Meningitis Factsheet

Late
High pitched or moaning cry
Coma
Neck retraction
Shock
Widespread non-blanching rash

Late
Coma
Shock
Wide spread non-blanching rash

STATISTICS
Acute meningitis, whether bacterial or viral, is a notifiable disease. Meningoccal septicaemia is also notifiable.
Notifications of acute meningitis in England and Wales have declined slightly, with 2360 cases in 1997 (source ONS). There were also 1426 notified cases of meningococcal septicaemia (source ONS). In the same year there were 75 case of bacterial meningitis and 56 cases of meningococcal septicaemia in Northern Ireland. (DHSS for N.Ireland) and 259 notified cases in Scotland of meningococcal disease ( meningitis and/or scepticaemia – SCIEH Weekly Reports). These figures are correct at time of print.

PENICILLIN
An injection of benzylpenicillin (Crystapen) is recommended immediately if a diagnosis of meningitis or scepticaemia is suspected. Two studies (BMJ 1992; 305:141-7) indicate that this can significantly reduce fatality rates. Current fatality rates range from around 2-3% for meningococcal meningitis to 20% for pneumococcal meningitis and meningococcal septicaemia.
Give intravenously if possible, but intramuscular injection is satisfactory if a vein cannot be found.
Suggested stat dose:
1200mg (2 megaunits) for adults and children over 10.
600mg (1 megaunit) for 1 – 10 year olds.
300mg (½ megaunit) for children under 1 year old
For patients with a history of anaphylaxis to penicillin, chloramphenicol can be given instead. Penicillin allergy without anaphylaxis is not a contraindication. If the antibiotic is not available, take the patient directly to hospital with minimum delay.
Benzylpenicillin has a shelf life of three years at 25ºC. A single injection may be life saving and is most unlikely to affect the laboratory diagnosis of infection

PROPHYLAXIS
Prophylactic antibiotics (often rifampicin) are recommended for intimate contacts of meningococcal disease (meningitis and/or septicaemia). This may reduce the risk of secondary cases, but there is still a 1% chance of secondary cases in the family during subsequent months. with other causes of meningitis, chemoprophylaxis is not normally indicated.
Intimate contacts of both Group A, C, W and Y meningococcal disease should receive vaccine in addition to chemoprophylaxis. The latter should be given first and the decision to offer vaccine should be made when results of typing are available. Vaccine should not be given to contacts of Group B cases. (Immunisation Against Infectious Disease, Department of Health 1996).
For details of local policy, contact the consultant in communicable disease control at your health authority.

POINTS TO NOTE
Consider a diagnosis of meningitis or scepticaemia in any child with an unexplained illness or fever, particularly if there is any suggestion of clouded consciousness.
Meningism may be absent so look carefully for any sign of a petechial or purpuric rash. The combination of fever with a petechial or purpuric rash constitutes a medical emergency. Such a patient may deteriorate rapidly and should be given benzylpenicillin and transfered immediately to hospital.

The National
Meningitis Trust
Fern House
Bath Road
Stroud
Glos GL5 3TJ

Phone/Minicom:
(01453) 768000

Fax: (01453) 768001

24hr Help Line:
(0845) 6000 800

The trust is a national charity which provides free information on meningitis, funds medical research and supports patients and their families.