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Meningitis, acute, including: bacterial, viral and other

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Reporting Obligations

Individuals who have or may have meningitis shall be reported to the local Health Unit.

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Epidemiology

Aetiologic Agent

Meningitis is defined as “any infection or inflammation of the membranes covering the brain and spinal cord”; it can be caused by various organisms including bacteria, fungi and viruses.

Some common causes of bacterial meningitis are Neisseria meningitidis, Haemophilis influenzae type b (Hib) and Staphlococcus pneumonia.

Viral meningitis (aseptic meningitis, nonbacterial meningitis) may be caused by a variety of viruses, many of which are also associated with other manifestations. These include enteroviruses, coxsackievirus, echovirus, arboviruses and herpes simplex virus. Many of the cases of viral meningitis have no obvious causative agent.

Other infectious agents and conditions may also cause the clinical presentation of meningitis, including pyogenic meningitis, tuberculosis, fungi and cerebrovascular syphilis.

Clinical Presentation

Meningitis has a very sudden onset, usually with high fever, severe headache, vomiting, confusion, seizures, progressive lethargy, drowsiness, stiff neck, and skin rash especially on hands and feet. Petechial rashes and other types of rashes may also occur depending on causative agent. Newborns and infants may not have all the classic symptoms above. They may present with irritability, may refuse meals, have unusual sleep patterns and constant crying; newborns and infants may also have the soft spots on their heads bulge and a lower than normal body temperature.

Modes of Transmission

Depends on causative infectious agent, however, transmission is usually by direct contact, or droplets, originating from respiratory secretions from the nose or throat.

Incubation Period

Depends on causative agent for both bacterial and viral.

Period of Communicability

For bacterial, usually as long as organisms are present; effective antibiotic treatment reduces communicability after 24–48 hours. For viral, it varies according to causative agent.

Risk Factors/Susceptibility

Susceptibility decreases with age; those not immunized with relevant vaccines are also susceptible.

Diagnosis and Laboratory Testing

Probable case: Clinically compatible signs and symptoms of meningitis (characterized by fever, headache, stiff neck and pleocytosis).

Confirmed case: As above with: Isolation of an organism (i.e. bacterial, viral or other) from an appropriate clinical site (e.g. cerebrospinal fluid (CSF), blood).

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Treatment and Case Management

For bacterial meningitis, routine infection prevention and control practices, as well as contact and droplet precautions should be in effect until at least 24 hours after beginning and complying with appropriate antimicrobial therapy although this may be dependent on the causative organism. Treatment is under the direction of the attending health care provider.

Contact identification is dependent on the causative organism. For viral meningitis, contact tracing is generally not indicated.

Patient Information

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Additional Resources

Nemours Foundation. “Meningitis.”

Centers for Disease Control and Prevention. “Meningitis.”

References

Ministry of Health and Long-Term Care, Infectious Diseases Protocol, 2019.