Meningitis Risk Profile

Q: Which patients are at high risk for meningitis?

A: Meningitis ranks 8th in conditions that lead to malpractice claims for failure to diagnose. Because chronic carriers of meningococcus, who are asymptomatic themselves, are the principle reservoir, patients with possible meningitis often will not recall being exposed to anyone who was ill. Transmission is via respiratory droplets from the nose and throat of an infected individual or via direct contact with nasal secretions or saliva.

The incubation period is 2-10 days, with an average of 3-4 days. Outbreaks have occurred in child care centers, nursery schools, colleges and military recruit camps. To determine whether a patient is at high risk, the following historical and social questions are relevant, especially if the patient presents with fever, nausea, rash, headache and/or neck stiffness:

For adults, teenagers or adolescents:

• Have you shared cigarettes, marijuana joints, bottled drinks, drinking glasses or other implements where another person's saliva may be present? (Incidence of meningitis has been found to be higher than average among marijuana users and college students who frequent bars.)

• Who have you kissed in the past 10 days? (Transmission is by oral/nasal secretions.)

• Do you live in close living quarters with people other than your parents? (Incidence of meningitis has been found to be higher than average among individuals who live in college dormitories or other group living accommodations.)

• Have you been found to have an immune deficiency? (Incidence of meningitis is higher than average in immunosuppressed individuals.)

• Have you had a recent sinus infection, otitis media, or mastoiditis? (Each of these is a predisposing factor for meningitis.)

This tip comes from The Gold Sheet, a monthly newsletter addressing quality issues for nurse practitioners, published by the Law Office of Carolyn Buppert. To purchase a 12-month subscription, send a check for $30 to Law Office of Carolyn Buppert, 1419 Forest Dr., Suite 205, Annapolis, MD 21403.