Who gets meningitis and septicaemia?
About half of meningococcal disease occurs in children aged less than five years13, and babies are at the highest risk because their immune systems have not yet fully developed. There is a second, smaller increase in risk for older adolescents, mainly for social and behavioural reasons14. People with immune deficiencies, such as those without a spleen, are also at a higher risk from infection. Genetic factors play a role, but few of these have a strong effect15.
Meningococcal disease in the UK and Ireland is seasonal, with a peak during the winter months.
How is meningococcal meningitis treated?
Prompt recognition and treatment offer the best chance of a good recovery.
A GP who suspects that someone has meningococcal disease will arrange for emergency transfer to hospital, and give antibiotics16or else ensure that antibiotics are given urgently by the ambulance paramedic or as soon as possible on reaching hospital. Meningococcal disease must always be treated in hospital.
Treatment may begin immediately if signs and symptoms of meningococcal disease are clear enough. If what is wrong is not clear, the patient may be kept under observation at first. Along with a physical examination, blood will be taken for tests and the doctor may do a lumbar puncture. Lumbar puncture is important to confirm the diagnosis of meningitis, and to show which germ is causing the illness so that the most appropriate antibiotics can be chosen. If a patient with meningitis is very severely ill, it might not be safe to do a lumbar puncture right away, so this may be postponed. Having the diagnosis confirmed can be helpful afterwards, for example when seeking long-term medical advice and follow-up care.
Many patients need resuscitation when they get to hospital: oxygen is given and one or more intravenous lines put in to deliver medicines and resuscitation fluids. Patients with septicaemia may need large amounts of resuscitation fluid to bring their blood volume back to normal. Patients with meningitis may be given steroids to reduce inflammation and other medicines to lower pressure around the brain. Most patients are treated on a regular hospital ward, but the sickest patients will need intensive care treatment: about a quarter of children with meningococcal disease need treatment on a Paediatric Intensive Care Unit (PICU)17.
A patient being treated on a regular paediatric or adult ward will be closely monitored. The first couple of days and nights may be hectic and disturbed. The patient may be very drowsy or have many short naps, and may be miserable and irritable when awake. The course of antibiotics usually lasts five to seven days17, and so patients who respond well to treatment usually spend about a week in hospital. Some patients recover so quickly that they are able to go home after just a few days, either returning to hospital, or having a community nurse visit for their daily dose of antibiotics.
Very sick patients have to be transferred to intensive care. For children, this might mean a journey by mobile intensive care unit or ambulance to a specialist PICU. There, specialist doctors and nurses work around the clock to stabilise the patient and closely monitor their condition. The patient has to be sedated and put on a ventilator to help them breathe, tubes inserted, wires hooked up and connected to monitors, and more intravenous lines put in to deliver medicines that support the function of vital organs such as the heart, lungs and kidneys. Patients with septicaemia who need very large volumes of resuscitation fluid may look very bloated. However, when they start to recover this fluid will be reabsorbed into the circulation and got rid of through the kidneys. Most intensive care patients begin to improve after a few days and return to the regular wards. But very severely ill patients may have a prolonged stay, for weeks or even months.
What happens after meningococcal disease?
Most people recover very well from meningococcal disease, with no long term after effects, but about a quarter of survivors are left with problems that reduce their quality of life5. Some of these difficulties are temporary and disappear or improve with time. Behavioural and emotional effects are quite common: children can be clingy and have temper tantrums, adults can feel despondent and irritable. Although these feelings usually resolve themselves, psychological problems can be serious enough to need referral to mental health services or to a counsellor18. Parents of children affected by meningococcal disease may also need this kind of support19.
Such a severe illness, especially if there has been a long stay in intensive care, can leave the patient feeling weak and tired and much less active and mobile than before. They may also have problems with concentration, memory and attention and find it difficult to do tasks that seemed effortless before they became ill. In most cases, these difficulties gradually disappear.
What are the severe after effects?
Meningitis can cause permanent neurological damage, ranging from minor problems with coordination and movement or mild learning difficulties, to epilepsy, paralysis, palsy and severe mental impairment. Deafness is the most frequent severe after effect of meningitis. Scarring, amputations and organ damage can result from septicaemia.
In the first few days of treatment for severe meningococcal disease, it is often impossible to tell whether there will be any permanent damage, but in most cases any serious problems become obvious while the patient is still in hospital.