Lightning Meningitis: an absolute emergency

There are several types of meningitis depending on their origin, mainly viral or bacterial. Bacterial meningitis is particularly severe, especially meningococcal meningitis. Each year in France, 800 people are victims of meningococcal infections, of which 80 to 90 lead to death. Discover the symptoms to identify and how to react as soon as possible.

Meningococcal meningitis 

Meningitis can result from invasive meningococcal infections. Of the 13 serogroups of this bacterium, 5 are very virulent, and rapidly invade blood (septicemia) causing multiple infectious and highly inflammatory foci in the meninges but also other organs. These bacteria live only in humans. In Europe, we find essentially two types: types B and C (the latter being in theory the most harmful). But these microbes are not always dangerous. Moreover, 5 to 10% of the population is a healthy carrier of this bacterium: it is present in the throat and nose. It is transmitted directly by postilions, saliva, sneezing ... If these bacteria are so common, how can they become lethal?In fact, it is not really known why suddenly an invasive meningococcal infection, causing fulminant meningitis, suddenly occurs. The disorder appears to be linked to a more fragile immune system: immunity is not yet well developed, or declines transiently. This is why young children are the most affected. There are 15 cases per 100,000 babies under one year of age (compared to less than two per 100,000 babies in adults). There are thus two peaks in infections: before the age of two years and between 15 and 20 years and nearly half of the fatal cases of meningitis concern children under four years.

Symptoms sometimes difficult to distinguishMeningococcal meningitis, which is dreaded for its rapid, unpredictable and even fierce development, affects 1 to 2 people per day in France (mostly infants but adolescents and young adults as well as immunocompromised persons are also at risk), with a mortality rate Of 10% despite appropriate treatment. In addition, 30-36% of survivors will have severe and disabling sequelae (amputations of limbs, renal insufficiency, deafness, epilepsy, motor handicaps ...).

In young children, the symptoms of meningitis are less obvious and often more difficult to recognize. In fact, the disease is often difficult to recognize in their homes. Only some of these symptoms may be present: unusual behavior (moans, incessant crying, irritability, abnormal sleepiness); Fever with a feeling of discomfort, shivering; A refusal to eat or vomiting; A soft neck (not stiff as in the older ones); A gray or marbled complexion; An important fatigue (he appears dejected); A tight fontanelle (the space that separates the bones of the skull that are not attached to each other in young children); Convulsions ...In case of doubt (meningeal syndrome, high fever, unusual behavior), call your doctor. The latter may interpret signs suggestive of meningitis. In this case, the child will be hospitalized and a lumbar puncture will make the diagnosis: identify the germ in order to prescribe the adapted treatment.

Purpura fulminans, a factor of seriousness Also, undress him and watch his skin. The presence of small haemorrhagic spots (bright red or "blue" star spots not disappearing under the pressure of the finger) called purpura is a sign of seriousness, requiring immediate emergency call. Urgency is necessary because purpura is encountered in meningococcal meningitis with sometimes fulminating evolution ("purpura fulminans"). Emergency physicians insist on inviting parents not to hesitate to contact them the number of times it will be necessary in case of doubt. It is preferable that to see his child in resuscitation the next day ...

Testimony of a survivorOn September 7, 2005, the life of Emilie Sougey was overwhelmed: when she had just started her school year in a lycée in Voiron, she was the victim of a C meningococcal purpura fulminans, which almost took her away. Victim of sequels that have earned her several surgeries, this girl decided to share her experience and tell the fear of the disease and its consequences but above all to alert against the risks of this formidable disease. His book entitled "Like a Butterfly was published with the support" of the editions La Vertevelle.

Treatment of the acute phase and vaccination: the two weapons against meningitisThe treatment of meningococcal meningitis is based on antibiotics administered initially intravenously for at least several days. It is usual to prescribe a prophylactic antibiotic (rifampicin or spiramycin) in all individuals who may have been in contact with a patient. If a meningococcus A, B or C is involved, contact persons will also be treated with "occasional vaccination".

Several vaccines protect children against meningococcal meningitis:

    C meningococcal vaccine is recommended for all infants at 12 months of age. The extension of this vaccination up to the age of 24 years is recommended according to the same vaccine schedule at a dose.
    Meningococcal vaccine A, C, Y, W135 is 65% reimbursed by the Health Insurance for patients at high risk of invasive meningococcal infection.
    The B meningococcal vaccine is recommended and reimbursed in specific situations (fragile persons at risk or in epidemic or hyperendemic situations).The vaccine schedule for Hæmophilus influenzae type B recommended for all infants is given in four doses between 2 and 18 months, as is the vaccine against pneumococcus (for 13 serogroups) recommended for all infants and administered Three doses from the age of two months. Finally, mumps, measles or tuberculosis (BCG) vaccines also help prevent meningitis related to these diseases.