Meningitis is a serious infection of the meninges, the membranes covering the brain and spinal cord. It is a very serious illness and can be fatal. When the brain becomes inflamed or infected, the problem is called encephalitis. If both the meninges and the brain are infected, the condition is called meningo-encephalitis. The disease can be caused by many pathogens, including bacteria, fungi and viruses.

A very serious incident has recently been reported at Basti Behram Leghari, Rukanpur, Rahim Yar Khan. Twelve people from the same family got sick and expired. Medical investigation of the 12 deceased persons, including children and teenagers, revealed that they all had died of meningo-encephalitis.

A retrospective study was conducted at the Aga Khan University Hospital, Karachi, between July 2010 and June 2019 and comprised patients of either gender of age 18 years and above diagnosed with bacterial, viral or tuberculous meningitis. The most common aetiology found was bacterial meningitis (64 percent), followed by viral meningitis (27.9 percent). The incidence of in-patient mortality was 10.5 percent. 14.8 percent of patients required intensive care unit admission.

The organisms that cause meningitis and encephalitis are transmitted from person-to-person through droplets of saliva and spit. Coughing/ sneezing and kissing also spread the disease. Close and prolonged contact, such as sharing the same room or crowding in small spaces, facilitates the spread of viruses and bacteria. Luckily, they are not as contagious as germs that cause the common cold or the flu. Casual contact with diseased persons doesn’t infect healthy individuals.

Warning symptoms

Warning symptoms are headache, fever, neck stiffness, drowsiness, disorientation, seizures, intolerance to light, weakness or loss of sensation in a part of the body, difficulty in speech, hallucinations and behavioural change. Any of these symptoms warrant an immediate check-up in the emergency unit of a reputable hospital where neurology services are available.

Meningococcal meningitis can affect people of any age but mainly affects babies, pre-school children and young people. The disease can occur in sporadic cases, small clusters to large epidemics throughout the world or with seasonal variations. Neisseria meningitides only infects humans. A significant proportion of the population (between five and ten percent) carries Neisseria meningitides in their throat at any given time and can lead to serious illness when the body’s immune system becomes weak.

Entero-viruses (EVs) are among the most common cause of viral meningitis, with a peak incidence between late summer and fall. The onset of symptoms is sudden and typically includes headache, fever, nausea or vomiting, malaise and photophobia. In addition, diarrhoea, upper respiratory symptoms, and a rash may also be present. Five consecutive cases of viral meningitis (first case series) were reported in a tertiary care hospital in Karachi, in the year 2021. Diagnosis of enteroviral encephalitis was confirmed by the detection of RNA in cerebrospinal fluid. Those five young adults had presented with similar complains – headache, fever and neck stiffness; 40 percent had diarrhoea.

According to the WHO report published in December 2015, the Japanese encephalitis virus is the most common in Asia, with approximately 68,000 infected patients per year. There is limited literature about causative organisms in Pakistan as many patients do not get investigated timely and all cases are not reported.

Age is among the various factors related to the poor prognosis of patients with encephalitis. Individuals aged <12 months and >55 years are at high risk for poor prognosis. The extremes of age (children and elderly) are also vulnerable with regard to encephalitis, but it can occur at any age.

Brain damage can affect speech and cause language, memory, behavioural, balance and coordination problems. It can also cause emotional and psychological problems.

Diagnosis

For suspected meningitis or encephalitis, blood tests and lumbar puncture are advised for confirmation and identifying the causative organism so as to begin treatment accordingly. Non-medical personnel are usually scared of lumbar puncture, but it has a low risk of injury if performed by qualified and skilled healthcare professionals. It is important to understand that it is not wise to delay diagnosis if such a serious neurological infection is suspected.

Recovering from encephalitis can be a long, slow and difficult process. Many people will never make a full recovery. Rehabilitation for residual problems helps improve the quality of life. Speech and language therapy helps improve speech problems. Occupational therapists help in solving problems with daily activities. Physiotherapy has a role in movement problems. Psychologists assist in coping with emotional disturbances. The rehabilitation facilities are available in separate centres, also in tertiary care hospitals.

A previous meningococcal infection will not offer lifelong immunity. Therefore, the Centre of Disease Control recommends meningococcal vaccines for all pre-teens and teens. In certain situations, children and adults should also get meningococcal vaccines. Vaccine against meningo-coccus are now available in Pakistan. This vaccine can be given as a single injection in people 2–55 years of age.

The writer is a consultant in family medicine [MBBS, FCPS, MRCGP (int)]