Lightning meningitis is a potentially fatal infection of the meninges caused by the presence of bacteria in the cerebrospinal fluid.
When it is viral, meningitis is often benign. On the other hand, bacterial meningitis (lightning) is a medical emergency (SAMU) and requires urgent antibiotic treatment. In the absence of rapid treatment, these bacterial meningitis can affect other parts of the central nervous system such as the brain, the cerebellum or the brainstem (this is then called “meningoencephalitis”); affect the entire body (generalized infection or “sepsis”). In this case, the disease is “invasive”.
Definition: what is lightning meningitis?
“Lightning meningitis is an inflammation of the meninges, that is to say the coverings which protect the central nervous system (brain and spinal cord), explains Professor Marc Leone, anesthesiologist-resuscitator. It is linked to the presence of bacteria in the cerebrospinal fluid, that is to say an infection most often, for typical forms, due to pneumococcus or meningococcus“. “Bacterial meningitis is characterized by a sudden onset of a deterioration in the general condition with fever, violent headaches, vomiting, intolerance to light, stiff neck, intolerance to light… Sometimes small red spots called purpura, predominantly on the lower limbs and signs of serious infection (septic shock).
What is the cause of severe meningitis?
Lightning meningitis is essentially linked to two bacteria: pneumococcus (20 to 30% mortality) and meningococcus (10% mortality). “After a local, respiratory (pneumonia), ENT (angina, otitis, etc.) infection or in particular patients (splenectomy, breach between brain and ENT system), these bacteria present in the nasopharynx can pass into the blood and infect the cerebrospinal fluid. spinal“, continues the professor. Pneumococcal meningitis (around 700 cases per year in France) can occur in children, but more often in adults. Serious meningococcal infections affect around 500 to 600 people per year (including two third of meningitis), with a peak in frequency in winter. They are responsible for 50 to 60 deaths per year.
At what age are we most at risk?
Pneumococcal meningitis can occur in children, but more often in adults. The people most affected by serious meningococcal infections are children under one year old, children between 1 and 4 years old and young adults unprotected by vaccination aged 15 to 24 years old.
Is lightning meningitis contagious?
“Severe meningitis linked to meningococcus is contagious, specifies our interlocutor. Transmission occurs via fine droplets coming from the upper airways of patients or healthy carriers (kissing, coughing, sneezing, saliva, use of contaminated objects coming into contact with the mouth, etc.). Given its contagiousness, the implementation of a protocol – respiratory isolation with wearing of masks, antibiotic therapy, vaccination of contact subjects, etc. – for those close to the patient is mandatory“.
In the event of severe meningitis, a case report must be made to the Regional Health Agency (ARS). This is a mandatory procedure. A circular from the General Directorate of Health of July 27, 2018 defines prevention among contact subjects. In all cases of meningococcal infections, antibiotic prophylaxis is recommended for those close to them, which prevents contagion between individuals. In the case of meningococcal serogroup A, C, Y or W meningitis, prevention through vaccination makes it possible to supplement the antibiotic prophylaxis established for the protection of subjects who have had close and repeated contact with a patient (generally people living at home). of the patient) and young children living in communities, where promiscuity is great.
How deadly is severe meningitis?
The World Health Organization (WHO) estimates that globally, one in ten people die from bacterial meningitis and that half of patients suffer serious complications.
Can we be cured of severe meningitis?
“The risk of rapid progression of severe meningitis requires the implementation of antibiotic treatment as quickly as possible, if possible as soon as the diagnosis is made, Professor Leone warned. In industrialized countries, 3rd generation cephalosporins (cefotaxime, ceftriaxone) are used as first-line intravenously for a variable duration depending on the organism (from 4 to 14 days). Most of the time, corticosteroids are combined with antibiotics which improve the prognosis. The diagnosis of bacterial meningitis is confirmed with a lumbar puncture to identify the bacteria in question, blood cultures (= blood culture also allowing the germ to be identified) and a blood test. “We can also do a brain scan before or after the lumbar puncture to look for cerebral complications.”
What are the after-effects after severe meningitis?
“If the patient is treated quickly, normally, within a few days of treatment, his condition returns to normalreassures our interlocutor. Otherwise, there may be neurological sequelae such as visual, cognitive, hearing (deafness) or memory problems. He also risks paralysis or even gangrene which could lead to amputation of a limb.“.
Does the vaccine protect against severe meningitis?
“Approved vaccines against meningococcal and pneumococcal meningitis have been available for many years and protect patients against certain strains“, recalls Professor Leone. Furthermore, vaccination against pneumococcus is compulsory for infants born since January 1, 2018: two injections two months apart (two and four months); a booster at the age of 11 months It remains recommended for unvaccinated people up to the age of 24 as well as for babies born before this date.
Thanks to Professor Marc Leone, head of the anesthesia and intensive care unit at the Nord hospital in Marseille and vice-president of the French Society of Anesthesia and Resuscitation (SFAR).