| Bacterial meningitis is an inflammation of the membranes that cover the brain and spinal cord (meninges) that is caused by bacteria. In most cases, the bacteria spread to the meninges through the bloodstream from an area of infection elsewhere in the body.
The bacteria known as Streptococcus pneumoniae, accounts for about 40% to 60% of adult cases of bacterial meningitis. Another type of bacteria that causes meningitis, Neisseria meningitidis (also known as Meningococcus), spreads quickly within relatively confined environments such as boarding schools or military bases and can cause local epidemics. This type of meningitis is considered to be a medical emergency as it can be lethal within hours if not diagnosed and treated promptly.Risk: Although it may occur in healthy individuals, bacterial meningitis usually afflicts those with significant underlying diseases such as sickle cell anemia, alcoholism, cirrhosis, and concurrent infections of the ears, paranasal sinuses, lungs, or cardiac valves. A viral infection of the upper respiratory tract may predispose an individual to bacterial meningitis by allowing bacteria already present in the respiratory tract to enter the bloodstream and invade the meninges. Due to the vaccination of children to particular bacteria called Haemophilus influenzae Type B, bacterial meningitis has become predominantly a disease of adults. Factors associated with higher mortality include advanced age (over 60), onset of seizures during the first 24 hours after infection, and coma on hospital admission. Incidence and Prevalence: The incidence of all forms of bacterial meningitis in the US is approximately 2 to 3 per 100,000. Meningococcal meningitis is endemic in parts of Africa, India, and other developing nations. There are periodic epidemics in the so-called sub-Saharan "meningitis belt" as well as among religious pilgrims traveling to Saudi Arabia for the Haj. According to the Centers for Disease Control and Prevention, in 1996 to 1997, there were 213,658 cases of meningococcal meningitis (including 21,830 deaths) in West African countries alone. |
Source: Medical Disability Advisor
| History: The duration of symptoms before individuals seek medical help varies from less than 24 hours to more than 1 week. Initially, symptoms of a viral respiratory tract infection such as sore throat, runny nose, nasal congestion, and general aches and pains occur. The symptoms then progress to those most commonly found in bacterial meningitis: headache, fever, and stiff neck (apparent in 90% of persons). Patients may deteriorate rapidly or over several days to a week. Deterioration is evident if the individual demonstrates confusion, irritability, drowsiness, seizures, and coma. In meningococcal meningitis, the symptoms develop more rapidly than in other forms of bacterial meningitis. Adults may become desperately ill within 24 hours. Tuberculosis meningitis progresses much more slowly. In this form of meningitis, the individual may be sick for several weeks before the typical meningitis symptoms develop.
Individuals with meningitis may report a recent vaccination against pneumonia, meningitis, influenza, mumps, or chickenpox. Individuals may report recent contact with someone who has meningitis or travel to an area where hygiene conditions are poor and/or a meningitis outbreak occurred. Physical exam: An involuntary flexion of the knees (Brudzinski's sign) may be evident when the neck is abruptly flexed (neck bending towards chest) with the individual lying on his back. Attempts to extend the knee from the flexed-thigh position are met with pain and reflex contraction (Kernig's sign). Tests: Lumbar puncture is performed in all suspected cases of bacterial meningitis. The cerebrospinal fluid is analyzed for increased pressure, protein, white blood cells (leukocytes), and bacteria. The fluid is cultured. Search for an infectious source may also include cultures of blood, nose, and throat (nasopharynx), respiratory secretions, urine, and any skin lesion. Laboratory analysis of the blood usually includes a complete blood cell count (CBC) and glucose level. X-rays of the skull may show evidence of sinus or mastoid infection or skull fracture. |
Source: Medical Disability Advisor
| Bacterial meningitis is treated with medications that fight infection (antibiotics). The specific antibiotic used depends on the type of bacteria causing the infection. The antibiotics will often be given directly into the vein (intravenously). Medications may also be given to reduce pain (analgesics), fever (antipyretics), and to prevent or stop seizures. If the individual is unconscious, nutrients are given intravenously. Depending on the length and severity of the disease, the treatment is usually given in the hospital setting. |
Source: Medical Disability Advisor
| Prognosis depends on the causative organism and the severity of the illness. In most cases, recovery is possible with prompt and appropriate treatment. In some cases, brain damage may occur. Mortality is approximately 10% to 15% from meningococcal meningitis. Mortality is higher, typically 20% to 30%, from meningitis caused by other organisms.
About 30% of individuals with pneumococcal meningitis have moderate to severe residual problems including dementia, seizures, hearing loss, and difficulty walking. About 20% have mild problems, such as dizziness, impaired memory, and headaches. |
Source: Medical Disability Advisor
| Possible complications include seizures, shock, deafness, dehydration, and death. Fluid leaking into the membrane covering the brain (subdural effusion) can cause swelling in the brain tissues (cerebral edema), or in the spaces (ventricles) within the brain (hydrocephalus). A localized infection (cerebral abscess) can form in the brain. Ten to fifteen percent of patients with meningococcal meningitis have permanent hearing loss, mental retardation, loss of limbs, or other serious sequelae ("Meningococcal Disease"). |
Source: Medical Disability Advisor
| Restrictions or accommodations depend on the individual's work responsibilities. Physical weakness may be a factor. Strenuous activities may need to be modified temporarily or permanently. Frequent breaks or rest periods may need to be built into the individual's work schedule. If there is difficulty walking, ramps may need to be installed as needed, and access to an elevator made available. If dizziness remains a problem, jobs that require driving a car or operating machinery may need to be curtailed and vocational counseling offered. If there is hearing loss, special equipment may need to be purchased to enhance the individual's ability to hear, or duties may need to be re-evaluated. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Has diagnosis of bacterial meningitis been confirmed?
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Have conditions with similar symptoms been ruled out?
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Has source of infection been identified?
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Has individual experienced any complications related to the meningitis?
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Does individual have a coexisting condition that may impact recovery?
Regarding treatment:
- Do symptoms persist despite treatment?
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Was culture and sensitivity done to identify causative organisms and determine the most effective antibiotic to use?
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Were antibiotic-resistant organisms ruled out?
Regarding prognosis:
- Do symptoms persist despite treatment?
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Does diagnosis need to be revisited?
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Would individual benefit from evaluation by an infectious disease specialist?
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Did individual experience residual impairment?
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If impairment is physical, would individual benefit from physical therapy?
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Would individual be able to return to present occupation if appropriate accommodations could be made? If not, is vocational re-training warranted?
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Source: Medical Disability Advisor
| "Meningococcal Disease." Centers for Disease Control and Prevention. 11 Feb. 2004. U.S. Department of Health and Human Services. 10 Nov. 2004 <http://www.cdc.gov/ncidod/dbmd/diseaseinfo/meningococcal_t.htm>. |
Source: Medical Disability Advisor
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