Meningitis · Most cases of viral meningitis are caused by entero-viruses (viruses that typically...
Transcript of Meningitis · Most cases of viral meningitis are caused by entero-viruses (viruses that typically...
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Parental concerns
New cases of measles began being reported in some
countries—including Great Britain—in 2001 because of
parents’ fears about vaccine safety. The combined vac-
cine for measles, mumps, and rubella (MMR) wasclaimed to cause autism or bowel disorders in some chil-dren. However, the World Health Organization (WHO)
position is there is no scientific merit to these claims.
The United Nations expressed concern that unwarranted
fear of the vaccine would begin spreading the disease indeveloping countries and ultimately in developed coun-
tries as well. Parents in Britain began demanding the
measles vaccine as a separate dose, and scientists were
exploring that option as an alternative to the combined
MMR vaccine. Unfortunately, several children died dur-ing an outbreak of measles in Dublin because they had
not received the vaccine. Child mortality due to measles
is considered largely preventable, and making the MMR
vaccine widely available in developing countries is part
of WHO strategy to reduce child mortality by two-thirds
by the year 2015.
Resources
BOOKS
Katz, Samuel L. ‘‘Measles (Rubeola).’’ In Principles andPractice of Pediatric Infectious Diseases, 2nd ed. Editedby Sarah S. Long et al. St. Louis, MO: Elsevier, 2003.
Maldonado, Yvonne. ‘‘Measles.’’ In Nelson Textbook ofPediatrics. Edited by Richard E. Behrman et al.Philadelphia: Saunders, 2004.
PERIODICALS
Kerr, C. ‘‘Good response rate for MMRV vaccine.’’ LancetInfectious Disease 3 (December 2003): 748.
Stalkup, J. R. ‘‘A review of measles virus.’’ DermatologyClinics 20 (April 2002): 209–215.
ORGANIZATIONS
American Academy of Pediatrics (AAP). 141 Northwest PointBlvd., Elk Grove Village, IL 60007. Web site:
.
Centers for Disease Control and Prevention. 1600 Clifton Rd.,NE, Atlanta, GA 30333. Web site: .
Rosalyn Carson-DeWitt, MD
Rebecca J. Frey, PhD
Measles, mumps, rubella vaccineseeMMR vaccine
Meditation see Yoga
Mediterranean fever see FamilialMediterranean fever
Meningitis
Definition
Meningitis is a serious inflammation of the
meninges, the membranes (lining) that surround the
brain and spinal cord. It can be of bacterial, viral, or fun-
gal origin.
Description
Meningitis is usually the result of a viral or bacterial
infection. Viral meningitis, also called aseptic meningi-
tis, is generally less severe and often disappears without
specific treatment, while bacterial meningitis can be
quite serious and may result in brain damage, hearing
loss, or learning disabilities in children. The infection
may even cause death.
Bacterial meningitis is either monococcal or pneu-
mococcal, depending on the type of bacteria responsible
for the infection. Meningitis caused by Haemophilusinfluenzae and related strains (A, B C, Y, and W135) isalso called meningococcal meningitis. Similarly, menin-
gitis due to Streptococcus pneumoniae is also calledpneumococcal meningitis.
Transmission
Most types of meningitis are contagious. A person
may be exposed to meningitis bacteria when someone
with meningitis coughs or sneezes. The bacteria can also
spread through kissing or sharing eating utensils or a
toothbrush.
Demographics
According to the National Institute of Neurological
Disorders and Stroke (NINDS), some 6,000 cases of
pneumococcal meningitis are reported in the United
States each year. Meningococcal meningitis is common
in minors ages two to 18. Each year about 2,600 people
get this highly contagious disease. High-risk groups
include infants under the age of one year, people with
suppressed immune systems, travelers to foreign coun-
tries where the disease is endemic, and college students
and Army recruits who reside in dormitories and other
close quarters. Between 10 and 15 percent of cases are
fatal, with another 10 to 15 percent involving brain
damage and other serious side effects.
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Causes and symptoms
The bacteria which cause bacterial meningitis live
in the back of the nose and throat region and are carried
by 10 to 25 percent of the population. They cause menin-
gitis when they get into the bloodstream and travel to the
meninges.
At least 50 kinds of bacteria can cause bacterial
meningitis. According to the Centers for Disease Control
(CDC), before the 1990s, Haemophilus influenzae type b(Hib) was the leading cause of bacterial meningitis, but
subsequent vaccines given to all children as part of their
routine immunizations have reduced the occurrence of
the disease due to H. influenzae. As of 2004, Streptococ-cus pneumoniae and Neisseria meningitidis were theleading causes of bacterial meningitis.
In newborns, the most common agents of meningitis
are those that are contracted from the newborn’s mother,
including Group B streptococci (becoming an increas-
ingly common infecting organism in the newborn per-
iod), Escherichia coli, and Listeria monocytogenes. Thehighest incidence of meningitis occurs in babies less
than a month old, with an increased risk of meningitis
continuing through about two years of age.
Older children are more frequently infected by the
bacteria Haemophilus influenzae, Neisseria meningitidis,and Streptococci pneumoniae.
Most cases of viral meningitis are caused by entero-
viruses (viruses that typically cause stomach flu). How-
ever, many other types of viruses, such as the herpessimplex virus, the mumps and measles viruses (againstwhich most children are protected due to mass immuni-
zation programs), the virus that causes chickenpox, therabies virus, and a number of viruses that are acquiredthrough the bites of infected mosquitoes.
Meningitis symptoms include high fever, head-ache, and stiff neck in children over the age of twoyears. These symptoms can develop over several hours,
or they may take one to two days. Other symptoms may
include nausea, vomiting, discomfort looking intobright lights, confusion, and sleepiness. In some cases, a
rash may be present. In newborns and small infants,
these symptoms may be absent or difficult to detect, and
the infant may only appear slow or inactive, or be irrita-
ble, have vomiting, or be feeding poorly. As the disease
progresses, patients of any age may also have seizures.
Brain tissue infectedwith acute meningitis. (�CustomMedical Stock Photo, Inc.)
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When to call the doctor
Parents should call a doctor if a child has a tempera-
ture above 101�F (38.5�C). If any meningitis symptomsoccur, the child should see a doctor immediately, as
early diagnosis and treatment are very important for a
successful outcome.
Diagnosis
Viral meningitis often remains undiagnosed because
its symptoms are similar to those of the common flu. As
for bacterial meningitis, the diagnosis is established by
growing bacteria from a sample of spinal fluid. The
spinal fluid is obtained by performing a lumbar puncture
(also called a spinal tap), in which a needle is inserted
into an area in the lower back where fluid in the spinal
canal is readily accessible.
Treatment
Bacterial meningitis treatment usually involves
intravenous administered antibiotics, for a minimum offour days. The type of meningitis contracted will deter-
mine the specific antibiotic used. It is imperative that
treatment start as early as possible, in order to avoid
brain damage and death.
Viral meningitis cases usually resolve without com-
plications, but typically, antibiotics are ineffective in
treating it, so none are prescribed. The child will be told
to get as much rest as he or she can. If the child has painrelated to the disease such as headaches or other body
pains, medication can be used to treat it.
Prognosis
The long-term outlook for children who develop
bacterial meningitis varies significantly. The outcome
depends on the child’s age, the bacteria causing the
infection, complications, and the treatment the child
receives. The complications of bacterial meningitis can
be severe and include neurological problems such as
hearing loss, visual impairment, seizures, and learning
disabilities. The heart, kidneys, and adrenal glands may
also be affected. Although some children develop long-
lasting problems, most children who receive prompt
diagnosis and treatment recover fully.
The majority of cases of viral meningitis resolve
with no complications.
Prevention
Many children as of 2004 routinely receive vaccines
against meningitis, starting at about two months of age.
Immunizations are recommended by the American
Academy of Pediatrics and many other organizations. If
a child has not been vaccinated, parents should talk to
their doctor about the Hib and pneumococcal (Prevnar 7)
vaccines.
Vaccines are available for both meningococcal and
pneumococcal meningitis. Specifically, there are vac-
cines against Hib and against some strains of N. meningi-tidis and many types of Streptococcus pneumoniae. Thevaccines against Hib are very safe and highly effective.
There is a vaccine that protects against four strains of N.meningitidis, but it is not routinely used in the UnitedStates. There are also vaccines to prevent meningitis due
KEY TERMS
Analgesics—A class of pain-relieving medicines,including aspirin and Tylenol.
Antibody—A special protein made by the body’simmune system as a defense against foreign mate-rial (bacteria, viruses, etc.) that enters the body. Itis uniquely designed to attack and neutralize thespecific antigen that triggered the immuneresponse.
Antigen—A substance (usually a protein) identifiedas foreign by the body’s immune system, triggeringthe release of antibodies as part of the body’simmune response.
Bacterial meningitis—Meningitis caused by bac-teria. Depending on the type of bacteria responsi-ble for the infection, bacterial meningitis is eitherclassified as monococcal or pneumococcal.
Immunization—A process or procedure that pro-tects the body against an infectious disease by sti-mulating the production of antibodies. A vaccina-tion is a type of immunization.
Meninges—The three-layer membranous coveringof the brain and spinal cord, composed of the duramater, arachnoid, and pia mater. It provides pro-tection for the brain and spinal cord, as well ashousing many blood vessels and participating inthe appropriate flow of cerebrospinal fluid.
Viral meningitis—Meningitis caused by a virus.Also called aseptic meningitis.
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to S. pneumoniae, which can also prevent other forms ofinfection due to S. pneumoniae.
Parents should teach children to wash their hands
often, especially before they eat and after using the bath-
room, or after petting animals. They should be taught
how to wash their hands vigorously, covering both the
front and back of each hand with soap and rinsing thor-
oughly under running water.
Parental concerns
Some forms of bacterial meningitis are contagious.
The bacteria are spread through coughing, kissing, and
sneezing. Fortunately, the bacteria that cause meningitis
are not as contagious as the common cold or the flu, andthey are not spread by casual contact or by simply
breathing the air where a person with meningitis has
been. However, people in the same household or daycare
center, or anyone with direct contact with a patient’s oral
secretions is considered at increased risk of acquiring the
infection.
Awareness of the symptoms and signs of meningitis,
especially the rash which may accompany meningococ-
cal meningitis is very important.
Resources
BOOKS
Leigh, Jenny. A Dr. Spot Casebook: George Has Meningitis.London: Haldane &Mason, 2003.
Routh, Kristina.Meningitis (Just the Facts). Chicago:Heineman Library, 2004.
Tunkel, Allan R. Bacterial Meningitis. Philadelphia: LippincottWilliams &Wilkins, 2001.
PERIODICALS
Anderson, V., et al. ‘‘Cognitive and executive function 12
years after childhood bacterial meningitis: effect of acute
neurologic complications and age of onset.’’ Journal ofPediatrics & Psychology 29, no. 2 (March 2004): 67–81.
Gupta, S., and A. B. Tuladhar. ‘‘Does early administration of
dexamethasone improve neurological outcome in children
with meningococcal meningitis?’’ Archives of Disease inChildhood 89, no. 1 (January 2004): 82–83.
Hvidd, A., and M. Melhye. ‘‘Impact of routine vaccination with
a conjugate Haemophilus influenzae type b vaccine.’’
Vaccine 22, no. 3–4 (January 2004): 378–82.
Posfay-Barbe, K. M., and E. R. Wald. ‘‘Pneumococcal
vaccines: do they prevent infection and how?’’ CurrentOpinions in Infectious Diseases 17, no. 3 (June 2004):177–84.
Spach, D. H. ‘‘New issues in bacterial meningitis in adults.
Antibiotic resistance has complicated treatment.’’
Postgraduate Medicine 114, no. 5 (November 2004):43–50.
ORGANIZATIONS
Meningitis Foundation of America. 6610 North ShadelandAvenue, Suite 200, Indianapolis, IN 46220–4393. Web
site: .
National Institute of Allergy and Infectious Diseases (NIAID).National Institutes of Health, 6610 Rockledge Drive,
MSC 6612, Bethesda, MD 20892–6612. Web site:
.
National Meningitis Foundation. 22910 Chestnut Road,Lexington Park, MD 20653. Web site:
.
Meningitis Research Foundation.Midland Way, Thornbury,Bristol BS35 2BS, UK. Web site: .
WEB SITES
‘‘Meningococcal Disease Homepage.’’ Centers for DiseaseControl and Prevention. Available online at (accessed October 25, 2004).
Monique Laberge, Ph.D.
Meningocele see Spina bifida
Meningococcal meningitisvaccine
Definition
The meningococcal meningitis vaccine is given byinjection (shots) to provide immunization against menin-
gococcal disease and meningitis caused by the bacterium
Neisseria meningitides.
Description
Meningococcal disease, or meningococcemia, is aleading cause of meningitis in children, and then disease
can also lead to infections of the blood. People who
acquire the disease can become very ill, especially the
young children. Meningococcal disease is treated with
antibiotics, and the vaccine is not routinely recom-mended for most people in the United States. Particu-
larly, it is not for children under age two, except under
special circumstances.
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Diseases and Conditions Meningitis Print
Sections 1. Basics
1. Definition 2. Symptoms 3. Causes 4. Risk factors 5. Complications 6. Preparing for your appointment 7. Tests and diagnosis 8. Treatments and drugs 9. Prevention
2. 3. InDepth 4. Expert Answers 5. Multimedia 6. Resources 7. News From Mayo Clinic 1. Definition 2. Symptoms 3. Causes 4. Risk factors 5. Complications 6. Preparing for your appointment 7. Tests and diagnosis
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8. Treatments and drugs 9. Prevention
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Definition
By Mayo Clinic Staff Meningitis is an inflammation of the membranes (meninges) surrounding your brain and spinal cord. The swelling associated with meningitis often triggers the "hallmark" signs and symptoms of this condition, including headache, fever and a stiff neck. Most cases of meningitis in the U.S. are caused by a viral infection, but bacterial and fungal infections also can lead to meningitis. Depending on the cause of the infection, meningitis can get better on its own in a couple of weeks — or it can be a lifethreatening emergency requiring urgent antibiotic treatment. If you suspect that you or someone in your family has meningitis, seek medical care right away. Early treatment of bacterial meningitis can prevent serious complications.
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March 19, 2013
References
1. Meningitis and encephalitis fact sheet. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/encephalitis_meningitis/detail_encephalitis_meningitis.htm. Accessed Dec. 29, 2012. 2. Bacterial meningitis. Centers for Disease Control and Prevention. http://www.cdc.gov/meningitis/bacterial.html. Accessed Jan. 2, 2013. 3. Bartt R. Acute bacterial and viral meningitis. Continuum Lifelong Learning in Neurology. 2012;18:1255. 4. Viral meningitis. Centers for Disease Control and Prevention. http://www.cdc.gov/meningitis/viral.html. Accessed Jan. 2, 2013.
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5. Fungal meningitis. Centers for Disease Control and Prevention. http://www.cdc.gov/meningitis/fungal.html. Accessed Jan. 2, 2013. 6. Derber CJ, et al. Head and neck emergencies. Medical Clinics of North America. 2012;96:1107. 7. Longo DL, et al. Harrison's Online. 18th ed. New York, N.Y.: The McGrawHill Companies; 2012. http://www.accessmedicine.com/resourceTOC.aspx?resourceID=4. Accessed Dec. 28, 2012. 8. Acute bacterial meningitis. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merckmanuals.com/professional/neurologic_disorders/meningitis/acute_bacterial_meningitis.html. Accessed Dec. 31, 2012. 9. Prevention — Listeriosis. Centers for Disease Control and Prevention. http://www.cdc.gov/listeria/prevention.html. Accessed Jan. 2, 2013. 10. Subacute and chronic meningitis. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merckmanuals.com/professional/neurologic_disorders/meningitis/subacute_and_chronic_meningitis.html. Accessed Jan. 2, 2013. 11. Van de Beek D, et al. Advances in treatment of bacterial meningitis. The Lancet. 2012;380:1693. 12. Recommended immunization schedule for persons aged 0 through 18 years — United States, 2013. Centers for Disease Control and Prevention http://www.cdc.gov/vaccines/schedules/hcp/childadolescent.html. Accessed Feb. 19, 2013. 13. Recommended adult immunization schedule — United States, 2012. Centers for Disease Control and Prevention. http://www.cdc.gov/vaccines/schedules/downloads/adult/adultschedule.pdf. Accessed Dec. 28, 2012. 14. Meningococcal vaccine: Who and when to vaccinate. Centers for Disease Control and Prevention. http://www.cdc.gov/vaccines/vpdvac/mening/whovaccinatehcp.htm. Accessed Dec. 28, 2012.
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