You may have heard about a meningitis outbreak that occurred at a nursing home or college dorm. That's partly because some strains of this condition, which is the inflammation and swelling of protective tissue covering the brain and spinal cord, can be highly contagious. Meningitis is spread through bacteria, virus and fungus. Because it affects such important areas of the body like the brain and spinal cord, it needs to be detected early and treated rapidly.
Yale Medicine is one of few medical institutions in the country with a dedicated laboratory medicine department. With its highly collaborative approach to patient care, we can diagnose and treat meningitis quickly and effectively. “The challenge is in balancing those quick methods, which tend to be less definitive, with those more definitive methods, which tend to take more time," says David Peaper, MD, PhD, director of the Virology Reference Laboratory and Clinical Microbiology Laboratory at Yale New Haven Hospital.
What are the symptoms of meningitis?
Patients with meningitis can experience a rapid change in severity of symptoms. Usually the earliest symptoms are related to the infection that causes the condition, such as headaches, light sensitivity, neck stiffness, fever and skin rashes. As time passes and swelling and inflammation progress, the later and more dangerous symptoms become apparent: altered mental states that may cause disorientation, confusion or a lack of focus, which in turn could lead to a coma or even death.
Because the disease can rapidly escalate into a medical emergency, it’s vital to seek immediate attention through the emergency department.
What are some risk factors for meningitis?
Infants, young children, and anyone whose immune systems are compromised due to illness or certain kinds of medical treatment are at a higher risk for meningitis based on their diminished ability to fight infections.
Because some causes of viral and bacterial meningitis can be contagious, people who come into close contact with affected patients may be at risk of infection. This is the primary reason why outbreaks can occur in areas such as nursing homes or universities, where many people interact in close quarters.
How does Yale Medicine screen for meningitis?
There’s a variety of techniques to test for meningitis, ranging from just a few minutes in a lab to longer tests, which take up to 48 hours or more.
All meningitis screening, no matter what technique the lab uses, requires a sample of a patient’s cerebrospinal fluid (CSF). To take the sample, a clinician will insert a needle into the lower spine between two lumbar vertebrae. The spinal fluid is then sent to the lab, where it will be tested for the presence of bacteria, fungi or viruses that could cause meningitis. A preliminary analysis of CSF by can take just a few minutes after the specimen arrives in the lab.
To identify the specific microorganism causing the meningitis, doctors keep the patient’s spinal fluid in a lab environment from 18 to 48 hours or more. During that time, they work to identify the specific strain of bacteria or virus, or, in rare cases, fungus, by growing a sample of it from the spinal fluid.
How is meningitis treated?
Because meningitis is such a high-risk condition, patients may need to be treated while waiting for the most definitive results of the screening – especially if they’re at risk of other diseases or infections.
“The care team that's assessing and treating the patient is thinking about the risk factors for the patient and what their therapy needs to cover, in real time,” Dr. Peaper says.
Early treatment could include a broad-spectrum antibiotic, meaning one or a combination of drugs that cover almost all of the bacteria that could be causing the disease, and anti-viral or anti-fungal medications, if the situation calls for them.
“In the meantime,” Dr. Peaper says, “the laboratory works very rapidly to try to characterize the patient's spinal fluid as quickly as possible.”
Once the lab’s analysis is complete, it can shed light on the cause of the meningitis, which then allows the care team to identify the correct course of action for the patient.
What are the innovations in the field for meningitis screening?
Traditionally, to identify exactly what kind of bacteria, fungus or virus is causing the swelling, doctors have had to grow a culture from a patient’s spinal fluid.
“Recently there's been a tremendous advance in the field wherein methods are becoming available that are very sensitive, very definite and very rapid,” Dr. Peaper says.
These new molecular techniques provide evidence as to if specific kinds of organisms are present, and also indicate exactly what kind they are, allowing precise treatment to begin more quickly than before.
These advanced methods are also becoming so simple that they can be performed around the clock by a wider variety of laboratory staff than was previously necessary. In the future, it may even be possible for clinicians to conduct the tests at the patient’s bedside.
What's makes Yale Medicine’s approach to meningitis screening unique?
Yale Medicine has dedicated lab medicine researchers conducting innovative research on new techniques and methods and a dedicated microbiology staff.
For conditions such as meningitis, for which time is of the essence, our dedicated team collaborates to come to a diagnosis as quickly as possible.