Meningitis is an infectious disease of the nervous system that is characterized by inflammation of the meninges, ie the membranes that cover the brain. After the recent cases of meningitis in Milan and Romagna, and the 57 in Tuscany recorded since the beginning of 2015, attention is high, especially from parents of children of school and preschool age, who want to know more about this serious infection, to understand what the symptoms of meningitis are, how the infection occurs, what is the therapy and who can get the vaccine. We have chosen, as an exceptional interlocutor, Prof. Pierluigi Viale, Director of the Infectious Diseases Operating Unit of the Sant’Orsola – Malpighi Hospital of Bologna.

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Professor Viale, can you explain the difference between the viral form and the bacterial form of meningitis, and what are the symptoms?

PV “First of all, it is important to know that, in general, the diagnosis of meningitis should be suspected in every patient with a febrile headache. Furthermore, in the extreme ages of life, the disease can have more elusive clinical connotations: in the child, symptoms such as numbness, reduced reactivity, absence of crying must arouse suspicion, while in the elderly the disease can manifest itself, even in the absence of fever, with alterations of the sensory, for which the patient does not speak, is strange, irritable or slowed down. As for viral meningitis, this term is underlying a universe of clinical conditions that vary according to the age of the patient, the time of year, and also the geographical area. There are, in fact, viral meningoencephalitis that has a classic geographical connotation, such as the Tuscan virus meningitis in the provinces of the Tuscan-Emilian Apennines, the Tick-Borne Encephalitis of the Belluno area and the Friulian Alps, the West Nile Fever in the Po Delta area. They are diseases different from each other, with a seasonal cycle, linked to the bites of different insects.

Finally, there are ubiquitous forms, which can affect all places and at all ages: in this case, the symptoms of meningitis are evident and manifest with intense fever and headache, also associated with sensory alterations, but usually have a good prognosis. , unlike the bacterial forms “.

Bacterial meningitis and time factor: what does this link consist of?

PV “Often patients come to the emergency room with a febrile headache that has already been present for a few days. If it is viral meningitis, there are mostly no problems. If, on the other hand, the lumbar puncture shows bacterial meningitis, in most cases caused by meningococcus, Haemophilus influential, or pneumococcus , the sooner the therapy is started, the better. In bacterial meningitis, in fact, there is a close correlation between the time of initiation of therapy and mortality “.

What are the causes of bacterial meningitis?

PV “The frequency of the different etiological agents can vary in relation to the age of the patient and his comorbidities, or the coexistence of several different pathologies in the same individual: in general, and neglecting the neonatal area, it can be said that haemophilus influenzae in children , meningococcus in children and young adults, pneumococcus and listeria monocytogenes in the elderly are the prevalent pathogens. In fact, these bacteria share most of the bacterial meningitis that occur in Italy. For the three most frequent, haemophilus, meningococcus and pneumococcus, the infection occurs by air, usually directly “.

Can bacterial forms be cured?

PV “Yes, there are antibiotic therapies that, if done in the right way and at the right time, solve the problem. However, bacterial meningitis still has an average mortality rate of around 15% and this is due both to the fact that patients often arrive too late in the emergency room , and unfortunately to the presence of such acute cases that lead to death within a few hours. , with respect to which the margins for intervention are really modest. However, the time factor remains a fundamental principle in managementbacterial meningitis. So much so that the “school of Bologna” has for some time been pursuing a protocol that provides for early therapy, indeed very early, even before having diagnostic certainty. In other words, if the doctor after visiting the patient believes that there are signs that support the suspicion of meningeal syndrome and is not in a position to perform a lumbar puncture in a short time (because a transfer to a referral hospital or to other reasons) in the meantime he intervenes immediately by administering antibiotic and steroid therapy, this is because those few hours gained can save the patient’s life. This is a protocol applied for over 10 years, first in Friuli Venezia Giulia and now in the Bologna area, which has resulted in a significant reduction in the mortality rate compared to the average ”.

Compared to the case of the two Milanese girls: what happened? Why was it not possible to intervene?

PV “These people did not die of meningococcal meningitis, but of meningococcal sepsis , which is a different thing. These are strains of meningococcus (and sometimes even pneumococcus) so aggressive that they lead to a condition of septic shock and often death even before developing meningitis. This is what happened, for example, to the athlete Bebe Vio, who is not dead, but has paid a very high price. These are rare, but not very rare cases, which have a fulminant course, do not present the classic symptoms of meningitis and unfortunately are part of normal European epidemiology. These pathogens, in fact, are found in our ecosystem and we breathe them. We are all in contact with the meningococcus or pneumococcus bacterium, but in these rare cases people have breathed the wrong pathogen, that is particularly aggressive, in the wrong quantity, at the wrong time, perhaps because the immune system was not ready to implement any. response mechanism. Unfortunately for these cases it is really a matter of bad luck. But in all of thisthe solution is there: to defend oneself from meningitis with the vaccine “.

So let’s talk about the prevention of meningitis. Is vaccinating important? Who can get the vaccine?

PV “The vaccine works. Unfortunately, none of the dead people were vaccinated. The meningitis vaccine allows us to avoid these deaths, but unfortunately in Italy we have a low adherence to any type of vaccination. That from meningococcal C , the most widespread in Italy, is part of the offer vaccination in children . In fact, there is a quadrivalent vaccine that covers four strains, including meningococcus C, and no matter how many new strain selections may arise, if everyone were vaccinated with this it would be an extraordinary result, which would reduce the number of cases to values ​​close to zero.

The meningococcal meningitis B vaccine is on the market and is expected to be part of the free vaccination offer from next year. Therefore, everyone can get vaccinated: there are no doubts about the child and you must follow the vaccination offer of your region of belonging. If they haven’t done so yet, even young adults aged 20 to 40 should get the vaccine; for example high school and university students,who have a very intense social life (they frequent classrooms, discos, crowded places, travel and stay in contact with many people), are an important vaccination target. After the age of 60, however, the vaccine for pneumococcus is recommended, which among other things also eliminates the risk of pneumococcal pneumonia, a very frequent disease, which in the elderly can have serious consequences “.

In Italy, therefore, on a general level, we need to talk again about the importance of vaccines.

PV “Yes, because in Italy we no longer vaccinate, and we tend to forget that the costs and side effects of vaccines are a drop in the bucket compared to the costs and side effects, including death, of the diseases that go to to prevent. This is the case, for example, of the measles vaccine which has an incidence of post-vaccination encephalitis of 1 case in 10,000,000, while measles, in addition to being particularly annoying, has an incidence of post measles encephalitis of 1 case. out of 1000.

We need to look at vaccines with confidence and civic sense: getting vaccinated is not something that is done only for oneself, but also for all those around us. Not getting vaccinated is a choice that is part of an individualistic culture, to the detriment of the entire community. This is why I say that adherence to vaccination is an example of civic education , it is a sign of civility and a yardstick to understand how open we are towards others “.

Thank you Professor Viale for the time you have dedicated to us and for the valuable information.

Knowing the main symptoms of meningitis and the importance of the vaccine helps us make informed choices. Are there any other aspects you would like to learn more about this infection?