Meningitis

Meningitis is inflammation of the membranes (meninges) that cover the brain and spinal cord. It can be caused by bacteria, viruses, fungi, or parasites. Bacterial meningitis is a medical emergency — it can progress from first symptoms to life-threatening illness within hours. Viral meningitis is usually less severe and often resolves on its own. Tuberculous meningitis is an important cause in India and has a slower, more subtle presentation.

Symptoms — know these

Classic signs in adults and older children:

• Severe headache
• Stiff neck — difficulty touching chin to chest
• High fever
• Photophobia — bright light hurts the eyes
• Nausea, vomiting
• Drowsiness, confusion
• Seizures
• A rash — small red or purple spots that do NOT fade when a glass is pressed against them (the "glass test") — can indicate meningococcal meningitis, a particular emergency

In babies and very young children, signs can be different and subtle:

• Fever or low temperature
• Irritability, high-pitched crying
• Refusing feeds
• Floppy or unusually stiff
• Bulging fontanelle (soft spot on top of head)
• Drowsiness, hard to wake
• Vomiting
• The glass-test rash also applies

If you suspect meningitis, go to hospital immediately — dial 112. Don't wait for all symptoms. Every hour of delay worsens outcomes for bacterial meningitis.

Causes

• Bacteria — Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae, Listeria, Group B strep (in newborns). Mycobacterium tuberculosis causes TB meningitis, with slower onset and a particular concern in India.
• Viruses — most cases; usually milder. Enteroviruses common
• Fungi — cryptococcal meningitis, seen in immunocompromised people (HIV, transplant)
• Rarely — parasites, cancer, autoimmune conditions, medicines

Diagnosis

• Clinical examination
• Lumbar puncture — sampling spinal fluid for tests; the key diagnostic
• Blood tests, blood cultures
• CT or MRI of the brain
• TB testing where indicated

Treatment

• Bacterial meningitis — IV antibiotics started immediately, even before final test results; steroids for some bacterial types
• Viral meningitis — supportive care; most recover
• TB meningitis — prolonged anti-TB treatment, often 9-12 months, started promptly
• Fungal meningitis — antifungal medicines
• ICU care, anti-seizure medicines, management of raised pressure in the brain
• Close contacts of meningococcal cases may need preventive antibiotics and vaccination

Prevention

• Vaccines — against Haemophilus influenzae type b (Hib), pneumococcus, meningococcus (for certain risk groups and travellers), BCG (against TB), MMR
• Good hand hygiene
• Avoid close contact during outbreaks
• For babies and children — ensure full UIP immunisation
• For people with weakened immunity — extra vaccination discussions with the doctor
• For travellers to regions with meningitis outbreaks (e.g. the "meningitis belt" in sub-Saharan Africa, Haj pilgrimage) — specific vaccines are recommended