$Unique_ID{BRK03994} $Pretitle{} $Title{Meningitis, Bacterial} $Subject{Meningitis Bacterial Bacterial Meningitis Pyogenic Meningitis Meningitis Encephalitis} $Volume{} $Log{} Copyright (C) 1990, 1991 National Organization for Rare Disorders, Inc. 819: Meningitis, Bacterial ** IMPORTANT ** It is possible the main title of the article (Bacterial 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 Bacterial Meningitis Pyogenic Meningitis Information on the following disorder may be found in the Related Disorders section of this report: Meningitis 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. Bacterial Meningitis is a central nervous system disease caused by certain types of bacteria. Meningitis is characterized by inflammation of the membranes (meninges) around the brain or spinal cord. Inflammation can begin suddenly (acute) or develop gradually (subacute). Major symptoms may include fever, headache, and a stiff neck, sometimes with aching muscles. Nausea, vomiting and other symptoms may occur. Symptoms Bacterial Meningitis in adults and children is often preceded by respiratory illness or a sore throat. Most forms of bacterial meningitis are acute. In its acute form, the disorder is characterized by sudden 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 is common. Other symptoms may include chills, sweating, weakness, loss of appetite, or inability to tolerate bright light (photophobia). Later symptoms may include hydrocephalus (accumulation of fluid in the brain cavity), paralysis of one side of the body (hemiparesis), hearing loss, or other neurological abnormalities. Among infants between 3 months and 2 years of age, fever, refusal of feedings, 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 investigated. 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 Bacterial Meningitis on the central nervous system. A neonatal form of Bacterial Meningitis in newborn babies up to 4 weeks old 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 nonspecific 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. Bacterial 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. Other symptoms such as fever, drowsiness, and seizures may occur. Causes Bacterial Meningitis is the most common type of meningitis. Three types of bacteria are responsible for 80% of all Bacterial Meningitis. These are: 1) Hemophilus influenzae (type B), 2) Streptococcus pneumoniae (Pneumococcus), and 3) Neisseria meningitidis (Meningococcus). (For more information on Meningococcal Meningitis, choose "meningococcal" as your search term in the Rare Disease Database). All three types occur most often in winter. Gram-negative bacteria such as Escherichia coli, Klebsiella-Entero, or Pseudomonas often cause Bacterial Meningitis in newborn infants. Other types of bacteria that may cause the disorder are Streptococci, Staphylococci (Staphylococcus aureus) or listeria monocytogenes. Bacterial Meningitis due to hemophilus influenza type B bacteria occurs most often in infants over 1 month old and young children. It usually does not occur in adults except in relation to another condition such as head trauma or impaired immunity. Bacterial Meningitis caused by pneumococcus occurs most often in adults, especially those with alcoholism, chronic otitis (inflammation of the ear), sinusitis (inflammation of the mucous membranes lining the sinuses that open into the nose), mastoiditis (infection of the bone located behind the ear), closed head injury, recurrent meningitis, pneumococcal pneumonia, or sickle cell anemia. (For more information choose "meningitis," or "sickle" as your search terms in the Rare Disease Database). Bacterial Meningitis from gram-negative organisms such as Escherichia coli and Klebsiella-Enterobacter is called Gram-negative Meningitis and frequently occurs after central nervous system trauma or surgery, or from blood poisoning). Newborns or people who have impaired immunity may also become infected. Staphylococcal Meningitis (from Staphylococcus bacteria), another form of Bacterial Meningitis, occurs after blood poisoning (e.g., from endocarditis which is inflammation of the inner lining of the heart), open head trauma, or neurosurgery. Listeria Meningitis is another form of meningitis that occurs in newborns, in patients who have chronic renal (kidney) failure, or adults taking immunosuppressive drugs (e.g. organ transplant patients). (For more information on Listeria, choose "Listeria" as your search term in the Rare Disease Database). Intravenous drug use from unsterilized needles can cause blood poisoning that may lead to Bacterial Meningitis. Of all bacteria causing Bacterial Meningitis, Hemophilus influenza type B is the most common and represents almost half of all Bacterial Meningitis cases. Meningococcal Meningitis represents about 27 per cent, and Pneumococcal Meningitis represents about 11 per cent. Affected Population In the United States, about 20,000 to 25,000 cases of Bacterial Meningitis are reported annually. About 70 per cent of all Bacterial Meningitis occurs in children aged 5 and under, especially those under the age of two. Males are affected more often than females. Bacterial Meningitis in general occurs most often during the first month of a newborn's life and is usually caused by gram-negative bacteria such as Escherichia coli or by group B streptococcus. Bacterial Meningitis caused by Hemophilus influenzae type B occurs most often in infants over 1 month old and young children. Bacterial Meningitis caused by pneumococcus bacteria occurs most often in adults. Related Disorders Symptoms of the following disorders may resemble those of Meningitis. Comparisons may be useful for a differential diagnosis: Meningitis is characterized by inflammation of the membranes (meninges) around the brain or spinal cord. This inflammation may be caused by different types of bacteria, viruses, fungi, malignant tumors, or chemical reactions to certain injections into the spinal canal. (For more information on other types of Meningitis, choose "meningitis" as your search term in the Rare Disease Database). 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 Testing for Bacterial Meningitis may include imaging techniques such as CT scans or MR imaging. Other testing may include examination of the patient's blood and/or skin. Diagnosis is made by examination of the cerebrospinal fluid. Bacterial 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, cefuroxime, cefotaxime, ceftizoxime, oxacillin, vancomycin, or rifampin. The addition of dexamethasone to the antibiotic treatment is also being used and is helpful in reducing meningeal inflammation. For children under 5 who have come in close contact with a person having Meningitis caused by Hemophilus influenzae, the drug rifampin may be prescribed as a preventative measure. Children over 2 years of age can be immunized against Meningitis with the Hemophilus 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 Hemophilus influenzae type B Meningitis. Therapies: Investigational This disease entry is based upon medical information available through June 1991. 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 Bacterial 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 Infectious 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 CECIL TEXTBOOK OF MEDICINE, 18th Ed.: James B. Wyngaarden, and Lloyd H. Smith, Jr., Editors; W.B. Saunders Co., 1988. Pp. 57, 65, 1604-1610. INTERNAL MEDICINE, 2nd Ed.: Jay H. Stein, ed.-in-chief; Little, Brown and Co., 1987. Pp. 1494-1502. BACTERIAL MENINGITIS IN OLDER CHILDREN. W. A. Bonadio, et al.; Am J Dis Child (Apr 1990; issue 144 (4)). Pp. 463-465. CEFTRIAXONE ALONE COMPARED TO AMPICILLIN AND CHLORAMPHENICOL IN THE TREATMENT OF BACTERIAL MENINGITIS. N. I. Girgis; Chemotherapy (1988; issue 34 (Suppl 1)). Pp. 16-20. Gd-DTPA-ENHANCED MR IMAGING OF THE BRAIN IN PATIENTS WITH MENINGITIS: COMPARISON WITH CT. K. H. Chang, et al.; AJR Am J Roentgenol (April 1990; issue 154 (4)). Pp. 809-816.