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Meningitis

Also listed as: Brain inflammation - meningitis

• Signs and Symptoms
• What Causes It?
• Who's Most At Risk?
• What to Expect at Your Provider's Office
• Treatment Options
• Prognosis/Possible Complications
• Following Up
• Special Considerations
• Supporting Research

Meningitis results from the inflammation of the meninges (the thin membranes surrounding the brain and spinal cord). It is usually caused by a viral or bacterial infection. Most cases of meningitis are viral, but it can be hard to tell the difference without medical tests. It is extremely important to determine the type of infection (and bacteria), because bacterial meningitis tends to be much more serious and requires emergency treatment. Viral meningitis usually clears up on its own and does not cause any permanent harm. Bacterial meningitis can cause brain damage, learning disabilities, hearing loss, or even death without treatment for the specific type of bacteria. Meningitis can also be caused by fungal infections (cryptococcus), but that is rare.

Signs and Symptoms

Early symptoms of meningitis can easily be mistaken for the flu.

In newborns, signs and symptoms include the following:

• Irritability
• High-pitched cry
• Poor feeding
• Vomiting
• Fever
• Seizures
• Bulging fontanelle ("soft spot" in the skull) or stiff neck (less common)

In children and young adults, signs and symptoms include the following:

• High fever
• Severe headache
• Vomiting or nausea
• Stiff neck
• Sensitivity to light
• Drowsiness
• Skin rash (in cases of meningococcal meningitis -- see section titled What Causes It? )
• Confusion
• Seizures
• Clouding or loss of consciousness

Older adults may have no signs or symptoms other than altered mental state and lethargy. Often they have no fever.

What Causes It?

Bacterial meningitis is not as common as viral meningitis, but it is more serious. Several types of bacteria can cause meningitis. Knowing the right type is crucial for proper treatment:

• Neisseria meningitidis causes meningococcal meningitis, a common form of meningitis in children and young adults, and the only type that occurs in outbreaks. It is highly contagious.
• Haemophilus influenzae was the most common cause in infants and children under 6 years old before 1986, when a vaccine (HiB) was introduced. The vaccine has mostly eradicated this kind of meningitis in countries where it is given to infants.
• Streptococcus pneumonia is the most common cause of bacterial meningitis in children. It may occur along with an ear or sinus infection or pneumonia.
• Listeria monocytogenes is a common form of bacteria that can be found all around us. It does not tend to infect most people, but the very young and very old, as well as pregnant women, can be at risk.
• Staphylococcus aureus may be seen following a head injury or brain surgery.

Viral meningitis can be caused by several types of viruses, but by far the most common are enteroviruses (which cause stomach flu and multiply in the intestinal tract). Other viruses that can cause meningitis include:

• Arboviruses -- carried by arthropods, such as ticks or mosquitoes
• Mumps virus -- seen in children between age 5 - 9 who have not had the MMR vaccine
• Herpesviruses
• Human immunodeficiency virus (HIV) -- meningitis may be the first sign a person is infected with HIV.

Who's Most At Risk?

These conditions and characteristics increase the risk for bacterial meningitis:

• Living in a crowded setting, such as a dormitory or child-care facility (for meningococcal meningitis)
• Age -- children, young people and older adults are more likely to develop meningitis.
• Significant head injury, skull trauma, or cerebrospinal rhinorrhea (flow of cerebrospinal fluid from the nose after a head injury)
• A suppressed immune system (for pneumococcal meningitis)
• Never receiving the HiB vaccine (see section titled What Causes It? )
• Doing laboratory work that requires handling rats, hamsters, and mice; or working with animals on a farm or ranch (for listeria)

What to Expect at Your Provider's Office

If you or your child has symptoms of meningitis, seek emergency treatment. Early diagnosis is the key to treating meningitis successfully. Doctors will ask for a detailed medical history and may order a lumbar puncture (spinal tap). In this test, doctors remove cerebrospinal fluid from the spine through a needle so that the fluid can be tested for infection and to identify the kind of bacteria responsible. If your doctor suspects bacterial meningitis, your doctor may start you on antibiotics right away, even before the test results are available.

Treatment Options

Prevention

Children should be vaccinated against H. influenzae and mumps. People over 65 and those whose immune systems are compromised should receive a pneumococcal vaccine (PPV). A meningococcal vaccine may be given to control epidemics in dormitories, for example. Because meningitis is usually contagious, practicing good hygiene, such as washing your hands frequently -- and teaching children to do the same -- can reduce your risk of catching the disease.

Drug Therapies

The length and type of treatment varies depending on the kind of meningitis being treated, ranging from one to three weeks. The treatment for most cases of viral meningitis is aimed at reducing symptoms of fever and aches; sometimes acyclovir, an antiviral drug, may be given. If bacterial meningitis is suspected, antibiotics must be started immediately, even before results from lab tests have been returned. Some of the medications used for bacterial meningitis are:

• Antibiotics, often in combination, including ampicillin, cephalosporins, gentamicin, vancomycin, or trimethoprim-sulfamethoxazole
• Corticosteroids to reduce inflammation
• Diazepam or phenytoin if seizures occur
• Rifampin is given to family members to reduce their risk of contracting the disease.

Complementary and Alternative Therapies

Bacterial meningitis must be treated with conventional medical therapies, especially antibiotics. Because it is usually impossible to distinguish between bacterial and viral meningitis without lab tests, you should always seek conventional medical care for symptoms of meningitis. Complementary and alternative therapies should be used only with conventional treatment, not in place of it, and only with the guidance of a qualified health professional. Some supplements and herbs may help strengthen the immune system, and homeopathic remedies may help relieve symptoms that accompany meningitis.

Nutrition and Supplements

Several nutrients can help strengthen the immune system, possibly helping to prevent meningitis or to build up the immune system after meningitis has been treated, though scientific studies have not examined these nutrients specifically for meningitis. Talk to your doctor before taking any supplements, and never treat a child without talking to your doctor first.

• Vitamin A (up to 10,000 IU per day for adults)
• B complex vitamins (dose varies)
• Vitamin C (1,000 mg two to six times per day for adults. Lower dose if diarrhea develops.)
• Quercetin (400 - 500 mg per day), an antioxidant found in plants
• Omega-3 essential fatty acids (found in fish oil, 1 - 2 g per day)

Herbs

Some herbs may help support your immune system, although there is no evidence they can prevent or treat meningitis. Meningitis is a medical emergency and should never be treated with herbs alone.

• American ginseng (Panax quincefolius , 100 - 300 mg two times per day) -- may have anti-inflammatory and antibacterial effects. Ginseng interacts with several medications and other herbs, so talk to your doctor before taking it. Do not take ginseng if you take blood-thinning medication, have diabetes, high blood pressure, or heart disease.
• Astragalus (Astragalus membranaceus , 4 - 7 g per day) --preliminary test tube studies suggest astragalus may stimulate the immune system. It is often taken as a tea -- steep 1 tsp. root in one cup boiling water, strain, and cool. Drink three or four times per day. Do not take astragalus if you have diabetes or high blood pressure, or if you take blood-thinning medication or diuretics (water pills).
• Garlic (Allium sativum , 600 - 1,200 mg per day in two or three divided doses) -- has antibacterial properties and can help support the immune system. In laboratory tests, it has also been shown to stop the growth of and even kill the fungus Cryptococcal neoformans. A small study of five people with cryptococcal meningitis suggested that it may be effective in people, but more research is needed. Do not take garlic is you take blood-thinning medication.
• Echinacea (Echinacea purpurea , 200 mg two times per day) -- is traditionally used for immune system support. In animal studies, echinacea significantly reduced the amount of bacteria and increased survival rate for those infected with L. monocytogenes. It's not clear whether the same would be true in humans.
• Elderberry (Sambucus nigra) -- has antiviral properties. It is usually taken as either tincture (alcohol extract) or glycerite (glycerin extract). Doses vary with different preparations, so consult your health care provider to establish a dose that's right for you.

Homeopathy

Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies to help alleviate symptoms of meningitis, in addition to standard medical care. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for each individual.

• Apis mellifica -- for meningitis in children with such intense head pain that they bore their heads into a pillow
• Arnica montana -- for meningitis following surgery or an injury to the head. This remedy is most appropriate for individuals who often insist that there is nothing wrong with them.
• Belladonna -- for a sudden onset of high fever which accompanies meningitis. This remedy is most appropriate for individuals who are hot and flushed with wide pupils, and may have nightmares and delusions.
• Bryonia -- for meningitis with impaired consciousness and a characteristic movement of the mouth in which the jaw moves side to side quite rapidly in a somewhat contorted manner
• Helleborus -- for meningitis with impaired consciousness and stupor. Individual may also be anguished and pleading for help. Shaking or rolling of the head may also occur.
• Hyoscyamus -- for meningitis with violent spasms that occur with shrieking and grinding of the teeth

These treatments must not be used for meningitis without direction and supervision by an appropriately trained and certified homeopathic doctor.

Prognosis/Possible Complications

About 25 - 30% of people with bacterial meningitis die from it. Sixty percent of infants who survive bacterial meningitis have brain damage, hearing problems, or developmental difficulties. Most people who get viral meningitis recover completely without any problems.

Complications of meningitis may include hearing loss, seizures, cerebral edema (brain swelling), weakness on one side of the body, speech problems, visual impairment or blindness, difficulty coordinating movements, trouble breathing, respiratory arrest, and recurring meningitis.

Following Up

For the first 1 - 2 days, patients should be monitored in the intensive care unit to be sure that the medication is working, to watch for any seizures, and to watch for breathing difficulties. If signs and symptoms do not improve after 1 - 2 days, health care providers should check the cerebrospinal fluid again.

Special Considerations

Pregnant women often carry L. monocytogenes and S. agalactiae without having symptoms and may pass these infections to their children during birth. Pregnant women should not take rifampin to prevent meningitis because it is not clear whether this drug may harm the fetus.

Supporting Research

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• Review Date: 12/17/2006
• Reviewed By: Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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