- 1 What is bacterial meningitis?
- 2 Bacterial meningitis symptoms
- 3 How do you get bacterial meningitis?
- 4 Is bacterial meningitis contagious?
- 5 How to treat bacterial meningitis?
- 6 Spinal meningitis treatment
- 7 Cryptococcal meningitis treatment
- 8 How to treat viral meningitis?
- 9 Bacterial meningitis antibiotics
- 10 Antibiotics for viral meningitis
What is bacterial meningitis?
Bacterial meningitis is a dangerous infectious inflammatory disease of the brain tunic and spinal cord. The brain and spinal cord are coated with three layers of the tissues that are called as meninges:
- Dura mater;
- Meninx serosa;
- Pia mater.
There is subarachnoid cavity between the meninx serosa and pia mater. This cavity is filled with the cerebrospinal fluid. The immune system reacts to the invasion after the penetration of bacteria into the meninges and the cerebrospinal fluid. The immune cells are collected to protect the body. As a result, the inflammatory process (meningitis) occurs that may induce serious complications.
The complications of the bacterial meningitis may be very dangerous:
- Thrombi of the blood vessels of the brain;
- Cerebral edema;
- Dropsy of brain;
- Inflammation of the intracranial nerves;
- Subdural empyema;
- Septic shock.
If the treatment is neglected, the bacterial meningitis quickly progresses, and a fatal outcome is possible in 50% of the cases. The fresh data of the WHO about the bacterial meningitis is as follows:
- More than 1,2 million cases of the bacterial meningitis are registered every year in the world.
- The disease leads to the nonreversible lesion of the brain in 10% of patients: hearing loss, loss of vision, poor cognitive functions, organic affection of the central nervous system, and others.
- An infectious organism is N. Meningitidis.
- According to the scientists, 10-20% of population in the world are carriers of N. Meningitidis.
- About 5% to 10% of patients with the acute bacterial meningitis die within 24 hours after the disease diagnosis.
Bacterial meningitis symptoms
Bacterial (meningococcal) meningitis often begins all of a sudden. A patient experiences a sharp increase of the body temperature, fever and vomiting occurs. These symptoms are peculiar for many infectious processes, and therefore it is difficult to detect the disease at the early stage.
In case of the acute bacterial meningitis, the symptoms are developed quickly. A patient may have the following symptoms within 12-24 hours after the occurred first signs of the disease:
- Confused mental state;
- Muscle cramps;
- Severe headache in the back of the head;
- Muscular rigidity of the neck.
The muscular rigidity of the neck is very serious than just a painful sensation. The patient is not able to put the chin to the chest or any attempts cause pain. Some people have the symptoms of stroke including paralysis during the acute type of the meningitis.
But it happens that the symptoms of the bacterial meningitis are latent and grow systematically. Children and adults become irritable, the confused mental state and the narcolepsy symptoms are observed during the infection progression. In this case, it is rather difficult to make a diagnosis, so that the disease often catches a patient and doctors off guard.
How do you get bacterial meningitis?
The activators of meningitis are various organisms including bacteria, fungi, and viruses. Only a human is a carrier of N. Meningitidis. The pathogenic organisms are absent in the tissues and cells of animals. The carriers of the infection do not even know about it, so that there are high risks of the virus transmission to the vulnerable population categories.
The pathogenic organism of the bacterial meningitis lives in the mucous coat of the throat and respiratory tracts. The disease is transferred through the drops of the discharges from the airway tracts or the throat of the carrier. Bacteria are airborne only during the prolonged and close contact with a barrier.
A kiss, sneezing, or cough will induce the infection in 70%. The bacterial meningitis is very virulent. The use of the dishes or living with a carrier guarantees the infection of the body. Moreover, the bacterial meningitis may appear not at once after the infection. The incubation period of the disease is 2 to 10 days. First off, the pathogenic organisms is based in the mucus of the throat and airway tracts. But in case of the decrease in immunity, bacteria quickly penetrate into the systemic blood flow and reach the brain tissues.
When N. Meningitidis has reached the brain tissues, the inflammation does not occur at once. The inflammatory process begins after the maximal activation of the immunity. It happens in 2-3 days.
Patients with the low immune status may have blurred symptoms of the bacterial meningitis. This is very dangerous. The infection may affect a big part of the brain tissues in 1-2 weeks, and it will become a cause of the inconvertible complications.
Is bacterial meningitis contagious?
The bacterial meningitis may be acute and dangerous for the patient’s life. Its activators are often Neisseria meningitidis or Streptococcus pneumoniae. It is very contagious pathogenic organism that is airborne.
But there is one condition. The meningococcal bacteria are not able to quickly resist the external environment and quickly die outside the human body. Therefore, a risk of the infection transfer is very low in the public transport or public places.
A risk of the transmission grows in case of the close contact with a carrier. For example, the disease quickly spreads in kindergartens, schools, and hospitals. Bacteria spread through saliva, coughing, sneezing, public dishes, and kisses.
The non-bacterial types of the meningitis are less contagious. They often appear as a result of the prolonged development of the fungal or viral disease. And if a person got the infection, the immunity blocks the infection development. If the meningitis is a complication of any disease (inflammation of the ear, throat, tooth, etc.), a risk of the transmission is zero. In this case, the disease has an internal inflammatory process that has passed to the brain tissues through the blood.
In case of the bacterial type of the disease, the pathogenic organisms is more active and finds vulnerable places in the body in order to reach the brain tissues. Therefore, the bacterial meningitis is highly contagious and dangerous.
How to treat bacterial meningitis?
The acute bacterial meningitis may lead to the lesion of the brain, nerve endings or death within several hours. The treatment must be started as soon as possible, without waiting for the results of the diagnostic tests. If you have noticed the first symptoms of the meningitis, go to a doctor at once.
It is impossible to know a type of bacterium-activator of the bacterial meningitis before doing the cerebrospinal function. Therefore, a patient is prescribed two or more antibiotics with the broad action.
Examples of broad-spectrum antibiotics:
- Aminoglycosides (except for streptomycin)
- Amoxicillin/clavulanic acid (Augmentin)
- Carbapenems (e.g. imipenem)
- Quinolones (e.g. ciprofloxacin)
The antibacterial therapy is the essential way of the bacterial meningitis treatment. The medication is pushed IV to reach the systemic blood. If the drug is taken orally, the action begins later. Every minute counts during the bacterial meningitis.
Antibiotics are as a rule replaced by another, more effective drug after identifying the infecting organism. Corticosteroids are used 15 minutes before or with the first dose of the antibiotic. The edema of the brain tissues may be increased because of the bacterial breakdown under the action of the antibiotic. Therefore the corticosteroids reduce the edema of the tissues and will help the antibiotic to quickly penetrate inside the bacterial cell. The use of the corticosteroids is continued from 2 to 5 days, till the intensive edema is kept.
The corticosteroids help to reduce the intracranial pressure and remove the septic shock. In case of the lesion of the adrenal body, the drugs will help to compensate the deficit of the natural hormones of the adrenal cortex.
Spinal meningitis treatment
Spinal meningitis is an inflammatory disease of the meninges. A peculiarity of this type of the disease consists in a severe course. Complications rather quickly occur during the spinal meningitis. If the proper treatment of the meningitis is absent, a fatal outcome and paralysis may happen.
The spinal meningitis can be purulent and serous.
The purulent meningitis may be conditioned by the entry of the infectious agents: meningococci, pneumococci, Haemophilus influenza. Also, a surgical intervention on the spinal cord or traumas of the spine may be a cause. The purulent type of the disease is accompanied by the fast infection of the blood and severe complications.
The serous type of the meningitis is conditioned by the entry of the viral agents: tubercle bacillus, enteroviruses, and Coxsackie virus. The symptoms do not differ from the previous type of the meningitis. But the difference is a slow development of the disease. Doctors have more time to detect an activator of the inflammatory disease and prescribe a proper treatment.
In case of the purulent meningitis, the treatment should be started during the first suspicion. As every type of the meningitis has its classificatory peculiarities, the method of the treatment also differs and is prescribed according to the activator of the disease.
If doctors did not detect the type of the spinal meningitis in time, they prescribe a combined therapy. The antibacterial therapy gives great results in combination with the immune stimulating medical products. This combined therapy improves the functionality of the nervous and blood vessel systems of the body and inhibits the inflammatory process. Moreover, the natural processes of the recovery of the spinal cord tissues are launched.
The antiviral drugs may be also prescribed instead on the immune stimulating therapy. This way, it is possible to affect the pathogenic bacterial organisms and viral agents.
The treatment of the spinal meningitis suggests standing a patient in the hospital inpatient department. The treatment is continued till the complete arresting of the inflammatory process. The treatment of the spinal meningitis usually takes from 20 to 30 days depending on the immunity of a patient.
After healing, a maintenance therapy takes a month. It is required to restore all functions of the spinal cord and the nervous system. In case of the serious lesions, the maintenance therapy may take up to 1-2 years.
The inflammation of the brain tissues is a serious stroke for the nervous system. Therefore, patients are prescribed a neurologist supervision.
Cryptococcal meningitis treatment
Cryptococcal meningitis often develops in patients with weak immune system. The disease often touches people with malignant neoplasms, AIDS, diabetes mellitus, uremia, and hemoblastosis. This type of the meningitis is often met in HIV-people.
Cryptococcal meningitis is a fungal affection of the meninges. Cryptococcosis affects people with the compromised immune system, the fungal infection occurs inhalatively, the causative agent may be latent in the lungs for a long period.
When fungi reach the brain blood vessels, the walls of the blood vessels are damaged, the microcirculation is disordered, the focal lesions of the brain, and neuron dystrophy are developed.
The initial stage of the disease always develops symptoms-free. Moreover, fungi affect the tissues of the brain and the spinal cord. A patient experiences headache, dizziness, and light affection of the vision at the initial stage. Then the spasms of the muscles, seizures, and fever appear.
To treat cryptococcal meningitis, antimycotic drugs are used (clotrimazole, fluconazole, ketoconazole). The essential medical products help to stop the progress of the fungal infection. Antibiotics (to reduce the inflammatory process) and corticosteroids (to arrest other symptoms of the meningitis) are also prescribed besides the antifungal products.
The scheme of the treatment suggests the intravenous introduction of Amphotericin B in the dose of 0,6-0,8 mg per 1 kg per day. Any broad spectrum antibiotic is added to this drug, for example, Doxycycline in the dose of 100 mg 2 times a day. When the inflammatory process is reduced, Amphotericin B is replaced by Fluconazole. It is prescribed in the dose of 400 mg a day within 2-3 months. Amphotericin B should be replaced in 1-2 weeks of the treatment. This product better inhibits the activity of the Cryptococci but it has a bad influence on the kidney functions.
The diagnostics of the cryptococсal meningitis is complicated. This type of the meningitis is often diagnosed at late stages because of the absent intensive symptoms. Due to this, the disease affects the significant part of the tissues of the brain and the spinal cord.
So, the cryptococcal meningitis needs a causal therapy, and the intracranial pressure is adjusted. The therapy helps to reduce the edema of the brain and a risk of the lesion of the important tissues. Moreover, a neurologist supervision is obligatory within 2 years.
According to the statistics, about 40% of patients have the cryptococcal meningitis for the second time within 10 years. Therefore everybody who has had this disease should take the antifungal and immune stimulating medications for the prophylaxis from time to time. It gives the body an opportunity to better resist the fungal infections and reduce a risk of the repeated infection.
In case of the bacterial meningitis, the body produces the immunity to the causative agent. In case of the fungal meningitis, the body becomes more vulnerable to the Cryptococci, and so the infection happens easier.
The viral meningitis is an inflammation of the meninges and develops under the action of viruses and their metabolic byproducts. It has a lighter course than the bacterial meningitis and is easily treatable.
Children are often exposed to this disease. The viral meningitis is airborne or fecal-oral (through the dirty products and raw water).
According to the statistics, the disease develops as a result of the enteroviruses in more than 60% of cases. The viral agents include:
- ECHO viruses;
- Coxsackie viruses types A and B;
- Mumps virus;
- Epstein-Barr virus;
- Herpes simplex virus of the second type;
The first symptoms of the viral meningitis are the same as during the bacterial one. At first, a patient has the signs of the ARVI that are aggravated. But unlike the bacterial type of the disease, the viral meningitis develops slowly. Doctors have more time to search the activator of the inflammatory process.
The treatment of the viral meningitis begins from the use of the antiviral and immune stimulating products:
- Recombinant α-interferon;
- Inducers of endogenous Interferon (Cycloferon);
- Antiviral drugs (Acyclovir);
- Intravenous immunoglobulins.
All these products are required to stop the lesion of the cells with the viruses and activate the natural mechanisms of the protection.
A patient is prescribed corticosteroids from the first day. The drug arrests the inflammatory process and activate the recovery of the brain tissues. Moreover, the corticosteroids help to prevent the complications.
In case of the late treatment of the viral meningitis, complications may happen. This is often an infectious process, and therefore patients are additionally prescribed antibiotics with a broad action:
- Amoxicillin/clavulanic acid (Augmentin);
- Carbapenems (e.g. imipenem);
- Quinolones (e.g. ciprofloxacin);
The treatment of the viral meningitis is based on the reduction of the disease symptoms and an inhibition of the main virus agent. Most part of the drug is needed to reduce a risk of the complications and keep the brain tissues. A patient is prescribed a desintoxication treatment and anti-seizure medications.
In most cases, the viral meningitis has a good prognosis. The inflammation of the brain tissues is light and not more than a month is needed for the complete recovery. However, neurologist, neuropathologist, and infection disease doctor must be visited within a year.
A peculiarity of the viral meningitis is that it is impossible to completely kill the viral agent. The therapeutic procedures just block the activity of the viruses and enhance the immunity. There is a risk of the meningitis aggravation within a year after the recovery. Therefore, a doctor’s supervision is obligatory.
Bacterial meningitis antibiotics
A choice of the antibiotic depends on a type of the activator of the inflammatory process during the bacterial meningitis. The treatment is usually started before getting the results of the microbiological test. In this case, the broad action antibiotics are prescribed:
An individual scheme of the treatment is prescribed after getting the test results.
Activator of Bacterial meningitis
|Drug of choice|
- A patient is prescribed the maximal high doses regardless of a choice of the antibiotic.
- The use of the antibiotics must be controlled, a concentration of the antibacterial ingredients in the blood must be always high.
- It is better to have intravenous injections during the first 2-4 days. The peroral antibiotics may be used from the 5th day of the treatment.
None drug is recommended being taken more than 10-14 days. If the antibacterial therapy should be continued, the antibiotic must be replaced. Select medications from different groups. This way, bacteria do not develop the cross-resistance.
The following drugs are recommended for the treatment of meningitis in brain abscess:
- Combinations of 3rd generation cephalosporins with Vancomycin and Metronidazole (Flagyl);
- Combinations of 3rd generation cephalosporins with fluoroquinolones and Metronidazole;
- Meropenem with Amikacin.
The antibiotics are not prescribed during the viral meningitis. The antibacterial drugs act as to the pathogenic organisms and are not active as to the viral agents. In order to effectively cope with the symptoms of the viral meningitis, a patient is prescribed antiviral drugs such as:
The immunomodulatory drugs on the basis of the recombinant α-interferon play an essential role in the therapy like during any viral disease. This type of protein stimulates the activity of the immune system. This protein penetrates into the infected cells during the entry of the viral agent and does not let viruses spread.
The antibiotics during the viral meningitis may be used only when the inflammatory process has induced the complications. In case of the complications, the body is vulnerable for the pathogenic organisms. Any additional infectious process may induce the complications of the meningitis. Therefore, the antibiotics are prescribed only for the prevention of the complications, and not to treat the viral meningitis.
Any antimicrobial drugs with the broad action will do for those purposes: penicillin, cephalosporins of the third generation, macrolides, and fluoroquinolones. Take the blood test before taking the antibiotic. If any infectious agent is detected in the blood, take the drug that is the most active in this clinical case.
Author: Dr. Eddie Louie , Infectious Diseases & Immunology, Internal Medicine, Phone: (212) 682-9202