when it could be meningitis…

by Jenny Bryan

Meningitis is inflammation of the protective layers of tissue, called the meninges, that cover the brain and spinal cord, and about 3,500-4,000 cases are reported each year in the UK. Meningitis can be caused by a variety of viruses and bacteria. Although viral infection is more common, bacterial meningitis is more serious as it can lead to blood poisoning (septicaemia).

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It is the life-threatening bacterial meningitis which regularly hits the headlines. Jess from Hollyoaks is affected by the viral form, which isn't usually as serious.

what is viral meningitis?

Viral meningitis is more common in summer, bacterial meningitis in winter. Most of the viruses that cause meningitis live in the intestines and tend to be passed on as a result of poor hygiene. Jess may have eaten food prepared by someone who didn't wash their hands properly after going to the toilet.

Once the virus was in Jess's system, it would have got into her bloodstream and travelled around her body, putting up her temperature, making her feel tired, achy and sick, and giving her diarrhoea. The fever, aches and pains and upset stomach of viral meningitis are easily confused with flu symptoms. Eventually, the virus finds its way up to the tissue around the brain - and that's when the trouble really starts.

Fortunately, viral meningitis rarely progresses to the paralysis, fits, double vision and coma that can occur in the most severe cases. Most cases of viral meningitis can be treated at home with rest, plenty of fluids and paracetamol. Antibiotics aren't helpful because they don't work against viruses – only bacteria.

bacteria at work

The bacteria that can cause bacterial meningitis don't usually live in the intestines. Their home tends to be the nose and throat and they are passed on through coughing, sneezing, kissing or other close contact.

There are four main groups of bacteria which can cause meningitis – pneumococci, streptococci, meningococci and Haemophilus influenzae type b (Hib). Two forms of meningococcal meningitis – B and C – are a particular problem in the UK. Until a vaccine was introduced in autumn 1999, meningococcus C caused about 40% of meningitis cases in the UK and, of these, about 10% were fatal. But the number of cases of this type of meningitis has fallen dramatically since children were routinely immunised.

Some of the symptoms of bacterial meningitis are the same as for the viral version, but others are much more serious. Adults and older children may get:

• a high temperature
• vomiting
• stiff neck
• aversion to bright light
• sore throat
• drowsiness
• joint or muscle pains
• stomach cramps
• fits
• confusion
• disorientation

Babies and infants may get:

• a high temperature
• fever (possibly with cold hands and feet)
• vomiting and refusing feeds
• high pitched moaning
• wimpering cry
• blank staring expression
• difficult to wake
• lethargic
• pale, blotchy skin
• floppiness
• dislike of being handled
• fretful
• arching the back
• convulsions
• bulging fontanelle (soft spot on head)

Bacterial meningitis can be treated with antibiotics and the sooner the infection is diagnosed the greater the chance of a full recovery. Anyone who has been in close contact with someone with bacterial meningitis, such as family, should be examined by a doctor and may need antibiotics.

the dangers of blood poisoning

The biggest danger from bacterial meningitis is that the infection will get into the bloodstream and cause septicaemia. This makes blood vessels leak and little blood blisters appear under the skin, like a rash. Without emergency treatment, the blood supply to hands, feet, arms or legs may be cut off, and people lapse into coma. About one in ten people with septicaemia die, and some of those who recover need limbs amputated because the damage caused by lack of blood supply is so severe.

Rashes are very common, but the septicaemia rash is special. Purple-red spots can appear anywhere on the skin, starting as a cluster of tiny blood spots which join to give the appearance of fresh bruises. The 'tumbler test' can distinguish a septicaemia rash from other rashes. When the side of a clear glass or tumbler is pressed flat against an ordinary rash, it will fade so that you cannot see it through the glass. But the spots of a septicaemia rash don't fade. Look through the side of the glass and they will still be there.

what about vaccines?

Children are now routinely immunised against both meningococcal C and Hib meningitis. Eight months after the new vaccine against meningococcus C was introduced, the number of cases caused by the bacterium had already fallen by 75%. Amongst the millions of children and teenagers who have been immunised, the vaccine has proved 96% effective.

Few people get any problems after having the vaccines. After the meningococcal C vaccine, there may be some redness and swelling where the injection is given. Toddlers may have disturbed sleep and some children may develop a mild fever.

Hib is given along with vaccines against diphtheria, tetanus and pertussis (whooping cough) when children are two, three and four months old. Many babies feel a bit miserable within 48 hours of the injection and some develop a fever. Sometimes a small lump develops where the injection was given and this can last for several weeks.

Always talk to your doctor if you are worried about your child's reaction to a vaccine. A few children do get more severe reactions to all sorts of vaccine, not just those for meningitis, and this may mean that they should not complete the course of injections.

help and info

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organisations

Meningitis Research Foundation
Midland Way
Thornbury
Bristol BS35 2BS
Tel: 01454 281811
Helpline: 0808 800 3344 (24 hours)
Website: www.meningitis.org
Funds scientific research into the prevention, detection and treatment of meningitis and septicaemia, and raises awareness about these diseases. Can offer support through in-depth information and befriending. The helpline is operated by trained staff and qualified nurses, and is for anyone with concerns about meningitis and septicaemia.

Meningitis Trust
Fern House
Bath Road
Stroud GL5 3TJ
Tel: 01453 768000
Nurse-led Helpline: 0845 6000 800 (24 hours)
E-mail: helpline@meningitis-trust.org
Website: www.meningitis-trust.org
An international charity with a strong community focus, fighting meningitis through the provision of support, awareness, research and information for anyone concerned about meningitis and meningococcal disease.

Meningitis UK
Tel: 0117 373 73 73
E-mail: information@meningitisuk.org
Website: www.meningitisuk.org
Charity which funds research into finding a vaccine to eradicate meningitis and septicaemia. Also provides a wide range of material to the general public to raise awareness of the common symptoms and the importance of prompt treatment.

websites

Babycentre – Meningitis
www.babycentre.co.uk/refcap/536378.html
An article aimed at new parents, outlining how to be fully aware of the symptoms and treatment of meningitis.

Meningitis C Vaccine
www.immunisation.nhs.uk/article.php?id=44
Online information from the Department of Health outlining the facts supporting the vaccine, with further links to information on meningitis and septicaemia, and their risks, symptoms, causes and treatment.

Meningitis C Vaccine Produces 85% Fall in Cases
www.dh.gov.uk/PublicationsAndStatistics/ ..
Department of Health article outlining figures from the Public Health Laboratory Service which show the effectiveness of the new vaccine in drastically reducing the number of Meningitis C cases in the UK.

Meningitis Foundation of America
www.musa.org
Information about the symptoms of meningitis, answers to frequently asked questions, and support pages featuring personal stories.

Preventing Meningitis
www.dh.gov.uk/AboutUs/ ..
Deparytment of Health publication providing information about meningitis, its symptoms and the campaigns that have been organised to help fight the disease.

(resources updated March 2006)