Also see our topic After meningitis and meningococcal disease

What is meningitis and what is meningococcal septicaemia?

Meningitis is inflammation of the meninges, the linings surrounding the brain. It can be caused by bacteria and viruses.

Septicaemia is blood poisoning caused by bacteria entering the bloodstream and multiplying uncontrollably.

Bacterial meningitis and meningococcal septicaemia

Bacterial meningitis and meningococcal septicaemia are very serious and need urgent treatment with antibiotics. Meningitis is mainly caused by the meningococcal bacteria (Neisseria meningitis), but can also be caused by the pneumococcal, Haemophilus influenzae b (Hib) and tuberculosis (TB) bacteria amongst others.

Escherichia coli (E. coli) and group B streptococcal bacteria can also cause meningitis in newborn babies.

The meningococcus (Neisseria meningitis) has five main groups - A, B, C, W135 and Y. In New Zealand, group B meningococcal disease accounts for the majority of cases (around 93%). Group C causes the highest number of remaining cases (around 6%). Group Y accounts for a small number of cases each year. Group A rarely causes disease.

Amoebic meningitis

Amoebic meningitis is a very serious and very rare illness that, sadly, nearly always ends in death. It is caused by an amoeba that can live in geothermal pools and can be picked up through the nose when a person puts their head under the water.

Symptoms of amoebic meningitis are similar to other types listed here. The incubation period is normally three to seven days. If you have symptoms see a doctor immediately.

Viral meningitis

Viral meningitis is more common than bacterial meningitis. It is rarely life-threatening, but it can make people very weak. Viral meningitis can be caused by many different viruses. Some are spread by people coughing and sneezing, or through poor hygiene or sewage-polluted water.

How do you get bacterial meningitis or meningococcal septicaemia?

The bacteria are very common and live naturally in the back of the nose and throat. They normally spread between people in close and prolonged contact by coughing, sneezing and intimate kissing. They do not live for very long outside the body, so can't be picked up from water supplies, swimming pools or buildings.

People of any age can carry the bacteria for days, weeks or months without becoming ill and carrying the bacteria can help to make you more immune to meningitis. Occasionally, the bacteria overcome the body's defences and cause meningitis and septicaemia. The bacteria which can cause meningitis in newborn babies are commonly found in the intestine and vagina.

Signs and symptoms

Meningitis and meningococcal septicaemia may not always be easy to spot at first, because the symptoms can be similar to those of flu. They may develop over one or two days, but sometimes develop in a matter of hours.

The incubation period is between two and 10 days. Symptoms do not appear in any particular order and some may not appear at all. It is important to remember that other symptoms may occur and that the patient may be confused or disoriented.

In children and adults:

Vomiting, sometimes diarrhoea	High temperature, fever, possibly with cold hands and feet	Severe headache	Neck stiffness (unable to touch chin to the chest)
Dislike of bright lights	Drowsiness	Joint or muscle pains, sometimes stomach cramps with septicaemia	Fitting

In babies:

High temperature, fever, possibly with cold hands and feet	Vomiting, or refusing feeds	High pitched moaning, whimpering cry	Baby may be floppy, may dislike being handled, be fretful
Neck retraction or arching of the back	Blank, staring expression. The fontanelle (soft spot on babies heads) may be tense or bulging.	Difficult to wake or lethargic	Pale, blotchy complexion

Both adults and children may have a rash (see below).

What should you do?

• If someone you know is ill and you suspect meningitis/meningococcal septicaemia contact a doctor immediately.
• Describe the symptoms carefully, mention that you think it might be meningitis or meningococcal septicaemia.
• If a doctor is not available go straight to the nearest hospital or clinic.
• If it is meningitis or meningococcal septicaemia early treatment is vital.

Meningitis and meningococcal septicaemia need URGENT medical attention.

Septicaemic rash

Patients with meningococcal septicaemia often develop a rash which does not fade under pressure. The rash may start anywhere on the body as a cluster of tiny blood spots, which look like pin-pricks in the skin. If untreated, these blood spots will join to give the appearance of fresh bruises.

The "glass test" can be used to see if a rash might be septicaemia. If you press the side of a clear drinking glass firmly onto the spots or bruises, they will not fade. NB. In a small number of cases, the rash may fade at first, but may later change into one that does not.

Even though the rash may be harder to see on dark skin, the glass test can still be done. Look for the spots or bruises on paler parts of the skin, eg, palms of the hand or soles of the feet. There is sometimes a rash on the surface of the eye - the part mainly covered by the eyelid.

Do not wait for a rash. It may be the last symptom to appear, and in some cases it may not appear at all.

Treatment and Prevention

Viral meningitis does not respond to antibiotics, treatment is based on rest and good nursing care. Bacterial meningitis and meningococcal septicaemia need immediate treatment with antibiotics.

Only people who have come into close contact with meningococcal meningitis and meningococcal septicaemia require antibiotics (close contacts are people living or sleeping in the same household or who have intimately kissed the patient). School friends and work mates of the patient with meningococcal disease are rarely at higher risk.

Antibiotics are given to kill off any meningococcal bacteria which may be carried in the back of the nose and throat. This reduces the risk of passing the bacteria on to others.

Research suggests that not smoking may reduce the chances of contracting meningitis in your family.

Apart from vaccines, there is no known way to protect against meningitis and meningococcal septicaemia.

Vaccines

Some forms of meningococcal disease can be prevented by vaccine. Vaccines effective against groups A, B, C, W135 and Y are available in New Zealand. A vaccine against A & C can be given to people travelling to areas of the world where these groups commonly occur.

The vaccine is effective in about 80% of those who receive it, but it is not effective in children under the age of 18 months and only offers protection for about three years.

There has been a recent immunisation programme (2005/2006) against meningococcus group B, which is the most common group causing meningitis and meningococcal septicaemia in New Zealand. New Zealand has had an epidemic of meningococcal B disease.

This earlier Meningococcal B Immunisation Programme offered free immunisation to all babies, children and young people aged from 0-19 years to help prevent this disease. Even though the programme has ended, the vaccine may still be recommended for children and young people under 20 years, particularly those who are considered to be at increased risk of meningococcal B disease - see your doctor or practice nurse to discuss. People with certain medical conditions may also be recommended to have the vaccine.

More information

The New Zealand Ministry of Health also has informative web pages on Meningococcal disease in New Zealand and information about the previous Meningococcal immunisation programme and the vaccine used.

The Ministry of Health runs a free (within New Zealand) helpline for people of all ages with health concerns - 0800 611 116 - it is available 24 hours a day and calls are answered by a registered nurse or other health professional.

The Meningitis Trust (UK)

The Trust is a registered charity founded in the UK in 1986 by people who had a direct experience of meningitis. It leads the fight against meningitis by:

• offering a wide range of emotional and practical support for people affected by meningitis/meningococcal septicaemia.
• producing tailored education packages for childcarers and healthcare professionals.
• producing an extensive range of information to raise awareness of the disease.
• funding research into vaccines and treatment.

Also see the Meningitis Trust website www.meningitis-trust.org

Original material provided by the Meningitis Trust. Edited by everybody, Updated April 2009