Meningitis Inflames the Brain's Protective Layers: Why Urgent Care is Key

Meningitis is a potentially life-threatening condition owing to its sudden onset, fast progression and severity. According to studies in India, pneumonia and meningitis are the top causes of death in children under five years of age, accounting for almost 22% of all deaths. Reports from 2015 show that despite vaccinations and widespread use of antibiotics, the global burden of meningitis cases amounted to 8.7 million. Meningitis, a multifactorial brain infection caused by bacteria, viruses, fungi, and other pathogens, requires a critical understanding of its causes, progression, and preventive measures for effective control. 

To put it simply, meningitis is the inflammation of the meninges, the membranes that cover and protect the brain, the cerebrospinal fluid (CSF), and the spinal cord. It is a medical emergency that can result in permanent nervous disabilities or death if unnoticed. According to the World Health Organization, in 2023, meningitis occurs when the tissues surrounding the brain and spinal cord become inflamed, and this can result from infections caused by different bacteria, viruses, fungi, or parasites.

Meningitis can be caused by various bacteria, each affecting different age groups and individuals with specific health conditions. Newborn babies are most at risk from Group B streptococcus infection, while young children are at higher risk from meningococcus, pneumococcus, and Haemophilus influenzae infection. Adolescents and young adults are at particular risk of meningococcal infection, while the elderly are more at risk of pneumococcal infection.
The most common meningitis virus includes non-polio enteroviruses. Other viruses could include Herpesviruses, measles, influenza, and the mumps virus. 

Patients with diabetes mellitus and transplant recipients and those with sinus infections (sinusitis) may be prone to fungi-dependent meningitis caused by Mucormycosis. Among the parasitic causes, eosinophilic meningitis (EM) is a rare type of parasitic meningitis.

Non-infectious health conditions can also cause meningitis. This includes:

• Autoimmune disorders: Conditions where the body's immune system attacks its own healthy cells.
• Cancer/paraneoplastic syndromes: Cancers or related conditions where the body shows unusual symptoms not directly caused by the tumour.
• Drug reactions: Harmful or unexpected responses to medications.

Based on the causes, the disease can be broadly classified as Septic meningitis and Aseptic meningitis.

Septic meningitis is exclusively caused by bacterial infections and can be further divided into two categories: acute and chronic. Acute meningitis, primarily caused by Streptococcus pneumonia, is more common in older people. Other microorganisms include Neisseria meningitides, Beta-streptococcus, and Haemophilus influenza. Chronic meningitis, on the other hand, is characterised by inflammation in the CSF that lasts for four weeks or more.

Aseptic meningitis is caused by viral or nonviral agents that produce similar clinical symptoms and inflammatory responses. It can be further divided into acute and subacute based on the duration of the disease and how the CSF responds to the agent. The most common type of aseptic meningitis is caused by Enterovirus.

The telltale triad of symptoms in menigitis is:

• Fever
• Headache
• Neck stiffness

The symptoms and signs of meningitis closely reflect the causative agent and progress of the disease. Meningitis has three pathways:

• Bloospsread: The bacteria form colonies in the nasopharynx, get absorbed by the tissues (mucosal membranes) and enter the bloodstream to reach the nervous system.
• Direct contamination: Causative agents can directly enter the brain and spinal cord through the inner ears, medical devices, etc, or even due to trauma. 

Other symptoms are photophobia (light intolerance), dizziness, confusion, delirium, irritability, and nausea/vomiting. As the disease progresses, the meninges swell and pressurise the brain. Changes in mental performance, cognition, neurologic deficits, seizures, etc., deteriorate conditions.

The biggest risk factor for meningitis is compromised immunity. Thus, immunosuppressive medications like steroids, cancers, damaged spleen (spleen produces immune cells), transplantation procedures like bone marrow transplants, chemotherapy, cases of HIV/AIDS, diabetes, etc., are more prone to meningitis.

Apart from that:

• Severe ear infection
• Severe sinus infections
• Advanced pneumonia
• Leak of CSF due to trauma
• Cramped, unhygienic living spaces, etc.
• Brain or spinal cord injury
• Sickle cell disease
• Excessive alcoholism

Meningitis, an inflammatory condition, is not contagious, but some of its causes can spread and harm those nearby. 

Meningitis prevention is directly linked to the prevention, early diagnosis and management of all its risk factors. Medical science supports the use of prescription antibiotics and supportive care as the primary methods of preventing meningitis.

If you or your child falls under one of the risk categories of contracting meningitis, it is better to lead a disciplined lifestyle, such as:

• Avoiding alcohol and smoking
• Cleanliness — washing hands and personal hygiene to cleanse unknown contact with saliva or nasal secretions of those infected.
• Complete home rest and isolation in case of early stages of the bacterial, fungal, viral or parasitic infection
•  Staying away from those infected and not sharing utensils, food, and drinks is important.

There are also meningitis vaccinations that safeguard from the major meningitis types. Consulting your doctor is the best way forward.

Meningitis management and prevention are influenced by early detection of the infection or risk factor, strict adherence to the doctor's treatment plan, and quality aftercare. Recovery can take months, and some patients may experience permanent health changes like deafness, brain injury, or limb loss. Thus, those with compromised immunity and those with infections must receive good aftercare to ensure optimal recovery.

Meningitis is the inflammation of the meninges, the membranes that cover the brain and the spinal cord. Encephalitis is the inflammation of the tissues (the parenchyma) of the brain.

In the advanced stages, the worst symptoms of meningitis include changes in cognitive impairment, mood disturbances, behavioural and personality changes, neurologic deficits, seizures, etc.

People with compromised immunity, like HIV/AIDS, long-term corticosteroids, blood transfusions, transplants, cancer, chemotherapy, etc., are at higher risk of meningitis.

Meningitis can be a medical emergency. If untreated on time, it can lead to permanent disabilities like deafness, brain injury, limb loss, or death.

Those with compromised immunity or with untreated infections like pneumonia, herpes, etc, can suffer from meningitis.

Viral meningitis takes about a week, but the other forms of meningitis take weeks to months to completely resolve.