Meningitis

Signs and Symptoms

Early symptoms of meningitis can easily be mistaken for the flu.

In newborns, signs and symptoms include the following:

• Irritability
• High-pitched cry
• Poor feeding
• Vomiting
• Fever
• Seizures
• Bulging fontanelle ("soft spot" in the skull) or stiff neck (less common)

In children and young adults, signs and symptoms include the following:

• High fever
• Severe headache
• Vomiting or nausea
• Stiff neck
• Sensitivity to light
• Drowsiness
• Skin rash (in cases of meningococcal meningitis -- see section titled What Causes It?)
• Confusion
• Seizures
• Clouding or loss of consciousness

Older adults may have no signs or symptoms other than altered mental state and lethargy. Often they have no fever.

What Causes It?

Bacterial meningitis is not as common as viral meningitis, but it is more serious. Several types of bacteria can cause meningitis. Knowing the right type is crucial for proper treatment:

• Neisseria meningitidis causes meningococcal meningitis, a common form of meningitis in children and young adults, and the only type that occurs in outbreaks. It is highly contagious.
• Haemophilus influenzae was the most common cause in infants and children under 6 years old before 1986 when a vaccine (HiB) was introduced. The vaccine has mostly eradicated this kind of meningitis in countries where it is given to infants.
• Streptococcus pneumonia is the most common cause of bacterial meningitis in children. It may occur along with an ear or sinus infection or pneumonia.
• Listeria monocytogenes is a common form of bacteria. It does not tend to infect most people, but the very young and very old, as well as pregnant women, can be at risk.
• Staphylococcus aureus may be seen following a head injury or brain surgery.

Viral meningitis can be caused by several types of viruses, but the most common are enteroviruses (which cause stomach flu and multiply in the intestinal tract). Other viruses that cause meningitis include:

• Enteroviruses, spread through houseflies, wastewater, and sewage
• Arboviruses, carried by arthropods, such as ticks or mosquitoes
• Mumps virus, seen in children ages 5 to 9 who have not had the MMR vaccine
• Herpes viruses
• Human immunodeficiency virus (HIV), meningitis may be the first sign a person is infected with HIV.

Who is Most At Risk?

These conditions and characteristics increase the risk for bacterial meningitis:

• Living in a crowded setting, such as a dormitory or child care facility (for meningococcal meningitis)
• Age. children, young people and older adults are more likely to develop meningitis.
• Significant head injury, skull trauma, or cerebrospinal rhinorrhea (flow of cerebrospinal fluid from the nose after a head injury)
• A suppressed immune system (for pneumococcal meningitis)
• Never receiving the HiB vaccine (see section titled What Causes It?)
• Doing laboratory work that requires handling rats, hamsters, and mice, or working with animals on a farm or ranch (for listeria)
• People who have recently undergone a neurosurgical procedure

What to Expect at Your Provider's Office

If you or your child has symptoms of meningitis, seek emergency treatment. Early diagnosis is the key to treating meningitis successfully. Doctors will ask for a detailed medical history and may order a lumbar puncture (spinal tap). In this test, doctors remove cerebrospinal fluid from the spine through a needle so that the fluid can be tested for infection, and to identify the kind of bacteria responsible. If your doctor suspects bacterial meningitis, your doctor may start you on antibiotics before the test results are available.

Treatment Options

Prevention

Children should be vaccinated against H. influenzae and mumps. People over 65 and those whose immune systems are compromised should receive a pneumococcal vaccine (PPV). A meningococcal vaccine may be given to control epidemics in dormitories, for example. Because meningitis is usually contagious, practicing good hygiene, such as washing your hands frequently, and teaching children to do the same, can reduce your risk of catching the disease.

Drug Therapies

The length and type of treatment varies depending on the kind of meningitis being treated, ranging from 1 to 3 weeks. The treatment for most cases of viral meningitis is aimed at reducing symptoms of fever and aches. Sometimes, doctors prescribe acyclovir, an antiviral drug. If your doctor suspects bacterial meningitis, he may prescribe immediate treatment with antibiotics, even before the lab results come in. Some of the medications used for bacterial meningitis are:

• Antibiotics, often in combination, including ampicillin, cephalosporins, gentamicin, vancomycin, or trimethoprim-sulfamethoxazole
• Corticosteroids to reduce inflammation
• Diazepam or phenytoin if seizures occur
• Rifampin, given to family members to reduce their risk of contracting the disease.

Complementary and Alternative Therapies

Meningitis must be treated with conventional medical therapies, especially antibiotics. Complementary and alternative therapies (CAM) should be used only with conventional treatment, not in place of it, and only under the guidance of a qualified health professional. Some supplements and herbs may help strengthen the immune system, and homeopathic remedies may help relieve symptoms that accompany meningitis. Tell all your providers about any CAM therapies you may be using.

Several nutrients can help strengthen the immune system, possibly helping to prevent meningitis or to build up the immune system after meningitis has been treated, though scientific studies have not examined these nutrients specifically for meningitis. Talk to your doctor before taking any supplements, and never treat a child without talking to your doctor first.

You may address nutritional deficiencies with the following supplements:

• A multivitamin daily, containing the antioxidant vitamins A, C, E, D, the B-complex vitamins, and trace minerals, such as magnesium, calcium, zinc, and selenium.
• Omega-3 fatty acids, such as fish oil, 1 to 2 capsules or 1 to 2 tbsp. of oil daily, to help decrease inflammation and improve immunity. Omega-3 fatty acids can have a blood-thinning effect and may increase the effect of blood-thinning drugs, such as warfarin (Coumadin) and aspirin.
• Coenzyme Q10 (CoQ10), 100 to 200 mg at bedtime, for antioxidant and immune activity. CoQ10 might help the blood clot. By helping the blood clot, CoQ10 might decrease the effectiveness of warfarin (Coumadin), and other blood-thinning medications.
• Probiotic supplement (containing Lactobacillus acidophilus and other beneficial bacteria), 5 to 10 billion CFUs (colony forming units) a day, for maintenance of gastrointestinal and immune health. Some probiotic supplements may need refrigeration. Some clinicians have concerns about giving probiotics to severely immunocompromised people.
• Alpha-lipoic acid, 25 to 50 mg twice daily, for antioxidant support. Taking alpha-lipoic acid in the presence of Thiamine (vitamin B1) deficiency can be dangerous. Speak with your doctor.
• Vitamin B6. Preliminary studies suggest vitamin B6 may minimize some of the symptoms associated with bacterial meningitis.

Herbs are generally available as standardized, dried extracts (pills, capsules, or tablets), teas, or tinctures/liquid extracts (alcohol extraction, unless otherwise noted). Mix liquid extracts with favorite beverage. Dose for teas is 1 to 2 heaping tps./cup water steeped for 10 to 15 minutes (roots need longer). Some herbs may help support your immune system, although there is no evidence they can prevent or treat meningitis. Meningitis is a medical emergency and should never be treated with herbs alone.

• Cat's claw (Uncaria tomentosa) standardized extract for inflammation and immune stimulation. Take special care if you have leukemia or autoimmune diseases.
• Reishi mushroom (Ganoderma lucidum), 150 to 300 mg, 2 to 3 times daily, for inflammation and for immunity. You may also take a tincture of this mushroom extract, 30 to 60 drops, 2 to 3 times a day. High doses of Reishi can have blood pressure lowering and blood-thinning effects, and may dangerously increase the effect of blood-thinning medications, such as warfarin (Coumadin) and aspirin.
• Olive leaf (Olea europaea) standardized extract, 250 to 500 mg, 1 to 3 times daily, for antibacterial or antifungal activity and immunity.
• Aged Garlic (Allium sativum), standardized extract, 600 to 1,200 mg daily, for antibacterial or antifungal and immune activity. Garlic can have a blood-thinning effect and may increase the effect of blood-thinning medications, such as warfarin (Coumadin) and aspirin. Garlic can interact with some medications, including some HIV medications. Speak with your doctor.

Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies to help alleviate symptoms of meningitis, in addition to standard medical care. Before prescribing a remedy, homeopaths take into account a person's constitutional type, includes your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for each individual.

• Apis mellifica, for meningitis in children with such intense head pain they bore their heads into a pillow.
• Arnica Montana, for meningitis following surgery or an injury to the head. This remedy is most appropriate for individuals who often insist there is nothing wrong with them.
• Belladonna, for a sudden onset of high fever which accompanies meningitis. This remedy is most appropriate for individuals who are hot and flushed with wide pupils, and may have nightmares and delusions.
• Bryonia, for meningitis with impaired consciousness and a characteristic movement of the mouth in which the jaw moves side to side quite rapidly in a somewhat contorted manner.
• Helleborus, for meningitis with impaired consciousness and stupor. Individual may also be anguished and pleading for help. Shaking or rolling of the head may also occur.
• Hyoscyamus, for meningitis with violent spasms that occur with shrieking and grinding of the teeth.

These treatments must not be used for meningitis without direction and supervision by an appropriately trained and certified homeopathic doctor.

Prognosis/Possible Complications

About 25 to 30% of people with bacterial meningitis die from it. Among children who survive bacterial meningitis, 20 to 50% have brain damage, hearing problems, or developmental difficulties. Most people who get viral meningitis recover completely without any problems. However, some people will experience headaches, weakness, and fatigue for 2 to 3 weeks after symptoms begin.

Complications of meningitis may include hearing loss, seizures, cerebral edema (brain swelling), weakness on one side of the body, speech problems, visual impairment or blindness, difficulty coordinating movements, trouble breathing, respiratory arrest, and recurring meningitis. Children who have meningitis may experience cognitive impairment and developmental delay.

Following Up

For the first 1 to 2 days, doctors should monitor people in the intensive care unit to be sure:

• The medication is working
• To watch for any seizures
• To watch for breathing difficulties

If signs and symptoms do not improve after 1 to 2 days, health care providers should check the cerebrospinal fluid again.

Special Considerations

Pregnant women often carry L. monocytogenes and S. agalactiae without having symptoms and may pass these infections to their children during birth. Pregnant women should not take rifampin to prevent meningitis because it is not clear whether this drug may harm the fetus.

Supporting Research

Bamburger D. Diagnosis, Initial Management, and Prevention of Meningitis. American Family Physician. 2010;82(12).

Barichello T, Generoso JS, Simoes LR, et al. Vitamin B6 prevents cognitive impairment in experimental pneumococcal meningitis. Exp Biol Med (Maywood). 2014;239(10):1360-5.

Bhat KPL, Kosmeder JW 2nd, Pezzuto JM. Biological effects of resveratrol. Antioxid Redox Signal. 2001;3(6):1041-64.

Bope and Kellerman. Conn's Current Therapy 2012. 1st ed. Philadelphia, PA: Elsevier Saunders; 2011.

Ferri. Ferri's Clinical Advisor 2013. 1st ed. Philadelphia, PA: Elsevier Mosby; 2012.

Grandgirard D, Leib S. Meningitis in Neonates: Bench to Bedside. Clinics in Perinatology. 2010;37(3).

Hernandez M, Mejia GI, Trujillo H, Robledo J. Effectiveness of the antibiotics chloramphenicol and rifampin in the treatment of Streptococcus pneumoniae-induced meningitis and systemic infections. Biomedica. 2003 Dec;23(4):456-61.

Jimenez Caballero PE, Munoz Escudero F, Murcia Carretoero S, Verdu Perez A. Descriptive analysis of viral meningitis in a general hsopital: differences in the characteristics between children and adults. Neurologia. 2011;26(8):468-73.

Kasanmoentalib ES, Brouwer MC, van de Beek D. Update on bacterial meningitis: epidemiology, trials and genetic association studies. Curr Opin Neurol. 2013;26(3):282-8.

Kim BN, Peleg A, Lodise T, Lipman J, Li Jian, Nation R, Paterson D. Management of meningitis due to antibiotic-resistant Acinetobacter species. The Lancet Infectious Diseases. 2009;9(4).

Kwang S. Acute bacterial meningitis in infants and children. The Lancet Infectious Diseases. 2010;10(1).

Lalwani AK, Cohen NL. Longitudinal risk of meningitis after cochlear implantation associated with the use of the positioner. Otol Neurotol. 2011; 32(7):1082-5.

Long. Principles and Practice of Pediatric Infectious Diseases. 4th ed. St. Louis, MO: Elsevier Saunders; 2012.

Mandell: Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2009.

Srinivas D, Veena Kumari HB, Somanna S, Bhagavatula I, Anandappa CB. The incidence of postoperative meningitis in neurosurgery: an institiutional experience. Neurol India. 2011;59(2):195-8.

Swartz MN. Bacterial meningitis. In: Cecil Textbook of Internal Medicine. Vol. 2. 21st ed. Philadelphia, PA: W.B. Saunders Company; 2000:1645-1654.

Thigpen MC, Whitney CG, Messonnier NE, et al. Bacterial meningitis in the United States, 1998-2007. N Engl J Med. 2011;364(21):2016-25.

Waghdhare S, Kalantri A, Joshi R, Kalantri S. Accuracy of physical signs for detecting meningitis: a hospital-based diagnostic accuracy study. Clin Neurol Neurosurg. 2010;112(9):752-7.

Williams JE. Review of antiviral and immunomodulating properties of plants of the Peruvian rainforest with a particular emphasis on Una de Gato and Sangre de Grado. Altern Med Rev. 2001;6(6):567-79.