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General Description
Requirements
Overview of Steps
Detailed Steps
Subject Experts
Meningitis Information
Procedure

Document Number: EMER--122p Revision #: 1.0
Document Owner: Executive VP Date Last Updated: 12/12/2013
Primary Author: Executive VP Status: Approved
Date Originally Created: 10/30/2012

General Description
Description / Scope:

Information about viral, bacterial, and fungal meningitis.


Purpose:

To provide official information from the Tennessee Department of Health and from the Center for Disease Control.


Who Performs / Responsibility: Emergency Services

When to Perform: As needed

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Requirements
Pre-Knowledge: Before performing this task you must know:
Current University policy
Standard company policies
Standards of good practice

Terms and Definitions: Additional training

Corrective Action

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Overview of Steps
1.

What is Meningitis?

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Detailed Steps
1.

What is Meningitis?


How to Do:

Meningitis is a term that describes inflammation of the tissues and fluid surrounding the brain and spinal cord. It can be caused by bacteria or viruses.

 

Meningococcal meningitis is a type of bacterial meningitis caused by a type of bacteria called Neisseria meningitidis. This same bacteria can also cause other kinds of meningococcal disease such as septicemia (blood poisoning). The most common strains of meningococcal meningitis in the U. S. are B, C, Y and W-135.

 

Another common type of bacterial meningitis is pneumococcal meningitis, which is caused by Streptococcus pneumoniae. Before the 1990s, the leading cause of bacterial meningitis was Haemophilus influenzae type b, but new vaccines being given to children as part of their routine immunizations have reduced the occurrence of this disease.

 

Viral meningitis, which is caused by viruses, can cause similar symptoms to bacterial meningitis, however it is seldom life-threatening. Most people make a full recovery without any specific treatment.


1.1

Viral Meningitis (referenced from CDC website)


How to Do:

Viral meningitis is generally less severe and resolves without specific treatment.


1.1.1

Causes


How to Do:

Most viral meningitis cases in the United States, especially during the summer months, are caused by enteroviruses; however, only a small number of people with enterovirus infections actually develop meningitis.

 

Other viral infections that can lead to meningitis include

· Mumps

· Herpesvirus, including Epstein-Barr virus, herpes simplex viruses, varicella-zoster virus (which also causes chicken pox and shingles), measles, and influenza

· Viruses spread through mosquitoes and other insects (arboviruses)

· In rare cases LCMV (lymphocytic choriomeningitis virus), which is spread by rodents, can cause viral meningitis


1.1.2

Risk Factors


How to Do:

Viral meningitis can affect anyone. But infants younger than 1 month old and people whose immune systems are weak are at higher risk for severe infection. People who are around someone with viral meningitis have a chance of becoming infected with the virus that made that person sick, but they are not likely to develop meningitis as a complication of the illness.

 

Factors that can increase your risk of viral meningitis include:

· Age

· Viral meningitis occurs mostly in children younger than age 5.

· Weakened immune system.

· There are certain diseases, medications and surgical procedures that may weaken the immune system and increase risk of meningitis.


1.1.3

Transmission


How to Do:

Enteroviruses, the most common cause of viral meningitis, are most often spread from person to person through fecal contamination (which can occur when changing a diaper or using the toilet and not properly washing hands afterwards). Enteroviruses can also be spread through respiratory secretions (saliva, sputum, or nasal mucus) of an infected person. Other viruses, such as mumps and varicella-zoster virus, may also be spread through direct or indirect contact with saliva, sputum, or mucus of an infected person. Contact with an infected person may increase your chance of becoming infected with the virus that made them sick; however you will have a small chance of developing meningitis as a complication of the illness.


1.1.4

Signs and Symptoms


How to Do:

Meningitis infection is characterized by a sudden onset of fever, headache, and stiff neck. It is often accompanied by other symptoms, such as:

· Nausea

· Vomiting

· Photophobia (sensitivity to light)

· Altered mental status

 

Viral meningitis is an infection of the meninges (the covering of the brain and spinal cord) that is caused by a virus. Enteroviruses, the most common cause of viral meningitis, appear most often during the summer and fall in temperate climates.

 

Viral meningitis can affect babies, children, and adults. It is usually less severe than bacterial meningitis and normally clears up without specific treatment. The symptoms of viral meningitis are similar to those for bacterial meningitis, which can be fatal. Because of this, it is important to see a healthcare provider right away if you think you or your child might have meningitis.

 

Symptoms of viral meningitis in adults may differ from those in children:

 

Common symptoms in infants

· Fever

· Irritability

· Poor eating

· Hard to awaken

 

Common symptoms in adults

· High fever

· Severe headache

· Stiff neck

· Sensitivity to bright light

· Sleepiness or trouble waking up

· Nausea, vomiting

· Lack of appetite

 

The symptoms of viral meningitis usually last from 7 to 10 days, and people with normal immune systems usually recover completely.


1.1.5

Diagnosis


How to Do:

If meningitis is suspected, samples of blood or cerebrospinal fluid (near the spinal cord) are collected and sent to the laboratory for testing. It is important to know the specific cause of meningitis because the severity of illness and the treatment will differ depending on the cause.

The specific causes of meningitis may be determined by tests used to identify the virus in samples collected from the patient.

 


1.1.6

Treatment


How to Do:

There is no specific treatment for viral meningitis. Antibiotics do not help viral infections, so they are not useful in the treatment of viral meningitis. Most patients completely recover on their own within 7 to 10 days. A hospital stay may be necessary in more severe cases or for people with weak immune systems.

 


1.1.7

Prevention


How to Do:

People with certain viral infections can sometimes develop meningitis. There are no vaccines for the most common causes of viral meningitis. Thus, the best way to prevent it is to prevent viral infections. However, that can be difficult since sometimes people can be infected with a virus and spread the virus even though they do not appear sick. Following are some steps you can take to help lower your chances of becoming infected with viruses or of passing one on to someone else:

· Wash your hands thoroughly and often, especially after changing diapers, using the toilet, or coughing or blowing your nose.

· Clean contaminated surfaces, such as doorknobs or the TV remote control, with soap and water and then disinfect them with a dilute solution of chlorine-containing bleach.

· Avoid kissing or sharing a drinking glass, eating utensil, lipstick, or other such items with sick people or with others when you are sick.

· Make sure you and your child are vaccinated. Vaccinations included in the childhood vaccination schedule can protect children against some diseases that can lead to viral meningitis. These include vaccines against measles and mumps (MMR vaccine) and chickenpox (varicella-zoster vaccine).

· Avoid bites from mosquitoes and other insects that carry diseases that can infect humans.

· Control mice and rats. If you have a rodent infestation in and/or around your home, follow the cleaning and control precautions listed on CDC’s website about LCMV (Lymphocytic choriomeningitis virus).


1.2

Bacterial Meningitis (referenced from CDC website)


How to Do:

Bacterial meningitis is usually severe. While most people with meningitis recover, it can cause serious complications, such as brain damage, hearing loss, or learning disabilities.

 

There are several pathogens (types of germs) that can cause bacterial meningitis. Some of the leading causes of bacterial meningitis in the United States include Haemophilus influenzae (most often caused by type b, Hib), Streptococcus pneumoniae, group B Streptococcus, Listeria monocytogenes, and Neisseria meningitidis.

 

In the United States, about 4,100 cases of bacterial meningitis, including 500 deaths, occurred each year between 2003–2007.* [1]


1.2.1

Causes


How to Do:

Common causes of bacterial meningitis vary by age group:

 

Age Group

Causes

Neborns

Group B Streptococcus, Escherichia coli, Listeria monocytogenes

Infants and Children

Streptoccus pneumoniae, Neisseria meningitidis, Haemophilus influenzae type b

Adolescents and Young Adults

Neisseria meningitidis, Streptococcus pneumoniae

Older Adults

Streptococcus pneumoniae, Neisseria meningitidis, Listeria monocytogenes

 


1.2.2

Risk Factors


How to Do:

Factors that can increase your risk of bacterial meningitis include:

· Age

· Infants are at higher risk for bacterial meningitis than people in other age groups. However, people of any age are at risk. See the table above for which pathogens more commonly affect which age groups.

· Community setting

· Infectious diseases tend to spread more quickly where larger groups of people gather together. College students living in dormitories and military personnel are at increased risk for meningococcal meningitis.

· Certain medical conditions

· There are certain diseases, medications, and surgical procedures that may weaken the immune system or increase risk of meningitis in other ways.

· Working with meningitis-causing pathogens

· Microbiologists who are routinely exposed to meningitis-causing pathogens are at increased risk.

· Travel

· Travelers to the meningitis belt in sub-Saharan Africa may be at risk for meningococcal meningitis, particularly during the dry season. Also at risk for meningococcal meningitis are travelers to Mecca during the annual Hajj and Umrah pilgrimage.


1.2.3

Transmission


How to Do:

The germs that cause bacterial meningitis can be contagious. Some bacteria can spread through the exchange of respiratory and throat secretions (e.g., kissing). Fortunately, most of the bacteria that cause meningitis are not as contagious as diseases like the common cold or the flu. Also, the bacteria are not spread by casual contact or by simply breathing the air where a person with meningitis has been. Other meningitis-causing bacteria are not spread person-to-person, but can cause disease because the person has certain risk factors (such as a weak immune system or head trauma). Unlike other bacterial causes of meningitis, you can get Listeria monocytogenes by eating contaminated food.

 

Sometimes the bacteria that cause meningitis spread to other people. This usually happens when there is close or long contact with a sick person in the same household or daycare center, or if they had direct contact with a patient's oral secretions (such as a boyfriend or girlfriend). People who qualify as close contacts of a person with meningococcal or Haemophilus influenzae type b (Hib) meningitis are at higher risk of getting disease and may need antibiotics (see Prevention). Close contacts of a person with meningitis caused by other bacteria, such as Streptococcus pneumoniae, do not need antibiotics. Tell your doctor if you think you have been exposed to someone with meningitis.

 

Healthy people can carry the bacteria in their nose or throat without getting sick. Rarely, these bacteria can invade the body and cause disease. Most people who ‘carry’ the bacteria never become sick.

 


1.2.4

Signs and Symptoms


How to Do:

Meningitis infection may show up in a person by a sudden onset of fever, headache, and stiff neck. It will often have other symptoms, such as

· Nausea

· Vomiting

· Increased sensitivity to light (photophobia)

· Altered mental status (confusion)

 

The symptoms of bacterial meningitis can appear quickly or over several days. Typically they develop within 3-7 days after exposure.

 

Babies younger than one month old are at a higher risk for severe infections, like meningitis, than older children. In newborns and infants, the classic symptoms of fever, headache, and neck stiffness may be absent or difficult to notice. The infant may appear to be slow or inactive (lack of alertness), irritable, vomiting or feeding poorly. In young infants, doctors may look for a bulging fontanelle (soft spot on infant’s head) or abnormal reflexes, which can also be signs of meningitis. If you think your infant has any of these symptoms, call the doctor or clinic right away.

 

Later symptoms of bacterial meningitis can be very severe (e.g., seizures, coma). For this reason, anyone who thinks they may have meningitis should see a doctor as soon as possible.

 


1.2.5

Pregnancy


How to Do:

Pregnant women are at increased risk of developing listeriosis (caused by the bacterium Listeria monocytogenes). Pregnant women typically experience only a mild, flu-like illness with Listeria infection. However, infections during pregnancy can lead to miscarriage, stillbirth, premature delivery, or life-threatening infection of the newborn, including meningitis.

 

Pregnant women who test positive for group B Streptococcus (group B strep) can pass the bacteria to their baby, most often during labor and birth. A newborn infected with group B strep bacteria can develop meningitis or other life-threatening infections soon after birth.

You can reduce your risk of meningitis caused by Listeria monocytogenes by learning what foods to avoid and how to safely prepare and refrigerate food. If you are pregnant, you should get screened for group B strep at 35-37 weeks. Women who test positive for group B strep will be given antibiotics during labor to prevent infection in a newborn.

 

Talk to your doctor to learn more about how to prevent these infections.


1.2.6

Diagnosis


How to Do:

If meningitis is suspected, samples of blood or cerebrospinal fluid (near the spinal cord) are collected and sent to the laboratory for testing. It is important to know the specific cause of meningitis because that helps doctors understand how to treat the disease, and possibly how bad it will get. In the case of bacterial meningitis, antibiotics can help prevent severe illness and reduce the spread of infection from person to person.

 

If bacteria are present, they can often be grown (cultured). Growing the bacteria in the laboratory is important for confirming the presence of bacteria, identifying the specific type of bacteria that is causing the infection, and deciding which antibiotic will work best. Other tests can sometimes find and identify the bacteria if the cultures do not.

 


1.2.7

Treatment


How to Do:

Bacterial meningitis can be treated effectively with antibiotics. It is important that treatment be started as soon as possible. Appropriate antibiotic treatment of the most common types of bacterial meningitis should reduce the risk of dying from meningitis to below 15%, although the risk remains higher among young infants and the elderly.


1.2.8

Prevention


How to Do:

The most effective way to protect you and your child against certain types of bacterial meningitis is to complete the recommended vaccine schedule. There are vaccines for three types of bacteria that can cause meningitis: Neisseria meningitidis (meningococcus), Streptococcus pneumoniae (pneumococcus), and Haemophilus influenzae type b (Hib).

Antibiotics may be recommended for close contacts of people with meningococcal meningitis. Antibiotics may also be recommended for the entire family if a family member develops severe Hib infection and there’s a high risk person in the house. This is to decrease the risk of spreading disease to a high risk person, since they are at increased risk for severe disease. Your doctor or local health department will tell you if there’s a high risk person in your house and antibiotics are needed.

 

Maintaining healthy habits, like not smoking and avoiding cigarette smoke, getting plenty of rest, and not coming into close contact with people who are sick, can also help. This is especially important for young infants, the elderly, or for those with a weakened immune system, since they are at increased risk for severe disease.

 


1.3

Fungal Meningitis (referenced from CDC website)


How to Do:

Symptoms of fungal meningitis

During this outbreak, many patients with fungal meningitis had only a few mild symptoms. Most had headache, and some have had fever, nausea, and light sensitivity. Patients and clinicians need to remain vigilant for onset of symptoms because fungal infections can be slow to develop.

 

If you had an epidural steroid injection since May 21, 2012, and have any of the following symptoms, talk to your doctor as soon as possible.

· New or worsening headache

· Fever

· Sensitivity to light

· Stiff neck

· New weakness or numbness in any part of your body

· Slurred speech

· Increased pain, redness or swelling at your injection site

 

CDC will provide updated guidance as more information becomes available.

 

 


1.3.1

Causes


How to Do:

Fungal meningitis is rare and usually the result of spread of a fungus through blood to the spinal cord. Although anyone can get fungal meningitis, people with weak immune systems, like those with AIDS or cancer, are at higher risk.

 

The most common cause of fungal meningitis for people with weak immune systems is Cryptococcus. This disease is one of the most common causes of adult meningitis in Africa.


1.3.2

Transmission


How to Do:

Fungal meningitis is not contagious, which means it is not transmitted from person to person. Fungal meningitis can develop after a fungus spreads through the bloodstream from somewhere else in the body, as a result of the fungus being introduced directly into the central nervous system, or from an infected body site infection next to the central nervous system.

 

You may also get fungal meningitis after taking medications that weaken your immune system. Examples of these medications include steroids (such as prednisone), medications given after organ transplantation, or anti-TNF medications, which are sometimes given for treatment of rheumatoid arthritis or other autoimmune conditions.

 

Different types of fungus are transmitted in several ways. Cryptococcus is thought to be acquired through inhaling soil contaminated with bird droppings, and Histoplasma is found in environments with heavy contamination of bird or bat droppings, particularly in the Midwest near the Ohio and Mississippi Rivers. Blastomyces is thought to exist in soil rich in decaying organic matter in the Midwest United States, particularly the northern Midwest. Coccidioides is found in the soil of endemic areas (Southwestern US and parts of Central and South America). When these environments are disturbed, the fungal spores can be inhaled. Meningitis results from the fungal infection spreading to the spinal cord. Candida is usually acquired in a hospital setting.


1.3.3

Risk Factors


How to Do:

Certain diseases, medications, and surgical procedures may weaken the immune system and increase your risk of getting fungal infection, which can lead to fungal meningitis. Premature babies with very low birth weights are also at increased risk for getting Candida blood stream infection, which may spread to the brain.

 

Living in certain areas of the United States may increase your risk for fungal lung infections, which can also spread to the brain. For example, bird and bat droppings in the Midwestern United States may contain Histoplasma, and soil in the Southwestern United States may contain Coccidioides.

 

African Americans, Filipinos, pregnant women in the third trimester, and people with weak immune systems are more likely to get Coccidiodes infection, which is also called valley fever.

 


1.3.4

Signs and Symptoms


How to Do:

Signs and symptoms of fungal meningitis may include the following:

 

· Fever

· Headache

· Stiff neck

· Nausea and vomiting

· Photophobia (sensitivity to light)

· Altered mental status

 


1.3.5

Diagnosis


How to Do:

If meningitis is suspected, samples of blood or cerebrospinal fluid (near the spinal cord) are collected and sent to a laboratory for testing. Knowing the specific cause of meningitis is important because the severity of illness and the treatment will differ depending on the cause.

 

To confirm fungal meningitis, specific lab tests can be performed, depending on the type of fungus suspected.

 


1.3.6

Treatment


How to Do:

Fungal meningitis is treated with long courses of high dose antifungal medications, usually given through an IV line in the hospital. The length of treatment depends on the status of the immune system and the type of fungus that caused the infection. For people with immune systems that do not function well because of other conditions, like AIDS, diabetes, or cancer, treatment is often longer.


1.3.7

Prevention


How to Do:

No specific activities are known to cause fungal meningitis. Avoid soil and other environments that are likely to contain fungus. People with weak immune systems (for example, those with HIV infection) should try to avoid bird droppings and avoid digging and dusty activities, particularly if they live in a geographic region where fungi like Histoplasma, Coccidioides, or Blastomyces species exist. HIV-infected people cannot completely avoid exposure.


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Subject Experts
The following may be consulted for additional information.
Executive VP

Executive Director of Facilities and Safety

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