Bacterial Meningitis: Identification, Treatment, and Prevention

While most cases of meningitis are viral and mild, bacterial
forms of meningitis can be deadly.  For
this reason, vaccines are encouraged, but even then vaccines don’t guarantee
100% efficacy against the disease.  So it
is essential to be able to identify, treat, and prevent bacterial meningitis.  The following information comes verbatim from
The Ship’s Medicine Chest and Medical Aid
at Sea, a government publication.

“Meningitis is an inflammation of the sheath-like membranes
(meninges) that cover the brain and spinal cord.  Several different organisms may be carried by
the blood to the meninges, lodge there, multiply, and eventually cause
inflammation (meningitis).  The most
common forms of this condition are tubercular meningitis, pneumococcal
meningitis, gonococcal meningitis, staphylococcal meningitis, and meningococcal
meningitis.

The symptoms of these forms of meningitis are similar.  For emergency diagnosis and treatment at sea,
there is no practical need to differentiate among them, except to point out
that epidemic cerebrospinal meningitis (meningococcal meningitis) is extremely
infectious.  Thus one should assume that
any form of meningitis is contagious until proven otherwise.  All
cases suspected of being meningitis should be handled as though contagious.

The germ that causes cerebrospinal meningitis usually is
present in nose and throat secretions of those suffering from the disease, in
carriers who have recovered from it, or those who have been in contact with
patients with the disease.  The germs are
spread directly by person-to-person contact, and indirectly by contact with
articles freshly soiled with nose and mouth discharges of patients or
carriers.  Epidemics of cerebrospinal
meningitis (meningococcal) are related to overcrowding and close contacts as
those commonly found in barracks, camps, and ships.

About a week after exposure, fever, severe headache, nausea,
generalized muscle and joint pains, backache, and rigidity of the neck may
develop.  Symptoms like those of a common
cold may or may not be present.  There
may be vomiting, irritability, delirium, or convulsions.  The patient may become drowsy and difficult
to arouse.  He may become
unconscious.  There may or may not be a
generalized skin rash—flat pinhead-sized red spots that have the appearance of
bleeding into the skin.  These spots may
or may not have a small reddish or yellow blister in the center.  The patient often lies on his side facing
away from the light, with knees drawn up and head thrown back to lessen the
painful rigidity of the neck and back. 

The most important diagnostic findings for meningitis are
(1) fever and prostration, (2) severe headache, and (3) rigidity of the
neck.  These always are present and a
diagnosis cannot be made without them. 

Prevention of Spread

The patient should be isolated for at least 14 days after
the onset of meningitis.  All who care
for the patient must follow carefully the isolation nursing technique (see p.
321).  This includes wearing a gown and
mask in the sickroom, and washing the hands each time after giving care.

Crewmen should be advised about the danger of
meningitis.  They should be told to wash
their hands before eating.  Also they
should cough and sneeze into handkerchiefs to avoid spreading the disease by
droplet infection, in case they might have meningitis in an early form before
symptoms appear.  If possible, the space
should be increased between individuals in sleeping quarters.  Living and sleeping quarters should be well-ventilated.  Chilling, fatigue, and undue mental and
physical strain will increase susceptibility to the disease and should be
avoided, if possible, by those exposed to the infection. 

Treatment

Medical advice by
radio should be obtained on the treatment of meningitis.  2.4 million units of penicillin G
procaine sterile suspension should be given intramuscularly every six hours, if
the patient has no history of allergy to the drug.  After four days, further medical advice by
radio should be requested on whether oral penicillin may be given. 

Good nursing care, quiet, and rest in a darkened room are
important.  It may take persuasion,
firmness, and patience to get the patient to take the necessary medicine and
fluids when he is irritable, drowsy, or delirious.  If the patient cannot swallow whole tablets
but is able to take fluids, then the tablets should be crushed, mixed with a
little water, and fed to him with a spoon. 

If the symptoms are causing severe pain or the rigidity of
the back causes a great deal of distress, morphine sulfate 10 mg should be
given intramuscularly.  For extreme
restlessness phenobarbital 30 mg may be given once or twice a day by
mouth.  It may be necessary to give
enemas for constipation. 

The amount of urine voided should be measured.  Large amounts of water should be given; if
equivalent amounts of urine are not being passed, it may be an indication of
the toxicity or of urine remaining in the bladder.  If no urine is voided for 24 hours, the
patient will have to be catheterized. 
(See p. 325.)”  (The Ship’s Medicine Chest and Medical Aid at
Sea, 1978, pp 213-214).

The following additional information from other sources may
hasten diagnosis and treatment:

Additional Signs:

With meningococcal meningitis only (caused by Neisseria bacteria, and thus treated
with antibiotics), a rash of small, irregular purple or red spots (petechiae) may
appear.  This rash does not blanch (fade)
with pressure.  It is best identified
pressing a clear drinking glass against the trunk or lower extremities, where
the rash most frequently appears.[1]

Using Kernig’s sign, the patient lies face up with the hips
and knees at 90° angle.  Pain limits
passive extension of the knee.[2] 

Using Brudzinski’s sign, flexion of the neck causes
involuntary flexion of the knee and hip.[3]

The back is too stiff to put the head between the knees.[4]

In babies under 12 months of age, the fontanel (soft spot on
top of the head) bulges out.  However, if
baby is also dehydrated, the soft spot may feel normal.[5]

In babies and young children, early meningitis may be hard
to detect.  The child may cry in a
strange way (a “meningitis” cry), even when breast feeding.  Or the child may become very sleepy.[6]

A baby or young child often gets worse and worse and only
becomes quiet when he loses consciousness completely.[7] 

Tubercular meningitis develops more slowly, over days or
weeks in babies of infected mothers. 
Other forms come on more quickly, in hours or days.[8]

Risk factors

Meningitis is more common in children.  It may begin as a complication of another
illness like measles, mumps, whooping cough (all viral), or even an ear
infection.[9]

Babies of mothers who have tuberculosis are at greater risk for
tubercular meningitis.[10]

Treatment

Get medical help fast. 
Every second counts.  This disease
is not effectively treated with oral medications.  Following are treatment regimens suggested by
various doctors.

• Ampicillin 500 mg, every 4 hours, injectable; or
  penicillin, 1000000 U, every 4 hours. 
  Also administer chloramphenicol.[11]
• Ampicillin, 150-200 mg/kg/day, intravenously, in
  equally divided doses every 4 hours.[12]
• Benzyl penicillin, vancomycin, or ceftriaxone
  administered intravenously.
• Metronidazole, intravenously, no dosage given.[13]
• If the mother has tuberculosis or there is any other
  reason to suspect tubercular meningitis, inject the infant with 0.2 ml
  streptomycin per 5 Kg.[14]

The high fever should be lowered using wet cloths and
acetaminophen or aspirin.[15]

Prevention

Some forms of bacterial meningitis can be prevented by
vaccines.  The meningococcal vaccine
prevents meningitis due to the most deadly form (25% rate of fatality and
serious long-term effects), Neisseria meningitides.  The pneumococcal vaccine prevents the
Streptococcal form of pneumonia as well as S.
pneumoniae meningitis.  The Hemophilus
influenzae b (Hib) vaccine prevents meningitis caused by H. influenzae b. 

Prophylactic treatment for persons in close contact with
meningitis patient is recommended for the following groups:

• Young babies
• Older adults
• Immunocompromised
• Anyone without a spleen or with a spleen that
  does not work well.

An oral antibiotic like Cipro may prevent spread to family
members.  Physicians generally prescribe 500
mg, orally, once as a preventative among close contacts of the patient.[16] 

Links to related
posts:

Penicillin Primer for Preppers

Ciprofloxacin’s Most Critical Uses