BACTERIAL MENINGITIS

BY- DAKSHITA NAITHANI

INTRODUCTION

The inflammation of the meninges is known as meningitis. The Dura mater, arachnoid mater, and pia mater are the three membranes (meninges) that border the vertebral canal and skull, encapsulating the brain and spinal cord. Symptoms such as headaches, fever, and stiff neck are common.

Prior to the discovery of antibiotics, this was a fatal illness. Despite tremendous advancements in healthcare, the disease still has a death rate of over 25%. Many different pathogens can cause the disease, but bacterial meningitis has the largest worldwide impact.

Despite advances in diagnosis, treatment, and immunisation, 8.7 million cases of meningitis were recorded globally in 2015, with fatalities as much as 379,000. In early 2020, the first incidence of meningitis linked to COVID 19 was discovered. Every year on April 24th, World Meningitis Day is commemorated. Meningitis is one of the leading causes of illness and death in children under the age of five worldwide. According to Indian studies, meningitis is one of the main causes of mortality among infants under the age of five. 

TYPES OF MENINGITIS

Viral meningitis: It is the most frequent, but not the most dangerous, form of meningitis, accounting for 85 percent of cases. Enteroviruses are among the most prevalent causing viruses.

Bacterial meningitis: Bacterial meningitis is the second most prevalent kind of meningitis, affecting around 3 per million individuals each year. N. meningitidis, S. pneumoniae, H. influenzae, and S. aureus are the microorganisms that cause this kind of meningitis. Inflammation of the meninges can be caused by the same bacterium that causes TB.

In most countries, N.meningitidis is the primary cause of meningitis and a feared illness. The fatality rate from bacterial meningitis is frequently greater in underdeveloped nations than in industrialised countries.

Fungal meningitis: It’s a rare occurrence that generally leads to persistent meningitis. It is caused by a fungus that infects the body and travels from the blood to the nervous system, as the name implies.

Parasitic meningitis: It is less frequent than viral or bacterial meningitis and is caused mostly by parasites found in soil, excrement, cereals, or chickens. The infection is spread through ingesting the parasite’s eggs rather than normal routes. One of the most severe diseases is amoebic meningitis.

Non-infectious meningitis: It is a complication of an underlying health condition, rather than an infection. Inflammation in the tissues can be caused by a variety of factors, including drug use, head trauma, brain surgery, and cancer-related issues.

HOW DOES IT SPREAD FROM ONE INDIVIDUAL TO ANOTHER?

Meningitis caused by fungi, parasites, or non-infectious organisms is not contagious, while viral and bacterial are extremely contagious. Sneezing, coughing, and sharing utensils, cutlery, and toothbrushes are all ways to spread viral and bacterial meningitis. People who have these viruses or bacteria in their nose or throat but are not ill are generally carriers.

RISK FACTORS FOR MENINGITIS:

Risk factors for meningitis include:

•People who do not complete or skip their recommend childhood or adult immunization schedule

• Most of the viral cases occur in children younger than five years of age. Bacterial cases are common to those under the age of twenty years. Age also plays a big role in determining the risk factor.

 • It is possible to live in a community. Meningococcal meningitis is more common in college students who live in dorms and children who attend boarding schools or child care centres. This is most likely due to the bacterium’s ability to spread fast among big populations through the respiratory pathway.            

• Immune system dysfunction. Meningitis is also made more likely by AIDS, alcoholism, diabetes, immunosuppressive medications, and other immune system disorders. Anyone without a spleen should be immunised to reduce their risk.

SYMPTOMS

Meningitis affects more than two-thirds of children under the age of two, with the majority of cases occurring in the first two years of life. This might be related to low immunity and increased brain vascularity, which puts children at a higher risk. Furthermore, due to the immaturity of the central nervous system (CNS) in babies and children, the symptoms of infection are also hazy. Due to these reasons doctors depend more on the diagnostic tests rather than the symptoms.

-Fever for more than a week

-Neck stiffness

-Headaches

-Nausea and vomiting

-Altered or reduced level of consciousness

-Lethargy

-Rash

-Convulsions

Meningitis rash

A mild rash is one of the late indicators that one of the bacteria that causes meningitis, Neisseria meningitidis, is present in your circulation. The rash will become more visible as the illness progresses and spreads. The palms of the hands and the inside of the mouth, for example, may exhibit indications of a rash more easily than other parts of the body.

TREATMENT AND MANAGEMENT OF DISEASE

The therapy is determined on the underlying aetiology of meningitis. Antibiotics are used to treat bacterial meningitis, which may necessitate urgent hospitalisation. This might aid in the prevention of brain injury. The treatment of fungus meningitis may need the use of antifungal medicines. Viral meningitis may go away on its own, but you’ll need to see a doctor to figure out what’s causing it and how to treat it properly. On the basis of symptoms present parasitic meningitis is treated.

In all instances of bacterial meningitis, prompt treatment and supportive care and antibiotics are essential. Antibiotics are chosen depending on the organism that is thought to be causing the illness. In order to give the optimum antimicrobial coverage, the physician must consider the patient’s medical history.

Steroid Therapy: There isn’t enough data to back up the use of them in bacterial meningitis.

Chemoprophylaxis: Close contacts of a patient with N. meningitidis and H. influenzae type B meningitis should take this medication. People who have shared utensils, and health care providers in close proximity to secretions are all examples of close interactions.

Physical Therapy Management

In most cases, physical rehabilitation begins in the intensive care unit. It’s critical to remember a patient’s chart contraindications to therapy, such as intracranial pressure, cerebral pressure, and other lab results that dictate rehabilitation recommendations, while starting a plan of care. In the acute phase, proper posture and range of exercises should be started as soon as it is safe to do so. Proper pillow and towel placement will maintain the integrity of the skin and avoid contractures. Maintaining trunk and neck mobility is critical for functional mobility.

The earlier a patient begins therapy, the lower the risk of subsequent impairments, allowing for a better treatment.

If left untreated it can lead to significant brain problems and is sometimes deadly. In 10–20 percent of survivors, it can cause brain damage, hearing loss, or learning disabilities, as well as amputations in certain cases.

DIAGNOSTIC TESTS

 It is detected by analysing the cerebrospinal fluid, which includes a white blood cell count, glucose, protein, and, in rare circumstances, a polymerase chain reaction (PCR). A lumbar puncture is used to collect CSF, and the opening pressure can be monitored.

Bacteria in the blood are identified using blood cultures. Bacteria have the ability to move from the bloodstream to the meninges. Both sepsis and meningitis can be caused by a variety of bacteria, including N. meningitidis and S. pneumonia.

A differential complete blood count is an indicator of health general. The amount of red and white blood cells in your blood is counted. Infection is fought by white blood cells. In meningitis, the count is generally high.

Pneumonia, TB, and fungal infections can all be detected using chest X-rays. Meningitis can develop as a result of pneumonia.

A head CT scan may reveal issues such as a brain abscess. From the sinuses to the meninges, bacteria can spread.

A glass test may also be performed by doctors. The doctor performs this test by rolling a glass over the rash formed. It’s most probable meningitis rash if the rash doesn’t disappear with pressure. The odd patches on the skin may be the consequence of another ailment if it fades away.

PREVENTION

Microbes that cause meningitis can easily be dispersed all around through aerosols when a carrier coughs, sneezes or shares utensils or other oral items. A few steps which are present to prevent it are:-

• Please wash your hands. Hand cleaning is important in preventing the transmission of germs. Hands should be washed before and after meals, touching objects or animals in public places. Show children how to wash and rinse their hands completely and properly.

 •Practice good oral hygiene. Do not share edibles and utensils with anybody else.

•Maintain a good immune system by keeping a good diet and staying healthy.

 •One should always cover their mouth while coughing or sneeze.

• If you’re expecting a child, be cautious about what you eat. Reduce your risk of listeriosis by cooking meat to 165 degrees Fahrenheit, which includes hot dogs.  Choose pasteurised milk cheeses that are clearly stated on the package.