Bacterial Meningitis (Spinal Meningitis)

Risk FactorsA risk factor increases your chance of getting a disease or condition. The following factors increase your chances of developing bacterial meningitis. If you have any of these risk factors, tell your doctor: Age: infancy and early childhood; over 60 years of age People in close and prolonged contact with patients with meningitis due to Hib or Neisseria meningitidis A weakened immune system due to HIV infection or other conditions Alcoholism Smoking (for meningitis due to Neisseria meningitidis ) Living in proximity to others, such as dormitories and military barracks (for meningitis due to Neisseria meningitidis ) Symptoms Classic symptoms can develop over several hours, or may take 1 to 2 days: High feverHeadacheVery stiff, sore neck Other symptoms may include: Red or purple skin rashCyanosis (bluish skin color)NauseaVomitingPhotophobia (sensitivity to bright lights)SleepinessMental confusion In newborns and infants, classic symptoms are difficult to detect. Because symptoms in newborns and infants are unreliable, infants under three months old with a fever are often evaluated for meningitis. Symptoms in newborns and infants may include:

InactivityUnexplained high fever or any form of temperature instability, including a low body temperatureIrritabilityVomitingJaundice (yellow color to the skin) Feeding poorly or refusing to eatTautness or bulging of soft spots between skull bonesDifficulty awakening As bacterial meningitis progresses, patients of all ages may experience seizures and/or hearing loss . DiagnosisYour doctor will ask about your symptoms and medical history, and perform a physical exam. Tests may include the following: Spinal tap removal of a small amount of cerebrospinal fluid to check for bacteria Other Culturestesting of samples of blood, urine, mucous, and/or pus from skin infectionsMRI scan a test that uses magnetic waves to make pictures of structures inside the body (to be sure the inflammation is not from some other cause, such as a tumor) CT scan a type of x-ray that uses a computer to make pictures of structures inside the body TreatmentWhen treatment is provided immediately, more than 90% of all people with bacterial meningitis survive. Antibiotics and many times corticosteroids are given together to treat bacterial meningitis. Fluid replacement may also be given. Talk with your doctor about the best treatment plan for you. Treatment options include:

AntibioticsAntibiotics given through an intravenous line are administered as soon as bacterial meningitis is suspected. The antibiotics may be changed once tests identify the exact bacterial cause of meningitis. Patients usually stay in the hospital until fever has subsided and the cerebrospinal fluid is clear of infection. CorticosteroidsIntravenous corticosteroids are usually given early in the course of treatment, to control brain pressure and swelling, and reduce the bodys production of inflammatory substances that can cause further damage. Fluid ReplacementFluids lost due to fever, sweating, or vomiting are cautiously replaced to avoid complications of fluid overloading. Other MedicationsPain medications and sedatives may be used to reduce pain and fever. In addition, anticonvulsants may be prescribed to prevent seizures. Prevention To help reduce your chances of getting bacterial meningitis, take the following steps: Vaccines against Hib, which are very safe and highly effective, given to young children Pneumococcal polysaccharide vaccine against Streptococcus pneumoniae , given to: All people over age 65People ages 2 to 64 with certain chronic medical problems Pneumococcal conjugate vaccine against Streptococcus pneumoniae , given to: InfantsAll children older than 2years oldPreventative antibiotics given to healthcare workers or family members in close contact with infected patients Pasteurization of milk and milk products to prevent meningitis due to Listeria monocytogenesMonitoring for maternal infection during and before labor to prevent meningitis in newborns RESOURCES:

Centers for Disease Control and Preventionhttp://www.cdc.gov Meningitis Foundation of Americanhttp://www.musa.org National Institute of Neurological Disorders and Strokehttp://www.ninds.nih.gov CANADIAN RESOURCES: Health Canadahttp://www.hc-sc.gc.ca/index_e.html Public Health Agency of Canadahttp://www.phac-aspc.gc.ca References: Beers MH, Berkow R. The Merck Manual of Diagnosis and Therapy . 17th ed. Hoboken, NJ. John Wiley & Sons;1999. Diagnosis of acute meningitis in adult patients. Am Fam Physician . 2000 Jan 15:61. Meningitis and encephalitis fact sheet. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/encephalitis_meningitis/detail_encephalitis_meningitis.htm . Accessed November 27, 2005. Meningococcal disease. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/ncidod/dbmd/diseaseinfo/meningococcal_g.htm#Are%20there%20vaccines%20against%20meningitis . Accessed November 27, 2005. Last reviewed January 2008 by David Horn, MD, FACPPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.