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Don't wait for the 'rash'...

Meningitis usually affects babies, children and young adults. Some forms of the disease can be rapidly fatal if not recognised and managed aggressively, others can lead to life-changing injuries.


I'm currently helping to re-write the National Institute for Health and Care Excellence (NICE) Clinical Guideline on Meningitis, as it's a subject close to my heart. My daughter Elizabeth had bacterial Meningitis when she was just a few weeks old. Fortunately for us, after a stay in hospital it all turned out OK.


Meningitis is a topic that often confuses people, including clinicians and first aid trainers. It's definitely not straight forward, so I'm going to do my best to explain it in clear terms that are useful to you as a first aider.


If you understand what you're looking for, you're more likely to recognise it!



Meningitis


What is Meningitis?


Meningitis literally means 'inflammation of the meninges' - the lining around the brain and spinal cord. This inflammation is due to infection, and can spread to the cerebro-spinal fluid (CSF - the fluid around the brain and cord) and to the brain tissue itself.

This swelling can cause long term damage to parts of the brain, leading to problems such as learning disabilities or hearing loss, and can even be fatal.



What causes Meningitis?


In the UK, infection of the meninges is usually caused by a bacteria or virus, although very rarely it can even be from a fungus or other causes.


Bacterial Meningitis


There are about 50 different types of bacteria that can cause meningitis.


Just in case the terminology isn't yet complicated enough, perhaps the worst bacteria is called 'Meningococcus'. Infection with this bacteria is called 'Meningococcal Meningitis'.


There are a few strains of this particular bacteria. In the UK, we routinely vaccinate children against the most deadly - A, B, C, W, X and Y. As a result, deaths from this disease have dropped hugely over the past few decades.


Other common bacteria that cause Mengitis are Pneumoccocus and Haemophilus Influenzae Type b (Hib).


Elizabeth was infected with Streptococcal bacteria - a common cause of Meningitis in newborn babies. Streptococcus usually likes to infect the lungs. In fact, Elizabeth had had a chest infection for a week or so before she suddenly became seriously unwell. The bacterial infection in her lungs had managed to get to her meninges, causing Meningitis.


Viral Meningitis


Viral Meningitis is much less danagerous than bacterial and is very rarely fatal.


That said, Viral Meningitis can lead to a post-viral syndrome that can take weeks or months to recover from. Not much fun at all.


The MMR vaccine prevents some forms of Viral Meningitis.



Septicaemia and Sepsis


In the worst cases, the bacteria causing Meningitis can also cause Septicaemia and/or Sepsis.


But what do these terms really mean?


Different organisations use different definitions, and some even say they are the same thing. This creates even more confusion in an already complex disease!


This is how I think of it...


Septicaemia


Septicaemia can be described as 'blood poisoning', although this is somewhat incorrect.


Essentially, bacteria from an infection have overwhelmed the body's defences. This may be due to there being a lot of bacteria, or perhaps due to the person having a weak immune system (such as in babies and older people), or both.


When this happens and the bacteria invade the bloodsteam, it's called Septicaemia.


Sepsis


Sepsis concerns the body's reaction to an infection.


Scientists don't know why, but some people have an overwheming and life-threatening response to infection. The original infection could be anything, for instance from a wound, chest infection or urinary tract infection.


The person's immune system overreacts and causes blood clots and leaky blood vessels, leading to tissue damage, organ failure and ultimately, death.



Symptoms of Meningitis and Septicaemia


The symptoms of Meningitis are often non-specific, meaning that they're similar to those of many other, less serious conditions. People often experience symptoms such as:

  • Fever (a high temperature)

  • Vomiting

  • Headache

  • Irritable

  • Flu-like symptoms

  • Loss of appetite

  • Sore throat

However, as the infection gets worse, so do the symptoms...

  • Stiff neck

  • Dislike of bright lights

  • Sleepy or difficult to wake

  • Confusion

  • Seizures

  • Non-blanching rash

The symptoms in bold are also symptoms of Septicaemia. Other symptoms that indicate Septicaemia include:

  • Cold, mottled skin

  • Cold hands and feet

  • Limb, joint, muscle pain

  • Abdominal pain or diarrhoea

  • Fast breathing rate

The Rash


One of the first things people usually mention when I teach about meningitis is the non-blanching rash. In other words, a rash that doesn't go away when you press on it.

For people with dark skin, it may be better to look inside the eyelids for the same type of marks.


The reason it doesn't go away when pressed is that it's not a normal rash. In fact, it's small bleeding under the skin, which may be caused by meningococcal meningitis or septicaemia.


However, this symptom is a really poor way to spot meningitis. Around 60% of children with Meningococcal disease will not have this symptom at all. For those that do, it's a really late sign and the outlook is not good - the chance of survival may be 50/50 at this point.



What should I do if I suspect Meningitis or Septicaemia?


If you're in any way concerned that someone has symptoms of Meningitis or Septicaemia, you should call 999 for an ambulance immediately.


Always make your concerns known to the call handler and ambulance staff and make sure you say that you suspect Meningitis.


When Elizabeth had Meningitis, the very experienced nurse in the Resusitation Room kept telling me she thought it was Bronchiolitis - a respiratory condition common in children at that time of year.


Unfortunately she was wrong and I was right, and I'm very glad that I kept mentioning Meningitis to anyone that would listen!


If in doubt, call 999.

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