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Meningitis: an overview of types and symptoms

Meningitis is a swelling of the lining around the brain and spinal cord. One in ten individuals carry the bacteria in their noses and throats. Are we all at risk? If so, how do we protect ourselves, given its many strains?

“Meningococcal meningitis is caused by Neisseria meningitidis of groups A, B, C, Y, and W-135, among others,” explains Dr. Janis Coffin, Assistant Professor of Family Medicine, Medical Director, Family Medicine Center, Medical College of Georgia. “Meningitis due to serogroup A is uncommon in the U.S. Serogroup B generally causes sporadic cases. The frequency of outbreaks of meningitis caused by group C meningococcus has increased, and this serotype is the most common cause of epidemic disease in the U.S. Up to 40 percent of persons are nasopharyngeal carriers of meningococci, but relatively few develop the disease. Infection is transmitted by droplets. Symptoms include high fever, chills and headache, which can mimic flu-like illness. Patients then develop a stiff neck and nausea/vomiting. Occasionally, patients may present with altered mental status and seizures. Any time a patient has a severe headache with fever, this is a cause of concern, especially if this is associated with a stiff neck. Both viral and bacterial meningitis can have similar symptoms. The only way to distinguish bacterial versus viral meningitis is with a lumbar puncture, or spinal tap.”

According to the Centers for Disease Control and Prevention (CDC), approximately 2600 people contract meningococcal disease every year in the U.S, with a 10 to 15 percent mortality rate, despite antibiotic treatment. Among survivors, 11 to 19 percent lose their arms or legs, become deaf, have problems with their nervous systems or suffer seizures or strokes. “Bacterial meningitis carries a 3 to 10 percent fatality rate and meningococcemia carries up to a 40 percent fatality rate,” says Dr. Coffin. “Outbreaks occur more frequently in closed populations such as college dormitories and military barracks. Meningococcemia is when the bacteria escape from the brain/spinal cord to be disseminated through the rest of the body. This can lead to a petechial rash, vascular damage, multi-organ failure, shock, and death can occur in less than twenty-four hours.”

Two meningococcal vaccines are available in the U.S. Meningococcal polysaccharide vaccine (MPSV4) has been available since the 1970s, and meningococcal conjugate vaccine (MCV4) was licensed in 2005. Both vaccines can prevent four types of meningococcal disease, including two of the three types most common in the U.S. However, meningococcal vaccines cannot prevent all types of the disease. Both vaccines work well and protect about 90 percent of those who get it. MCV4 is expected to give better, longer-lasting protection. MCV4 should also be better at preventing the disease from spreading from person to person.

According to the CDC, anyone can contract meningococcal disease, but it is most common in infants less than 1 year of age and people with certain medical conditions, such as lack of a spleen. Preventing the disease through use of meningococcal vaccine is important for people at highest risk.

When symptoms present, do not wait. Go immediately to your doctor or the emergency room. “When a patient presents to the clinic or, more often than not, the emergency room, normally, immediate blood cultures and a lumbar puncture are performed,” says Dr. Coffin. “The cultures can take a while to come back, so antibiotics are started immediately. Household members exposed to a person with meningococcal meningitis are at increased risk and should be given prophylaxis, as are daycare center contacts. School and work contacts need not be treated. Hospital contacts receive therapy only if intense exposure has occurred.”

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