmitted through aerosolized respiratory particles, and that can be hard to control, but the same precautions that apply to regular viruses: coughing into the elbow, not sharing drinks with someone with a stomach bug, handwashing, etc. all apply.

Rx for good health habits

The takeaway points from this blog entry that I really want you to come away with are:

  1. Meningitis is serious but not an automatically fatal disease.
  2. There are different causes of meningitis, and knowing the symptoms can lead to early diagnosis and better outcomes.
  3. Viral meningitis is common in the summer, so watch out for it and pay attention to infection control measures just like during the winter.
  4. Viral meningitis is treated with supportive care, not antibiotics.
  5. Keeping current on immunizations is a crucial step in preventing bacterial meningitis.

Demystifying meningitis is meant to convert some fears (due to misunderstanding) into higher awareness and early recognition, all in the spirit of improved health outcomes for children, one kid at a time. I hope this post added a bit towards that goal.

 

 

 

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 Due to circumstances beyond our control, our Rockville Centre NY office will close at 6pm on June 6. All other offices are fully operational.