Meningitis

*The information on this website is not intended to diagnose, treat, cure or prevent any disease.

What is Meningitis?

Meningitis, put simply, is inflammation of the tissues (called the meninges) which line and protect the brain and spinal cord. There are multiple different types of meningitis, including viral, bacterial, fungal, parasitic, amoebic and sterile (autoimmune) forms. Regardless of the inciting cause, the immune system becomes activated, resulting in severe inflammation of the meninges. This can lead to swelling of the brain and spinal cord, and also result in impairment of a structure called the “blood-brain barrier,” which typically serves to protect the brain from infections and toxins. As a result, the brain becomes even more vulnerable to outside insults.

The inflammation also affects the blood vessels entering the brain, causing them to become leaky and lose their tone. This, combined with the swelling of the brain and nervous tissues, make it more difficult for blood to enter the brain, depriving the neurons of much-needed oxygen, leading to cell death.

Meningitis is a very serious condition which can result in death or permanent neurologic impairment. Nearly 9 million cases were reported globally in 2015, with a mortality rate of approximately 4%. Some parts of the world experience more case of meningitis than others, but it can occur anywhere, and frequently occurs as outbreaks.

Common Symptoms

Meningitis is a serious condition, and there are some common symptoms which are major clues to suggest meningitis may be occurring. Common symptoms include

Severe headache (> 90% of meningitis cases begin this way)
Stiffness of the neck which prevents flexing forward/downward
Fever
Abnormal mentation or confusion
Vomiting
Seizures
Sensitivity to light
Loss of appetite
Skin rash

Meningitis may also occur in infants who cannot communicate some of the above symptoms. Signs to look for in babies include:

High fever
Poor feeding
Stiffness in body and neck
A bulging fontanel (soft spot on the head)
Constant crying
Unusual inactivity or excessive sleeping

More serious signs of meningitis can include:

Seizures
Partial or total vision loss (temporary or permanent)
Mood swings
Aggressive behavior
Permanent deafness
Permanent brain damage

Diagnosis

The telltale symptoms listed above are often enough to diagnose cases of meningitis, however more specific testing will be needed in order to determine what the appropriate treatments are and to help determine a prognosis. Examples of diagnostic tests which may be run include:

Spinal tap: A sample of cerebrospinal fluid (the fluid which normally surrounds the tissues of the central nervous system) is obtained via a needle inserted between the vertebrae in the lower back. This fluid can be analyzed for the presence of infectious agents, cancerous cells, white blood cells, and abnormally high protein levels.
Advanced imaging: Computed tomography (CT) and MRI scans can help identify meningitis and potentially identify sources of infection (such as abscesses or sinus infections which have extended into the meninges).
Blood cultures: Blood samples are taken and put into an enriched medium which is intended to facilitate the growth of bacteria. These can help identify a causative agent of meningitis and help narrow down treatment options.
Other blood tests:
- Complete Blood Counts: This evaluates all the red and white blood cells to monitor anemia, help identify appropriate or inappropriate immune responses, and make sure there are adequate platelets in circulation to prevent bleeding.
- Serum Chemistry: This is a general panel which evaluates the functions of major organ systems like liver and kidneys, as well as measuring electrolyte levels. This may be important to ensure you do not need other supportive care or to ensure your liver and kidneys can handle some of the treatment options.

Treatment Options

Meningitis can be a serious condition which often requires emergency treatment and hospitalization to effectively manage. Do not delay seeing a doctor if you have signs consistent with meningitis.

Pharmaceuticals and Medical Procedures:

Broad spectrum antibiotics: Most cases of meningitis are due to bacterial infections, and antibiotics are often provided before a definitive diagnosis is determined. These are broad-spectrum in nature, meaning that they are efficacious against a wide variety of bacteria. Penicillin G is a standard medication given in cases of meningitis. Be sure to notify your doctor if you have known allergies to penicillin. Other antibiotics which may be used (and sometimes combined) include:
- Cephalosporins
- Vancomycin
- Chloramphenicol
- Ampicillin

Most cases of bacterial meningitis will respond quickly, however some types may require antibiotic treatment for a year or longer.

Corticosteroids: These are given in order to rapidly reduce the inflammation of the meninges, and are usually given intravenously. Benefits have only been demonstrated in bacterial meningitis if they are administered just before IV antibiotics.
- Some cases of meningitis are auto-immune in nature, and prolonged treatment with corticosteroids may be required.
Antifungal medications: In instances where fungal meningitis is suspected, antifungal medications such as amphotericin B may be given. Fungal meningitis may require prolonged treatment to effectively eliminate the fungal organisms.
Chemotherapeutics:
IV Fluids: These can help prevent dehydration and lower fevers during episodes of meningitis.
Pain medication: Medications such as acetaminophen may be helpful in relieving pain and lower fevers during meningitis.
Therapeutic spinal taps: In some cases, particularly meningitis due to fungal disease, pressures inside the central nervous system can rise dangerously. Daily spinal taps can help relieve this excess pressure until the inflammation subsides.

Non-pharmaceutical options:

There are many non-pharmaceutical complementary and alternative therapies for meningitis which may be beneficial in some people.

Supplements:

Vitamin B6: Supplementation may be helpful in relieving some symptoms and preventing cognitive impairment which can occur in cases of meningitis.

Omega-3 Fatty Acids: Omega-3 fatty acids found in fish oil are anti-inflammatory and may be neuroprotective as well.

Vitamin E: Vitamin E is an important antioxidant which may be protective of neurons during inflammation.

- - Vitamins D: Vitamin D is important for overall health, but seems particularly important for maintaining healthy immune function.
  - Co-enzyme Q10: The inflammation generated during meningitis can lead to lots of oxidative stress in the nervous system. Coenzyme Q10 is a powerful antioxidant which may help protect neurons from free radical-induced damage.
  - Alpha-lipoic acid: Alpha-lipoic acid helps recycle glutathione, an important free radical scavenger in the body. During periods of infection and inflammation, free radicals are generated which can damage the membranes and organelles of neurons.
  - Aged garlic: Garlic has antibacterial and anti-fungal properties which may help expedite recovery and improve immune function.
  - Mushrooms: There are several types of mushrooms which are believed to support immune function, including reishi mushrooms and maitake mushrooms. Combining them may increase their benefits.
  - Astragalus: Astragalus is a traditional herb with many medicinal uses. It purportedly has anti-viral effects and may be able to boost the immune system by reversing natural ageing changes which lead to declining immune function.
  - Cat’s Claw: This South American vine may be helpful in managing inflammation in the body. It Is used for a wide variety of conditions, but seems most effective in diseases characterized by excess inflammation.
  - Olive Leaf Extract: Olive leaf extract has anti-bacterial and anti-fungal properties which may be helpful in meningitis.
  - Melatonin: Melatonin is a hormone which promotes sleep but also has a neuroprotective effect and has been shown in animal models to be protective during meningitis.
  - Perilla leaf extract: This contains multiple anti-inflammatory compounds which may be beneficial in meningitis.
  - Genistein: This is a naturally-occurring compound found in many plants, but is especially abundant in soy products. Genistein inhibits a type of enzyme called a tyrosine kinase, which is used by certain amoebas to cross the blood brain barrier. Treatment with genistein may help limit the ability of amoebas to gain access to the central nervous system.
  - DHEA: This is a masculine hormone which seems to have immune-boosting and anti-viral properties.
- Homeopathic Remedies: These are extracts made from various sources which are then diluted many times over. The idea is that the beneficial properties of each compound are retained in solution, while the harmful properties are removed. There are a number of different remedies homeopaths may recommend in meningitis.

Aconite

Apis mellificai: An extract made from honeybee venom

Belladonna

Baptisia tinctorial

Bryonia

Dietary Modifications:

- - Increase intake of anti-oxidant rich foods like fruits and vegetables
  - Reduce intake of refined sugars and saturated fats
  - Stop caffeine and alcohol
  - Avoid sources of heavy metals, such as farmed fish
- Thermal therapy: Cold or warm compresses and ice packs applied to the head, neck, and shoulders can provide significant relief from the symptoms of meningitis.

Ozone therapy

Prevention

Many of the causes of meningitis are due to infectious diseases. While not all cases of meningitis can be clearly prevented (such as those which occur due to autoimmune disorders or cancer), there are preventative measures which can be taken for many types of meningitis.

Teenagers and young adults are at the highest risk of bacterial meningitis, particularly those who live in group situations such as dorms and military bases or training facilities. The reason that this group is at the highest risk stems from the sharing of common items like water bottles, eating utensils, toothbrushes, and personal care/cosmetic items which serve as vehicles to transmit the bacteria. Bacterial meningitis can also be transmitted through close personal contact or through kissing. Personal hygiene can and being conscientious about cleaning up old glasses and dishes can play a big role in preventing bacterial meningitis. For bacterial meningitis, highly effective vaccines have been produced. The CDC recommend vaccination for children around the age of 12, and re-vaccination around age 16. Following the development of vaccines, rates of meningitis fell by over 30% in the United States.

Vaccines for many of the agents which cause viral meningitis also exist. Many of these viruses are usually known for other illnesses rather than meningitis, but they may sometimes cross the blood brain barrier and infect the meninges. Routine vaccines like measles, mumps, rubella (MMR) and chickenpox should be considered. Vaccines may not be for everyone, however, particularly those who have had a history of allergic reactions. For some people, previous exposure to infectious diseases or past vaccinations may still be protective. Rather than vaccinating, tests which test for protective levels of antibodies can be run to determine if you need to be re-vaccinated to boost immunity.

There is also a form of meningitis which is caused by an amoeba. People usually become infected with amoebic meningitis by swimming in warm, stagnant bodies of water which are also frequented by water fowl. Inhaling the water up the nose allows the amoeba to cross into the central nervous system. Avoid swimming in stagnant bodies of water, particularly during the summer months. There has also been a single reported case of amoebic meningitis associated with the use of a Neti pot. The infected individual had been using tap water in the Neti pot rather than boiled or distilled water. This is a rare way to become infected, however, if you use a Neti pot for any reason, be sure to use safe sources of water.

Traveling to certain areas of the world also carries increased risk of developing meningitis. Sub-Saharan Africa is one of the most highly impacted regions, and people who travel there whether for work or for tourism are at increased risk of infection. Consider vaccination prior to travel, and take extra precautions to eat and drink from clean containers and utilize your own personal hygiene products. Avoid contact with ill people whenever possible. Some unusual or undercooked foods can also transmit parasites which cause meningitis. Although it can be tempting to try new dishes, things like undercooked snails, fish, reptiles, and amphibians are capable of transmitting some types of meningitis.

Like many diseases, reducing the risk of meningitis often comes down to personal habits and leading a healthy lifestyle. Getting enough sleep, exercise, and eating a diet rich in fruits and vegetables and minimizing refined carbohydrates and saturated fat sources will ensure a healthy immune system and reduce the risk of infection. Smoking is always an unhealthy habit, but it has also been shown to increase the risk of carrying and transmitting bacterial meningitis.

Causes

There are multiple known causes of meningitis, and likely some causes which have yet to be definitively determined. The most common and well-described causes of meningitis are due to infectious diseases. The most commonly described bacteria responsible for causing meningitis include Neisseria meningitides, Listeria monocytogenes, Streptococcus pneumoniae, Haemophilus influenzae, and Group B Streptococcus species. There are many, many other bacterial causes which are less common, however, including species such as Escherichia coli. The risk for each type of meningitis varies depending on age groups. Infants are at high risk of meningitis from Group B Streptococcus species, while children under 5 years of age are at the highest risk of Haemophilus influenzae. Meningococcal meningitis, caused my Neisseria meningitides, tends to affect teenagers and young adults. Lyme meningitis is transmitted by ticks and caused by the bacterium Borrelia burgdorferi, which is also implicated in a host of other diseases. Uncommonly, the bacterium responsible for tuberculosis can also cause meningitis if it travels to the central nervous system. Often, this type of infection may require treatment for over a year to eliminate.

There are also many causes of viral meningitis. Some of these are common viral infections in young children which take an aberrant course and cause meningitis. The chickenpox, measles, and mumps viruses are all capable of causing meningitis. Vaccinations for all of these diseases exist and are usually recommended in children. Other viruses, however, are also able to cause meningitis, including influenza, which tends to mutate frequently and vaccination may provide inconsistent protection, and herpes viruses. Some viruses are transmitted by insects, such as West Nile virus or St. Louis encephalitis virus. Vaccines do not currently exist for these insect-transmitted viruses. Rodents can also transmit a form of meningitis caused by the lymphocytic choriomeningitis virus. People with frequent rodent exposure such as researchers and pet-store employees are at the highest risk of contracting this virus, however it may be present in up to 5% of house mice which may be lifelong carriers of the virus. Human immunodeficiency virus (HIV) is another viral infection associated with meningitis, however it is itself is not the cause, but it does compromise normal immune function, paving the way for other invaders like bacteria.

A rare, very serious and often fatal form of meningitis is caused by an amoeba. Primary amebic meningoencephalitis (PAM) is caused by Naegleria fowleri, which usually enters the central nervous system after being inhaled in water. It is found only in freshwater, but has a world-wide distribution. Although it is usually found in natural bodies of water, it can also occur in improperly maintained pools and municipal water sources. It does not cause infection if consumed – only if inhaled. It is a particularly lethal form of meningitis, causing death in nearly 95% of reported cases from 2006 to 2015. Although a severe disease, this form of meningitis cannot be transmitted between people.

Certain parasites are also reported to cause meningitis. These are usually ingested parasites, which then become confused because humans are not the natural host for them. This leads to unusual migration patterns, which may end up in the central nervous system. The most common parasites associated with meningitis include Toxoplasmosis, Angiostrongylus cantonensis, Baylisascaris procyonis, and Gnathmostoma spinigerum. Toxoplasmosis is a common parasite which is associated (and probably unfairly) with cats. Although cats are capable of transmitting the disease through feces, they tend to shed the organism only for a very brief time following infection, and then never shed again in their lives. Most human exposures of Toxoplasmosis occur from consumption of undercooked pork products or other contaminated foods. Baylisascaris is a parasite which commonly infects raccoons, and infection is the result of accidental ingestion of raccoon feces. The other two parasites commonly occur in undercooked foods like snails, slugs, reptiles, amphibians, and fish. The migration of these parasites can also lead to a profound immune response causing eosinophilic meningitis. Eosinophils are a type of white blood cell which responds to parasitic infections. In cases of eosinophilic meningitis, the response is inappropriately robust, leading to serious inflammation and swelling of the meninges and nervous tissue.

Fungal meningitis is another rare form of meningitis in the United States, but it is more common in places like Africa. Immunocompromised people are at particularly increased risk of fungal meningitis. The most common cause is a fungal organism called Cryptococcus. This organism tends to live in the soil and is found in areas with heavy amounts of bird droppings. Other causes include Histoplasma, Blastomyces, and Coccidoides. Interestingly, these fungal diseases often have distinct strict geographic regions. Blastomyces tends to occur the most commonly in the Mississippi River valley in the northern Midwestern United States, while Coccidoides tends to occur in the Southwestern US and is the cause of the condition called “Valley Fever.” Histoplasma tends to occur in the Ohio and Mississippi River valleys of the Midwest, and also is associated with bat guano and bird droppings. These organisms cannot be transmitted between people, but infection occurs after environmental exposure.

Sterile or non-infectious causes of meningitis also occur. These can be from a variety of causes, but are often the result of other systemic diseases in the body, such as cancer or autoimmune diseases. Systemic lupus erythematosus (SLE) is an autoimmune disorder which can sometimes manifest with meningitis, while cancers like lymphoma sometimes invade the central nervous system, leading to inflammation and swelling. Sterile meningitis can also occur in response to injuries, such as head trauma, or as the result of brain surgery and direct trauma/cutting of the tissues surrounding the central nervous system. Some drugs, such as NSAIDs and trimethoprim-sulfa have also been associated with causing sterile meningitis. Some drugs also appear to trigger sterile meningitis in people with SLE.

Clinics for Management of Meningitis

Meningitis is often an emergency situation. Although these clinics are wonderful options, for most people, finding a local hospital to begin emergency treatment for meningitis is usually the best option.

Standard Clinics

University of Wisconsin-Madison

Johns Hopkins All Children’s Hospital

Mayo Clinic

Stanford Infectious Disease Clinic

UCSF Neuro-Infectious Disease Clinic

Alternative Clinics

Northwest Natural Health

Richmond Natural Medicine

The Redwood Clinic

Marin Natural Medicine Clinic

Seattle Integrative Medicine