Meningitis

What is meningitis and why should I care about it?

The meninges is the name of the three-layered protective tissue that covers the brain and spinal cord. The suffix “-itis” is commonly used in medicine to denote “inflammation.” Meningitis is an infection, inflammation and swelling of the covering of the brain and spinal cord (meninges).

Meningitis can be caused both by bacteria and viruses. Bacterial infections of the meninges are usually more serious.

One of the bacteria that cause meningitis is “meningococcus.” Meningococcus normally inhabits the throat, harmlessly. Unfortunately, if it gets into the blood or even spinal fluid, the results can be catastrophic. There are many types of bacteria that cause meningitis, but a common meningococcus is “meningococcus type B,” commonly referred to as “meningitis B.”

When a child is born, their immune system has not developed. Nature has helped by allowing the mother to pass some of her antibodies to the baby through the placenta. These antibodies (immune system proteins) will give the baby temporary protection against many infections as a newborn.

Unfortunately, this maternal protection lasts just several weeks. There can be a lag time between when the mother’s antibodies wear off and when the infant’s immune system starts to function fully. During this period, infants have a higher risk of developing meningitis and other infections.

The most common time infants develop meningitis B is under the age of four. The vast majority of meningitis cases develop under age one. Meningitis B symptoms include:

sudden fever
nausea, vomiting
poor appetite
in infants, a bulge in the front of the head in the area of the “soft spot”
stiff neck
headache
avoidance of light (photophobia — light causes pain)
avoidance of loud sounds (phonophobia — loud sounds cause pain)
mental confusion
lethargy, tiredness
in infants, constant crying and extreme irritability (babies seem impossible to console)
difficulty walking or crawling
purple skin rash (if the bacterial infection gets into blood)

Why is meningitis so serious?

The concern for meningitis is that one in 10 patients can die from the infection. For the ones who survive a meningitis B infection, one in four will have significant complications including:

hearing loss
amputations
seizures learning problems or disabilities
brain damage
walking problems
kidney failure
memory problems
shock

Importantly, adolescents are also at a higher risk for developing meningitis. For some poorly understood reason, teenagers harbor a high amount of meningococcal bacteria in their throats. Although the incidence of meningitis in teens is not as high as infants, it is still significantly high and can have devastating effects.

Diagnosis

A physician can make a diagnosis via physical examination, blood tests, imaging studies and/ or a lumbar puncture (spinal tap).

Treatment

The good news is that with early diagnosis and aggressive treatment, most will do very well. If the infection is from a bacteria, intravenous antibiotics are required. If the infection is from a virus, supportive measures may be all that is needed. If the infection is from a fungus (very rare), medications may be used depending on the situation.

More good news

There is a meningitis B vaccine available for both infants and teenagers. The infant vaccination involves three shots given during the first year of life. For pre-teens and teenagers (especially ages 16-23), there are two different meningitis vaccines: the meningococcal conjugate vaccine and the meningococcal serogroup B vaccine.

The Centers for Disease Control recommends the meningococcal conjugate vaccination at age 11 or 12 with a booster of the same at age 16. The serogroup B vaccine should be given at age 16-18, so many teens get the booster of the conjugate and serotype B at the same 16-year-old visit.

Both vaccines can and should be given. Many colleges will require proof of meningitis vaccination, and many insurances will cover it.

Talk to your doctor about the precise vaccination schedules and risks, side effects and benefits of meningitis vaccinations for children of all ages. This could be one of the most important things you can do for the health of your child and teen.

Charles E. Crutchfield III, MD is a board certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He received his M.D. and Master’s Degree in Molecular Biology and Genomics from the Mayo Clinic. He has been selected as one of the top 10 dermatologists in the United States by Black Enterprise magazine. Dr. Crutchfield was recognized by Minnesota Medicine as one of the 100 Most Influential Healthcare Leaders in Minnesota. He is the team dermatologist for the Minnesota Twins, Vikings, Timberwolves, Wild and Lynx. Dr. Crutchfield is an active member of both the American and National Medical Associations.

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