01. What is meningitis?
02. What is septicaemia?
03. What causes meningitis?
04. Is it seasonal?
05. What vaccines are available?
06. If I get meningitis once can I get it again?
07. How is it spread?
08. Can anyone get it?
09. Are there different groups of disease?
10. What is the difference between meningitis and meningococcal septicaemia?
11. What are the main symptoms?
12. What is the rash?
13. Are signs and symptoms different for septicaemia?
14. What should you do if someone has signs and symptoms?
15. How is it treated?
16. What are the after-effects?
17. Why are antibiotics given to some people after a case of bacterial meningitis?
Meningitis is inflammation of the protective layers that surround the brain and spinal cord. These layers are called the meninges.
Septicaemia is blood poisoning and can be caused by some types of bacteria that also cause meningitis. The bacteria enter the bloodstream and multiply uncontrollably. As the bacteria die and breakdown, they release toxins (poisons) into the blood. These toxins damage the blood vessels throughout the body, causing organ damage. The rash associated with meningitis is actually caused by septicaemia.
Meningitis can be divided into two main types; viral and bacterial meningitis. Viral meningitis is reasonably common, but rarely fatal. It presents like flu and cannot be treated with antibiotics. Bacterial forms are comparatively rare, but extremely dangerous and can be fatal. The most common bacterial cause in the UK is the meningococcus. This can cause both meningitis and septicaemia (meningococcal disease). Other forms of bacterial meningitis include pneumococcal, Hib, neonatal (caused by E. coli and group B streptococcus) and TB.
Although meningitis can occur at any time of the year, the number of bacterial meningitis cases rise during the winter months and the number of viral meningitis cases increase during the summer months.
There are no vaccines to offer protection against all forms of meningitis and meningococcal disease. However, there are four vaccinations offered as part of the childhood immunisation programme:
- Hib – given to babies at two, three, and four months, with a booster at 12-13 months. It protects against Haemophilus influenzae type b.
- MenC – given to babies at three, four and 12-13 months. It protects against group C meningococcal disease only. This vaccine was introduced in 1999 and is available to all those aged under 25 years.
- Pneumococcal – given to babies at two, four and 12-13 months. It protects against pneumococcal meningitis.
- MMR – given at around 12-13 months, with a booster dose before the age of 5. It protects against mumps, measles and rubella. The virus that causes mumps is a common cause of viral meningitis.
Travel vaccines are also available for people visiting countries where there is a risk of meningococcal groups A, C, W135 and Y. A vaccine is also routinely offered to the over 65s in the UK to protect against pneumococcal disease (including meningitis).
It is very unusual for anyone to have meningitis more than once, but it is possible. Most people develop immunity to the organism that has caused their disease. However, there are several different causes of meningitis and therefore it is possible, but rare, to have the disease more than once.
The meningococcal bacteria are carried in the back of the throat and are spread by coughing, sneezing and intimate kissing (close prolonged contact). The bacteria are extremely fragile and cannot live outside the body for very long, therefore it is not a highly contagious disease. At any one time, around 10% of the population are carrying the bacteria.
Everybody carries a very small risk, but certain age groups are more susceptible. The under fives are the most at risk group, particularly the under ones. Teenagers and young adults are the second most at risk group. Scientists do not yet fully understand why a few people get meningitis or septicaemia from bacteria that appear to be harmless to most of us.
Yes, meningococcal disease can be divided into several groups, including A, B, C, W135 and Y. Group B causes over 90% of meningococcal disease in the UK.
There is still no vaccine to prevent group B meningococcal disease, so it is vital that you know the signs and symptoms to look out for.
The meningococcal bacteria can affect the body in several ways:
- Meningitis is caused when bacteria enter the bloodstream and travel to the meninges, where they multiply and cause inflammation.
- Septicaemia is caused when bacteria enter the bloodstream and multiply rapidly. They release toxins that poison the blood. If the bacteria do not reach the meninges, meningitis does not occur.
- Commonly, the bacteria will multiply in both the meninges and the bloodstream, causing meningococcal meningitis and septicaemia to occur.
There are several signs and symptoms associated with meningitis and septicaemia. They can appear in any order, and some may not appear at all.
In adults and children: fever with cold hands and feet – vomiting – drowsy, difficult to wake – confusion and irritability – severe muscle pain – pale blotchy skin, spots or a rash that does not fade under pressure – severe headache – stiff neck - dislike bright lights – convulsions/seizures.
In babies and toddlers: fever with cold hands and feet – refusing food or vomiting – fretful, dislike being handled – drowsy, floppy, unresponsive – rapid breathing or grunting – pale blotchy skin, spots or a rash that does not fade under pressure – unusual cry, moaning – tense, bulging fontanelle – neck stiffness, dislike bright lights – convulsions/seizures.
When bacteria multiply in the blood stream, they release toxins (poisons) that damage the blood vessels. The rash is caused by blood leaking from the damaged blood vessels into the tissues underneath the skin. The rash can start anywhere on the body. It begins as tiny red pin pricks, but may quickly develop to look like fresh bruising. The Glass Test can be used to see if the rash might be septicaemia. If you press the side of a clear drinking glass firmly onto the spots or bruises, they will not fade.
If the patient has septicaemia alone, the common signs for meningitis are not present. Early warning signs are sometimes not there, or are very difficult to spot. These can include fever with cold hands and feet, vomiting, muscle pain, pale blotchy complexion, stomach cramps and diarrhoea. Very often the first sign people notice is the rash. Septicaemia can progress very quickly and a patient can suffer severe shock and death within hours. If septicaemia is suspected, urgent medical help is needed.
If you have identified signs and symptoms and the patient’s general health is deteriorating, you need to act quickly. Seek medical help immediately, describe the symptoms as accurately as possible and mention that you think it could be meningitis or septicaemia. Early diagnosis can be difficult. If you have had advice and are still worried, get medical help again.
Meningococcal disease requires urgent hospital care and treatment with antibiotics. The progression of the disease varies, with some people needing only a few days in hospital and others needing a longer stay with treatment in an intensive care unit.
The majority of people will make a full recovery, but some people may be left with after-effects from both bacterial and viral meningitis. The most common after-effect of meningitis is deafness and others include:
- Learning difficulties.
- Mood swings.
- Disruptive behaviour.
- Sight problems.
- Memory loss.
- Concentration problems.
The toxins that are released during septicaemia cause damage to blood vessels. This can prevent the vital flow of blood and oxygen to major organs such as the kidneys, liver and the skin. Those who have suffered septicaemia may need skin grafts and sometimes amputations.
Meningococcal disease carries a slightly increased risk to the household and kissing contacts of a primary case. The antibiotics are given to destroy any meningococcal bacteria (which may be carried at the back of the throat) and prevent any further transmission. These antibiotics are not a form of prevention. If someone is already incubating the disease, the antibiotics will not stop them developing meningitis and/or septicaemia. It is still important to look out for signs and symptoms.