Meningitis: viral and bacterial

Meningitis is an inflammation of the meninges (which is the skin that covers the brain and spinal cord) caused by a viral or bacterial infection.
This condition is very serious and can be fatal.
Meningitis or meningitis can be triggered by viruses, bacteria, other microorganisms or non-infectious causes.

Viral meningitis is the most common and usually more benign than bacterial meningitis, which can be fulminant.
Viral meningitis can be very uncomfortable, but it is almost never life-threatening. Most people recover completely and quickly.

Usually, meningitis and septicemia caused by bacteria are much more severe than other forms.
There are at least 50 types of bacteria that can cause meningitis and septicemia, most of which are caused by meningococci.


Invasive meningococcal disease

Invasive meningococcal disease can occur as septicemia, meningitis, or a combination of both.
In a sick child, a generalized petechial rash in the course of the superior vena cava or a purple skin (rash) at some point should arouse the suspicion of meningococcal sepsis and one should immediately visit an emergency room.

The following signs and symptoms in a sick child are typical of invasive meningococcal disease: pinhead-sized skin bleeding, altered mental status, cold hands and feet, body aches, fever, headache, stiffness of the neck and patches on the skin.

Meningococcal meningitis and/or sepsis may also be associated with unusual skin color and hypotension.

Symptoms of meningitis

  • Fever
  • Headache
  • Neck stiffness and neck pain (usually not in children under one year of age or in patients with altered mental status)
  • Stiffness of the back muscles
  • Bulge of the fontanelles (in infants)
  • Photophobia
  • Opisthotonus, i.e. the posture of the back and neck is extremely stretched due to a strong contracture of the muscles of the spine
  • Altered state of mind, loss of consciousness, prefinality
  • Shock: Symptoms of shock include tachycardia and/or low blood pressure, respiratory failure, and low urinary output
  • The Kernig sign is a nerve stretching pain on the knee with a flexed hip joint
  • The Brudzinski sign is the spontaneous flexion in the hips and knees that occurs when the head is bent with the chin towards the sternum
  • Paresis and neurological deficits (including cranial nerves and puppile abnormality)
  • Epileptic seizures.

Viral meningitis cannot be clinically distinguished from the bacterial form, but the symptoms may be milder and the complications (for example, neurological deficits) less frequent.
Any person who turns to a doctor with suspected meningitis should be treated as if they have bacterial meningitis until the opposite turns out.
The classic symptoms are not obvious in infants and often also in the elderly.

Rather, some children and adolescents show non-specific symptoms or signs that are difficult to distinguish from other, less severe infections.
Children and adolescents with much more typical signs and symptoms are more likely to develop bacterial meningococcal meningitis or sepsis, the symptoms or signs may be more serious and much more specific over time.

About 25% of individuals with bacterial meningitis have symptoms that manifest themselves in an acute manner within 24 hours of infection.
Other patients with bacterial meningitis and most patients with viral meningitis present with subacute neurological symptoms that develop over more than 1-7 days.
Chronic symptoms lasting more than a week suggest meningitis caused by fungi or various bacteria, such as tuberculosis, syphilis.

Differential diagnosis of meningitis

  • Other causes of fever and serious infections.
  • Other causes with altered mental status and coma, for example, encephalitis, subarachnoid hemorrhage or a brain tumor.


Diagnostic examinations for meningitis

The examinations must not delay treatment.

Other investigations
These are often performed, they are blood cultures, blood sugar tests, lumbar puncture, kidney function test, uricult, etc.

Treatments and medications for meningitis

Treatment depends on the type of meningitis.
Acute bacterial meningitis involves prompt treatment with intravenous antibiotics and, more recently, corticosteroids to ensure recovery and reduce the risk of cerebral edema and epileptic seizures.

The antibiotic chosen by the doctor or the combination of antibiotics depends on the type of bacteria causing the infection. The doctor may recommend broad-spectrum antibiotics until the exact cause of meningitis is determined.
Sinus infections (sinusitis) or mastoid, the outer bone behind the ear that leads to the middle ear, may require drainage.

Viral meningitis: Antibiotics cannot cure viral meningitis, in most cases it improves on its own within a few weeks.

Treatment of mild cases of viral meningitis includes only:

  • Abundant hydration.
  • Over-the-counter medications to reduce fever and relieve physical pain.
  • If the cause is a herpes virus, an antiviral is available.

Other types: If the cause of the meningitis is not clear, the doctor can start virostatic therapy and, as long as one searches for the cause, also use antibiotics.

Fungal meningitis is treated with antifungal drugs.
However, these drugs can have strong side effects. Therefore, treatment may be delayed until laboratory tests confirm that the cause is a fungus.
Chronic meningitis is treated based on the cause, which is often a fungus.

Non-infectious meningitis is caused by an allergic reaction or an autoimmune disease treated with corticosteroids.

In some cases, no treatment is needed because the disease should heal spontaneously.
Meningitis, which is associated with cancer, requires the appropriate therapy for the respective type of cancer.

Complications of meningitis

Right away:

  • Septic shock.
  • Disseminated intravascular coagulation is a widespread coagulation phenomenon, characterized by the accumulation of fibrin in the small blood vessels and bleeding of the skin and mucosa.
  • Coma.
  • Epileptic seizure (30-40% of children, 20-30% of adults).
  • cerebral edema and increase in intracranial pressure.
  • Septic arthritis.
  • Hemolytic anemia (H. influenzae).
  • Excessive secretion of the antidiuretic hormone ADH.
  • Epileptic seizure, occurs more often in the acute phase of the disease.
  • Subdural effusion is a hemorrhage into the space between the hard meninges and the brain or spinal cord.
  • Reported in 40% of children aged 1-18 months with bacterial meningitis.
  • Risk factors include adolescent age, rapid onset of the disease, decreased peripheral white blood cells and high protein content of CSF.

Late complications:

  • Hearing loss or deafness.
  • Focal neurological deficits such as facial palsy, hemiplegia, tetraparesis and limitation of the field of vision.
  • Hydrocephalus is an excessive accumulation of cerebrospinal fluid in the cerebral ventricles and/or subarachnoid space.
  • Intellectual deficit.
  • Ataxia is a disorder of the nerves that leads to progressive loss of muscle coordination.
  • Blindness or vision loss.
  • Waterhouse-Friderichsen syndrome is a serious pathology that leads to blood clots and hemorrhagic infarction in the adrenal glands.
  • Peripheral gangrene.

Read more: