How do you catch pneumococcal meningitis?
Many people, including approximately half of pre-school children1, carry pneumococcal bacteria in the back of their nose and throat, and constantly pass them around by coughing and sneezing and close contact.
Carriage of the bacteria is completely harmless most of the time. However, in a susceptible person, these bacteria can cause a wide range of diseases, from fairly minor bronchitis and ear and sinus infections to life-threatening pneumonia, meningitis, and less frequently septicaemia. Sometimes pneumococcal meningitis can develop from milder forms of the infection, such as earache.
How is pneumococcal meningitis treated?
Prompt recognition of the symptoms and rapid treatment offer the best chance of a good recovery. Anyone who gets pneumococcal meningitis needs to be treated in hospital.
Pneumococcal meningitis can be difficult to recognise in the early stages because there is usually no rash, and if the patient already has a milder pneumococcal infection, such as ear ache or bronchitis, this can confuse the diagnosis. Once in hospital, treatment may begin immediately if the doctor suspects meningitis. Alternatively, if the doctor suspects a possible bacterial infection, but the signs and symptoms of meningitis are not clear enough, the patient may be kept under observation to try to assess the problem further.
Observation of the patient will involve a physical examination and normally blood will be taken for tests. The quantity of certain cells and components of the blood can help to show that the patient has a bacterial infection.
The doctor may do a lumbar puncture (LP). This is when a sample of CSF is taken from the spinal canal (the passageway through the back bones which contains the spinal cord). The sample of CSF will be examined and then sent for further laboratory testing. An LP is important to confirm the diagnosis of meningitis, and to show which germ is causing the illness so that the most appropriate antibiotics (drugs used to treat infection caused by bacteria) can be chosen. If a patient with meningitis is very severely ill, it might not be safe to do an LP immediately, so this may be postponed. Having the diagnosis confirmed in this way can be helpful after recovery, for example when seeking long-term medical advice and follow-up care.
If the doctor suspects meningitis, antibiotics will be given even if it has not been possible to do an LP, or if the LP results are delayed. Antibiotics are given intravenously, through a needle inserted into a vein (usually in the back of the hand or on the arm). Steroids may also be given in this way to reduce inflammation around the brain. In addition the patient is often put on an intravenous drip to give fluids, which stops them getting dehydrated and ensures the correct balance of sugars and other components in the blood.
Most patients are treated on a regular hospital ward, but the most severely ill patients will need intensive care treatment. Even patients who respond quickly to treatment and are well enough to stay on a regular hospital ward will need a two-week course of intravenous antibiotics to cure pneumococcal meningitis.
What happens after pneumococcal meningitis?
Most people who catch pneumococcal meningitis recover, but it is among the most life-threatening major forms of meningitis2. Approximately half of survivors are left with some type of after effect. These after effects may be mild or temporary and improve with time although around 22% of survivors end up with a moderate or severe disability3. Most serious problems can be identified whilst the patient is still in hospital.
Sometimes after effects are not identified until months or even years after the illness. When the patient is a baby not long out of hospital, it can be difficult to tell whether problems may appear at a later stage because learning difficulties and coordination problems may not be noticed until the child reaches school age. The picture becomes clearer as the baby grows and develops, but it can be distressing for parents not to know the extent of after effects in the first weeks and months after taking their child home from hospital.
What after effects can pneumococcal meningitis cause?
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, lasting psychological problems can be serious enough to need referral to mental health services or to a counsellor4.
Hearing loss is probably the most common serious physical after effect. Approximately 21% of children who survive pneumococcal meningitis have some degree of hearing impairment5. Damage to the brain and other parts of the nervous system can also cause severe learning difficulties, problems with movement and coordination that can be as severe as cerebral palsy and paralysis, speech and language problems6, epilepsy and visual impairment. Although pneumococcal meningitis is a very serious illness, most people do survive without any permanent damage.