The World Health Organization (WHO) has published global guidelines for the diagnosis, treatment and care of patients with suspected or diagnosed acute meningitis. The first-of-its-kind, ‘WHO guidelines on meningitis diagnosis, treatment and care’ makes recommendations based on globally recognised and evidence-based standards of care to improve early detection, treatment and access to aftercare for adults and children over the age of 1 month with acute meningitis. The guidelines aim to support health-care professionals working in primary or secondary health-care facilities, including emergency, inpatient and outpatient hospital services. They are also intended to inform policy-makers and health-care, academic and non-governmental organizations. Described as ‘a game changer’ by Dr Lorenzo Pezzoli (WHO’s Team Lead for Meningitis and Epidemic Bacterial Diseases), the guidelines provide a critical tool for reducing deaths and disability caused by the disease, and are being hailed as a significant step towards WHO’s ‘Global Roadmap’ to defeat meningitis by 2030. Why is meningitis such a global health threat? “From a medical perspective, I don’t think there’s a scarier disease than bacterial meningitis. It strikes without warning; it progresses incredibly fast and can change your life in a matter of hours, or end it.” [Dr Lorenzo Pezzoli, WHO’s Team Lead for Meningitis and Epidemic Bacterial Diseases.] Meningitis remains a significant global health threat, even though many forms of meningitis can be treated effectively or prevented by vaccination. According to the World Health Organization (WHO), an estimated 2.5 million cases of meningitis were reported worldwide in 2019, including 1.6 million cases of bacterial meningitis which led to around 240,000 deaths. The disease was most prevalent among children under five years of age, with 1.28 million cases and 112 000 deaths, but it can affect anyone, anywhere, at any age. The most dangerous form of the disease is bacterial meningitis, which can be caused by many pathogens and can kill within 24 hours. One in six people with bacterial meningitis die from the condition, and one in five (20%) are left with physical or neurological disability which affects their everyday activities, their finances, family and social relationships, and their quality of life. Long term disability and effects of acute meningitis can include: hearing loss; focal neurological deficits, such as hemiparesis (one-sided muscle weakness or paralysis) or aphasia (impaired language); neuropsychological, cognitive (thinking) or learning disability; behavioural issues; epilepsy and seizures; amputation and scarring. Meningitis survivors can also have less obvious ‘hidden’ disability which can cause social and emotional challenges. Common signs of acute meningitis include a rapid onset of fever (high temperature), neck stiffness, headache, photophobia (intolerance of light) or altered mental state ranging from dulled reactions and confusion to lethargy and coma. The classic triad of fever, neck stiffness and altered mental state are, in fact, only reported in around half of all cases. Other symptoms and signs of meningitis may be non-specific, including malaise, fatigue, nausea or vomiting, or severe such as seizures, focal neurological deficits, increased intracranial pressure or cerebral herniation (which can also be caused by lumbar puncture). The characteristic, non-blanching skin rash is often a (late) sign of meningococcal sepsis. Meningitis can also lead to septic shock, multiorgan failure or a dangerous blood clotting disorder called disseminated intravascular coagulation (DIC). In babies, the first signs of meningitis are often fever or hypothermia, bulging fontanel, lethargy or irritability, poor feeding, an abnormal cry, signs of respiratory distress (such as grunting or rapid breathing) or seizures. Vaccination remains the best way to prevent meningitis, but WHO hopes that the new guidelines will lead to improved diagnosis, treatment and care for those who do develop meningitis. What is covered by WHO’s new meningitis guidelines? According to the World Health Organization (WHO), improving clinical management of meningitis is essential to reducing mortality and morbidity, minimizing long-term complications and disability, and improving quality of life for affected individuals and communities. WHO’s new guidelines on meningitis diagnosis, treatment and care take an important step towards this by providing evidence-based recommendations for the clinical management of adults, adolescents and children aged over one month in primary, emergency and hospital care. They address all aspects of clinical care, including diagnosis, antibiotic therapy, adjunctive treatment, supportive care and the management of long-term effects of meningitis, as well as prophylactic antibiotic treatment for an affected patient’s close contacts. The guidelines are very detailed, providing a valuable knowledge and awareness-raising resource about meningitis and its causes, with specific recommendations for clinicians relating to: diagnosis - including the timing and appropriate use of lumbar punctures, cerebrospinal fluid (CSF) investigations, blood tests and cranial imaging (such as CT scans); treatment - including the importance of urgent admission to a suitably equipped hospital, timing and appropriate use of antibiotics (within the ‘one-hour golden window’) and corticosteroids, hydration, and management of associated complications such as raised intracranial pressure, seizures, DIC and septic shock; clinical assessment, rehabilitation and management of after-effects - including timely review and follow up, as well as psychological support for the meningitis sufferer and their caregivers. The guidelines recommend that early recognition of meningitis physical and neurological after-effects (sequelae) whilst the patient is still in hospital is critical to ensure that they receive care and rehabilitation, as soon as possible. They highlight the importance of assistive technology, including hearing aids or spectacles, wheelchairs and prostheses, to facilitate the disabled person’s inclusion and participation. They emphasise the vital role played by rehabilitation, which works with the injured person and their family to help adapt their environment (such as home or school) to better suit their needs, and uses assistive products, education and adaptation of tasks to help the injured person live independently and safely. They stress that where adults and children are living with sequelae due to acute meningitis from any cause, rehabilitation should be provided as soon as possible. Meningitis medical negligence claims World Health Organization (WHO) guidelines are not binding on healthcare organisations or medical clinicians, but the new ‘WHO guidelines on meningitis diagnosis, treatment and care’ provide clear recommendations based on globally recognised standards of care. Delays in recognition of signs and symptoms, or in emergency transfer and admission to a suitably equipped hospital, and time-critical IV antibiotic treatment are a common feature of meningitis disability, brain injury and amputation claims. After medical mistakes or delays lead to life-changing injury, a meningitis compensation claim can help the injured person by providing access to personalised rehabilitation and care support, restoring their independence and enabling them to participate in life more fully, with the peace of mind that comes with financial security. We welcome WHO’s new guidelines in the hope that they raise awareness of the signs and symptoms of meningitis, and provide clearer pathways for medical professionals to diagnose, treat and, ultimately, defeat meningitis. If you or a family member have suffered severe injury as a result of medical negligence or have been contacted by HSSIB/MNSI or NHS Resolution you can talk to a solicitor, free and confidentially, for advice about how to respond or make a claim by contacting us.
