What is meningitis and what are the symptoms?

According to the World Health Organization (WHO), meningitis is a public health problem that causes around 241,000 deaths a year in the world.

This disease is the inflammation of the meninges, which are the tissue that covers the brain and spinal cord and have several layers called the pia mater, arachnoid mater and dura mater, which is the outermost layer close to the bone. Any of these can become inflamed and lead to meningitis.

María Isabel Reyes Mantilla, a neurologist at El Bosque University and a specialist in neuroimmunology at Johns Hopkins University, spoke with Gestarsalud to clarify the most frequent doubts about this condition.

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What types of meningitis exist?

There are several.

  • Depending on their cause, they can be bacterial, viral or fungal.
  • Depending on the findings of the cerebrospinal fluid, it may be of aseptic origin (if microorganisms, especially bacteria, are not identified early, the main cause of aseptic meningitis is viral meningitis).
  • Depending on the time of evolution, it can be acute (usually develops rapidly in the first 24 hours) or chronic (symptoms last more than four weeks).

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What are the risk factors for meningitis?

Most of the risk factors for this condition are not modifiable. However, bacterial meningitis is more common at the extremes of life: under 5 years of age and over 60 years of age.

In addition to age, there are other factors such as immunosuppressive states (HIV, diabetes, immunosuppressive drugs such as long-term steroids, chemotherapy, primary immunodeficiencies), alcoholism, and smoking, which can also cause meningitis.

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What are the early symptoms of meningitis?

The most frequent symptoms are:

  • Fever.
  • Intense headache.
  • Nausea.
  • Threw up.

The classic presentation of acute meningitis is high fever, nuchal rigidity (detected by the doctor during the neurological examination) and altered state of consciousness, but it is only found in 60% of cases.

In general, one must be alert to a headache that is accompanied by other neurological symptoms or signs such as an altered state of consciousness (the person being more sleepy or even in a coma), confusion, speech problems, presence of seizures , difficulty in vision or problems in walking.

And if the suspicion of bacterial meningitis is high, antibiotic coverage should be started early by the physician in the emergency department.

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What infections can cause meningitis?

Most meningitis is caused by bacteria, viruses, fungi, or parasites. Specifically, bacteria such as pneumococcus (Streptococcus pneumoniae), meningicococcus (Neisseria meningitidis) and Haemophilus influenzae (H. influenzae) are among the most common causes.

However, the massive use of vaccines, as is the case with H. influenza, has managed to substantially reduce the presence of this infection (previously the cause of 50% of bacterial meningitis).

Likewise, other bacteria such as listeria (L.monocytogenes), staphylococcus (Staphylococcus aureus) and Mycobacterium tuberculosis, can also cause meningitis depending on the age group and other risk factors.

But within the most frequent viral causes are enteroviruses (echoviruses, coxsackieviruses, polioviruses), Herpes simplex type 2 and Varicella zoster virus (VZV). As well as patients in a state of immunosuppression, they can present with fungal meningitis, as is the case with cryptococcus.

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What tests are done to detect meningitis?

If the suspicion of meningitis is high, the key to diagnosis and identification of the etiology is the study of the cerebrospinal fluid that is done through a lumbar puncture.

In this liquid, the composition of the different cells, protein levels, sugar levels and specific tests (PCR, antibodies, culture) are evaluated to search for the causal microorganism.

On some occasions, neuroimaging such as brain MRI can give some clues for the diagnosis of the type of microorganism that is causing the infection.

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What is the incidence of meningitis in Colombia?

In Colombia, according to the SIVIGILA (National Public Health Surveillance System) report, between 2015 and 2020, the H. influenzae agent reported an average incidence of 0.03 cases per 100,000 inhabitants and a lethality between 3.5 and 17.6%.

For its part, pneumococcus (S. pneumoniae) reported an average incidence of 0.14 cases per 100,000 inhabitants and a lethality between 13 and 27% of cases.

Finally, for meningococcus (N. meningitidis), the average incidence is 0.10 cases per 100,000 inhabitants and a lethality between 13.4 and 22%.