What is Meningitis?
Meningitis is inflammation of the meninges, the linings surrounding the brain. It can be caused by bacteria and viruses.

Septicaemia is blood poisoning caused by bacteria getting into the bloodstream and multiplying uncontrollably.

Viral meningitis is more common than bacterial meningitis. It is rarely life threatening, but it can make people very weak. Viral meningitis can be caused by many different viruses. Some are spread between people by coughing and sneezing, or through poor hygiene or sewage-polluted water. Viral meningitis does not respond to antibiotics, treatment is based on rest and good nursing care.

Bacterial meningitis is less common, but it is very serious and needs urgent treatment with antibiotics. It is mainly caused by the meningococcal bacteria, but can also be caused by the pneumococcal, Hib and TB bacteria amongst others. E.coli and group B streptococcal bacteria can also cause meningitis in newborn babies.

The meningococcus has three main groups, A, B and C. Group A rarely causes disease in the UK. Of all the cases in the UK, Group B accounts for 60-70%, Group C accounts for 30-40% and is the main cause of clusters or outbreaks of the disease. The introduction of a new C vaccine will significantly reduce its incidence in the UK.

The main bacteria which cause meningitis are the meningococcal bacteria. These bacteria can also cause septicaemia (blood poisoning). They enter the bloodstream and travel to the meninges, when they can cause meningitis.

In some people, the bacteria multiply in the blood causing blood poisoning. This condition is known as meningococcal septicaemia. Patients with this condition do not have meningitis. In most patients, the meningococcal bacteria cause meningitis and septicaemia at the same time. In this leaflet, we will refer to meningitis and septicaemia caused by the meningococcal bacteria as meningococcal disease. Meningococcal disease and other types of meningitis affect approximately 4,000 people each year in the UK.

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Meningitis and meningococcal septicaemia may not always be easy to spot at first, because the symptoms can be similar to those of flu. They may develop over one or two days, but sometimes develop in a matter of hours. The incubation period is between two and ten days.

Symptoms do not appear in any particular order and some may not appear at all. It is important to remember that other symptoms may occur.

In babies:

• High temperature, fever, possibly with cold hands and feet
• Vomiting, or refusing feeds
• High pitched moaning, whimpering cry
• Blank, staring expression
• Pale, blotchy complexion
• Baby may be floppy, may dislike being handled, be fretful
• Fontanelle (soft spot on their head) may be tense or bulging
• Difficult to wake or lethargic

In children and adults:

• High temperature, fever, possibly with cold hands and feet
• Vomiting, sometimes diarrhoea
• Severe headache
• Neck stiffness (unable to touch the chin to the chest)
• Joint or muscle pains, sometimes stomach cramps with septicaemia
• Dislike of bright lights
• Drowsiness
• Fitting
• Patient may be confused or disoriented

Septicaemic rash
Patients with septicaemia will develop a rash which may start anywhere on the body as a cluster of tiny blood spots, which look like pinpricks in the skin. If untreated, these blood spots will join to give the appearance of fresh bruises.

The "glass test" can be used to see if a rash might be septicaemia. If you press the side of a clear drinking glass firmly onto the spots or bruises, they will not fade. 
NB. In a small number of cases, the rash may disappear at first, but may later change into one that does not.

Even though the rash can be harder to see on dark skin. The glass test can still be done. Look for the spots or bruises on paler parts of the skin, e.g. palms of the hand or soles of the feet. There is sometimes a rash on the surface of the eye - the part mainly covered by the eyelid.

Do not wait for a rash. It may be the last symptom to appear, and in cases of meningitis without septicaemia may not appear at all.

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• If someone you know is ill and you suspect meningitis/meningococcal septicamia contact your GP immediately.
• Describe the symptoms carefully, mention that you think it might be meningitis or meningococcal septicaemia.
• If your doctor is not available go straight to the nearest Accident and Emergency Department and insist on seeing someone.
• If it is meningitis or meningococcal septicaemia, early treatment with antibiotics is vital.

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Treatment and Prevention
Viral meningitis does not respond to antibiotics, treatment is based on rest and good nursing care.

Bacterial meningitis and meningococcal septicaemia need immediate treatment with antibiotics.

Only people who have come into close contact with bacterial meningitis and meningococcal septicaemia require antibiotics. (Close contacts are people living or sleeping in the same household or who have intimately kissed the patient.) School friends and work mates of the patient with meningococcal disease are rarely at higher risk.

Antibiotics are given to kill off any meningococcal bacteria which may be carried in the back of the nose and throat. This reduces the risk of passing the bacteria on to others.

Research suggests that not smoking may reduce the chances of contracting meningitis.

Apart from the vaccines, there is no known way to protect against meningitis and meningococcal septicaemia.

Vaccines
A new vaccine for Group C meningococcal disease is available. It will give long-term protection against this strain and will be given as part of the Childhood Immunisation Programme, along with the Hib vaccine (which protects against Haemophilus influenza type B meningitis).

There is also a vaccine against meningococcal groups A and C, which can be given to people travelling to areas of the world where these strains occur. It is effective in about 80% of those who receive it, but is not effective in children under the age of 18 months and only offers protection for about three years.