Lightning meningitis is a life-threatening infection of the meninges caused by the presence of bacteria in the cerebrospinal fluid. Contagion, sequelae, risks: the point with Professor Marc Leone, anesthesiologist-resuscitator.
And at meningitis viral infection is often benign, bacterial meningitis (lightening) is a medical emergency (SAMU) and requires urgent antibiotic treatment.
Definition: what is lightning meningitis?
“Lightning meningitis is a inflammation of the meninges, i.e. envelopes that 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 fluidthat is to say an infection most often, for the typical forms, due to pneumococcus or meningococcal“. “Bacterial meningitis is characterized by sudden onset of an alteration in general condition with fever, violent headaches, vomiting, intolerance to light, stiff neck, intolerance to light… small red spots called purpura, predominant on the lower limbs and signs of severity of the infection (septic shock)”. In the absence of rapid treatment, these bacterial meningitis can: reach other parts of the central nervous system such as the brain, cerebellum or the brainstem (we then speak of “meningoencephalitis“); affect the whole body (generalized infection or “sepsis“). In this case, the disease is called “invasive”.
What is the cause of lightning meningitis?
Lightning meningitis is essentially linked to two bacteria: pneumococcus (20 to 30% mortality) and the meningococcus (10% mortality). “After a local, respiratory infection (pneumonia), ORL (angina, otitis, etc.) or in particular patients (splenectomy, breach between the brain and the ENT system) these bacteria present in the nasopharynx can pass into the blood and infect the cerebrospinal fluid“, continues the professor. Pneumococcal meningitis (about 700 cases per year in France) can occur in children, but more often in adults, recalls health insurance. It is the germ most frequently responsible for bacterial meningitis. Serious meningococcal infections affect approximately 500 to 600 people per year (including two thirds of meningitis), with a peak in frequency in winter. They are responsible for 50 to 60 deaths per year. Bacterial meningitis is a medical emergency, and treatment must be implemented quickly.
At what age are we most at risk?
According to Health Insurance, 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 from 15 to 24 years old. Pneumococcal meningitis can occur in children, but more often in adults.
Is lightning meningitis contagious?
“A lightning meningitis linked to a meningococcus is contagious, says our interlocutor. Transmission takes place through fines gouttelettes from the upper airways of patients or healthy carriers (kissing, coughing, sneezing, saliva, use of contaminated object 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 … – for the entourage of the patient is obligatory“. In case of lightning meningitis, it is necessary to carry out a case report to the Regional Health Agency (ARS). It is a mandatory procedure. A circular from the General Directorate of Health of July 27, 2018 defines prevention in contact subjects. In all cases of meningococcal infections, antibiotic prophylaxis is recommended for the entourage close, which prevents contagion between individuals: rifampicin must be administered for 2 days. However, there are contraindications (hypersensitivity, pregnancy, severe liver disease, alcoholism, porphyria, etc.), and resistance to rifampicin for rare strains of meningococci. Prevention then relies on taking Ceftriaxone by injection or Ciprofloxacin orally, in a single dose. In the case of serogroup A, C, Y or W meningococcal meningitis prevention through vaccination supplements the antibiotic prophylaxis instituted for the protection of subjects who have had close and repeated contact with a patient (generally people living in the patient’s home) and young children living in a community, where crowding is high.
What is the mortality from lightning meningitis?
The World Health Organization (WHO) estimates that globally, one in ten people die from bacterial meningitis and that half of the patients suffer from serious complications.
Can lightning meningitis be cured?
“The risk of rapid development of lightning meningitis requires the establishment antibiotic treatment as soon as possibleif possible as soon as the diagnosis is mentioned, warns Professor Leone. In industrialized countries, first-line treatment is used 3rd generation cephalosporins (cefotaxime, ceftriaxone) intravenously for a variable period depending on the germ (from 4 to 14 days)”. Most of the time, the antibiotic is associated with corticosteroids which improve the prognosis. The diagnosis of bacterial meningitis is confirmed with a lumbar puncture to identify the bacterium in question, blood cultures (= blood culture also allowing the germ to be identified) and a blood test. “You can also make a brain scan before or after lumbar puncture to look for cerebral complications”.
What are the sequelae after lightning meningitis?
“If the patient is taken care of quickly, normally, within a few days of treatment, his condition is normalizingreassures our interlocutor. Otherwise, there may be consequences at the neurological level such as visual, cognitive, auditory (deafness) or memory disorders. He also risks paralysis or even gangrene that can lead to the amputation of a limb.“.
Does the vaccine protect against lightning meningitis?
“Approved vaccines against meningococcal and pneumococcal meningitis have been available for many years and protect patients against certain strains“, concludes Professor Leone. In addition, vaccination against pneumococcal disease is mandatory for infants born since January 1, 2018 by: two injections two months apart (two and four months); a reminder at the age of 11 months, recalls the Health Insurance. She stays recommended for unvaccinated people up to 24 years of age as well as in babies born before this date.
Thank you to Professor Marc Leone, head of the anesthesia and resuscitation department of the North Hospital of Marseille and vice-president of the French Society of Anesthesia and Resuscitation (SFAR).
Source: Instruction No. DGS/SP/2018/163 relating to the prophylaxis of invasive meningococcal infections, July 27, 2018, DGS