Meningitis (meningitis)

Headache and high fever often go hand in hand. But occasionally a simple infection turns out to be an insidious disease. Meningitis is an inflammation of the meninges caused by bacteria or viruses. Learn more about the causes, symptoms and treatment of meningitis.

What is a meningitis (meningitis)?

The brain is surrounded and protected by three meninges. Between the inner and middle meninges is a gap that is filled with an aqueous liquid and protects the gray mass against shocks. Viruses or bacteria can lead to inflammation of the meninges. In doing so, the tissue is attacked and impaired the function of the brain.

The infection causes swelling of the brain tissue and affects the blood circulation, so that paralysis similar to a stroke can occur. The life-threatening illness begins suddenly with high fever, strong headache and neck stiffness. In some cases it is even impossible to put your head on the chest.

Cramps, paralysis and vomiting can also occur. Pointed skin bleeding, clouding of consciousness and circulatory collapse are indications of a life-threatening disease course. In severe cases, the disease can lead to death within hours.

Three types of bacteria are the main culprits

More than 80 percent of all meningitis is triggered by three types of bacteria:

  1. meningococcal
  2. pneumococcal
  3. Haemophilus influenzae, which is responsible for the severe illness, especially in children under 4 years

All three pathogens are also present in healthy people, without causing any damage. But occasionally they infect the brain for no apparent reason.

Persons with an increased risk of meningitis

Infants up to two years of age and those with immune disorders are much more susceptible to meningitis.

In patients with chronic ear and nose infections, there is a risk that the bacteria enter the brain and thus cause inflammation. Even after surgery on the brain or spinal cord, there is an increased risk of meningitis.

Typical symptoms of meningitis

In children up to two years meningitis is noticeable by the following symptoms:

  • high fever
  • Feeding difficulties
  • Vomit
  • irritability
  • shrill screaming

Infants under one year must therefore always be presented to the doctor in case of fever, so that meningitis is excluded. Unlike adult and older children, neck stiffness is not necessarily present.

Older children and adults often feel irritated and confused and become increasingly drowsy. Coma and death can follow. Meningococcal meningitis quickly causes skin bleeding (petechiae) on the upper body and hands and feet. A blue and blotchy skin is also one of the typical identifiers.

Lumbar puncture brings clarity

Meningitis is diagnosed using a lumbar puncture. For this purpose, liquid is removed from the spinal cord. In the lower part of the spinal canal, usually between the third and fourth lumbar vertebra below the point where the spinal cord ends, a thin hollow needle is inserted. The spinal fluid can be removed and examined.

Part of the punctate is examined directly under the microscope for bacteria. The remainder is used to create bacterial cultures and thus to precisely determine the pathogen.

Immediate treatment with antibiotics

Purulent, ie bacterial meningitis, must be treated immediately with antibiotics. Eventually, cortisone is given to improve the general condition of the patient. In addition, the fluid loss suffered by the patient due to fever, sweat, vomiting and loss of appetite must be compensated.

Meningococcal meningitis can be complicated by a large drop in blood pressure, which is also treated with extra fluid or medication.

Meningitis as a result of viruses

Meningitis caused by viruses can not be treated with antibiotics. Due to their structure and metabolism, viruses do not respond to antibiotics. The symptoms of the disease, however, are very similar and do not allow a distinction without microbiological examinations.

Viruses that cause meningitis include herpes and mumps viruses. The herpes virus often triggers seizures in the early stages of the disease.

With the help of magnetic resonance imaging, swelling of the temporal lobes can be detected early on in herpes-related meningitis. If a herpes virus is the cause of the inflammation, it can be treated with the herpes-specific drug acyclovir, which does not help with other viruses.

Serious brain damage can be left behind

Virus-induced meningitis often develops without symptoms and just as often causes no damage. The severity of the disease depends on the latest research results obviously on the nature of the virus, but which can not be determined in each case with immunological tests.

Infants are more likely to experience serious injury than older children and adults.

The sequelae of bacterial meningitis may include seizures and permanent brain damage such as mental retardation and paralysis.

Vaccination against meningitis

Against certain bacterial pathogens, especially various types of meningococcus, vaccination is possible. There are several vaccines available that contain essentially fragments of the bacterium. The vaccine protection lasts between three and ten years depending on the type of vaccine and can usually be used in children as young as 2 years old. For some time, there is also a vaccine that can be used in children from 2 months.

Basically, vaccination against the Haemophilus bacterium (HiB) is part of the vaccination plan established by the Standing Vaccination Commission at the Robert Koch Institute (STIKO). The HiB vaccine is usually given to children four times. The first vaccination takes place after reaching the second month of life, the second and third vaccinations are given one month later and the last vaccination takes place between the 11th and 14th month of life.

It may be given alone or in combination with the combination vaccine against diphtheria, whooping cough and tetanus. After the age of 5, a HiB vaccine is only recommended in certain cases.

Meningitis vaccination before traveling

Meningitis vaccinations are also important for travelers. In principle, any country with difficult hygiene conditions can be considered as a possible meningitis area. At the same time, there is a temporal relationship between the season and the global spread of the disease. Between December and June, meningococcal epidemics occur more frequently south of the Sahara from Sudan to Zambia. From November to May, the risk of illness is particularly high in northern India and Nepal.

In England, Ireland, the Netherlands, the USA and Spain, the vaccination against meningococcal C has long been part of the vaccination plan: The pathogen is extremely common there. Exchange students, au pairs and anyone who wants to live longer should consider this. But even those who drive in the Bavarian Forest, should be vaccinated against the tick-borne encephalitis, which can be transmitted as a virus variant by tick bites.

Antibiotics in meningitis outbreak

In Germany, there are also cases of meningitis diseases that often occur frequently in certain places. Especially schools and kindergarten are contagious, because the bacteria are transmitted by coughing and sneezing as so-called "droplet infection". In this case, the people with close contact to the patient are treated with antibiotics as a precaution and observed.

In order to prevent such outbreaks it is particularly important to observe simple basic rules of hygiene. The hand over the mouth when coughing, the averting of the other for coughing and sneezing should be as natural as the frequent hand washing. In 2015, 287 people in Germany contracted a severe meningococcal infection, and 28 cases ended fatally.

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