Meningitis and Septicaemia

What are meningitis and septicaemia?

• Meningitis is an inflammation of the lining that covers the brain and spinal cord (the meninges). It is usually caused by a bacterial or viral infection.
• Septicaemia is an infection of the blood with bacteria ('blood poisoning'). If bacteria multiply and release toxins (poisons) into the blood it can can cause serious illness.

Meningitis and septicaemia are separate diseases. However, the most common cause of bacterial meningitis (the meningococcus) often causes septicaemia at the same time.

• Bacterial meningitis is uncommon in the UK. However, it is a serious illness and well known due to the media coverage when outbreaks occur. About 4 in 100,000 people in the UK have bacterial meningitis each year. Two types of bacteria cause most cases in the UK. These are Neisseria meningitidis (meningococcus) and Streptococcus pneumoniae (pneumococcus). Other bacterial causes are rare in the UK. Anyone can be affected. However, children under five years, and teenagers aged 15, 16 and 17 are the most at risk from meningococcal meningitis.
   
• Viral meningitis is more common than bacterial meningitis, but exact figures are not known. It is a complication of various viral illnesses. Viral meningitis is usually less serious than a bacterial cause. Most affected people make a full recovery (but not all).
   
• Other germs such as fungi are rare causes of meningitis.

Bacterial meningitis and septicaemia
Neisseria meningitidis (meningococcus) is a common bacterium and lives harmlessly in the noses and throats of about 1 in 4 people. These people are called 'carriers'. This bacterium does not survive outside the body. Close contact is needed to pass it on to others such as intimate kissing, coughing, or sneezing near to others.

Rarely, this bacterium overcomes the body's immune (defence) system and gets into the blood to cause meningitis and / or septicaemia. It is not clear why a few people are prone to serious illness, and many other people are carriers of the same bacterium but have no ill effect.

Most cases of meningococcal infection are isolated cases. The risk of others 'catching' it are low as many people are carriers and/or have natural immunity. Sometimes small outbreaks occur when two or more people in the same household or community are affected.

Streptococcus pneumonia (pneumococcus) is a less common cause of bacterial meningitis. This too is 'carried' by many people in the nose or throat with no ill effect. Again, meningitis probably occurs due to a breakdown in the immune system. It most commonly occurs in people over 45 years, and in babies. Meningitis due to this bacterium is not thought to be contagious.

Other bacteria that less commonly cause meningitis include: Haemophilus influenzae (Hib) Escherichia coli (E. Coli), Listeria and Tuberculosis. The meningitis infection from these germs may occur for various reasons such as a complication of an infection in another part of the body.

Viral meningitis
A variety of viruses can travel to the meninges and cause inflammation. For example, mumps, herpes, chickenpox, influenza, and many other virus infections sometimes cause 'viral meningitis'.

One or more of the following symptoms may occur. But note: not all symptoms may occur. For example, the classic symptoms of neck stiffness and rash may not occur. If you suspect meningitis or septicaemia - get medical help immediately.

Common early warning symptoms
Many children who are developing meningitis or septicaemia have 'non-specific' symptoms such as just feeling or looking generally unwell. However, three symptoms that commonly develop early on - often before the more classic symptoms listed later - are:

• Leg pains. The pains can become severe and prevent a child from standing or walking.
• Cold hands or feet - even if the child has a high temperature.
• Pale, dusky or blue colour of the skin around the lips.

Rash - commonly occurs, but not always
A typical rash is common with meningococcal infection. The rash is red or purple. Small spots develop at first and may occur in groups anywhere on the body. They often grow to become blotchy and look like little bruises. One or two may develop at first, but many may then appear in different parts of the body. The spots / blotches do not fade when pressed (unlike many other rashes). To check for this do the tumbler test. Place a clear glass (tumbler) firmly on one of the spots or blotches. If the spot / blotch does not fade and you can still see it through the glass, get medical help immediately.

The rash is a sign of septicaemia. It may not occur with meningitis alone.

Other symptoms that may occur in babies

• Excessive crying - often high pitched or moaning and different to their usual cry.
• Fast breathing, or unusual patterns of breathing.
• Fever - but the baby may not look hot and the skin may look pale or blotchy, or turn blue. The hands and feet may feel cold. The baby may shiver.
• Will not take feeds - sometimes repeated vomiting.
• Being irritable - especially when picked up and handled.
• Drowsiness or sleepiness - does not wake easily.
• A bulging fontanelle sometimes develops. The is the 'soft spot' on the baby's head.
• Jerky movements may occur and the body may appear stiff. Sometimes the opposite occurs and the body appears quite floppy. Convulsions (fits or seizures) sometimes develop.

• Fever and shivering - however, the hands and feet often feel cold.
• Stiff neck - cannot bend the neck forward.
• Headache - which can become severe.
• Fast breathing.
• Aches and pains in muscles or joints - the pains can become quite severe.
• The skin may look pale or blotchy, or turn blue.
• Dislike of bright lights - will shut eyes and turn away from the light.
• Drowsiness or confusion - may appear 'vacant'.
• Repeated vomiting. Sometimes abdominal pain and diarrhoea.

The course of symptoms
The symptoms often develop quickly, over a few hours or so. Symptoms can occur in any order, and not all may occur. Sometimes symptoms develop more slowly, over a few days. The symptoms may suggest a less serious illness at first. For example, fever, headaches, and vomiting are common with many viral illnesses such as flu. Therefore, even if you think it was flu to start with, if symptoms become worse then it may be meningitis or septicaemia.

What is the treatment for meningitis and septicaemia?

Bacterial meningitis / septicaemia
Urgent treatment is needed with antibiotic injections. Steroid medication may also be beneficial (steroids reduce inflammation). Intensive care is often needed at first as the infection often causes 'shock' and problems throughout the body.

Blood tests, and a sample of the fluid that bathes the spinal cord, may be taken. These tests aim to confirm the diagnosis, and to see which bacterium is causing the infection. The antibiotic may be changed depending on the results of the tests.

Viral meningitis.
Antibiotics may be given at first when the cause of the meningitis is not known. The antibiotics are stopped if the cause of the meningitis is found to be 'viral'. Antibiotics don't kill viruses. The body's immune system usually clears most virus infections.

What is the outlook (prognosis) for meningitis and / or septicaemia?

Bacterial causes.
The outlook often depends on how soon antibiotics are given after the illness starts. Most people make a good recovery if treated early enough. Without treatment, most people will die.

A difficulty is that bacterial meningitis and septicaemia can develop very quickly and can mimic other illnesses when symptoms first begin. Treatment may be delayed if the cause of early symptoms is not clear at first. In some cases, a person can be well in the morning, develop 'flu like' symptoms by the afternoon, and be critically ill or dead by the evening.

In the UK about 1 in 10 people who have bacterial meningitis without septicaemia die. Of those that survive, some are left with some permanent damage such as brain injury or deafness. If septicaemia occurs, then up to half of cases may die depending on how quickly treatment is given.

Viral meningitis
This can cause an unpleasant illness. However, most affected people make a full recovery. In some cases, some brain injury occurs.

Can meningitis and septicaemia be prevented?

Immunisation
Children are routinely immunised against certain causes of meningitis. These include Haemophilus influenza type B (HIB), Group C meningococcus and mumps. Other vaccines may be used for travellers going to meningitis prone countries. Vaccines are not yet available for other causes of meningitis, in particular, Group B meningococcus. See separate leaflets called 'Meningococcal Immunisation' and 'Immunisation Against Group C Meningococcal Infection'.

Contacts
Close contacts of a person with meningococcal infection have an increased risk of developing the illness. However, the risk is still low. Close contacts usually means household members, or intimate kissing contacts within the previous seven days. These people are offered a short course of antibiotics to prevent possible infection.

If Group C meningococcus is the cause, then immunisation is also offered to close contacts. Occasionally, an outbreak of two or more cases of meningococcal infection occurs in the same school, college, or similar community. Antibiotics and/or immunisation may then be offered to a wider group of people.

Further help and information

Meningitis Trust
Fern House, Bath Road, Stroud, Gloucestershire, GL5 3TJ
Tel (24hr helpline): 0845 6000 800 Web: www.meningitis-trust.org

Meningitis Research Foundation
Midland Way, Thornbury, Bristol, BS35 2BS
Tel (24hr helpline): 080 8800 3344 Web: www.meningitis.org

Department of Health
Preventing meningitis. Web based information from the Department of Health. Provides information about meningitis, its symptoms and the campaigns that have been organised to help fight the disease. It also includes information about meningococcal septicaemia, the more life-threatening form of meningococcal disease. Go to their website - www.dh.gov.uk and search for 'meningitis'.

© EMIS and PIP 2006   Updated: January 2006   PRODIGY Validated