Meningitis

Introduction

Meningitis is an inflammation of the meninges, the membranes surrounding the brain and spinal cord. It can be viral (the most common and most benign), bacterial (rare but severe, a medical emergency), parasitic, fungal, or inflammatory. Bacterial meningitis, particularly meningococcal or pneumococcal, is an absolute emergency: without early treatment, it can be fatal within hours or leave severe sequelae. The classic triad combines fever, intense headache, and neck stiffness.

If you suspect meningitis in yourself or a loved one, call 144 immediately. Bacterial meningitis cannot be treated at home. In parallel, also contact your treating physician or Docadom at 021 845 45 45 or via our application (App Store, Google Play) for advice and guidance.

Who is at risk?

The most exposed groups are infants, children, adolescents, and young adults (meningococcal meningitis), the elderly and the immunocompromised (pneumococcal, listeria), patients with splenic deficiency, cancer, HIV, undergoing chemotherapy or corticosteroid therapy. Living in a closed community (boarding school, barracks, shelter, university), travel to endemic areas (African meningitis belt), and contacts with a case increase the risk.

Symptoms of Meningitis

The classic presentation combines three signs but can be very misleading, especially in infants, the elderly, or the immunocompromised.

Main Symptoms (Classic Triad)

• High fever, often sudden, > 38.5 °C, with chills.

• Intense, helmet-like headaches, resistant to usual painkillers.

• Neck stiffness: inability or pain when flexing the neck.

Other Signs to Look For

• Photophobia (sensitivity to light) and phonophobia.

• Nausea, projectile vomiting.

• Altered consciousness: confusion, drowsiness, coma.

• Seizures.

• Focal neurological signs (paralysis, speech disorders).

• Purpura: red or purple spots that do not fade under pressure — a sign of extreme severity suggesting meningococcal purpura fulminans.

• In infants: refusal to eat, sleepiness, bulging fontanelle, irritability, whimpering, hypotonia.

• In the elderly: isolated confusion, sleepiness, sometimes moderate fever, often diminished meningeal signs.

When to Seek Emergency Care?

Any suspected meningitis is an absolute medical emergency:

• Combination of fever + intense headache + neck stiffness — call 144 immediately.

• Appearance of a purpura, especially if it spreads rapidly (purpura fulminans).

• Altered consciousness, seizures, neurological signs.

• Suspected meningitis in an infant, child, elderly person, or immunocompromised person.

• Recent contact with a case of meningitis.

What to do before emergency services arrive? Do not wait. If you have amoxicillin or ceftriaxone on site prescribed by a doctor (very rare at home), it can be administered. Lay the person down, keep them quiet and warm, and monitor their consciousness and breathing. If you call Docadom at 021 845 45 45 or use our application, you must mention the meningeal signs to obtain immediate referral to direct hospital emergencies. The timing of antibiotic administration determines the prognosis.

Causes of Meningitis

Viral Meningitis

The most common (70-80% of cases). The main viruses are enteroviruses, the mumps virus, the herpes simplex virus (HSV), HIV, and arboviruses. The clinical course is generally benign, with spontaneous recovery within a few days. Herpetic encephalitis is the exception: a neurological emergency.

Bacterial Meningitis

Rarer but much more severe. Pathogens vary by age:

• Newborn: Group B Streptococcus, E. coli, Listeria.

• Child and young adult: Meningococcus (Neisseria meningitidis) first, then pneumococcus, and Haemophilus influenzae.

• Adult and elderly: pneumococcus first, then meningococcus, and Listeria (> 50 years, immunosuppression, pregnancy).

• Tuberculous meningitis: subacute progression.

Other Causes

Parasitic or fungal meningitis (cryptococcosis in the immunocompromised), neoplastic meningitis, inflammatory meningitis (sarcoidosis, lupus), drug-induced meningitis (NSAIDs, antibiotics, immunoglobulins).

Diagnosis of Meningitis

Diagnosis is based on clinical examination and lumbar puncture.

Diagnostic Methods

• Anamnesis and clinical examination: search for the triad, full neurological examination, search for purpura.

• Lumbar puncture: the reference exam, to be performed urgently. Analysis of cerebrospinal fluid (CSF): cytology, biochemistry, direct examination, culture, PCR.

• Blood cultures before antibiotic therapy.

• Biological assessment: CBC, CRP, electrolytes, blood glucose, lactates.

• Brain CT scan before lumbar puncture in case of focal neurological signs or altered consciousness.

• Multiplex PCR on CSF: rapidly detects the main pathogens.

Alternative Diagnostics

• Subarachnoid hemorrhage: sudden, thunderclap headache.

• Isolated encephalitis.

• Severe migraine.

• Sphenoid sinusitis, brain abscess.

• Meningism (meningeal syndrome without inflammation of the meninges) during pneumonia or pyelonephritis.

Treatment of Meningitis

Bacterial Meningitis (Life-threatening Emergency)

Antibiotic therapy must be started within an hour following admission. Ceftriaxone or cefotaxime are used as first-line treatments, combined with amoxicillin in case of suspected Listeria. Dexamethasone is administered early if pneumococcus is suspected. The duration of treatment varies from 7 to 21 days depending on the pathogen. Hospitalization in intensive care is often necessary.

Viral Meningitis

Treatment is essentially symptomatic: painkillers, antiemetics, hydration. Intravenous acyclovir is indicated in case of suspected herpetic encephalitis. Recovery is generally complete within 7 to 10 days.

Antibiotic Prophylaxis for Contacts

In case of meningococcal meningitis, close contacts must receive antibiotic prophylaxis with rifampicin (or ciprofloxacin, ceftriaxone) within 24 to 48 hours. Notification to health authorities is mandatory.

Prevention of Meningitis

• Vaccinations: pneumococcus, meningococcus (B, C, ACWY), Haemophilus influenzae, MMR, BCG according to recommendations.

• Meningococcal ACWY vaccine required for the pilgrimage to Mecca and recommended in African endemic zones.

• Antibiotic prophylaxis for contact subjects in case of meningococcal meningitis.

• Respiratory hygiene (handwashing, wearing a mask) in communities.

• Limit close contact with a sick person.

• Monitoring and early treatment of ENT infections (sinusitis, otitis, mastoiditis).

Possible Complications

Complications depend on the pathogen and the speed of treatment. The mortality of meningococcal meningitis reaches 10-15%, that of pneumococcal meningitis 20-30%. Sequelae affect 10 to 30% of survivors: deafness, neurological deficits, epilepsy, psychomotor delay, cognitive disorders, amputations (purpura fulminans). Recurrences can occur in case of a meningeal breach or immune deficiency. Purpura fulminans is an absolute medical emergency with septic shock and disseminated intravascular coagulation.

When to Contact a Doctor for Suspected Meningitis

Any suspicion of meningitis is a medical emergency that warrants an immediate call to 144:

• Call 144 immediately in the presence of the triad fever + intense headache + neck stiffness, or any sign of extreme severity (purpura, confusion, seizures, altered consciousness).

• Contact your treating physician in parallel if they are reachable, or Docadom at 021 845 45 45 or via our mobile application (App Store, Google Play) for guidance and support.

• Do not attempt to treat at home: bacterial meningitis requires immediate hospital care.

Conclusion: Recognize Quickly, Treat Quickly

Meningitis is a rare but potentially extremely serious condition. It is characterized by fever, intense headache, and neck stiffness, sometimes associated with a purpura or altered consciousness, which can lead to complications such as death within hours, neurological sequelae, deafness, or purpura fulminans. Vaccination and early recognition are essential: any delay in management exposes the patient to dramatic consequences.

At the slightest doubt, dial 144. In parallel, your treating physician or Docadom (021 845 45 45, mobile app on App Store and Google Play) can advise you and assist with the steps.