Bacterial meningitis – symptoms, causes, treatment

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Bacterial meningitis is a disease of the central nervous system caused by bacteria entering the meninges. It manifests itself with fever, vomiting, meningeal syndrome and changes in the cerebrospinal fluid. Patients suspected of this ailment should be immediately referred to the hospital, to the infectious diseases ward.

Bacterial meningitis – definition

Bacterial meningitis is a condition in which inflammation attacks certain parts of the brain, such as the arachnoid or subarachnoid area, due to infection with bacteria. The ailment can attack people of all ages, however, in the group of patients particularly vulnerable to inflammation, there are children under 5 and those of school age. The main pathogens leading to meningitis are the meningococci and pneumococci. Affected people struggle with high fever and vomiting.

What are the causes of bacterial meningitis?

Ailment in the form of bacterial meningitis is an acute infectious disease caused by the entry of bacteria into the meninges. Where is the infection spreading?

1. infection may appear as a result of fractures of the skull bones, then the crack formed in the bones leads to bacteria passing through it. Pathogens can pass from the middle ear during, for example, fracture of a rocky part of the ethmoid bone;
2. infection can spread through airborne droplets;
3. infection through the blood – it can develop in a completely different place, spreading bacteria which are transported through the blood to the central nervous system;
4. infection may result from poorly treated or untreated infections, such as purulent infection of the ear or paranasal sinuses.

However, the factors that increase the risk of bacterial meningitis are:

Bacterial infections of the meninges are favored by:

1. catarrh in the upper respiratory tract,
2. inadequate hygiene,
3. poor housing and economic conditions,
4. defective connections of the meningeal space with the nasopharyngeal cavity, the middle ear and the paranasal sinuses,
5. streptococcus,
6. the presence of pathogens in the reproductive tract of a woman,
7. pneumonia
8. being in a large group of people on a daily basis (school, barracks),
9. flu virus
10. decreased immunity,
11. co-occurring chronic diseases.

Symptoms of bacterial meningitis

The disease occurs at any age and is often severe. The onset of symptoms is rapid (headache, fever, vomiting), and the inflammation occurs with a full meningeal syndrome, often with impaired consciousness, convulsions and paralysis. Bacterial meningitis is usually a secondary infection in the course of systemic infection, otitis, sinusitis, and cranial trauma.

Symptoms can be distinguished depending on which group of patients was affected by the disease.

1. Symptoms in newborns – they are not distinguished by anything characteristic, fever and classic meningeal symptoms usually do not occur. The newborn baby has an accelerated heart rate and less than seven points on the Apgar scale. Parents are most often concerned about their toddler’s strange behavior, it is sleepy and restless. Often there are eating problems, appetite disorders, diarrhea, vomiting and even problems with proper suckling. Some children may experience breathing problems and neurological symptoms in the form of increased or decreased muscle tone or nystagmus. Jaundice may be protracted. A common symptom in neonates suggesting bacterial meningitis is a seizure attack and enlargement of the head circumference due to developing hydrocephalus.

2. Symptoms in infants – the symptoms of bacterial meningitis appear suddenly and are characterized by a high temperature. Infants and children up to 5 years of age are in poor general condition, they can be sleepy and apathetic. You can observe some kind of anxiety and ecchymosis on the skin. In addition, convulsions and a tight front fontanelle may appear. Contrary to neonates, in this group of patients meningeal symptoms are much more common, such as neck stiffness, which prevents the head from coming closer to the chest.

3. Symptoms in adults – diagnostics in adolescents or the elderly is not as complicated as in the previous two groups of patients. The most common symptom is the aforementioned headaches, high temperature and, of course, meningeal symptoms. Patients complain of somnolence, nausea and vomiting, and there may be neurological disorders such as convulsions or muscle paralysis. In adults, we are dealing with a characteristic position on the side, the patient’s head is tilted back and legs are tucked up.

Bacterial meningitis and meningeal symptoms

Meningeal symptoms result from irritation of the meninges of the brain due to an inflammatory process. Together with ailments such as vomiting, headache, photophobia or hypersensitivity to noise – they form the meningeal syndrome. Meningeal symptoms can be divided into:

1. Kernig’s symptoms: when bending the patient’s torso forward, there is a reflex flexion of the lower limbs in the hip and knee joints, and when bending the leg in the hip joint, there is a forced flexion in the knee joint;
2. Herman’s symptoms: when the patient puts his chin on the chest, spontaneous flexion of the dorsal big toe appears;
3. Brudziński’s symptoms: first, when the head is bent towards the chest, the lower limbs bend at the hip and knee joints; in addition, when pressing the cheek below the zygomatic bone, it leads to bending and lifting of the forearms; when pressing on the pubic area, the limbs in the hip and knee joints bend;
4. Amoss symptoms: the patient, wanting to sit down, props himself on the straight upper limbs, which are set apart from the sides and directed backwards;
5. Flatau’s symptoms: pupil dilation occurs when the patient tries to tilt his head forward, while young boys that tilt the torso forward several times may develop an erection.

Diagnosis of bacterial meningitis

First, the doctor conducts a medical interview with the patient and performs a physical examination. On the other hand, additional tests that help to finally diagnose bacterial meningitis are the analysis of the cerebrospinal fluid, which is collected through the lumbar puncture. Thanks to him, it is possible to determine the specific features of a bacterial infection.

The culture of blood and cerebrospinal fluid enables the determination of the bacteria responsible for causing inflammation and its sensitivity to preparations. In addition, culture helps with the right type of treatment.

Other useful studies are:

1. tests to determine inflammation (e.g. CRP – C-reactive protein), ESR or procalcitonin;
2. neuroimaging tests in the form of computed tomography – performed in the case of increased intracranial pressure and symptoms of a neurological nature;
3. rapid latex tests to detect bacterial antigens.

Bacterial meningitis

Treatment is primarily causal and symptomatic therapy.

The causal treatment of this ailment is based on the intake of large amounts of antibiotics. As long as the cause of bacterial meningitis is not found, empirical antibiotic therapy is implemented, which includes agents that destroy typical bacteria that cause inflammation depending on the age of the patient. After an appropriate diagnosis is made and the etiology is determined, targeted antibiotic therapy is implemented, i.e. therapy affecting a specific type of bacteria. It is important to choose an antibiotic that can pass through the bloodstream to the brain.

As for symptomatic treatment of bacterial meningitis, it is implemented individually for each patient according to their condition and symptoms. Usually, preparations lowering intracranial pressure, e.g. corticosteroids, are administered, and water and electrolyte deficiencies are supplemented. In addition, it is important to prevent seizures, for example, diazepam is administered.

Prevention

Disease prevention is a very important part of the overall treatment. It is recommended to take protective vaccines, which in Poland are included in the compulsory vaccination program (against H.vinfluanzae), as well as against pneumococci and meningococci.

Can bacterial meningitis cause complications?

Yes, there can be complications that depend mainly on the type of bacteria causing the inflammation and the course of the disease and its treatment. Complications can affect up to half of patients suffering from bacterial meningitis. We include among them:

1. sleep disturbances,
2. behavioral disorders,
3. muscle paresis,
4. blindness,
5. hearing problems,
6. in children, growth disorders and exercise intolerance may occur,
7. hydrocele or subdural abscesses of the brain,
8. cranial nerve palsy.