$Unique_ID{BRK03993} $Pretitle{} $Title{Meningitis} $Subject{Meningitis Adult Meningitis Infantile Meningitis Neonatal Meningitis Waterhouse-Friderichsen Syndrome Encephalitis } $Volume{} $Log{} Copyright (C) 1988, 1989, 1992 National Organization for Rare Disorders, Inc. 539: Meningitis ** IMPORTANT ** It is possible the main title of the article (Meningitis) is not the name you expected. Please check the SYNONYMS listing on the next page to find alternate names and disorder subdivisions covered by this article. Synonyms DISORDER SUBDIVISIONS: Adult Meningitis Infantile Meningitis Neonatal Meningitis Includes: Waterhouse-Friderichsen Syndrome Information on the following disorder may be found in the Related Disorders section of this report: Encephalitis General Discussion ** REMINDER ** The information contained in the Rare Disease Database is provided for educational purposes only. It should not be used for diagnostic or treatment purposes. If you wish to obtain more information about this disorder, please contact your personal physician and/or the agencies listed in the "Resources" section of this report. Meningitis is characterized by inflammation of the membranes (meninges) around the brain or spinal cord. The disorder can occur in three different forms: adult, infantile, and neonatal. This inflammation may be caused by different types of bacteria, viruses, fungi, or malignant tumors. Chemical reactions to certain injections into the spinal canal can also cause Meningitis. This inflammation can begin suddenly (acute) or develop gradually (subacute). Adult forms of Meningitis are characterized by fever, headache, and a stiff neck, sometimes with aching muscles. Nausea, vomiting and other symptoms may occur. Treatment with antibiotics is usually effective against the infection. Symptoms Meningitis in adults and children is often preceded by respiratory illness or a sore throat. In its acute form, the disorder is characterized by fever, headache, a stiff neck, and vomiting. Adults may become seriously ill within 24 hours. In children, the course of the infection may be even shorter. Symptoms among older children and adults may progress from irritability through confusion, drowsiness, and stupor, possibly leading to coma. Dehydration often occurs, and collapse of the blood vessels may lead to shock (Waterhouse-Friderichsen Syndrome), especially when the Meningitis is caused by meningococcus bacteria which spreads to the blood (septicemia). Paralysis of one side of the body (hemiparesis) is uncommon early in the course of Meningitis, but may occur later as a result of tissue death in the brain (cerebral infarction). Meningitis may recur even after treatment with antibiotics. Infantile Meningitis: The course of the disorder is less predictable among infants between 3 months and 2 years of age. Fever, vomiting, irritability, and convulsions usually occur. A high-pitched cry, and a bulging or tight soft spot (fontanel) on the crown of the head (where the parts of the still unhardened bones join) may also occur. Since the incidence of Meningitis is highest among this age group, any unexplained fever needs to be closely watched. Cerebral fluid may accumulate just inside the tough outer membrane covering the brain (subdural effusions) after several days. Typical signs of Meningitis include seizures, a persistent fever, and an enlarging head size. A brain abscess or subdural pus accumulation may also occur. Water accumulating in the brain (hydrocephalus), deafness and slowed mental and physical development are possible effects of Meningitis on the central nervous system. Neonatal Meningitis: Meningitis in newborn babies can begin during the first 4 weeks of life. It may be caused by infections in parts of the body other than the brain or spine. Some cases may arise from complications occurring at birth. The disorder is characterized by subtle and non-specific signs such as jitteriness, interrupted breathing (apnea), vomiting, diarrhea, and a yellowish skin color (jaundice). Usually signs of infection elsewhere in the body (e.g. middle ear infection) are also present. The cerebrospinal fluid can be tested for a definite diagnosis. Meningitis due to Group B pneumococcus bacteria may be present in the first 10 days of life, when it frequently accompanies a lung illness. Usually, however, this form of Meningitis occurs after 10 days of age as an isolated illness. Neonatal Meningitis is also characterized by symptoms such as fever, drowsiness, and seizures. Causes Meningitis can be caused by different bacteria, viruses and organisms such as Neisseria meningitis, Hemophilus influenzae b, Streptococcus (Diplococcus) pneumoniae, Group A Streptococcus, Escherichia coli or other gram-negative organisms (chiefly Pseudomonas), and Staphylococcus aureus. Recurrent Meningitis occurs in special situations: 1) When there is a communication between the brain and the exterior that may be inborn or occur after an injury; 2) When infection occurs in areas close to the meninges as in mastoid infection, sinus infection, brain abscess, accumulation of pus under the outer meninge (subdural empyema), or spinal epidural abscess; 3) When the patient has impaired immunity against bacteria or other causes of illness. Affected Population Neonatal Meningitis usually occurs during the first 4 weeks of life, and predominantly affects infants of low birth weight who have had complications at birth. This form of the disorder occurs in approximately 2 out of 10,000 full-term infants, and in 2 out of 1,000 low birth weight infants. This form of Meningitis predominantly affects males. Related Disorders Symptoms of the following disorders may resemble those of Meningitis. Comparisons may be useful for a differential diagnosis: Encephalitis is a brain infection. There are different types of this disorder which are caused by different types of viruses. Encephalitis may also be caused by hypersensitivity initiated by a virus or other protein that is foreign to the body. Symptoms may include headache, drowsiness, hyperactivity, and/or general weakness. This disorder may have some symptoms similar to those of Meningitis such as a stiff neck, altered reflexes, confusion, speech disorders, possible convulsions, paralysis and coma. (For more information choose "Encephalitis" as your search term in the Rare Disease Database.) Therapies: Standard Meningitis is usually treated with different types of antibiotics used against the specific bacteria causing the infection. These may include ampicillin, chloramphenicol, gentamicin, penicillin, moxalactam, nafcillin, or in tuberculosis cases isoniazid. Children over 2 years of age can be immunized against Meningitis with the Haemophilus influenzae type b polysaccharide vaccine. A vaccine composed of attenuated bacteria with added protein, has been approved for use in children under two years of age to protect them against Haemophilus influenzae type B Meningitis Therapies: Investigational The orphan product, Amphotericin B Lipid Complex, has been sponsored by the Bristol-Myers Squibb Co., P.O. Box 4000, Princeton, NJ, 08543, for the treatment of Cryptococcal Meningitis. This disease entry is based upon medical information available through February 1992. Since NORD's resources are limited, it is not possible to keep every entry in the Rare Disease Database completely current and accurate. Please check with the agencies listed in the Resources section for the most current information about this disorder. Resources For more information on Meningitis, please contact: National Organization for Rare Disorders (NORD) P.O. Box 8923 New Fairfield, CT 06812-1783 (203) 746-6518 NIH/National Institute of Allergy and Infections Diseases (NIAID) 9000 Rockville Pike Bethesda, MD 20892 (301) 496-5717 Centers for Disease Control (CDC) 1600 Clifton Road, NE Atlanta, GA 30333 (404) 639-3534 References INTERNAL MEDICINE, 2nd ed.: Jay H. Stein, et al., eds.; Little Brown, 1987. Pp. 1494-1502. PREVENTION OF HAEMOPHILUS INFLUENZAE TYPE B INFECTIONS IN HIGH-RISK INFANTS TREATED WITH BACTERIAL POLYSACCHARIDE IMMUNE GLOBULIN: M. Santosham, et al.; New England Journal Med (October 8, 1987: issue 317(15)). Pp. 923- 929. PROSPECTS FOR PREVENTION OF HAEMOPHILUS INFLUENZAE TYPE B DISEASE BY IMMUNIZATION: D.M. Granoff, et al.; Journal Infect Dis (March 1986: issue 153(3)). Pp. 448-461. CAPSULAR POLYSACCHARIDE OF HAEMOPHILUS INFLUENZAE TYPE B AS A VACCINE: J.C. Parke, Jr.; Pediatr Infect Dis Journal (August 1987: issue 6(8)). Pp. 795-798.