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Meningitis

About meningitis and meningococcal septicaemia

Meningitis is inflammation of the meninges, the linings surrounding the brain. Meningitis can be caused by bacteria and viruses. Septicaemia is blood poisoning caused by bacteria entering the bloodstream and multiplying uncontrollably. Children under five years are more at risk, though all age groups can be affected. There can be serious complications and urgent medical treatment is needed. (Signs and symptoms are given further below).

Also see our topic: After meningitis and meningococcal disease

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 meningitidis), but can also be caused by the pneumococcal, Haemophilus influenzae b (Hib) and tuberculosis (TB) bacteria among others.

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

The meningococcus (Neisseria meningitidis) has five main groups - A, B, C, W135 and Y. In New Zealand, group B meningococcal disease accounts for the majority of cases, with group C being the second most common. Groups Y and W135 are not common here. Group A has caused some outbreaks in the past.

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 of meningitis

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.
  • Healthline offers free phone advice (within New Zealand) on 0800 611 116, available 24 hours a day and staffed by registered nurses or other health professionals.

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 of meningitis

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 workmates 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.

Viral meningitis, however, does not respond to antibiotics, so treatment is based on rest and good nursing care.

Basic hygiene precautions such as covering coughs and sneezes, washing your hands often, not sharing eating utensils or drinking vessels, and keeping a distance (one metre or more) from people who are coughing or sneezing, could help reduce the risk, or spread of bacteria (and viruses).

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

Vaccines against meningococcal disease

Some forms of meningococcal disease can be prevented by vaccine.

There is currently no meningococcal vaccine included on the National Immunisation Schedule. However, meningococcal vaccines may still be recommended for those at particular risk, and may be funded in some circumstances (eg, children with certain medical conditions). Parents who would like their child to receive a meningococcal vaccination should discuss this with their doctor, who can advise on individual factors, and cost of the vaccine and availability. 

Young people going to live in hostel-type accommodation may also want to consider having a meningococcal C vaccine, though this is not funded. People travelling overseas should get advice from their travel health doctor or medical centre about possible vaccinations, which may include for meningococcal disease.

Previous meningococcal B epidemic and vaccine

A meningococcal B immunisation programme was previously introduced in response to an epidemic in New Zealand of a meningococcal B strain (vaccine MeNZB was developed for this purpose). The special immunisation programme ran from 2004 to 2008, and was discontinued after disease rates had been reduced substantially. The last phase of the meningococcal B programme, which was for immunisation for people with a high medical risk, ended in March 2011.

More information

The New Zealand Ministry of Health also has informative web pages on Meningococcal disease in New Zealand

Healthline for advice

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 professionals.

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

Related topics

Also see: Childhood immunisation and Meningitis - recovery and Influenza

Original material provided by the Meningitis Trust (UK). Edited by everybody. Reviewed July 2013.

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