The first major paper looking at the causes and consequences of meningitis in the UK has found that viruses are now the most common cause of meningitis in adults and is a cause of substantial long-term ill health. The paper also found that the management of many patients with meningitis is sub-optimal.
The study by researchers at the University of Liverpool’s Institute of Infection and Global Health, published in The Lancet Infectious Diseases, funded by Meningitis Research Foundation (MRF) and the National Institute for Health Research, studied the diagnosis and treatment of more than 1000 patients with suspected meningitis.
It was found that diagnosis of meningitis is often delayed due to unnecessary brain scans being performed before lumbar puncture - which is the essential investigation to determine the cause of the illness. The majority of patients (81%) had a brain scan and 70% of those took place before lumbar puncture, otherwise known as a spinal tap.
Recommendations in national guidelines1 urge doctors to perform a lumbar puncture within the first hour in patients with suspected meningitis unless the patient has particular symptoms which make it unsafe to. Only 12% of patients studied should have had a brain scan prior to lumbar puncture if the guidelines had been followed.
Cases of bacterial meningitis - the life threatening form of the disease - have significantly reduced over the last few decades following the introduction of vaccines against some of the most common types, and the study found that viral meningitis now accounts for the majority of cases. Being able to quickly determine which bacteria or virus is causing the illness is essential for the appropriate treatment of patients. Antibiotics should be given urgently to those with bacterial meningitis, but not viral meningitis, as viruses don’t respond to antibiotics.
Delays in diagnosis mean that antibiotics are often inappropriately used in patients with viral meningitis, resulting in a longer than necessary stay in hospital, which poses a considerable burden on patients and the NHS and potentially also contributes to the problem of antimicrobial resistance.
Patients in the new study who were investigated promptly with lumbar puncture were also more likely to have a specific cause of the meningitis identified, and to spend less time in hospital. Overall, the specific virus or bacteria causing the illness was not identified for 43% of patients.