Meningitis Glass Test – Meningitis Rash Test

A rash that does not fade under pressure can be a sign of meningococcal septicaemia (meningococcal bacteria can cause meningitis and septicaemia). Using the glass test on a rash that appears on someone’s skin will help you to determine whether the rash is a medical emergency or not

People with septicaemia may develop a red rash of tiny ‘pin pricks’, which can develop into purple bruising.

This rash does not fade under pressure.

The meningitis glass test

Performing the meningitis glass test is very straight forward, follow the instructions below:

• Press the side of a clear glass firmly against the skin
• Spots/rash may fade at first
• Keep checking
• Fever with spots/rash that do not fade under pressure is a medical emergency
• Do not wait for a rash. If someone is ill and getting worse, get medical help immediately

On dark skin, the spots/rash can be more difficult to see, check lighter areas such as the palms of the hands, soles of the feet, inside the eyelids and the roof of the mouth. Be aware of all meningitis signs and symptoms.

What is the rash?

The rash associated with meningitis is actually caused by septicaemia, more information below:

• Meningococcal bacteria can cause meningitis and septicaemia 
• People will often have both together
• When the bacteria are in the bloodstream, they multiply rapidly and begin to release endotoxins (poisons) from their outer coating
• The body’s natural defences have little effect on these poisons and eventually blood vessels become damaged. As septicaemia advances, it affects the whole body and can cause organ damage or failure
• The rash associated with septicaemia is caused by blood leaking into the tissues under the skin

It’s important to know that septicaemia can also cause other more specific symptoms to look out for (as well as the red rash):

• Fever with cold hands and feet
• Joint or muscle pain
• Rapid breathing
• Stomach cramps and diarrhoea

If you are worried about spotting the symptoms in time, let us help you.  Download our phone optimised videos and images on your phone, or request one of our free credit-card sized signs and symptoms cards by calling our Meningitis Helpline on 0808 80 10 388.

Concerned about meningitis?

• If you live on your own, always make sure you tell someone if you are not feeling well. They can check up on you and take action if needed
• Trust your instincts. You know your loved ones, and your own body, best
• Describe the symptoms and say you think it could be meningitis or septicaemia
• Early diagnosis can be difficult. If you have had medical advice and are still worried, get medical help again 

Do not wait for a rash. If someone is ill and getting worse, get medical help immediately.

Septicaemia and sepsis

Many medical experts now use the term sepsis instead of septicaemia. Sepsis describes the life-threatening condition that arises when the body’s response to an infection injures its own tissues and organs.

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Neck, Physical Exam, at Home, and More

Testing for meningitis can include various tests, including a physical exam, blood tests, bacterial cultures, and cerebrospinal fluid tests.

Meningitis happens when the membranes, or meninges, around your spinal cord and brain become swollen from inflammation.

Four types of meningitis are possible:

• Bacterial: The most severe and life-threatening form of meningitis. This type can be fatal if it’s not treated immediately with antibiotics to prevent the spread of the infection and further complications.
• Viral (aseptic): The most common cause of a meningitis infection. This type usually isn’t as serious as bacterial meningitis and often goes away without requiring treatment.
• Fungal: This uncommon type is caused by a fungus that gets into your spinal cord from your bloodstream.
• Parasitic: This much less common form of meningitis is caused by parasites.

You don’t always need treatment for nonbacterial meningitis. The infection may clear up on its own. Meningitis can be mistaken for the flu, dehydration, or gastroenteritis. It can also be overlooked because symptoms may be mild or not always apparent.

Seek emergency medical attention if you notice any symptoms of meningitis. You should also contact your doctor if someone close to you at home or work has been diagnosed. Watch out for these symptoms:

• having severe neck stiffness with no apparent cause
• experiencing a constant, painful headache
• feeling disoriented
• feeling sick and throwing up
• running a high fever (101°F and higher), particularly with the above symptoms

Early treatment, within 2 to 3 days (less than 1 day is recommended), can help prevent long-term or severe complications. Bacterial meningitis can quickly become deadly or cause brain damage in a few days without antibiotics.

Your doctor will conduct a full physical examination as the first step in looking for signs of meningitis.

First, your doctor will ask you about your symptoms, your medical history, and whether you’ve been on any recent trips to regions with a higher rate of certain types of meningitis.

Then, your doctor will check your entire body for any unusual markings, signs, or lumps. A purplish or reddish skin rash that doesn’t get lighter or disappear when you press against it can be a sign of severe infection with one of the types of bacteria that causes meningitis.

Your doctor may also look for two specific signs of a meningitis infection:

• Brudzinski’s sign: Your doctor will pull your neck forward slowly. Neck stiffness and involuntary bending of the knees and hips can indicate meningitis.
• Kernig’s sign: Your doctor will flex your leg at the knee and bend the leg forward at the hip. Then, they’ll slowly straighten your leg. Intense pain in your back or thigh can indicate meningitis. Your doctor may repeat this test on both legs.

However, more recent research shows that many people with meningitis doesn’t display these signs. A negative result on either of these tests doesn’t rule out the possibility of meningitis.

To take a bacterial culture, your doctor will collect a blood sample through a needle in a vein in your arm. The blood is transferred to small dishes known as petri dishes. Bacteria or other microorganisms can grow and become more abundant in these nutrient-rich dishes.

After a certain period of time (usually a few days), your doctor can look at the bacteria through a microscope and diagnose the specific bacteria causing an infection in the blood.

Your doctor can also put a sample on a microscope slide and stain it so that the bacteria are easier to see under a microscope. The results of this test may come back earlier than those from a culture.

To do a blood test for signs of meningitis, a technician inserts a needle into a vein in your arm and draws out a sample of your blood to send to a lab for testing.

A complete blood count (CBC) or total protein count check for heightened levels of certain cells and proteins that can suggest a meningitis infection.

A procalcitonin blood test can also help your doctor tell if an infection is more likely caused by either bacteria or a virus.

Blood tests may also be done at the same time as a spinal tap to compare the levels of cells, antibodies, and proteins and confirm the diagnosis.

An imaging test, such as computerized tomography (CT) scan, allows your doctor to take detailed images of your head and chest to look for signs of brain and spine inflammation associated with meningitis and help confirm a diagnosis.

A CT scan, in addition to magnetic resonance imaging (MRI) and X-ray imaging tests, can also help your doctor notice other things that can cause severe symptoms of meningitis, such as:

• internal bleeding (hemorrhage)
• fluid buildup in tissue (abscess)
• swelling of the brain

These conditions may make it dangerous or impossible for your doctor to perform a spinal tap, so imaging tests are typically done before your doctor decides whether to do a spinal tap.

This is the only test that can truly diagnose meningitis. To perform this test, your doctor inserts a needle into your spine in order to collect cerebrospinal fluid (CSF) that’s found around your brain and spinal cord. Then, your doctor sends your CSF to a lab for testing. Meningitis is often confirmed when your CSF fluid has:

• low levels of sugar (glucose)
• high levels of white blood cells
• high levels of blood protein
• heightened level of antibodies responding to infection

A CSF test can also help your doctor figure out what type of bacteria or virus caused your meningitis.

Your doctor may also request a polymerase chain reaction (PCR) test. This test can analyze your CSF fluid for antibodies that increase in number during viral infections to decide what treatment will work best.

In theory, it’s possible to do the Brudzinski and Kernig tests at home to check for meningitis. However, you should still see your doctor for a diagnosis. These tests need to be performed by a professional — and even then they aren’t reliable as a sole method of diagnosis.

Remember that meningitis can be dangerous. Even if you could diagnose it at home, you wouldn’t be able to determine which type you have, and some types are life-threatening. Get emergency medical help if you have these symptoms:

• neck stiffness
• constant, painful headache
• feelings of disorientation
• vomiting or nausea
• high fever (101°F and higher)

Here’s how to do the Brudzinski test at home:

1. Lie flat on your back.
2. Gently and slowly push on the back of your neck so that your head moves forward. For better results, have someone do this for you.
3. Note if your hips and knees flex involuntarily as you raise your head. This is a positive Brudzinski sign, meaning that you may have meningitis.

And the Kernig test:

1. Lie flat on your back.
2. Lift your leg up at the hip and bend your knee to a 90-degree angle.
3. Gently and slowly lift your leg up at the knee.
4. Note if your back or thigh starts to hurt. This is a positive Kernig sign, meaning that you may have meningitis.

Always see your doctor for a diagnosis.

The different types of meningitis have different causes:

• Bacterial meningitis happens when bacteria pass through your blood into the CSF. Bacteria can also get into your meninges and infect them directly. Bacteria can be spread through infected blood.
• Viral (aseptic) meningitis happens when a virus gets into your CSF from your bloodstream. This can be caused by many types of viruses, such as the herpes virus, HIV, West Nile virus, and enteroviruses.
• Fungal meningitis happens when a fungus, such as Cryptococcus, gets into your meninges or CSF from your bloodstream. It’s most common in people who have weak or compromised immune systems from cancer or HIV.
• Parasitic meningitis happens when a parasite gets into your meninges or CSF from the bloodstream. It’s often caused by eating or drinking something that’s been contaminated by an infectious parasite that normally only infects animals.

Bacterial meningitis needs to be treated right away or it may result in severe complications, such as brain damage, or become deadly.

Seek emergency medical attention if you think you have a bacterial meningitis infection. Early and effective treatment can save your life and reduce your chance of complications.

Other causes may go away after a few days without treatment. See your doctor as soon as you can if you suspect that you have a meningitis infection caused by a virus or parasite.

How to recognize meningitis and diagnose the disease in the Optimum medical laboratory in Sochi (Adler)

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2. How to recognize the disease
3. Diseases of the nervous system
4. Meningitis

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Symptoms, diagnosis and prevention of meningitis

Meningitis is an inflammation of the membranes of the brain or spinal cord, which can be triggered by infections of viral and bacterial etiology. Pathology is accompanied by a severe headache, a typical body position in bed, hemorrhagic rashes on the skin and stiffness of the muscles of the occipital zone. Children and adolescents, as well as elderly people with weakened immune systems, are especially susceptible to this disease.

Causes of meningitis

The main cause of meningitis are infections of viral and bacterial etiology. The causative agent of the inflammatory process can be:

• pneumococci;
• Haemophilus influenzae;
• Escherichia coli;
• streptococci;
• amoeba.

In childhood, the main cause of the development of pathology is enteroviruses that enter the body by airborne droplets. Infection can occur during childbirth, through contaminated food, dirty water, and insect bites. The main causes of non-infectious meningitis are trauma and damage to the skull, as well as tumor processes occurring in the brain.

Mechanism of development

For the development of pathology, the pathogen must penetrate the cranial cavity and provoke an inflammatory process in the brain. In some cases, this is observed when foci of infection occur in tissues located near the meninges. Pathologies such as purulent otitis media or sinusitis can provoke meningitis.

In some cases, craniocerebral trauma becomes a provoking factor in the development of pathology, but the infection mainly penetrates into the cranial cavity along with the blood flow. The very process of entering the pathogen into the blood and its further spread to the meninges is associated with a poor state of immunity.

Symptoms

Meningitis causes the following clinical picture:

• rise in body temperature;
• photophobia;
• muscle tension in the occipital region;
• confusion;
• convulsive syndrome;
• strabismus;
• muscle pain syndrome;
• mental disorders;
• tachycardia;
• rashes on the skin.

If these symptoms develop, seek medical attention as soon as possible because meningitis has a high mortality rate.

Diagnostic methods

The main method for diagnosing meningitis is lumbar puncture with further examination of cerebrospinal fluid. This diagnostic method is used in all cases when there is a suspicion of a disease.

In addition, the doctor analyzes the patient’s complaints and collects an anamnesis, as well as conducts a neurological examination. With the help of a blood test, it is possible to diagnose signs of inflammation, and PCR of blood and cerebrospinal fluid helps to identify the pathogen.

Computed and magnetic resonance imaging allows to assess the structure of the brain and diagnose indirect manifestations of the pathological process in the meninges of the brain.

Prevention

Some forms of meningitis can be prevented by vaccination, which is effective for several years. As a preventive measure, it is recommended to treat chronic and acute pathologies of an infectious nature in a timely manner and take courses of immunostimulating drugs in the foci of meningococcal disease. In addition, you should harden the body, avoid visiting places with large crowds of people and severe hypothermia. In the autumn-winter period, you need to drink multivitamin complexes or vitamin C.

Tests for meningococcal infection

The causative agent of meningococcal infection is Neisseria meningitidis (meningococcus). Meningococcus colonizes the posterior wall of the human nasopharynx and, depending on the virulence of the strain and the resistance of the infected person, causes an infectious process with a wide range of clinical manifestations: asymptomatic carriage, nasopharyngitis and a generalized form – meningococcemia and / or meningitis. Meningococcal infection affects people of all ages, but more often (70%) children get sick. The lethality rate averages 10%, which determines the high social significance of the disease. Capsular strains of meningococcus, depending on the chemical structure of the capsular polysaccharide, are divided into a number of serological groups: A, B, C, X, Y, Z, W-135, 29-E, H, I, K, L. More than 90% of cases of generalized forms of meningococcal infection are caused by strains of serogroups A, B and C, much less often by strains of serogroups X, Y and W-135, the remaining serogroups are not of epidemiological interest. The determination of the serogroup is the most important procedure for the selection of an adequate vaccine product. All meningococci express on their surface one of the allelic variants of class 2 or 3 outer membrane proteins (PorB). Most meningococci express class 1 proteins (PorA). The antigenic structure of the PorB protein determines the serotype of the strain, while the PorA protein determines the serosubtype. Based on the chemical structure of the capsular lipopolysaccharide, the immunotype is determined. The antigenic characteristic may include some other AGs: Ora and Ors (class 5 outer membrane proteins), pili, FetA surface protein.

Indications for examination

• Diagnostic studies are carried out in a hospital with suspected purulent meningitis and / or a generalized form of meningococcal infection;
• studies according to epidemic indications are carried out in the focus of a generalized form of meningococcal infection among those who have been in contact with the patient and have clinical manifestations of nasopharyngitis.

Study material

• Blood – microscopic examination, culture;
• CSF – microscopic examination, culture, DNA detection, AH detection;
• swabs from the oropharynx and nose – culture;
• blood serum – detection of hypertension, determination of specific antibodies

Differential diagnosis

• Causative agents of purulent meningitis of other etiologies: Streptococcus pneumonia, Haemophilus influenza, Staphylococcus aureus, etc.;
• in the study of the nasopharynx – pigmenting Neisseria subflava, Neisseria flavescens, Neisseria mucosa, Neisseria sicca, Neisseria lactamica.

Laboratory diagnosis of a generalized form of meningococcal infection includes microscopy of biological material, inoculation of biological material with further cultural and biochemical identification of the pathogen, determination of antibiotic sensitivity; detection of specific genetic fragments of meningococcus and its AG, detection of specific antibodies.

Comparative characteristics of laboratory research methods and features of interpretation of their results. Microscopy of native cerebrospinal fluid or a “thick drop” blood product (stained with an aqueous-alcoholic solution of methylene blue) on a blue background reveals morphologically clear cocci, diplococci, stained in dark blue, resembling coffee beans or bean seeds, adjacent to each other with concave sides , sometimes the capsule comes to light. Microbial cells can be located both outside and inside leukocytes. The intensity of CSF contamination by microbial cells varies considerably and depends on the stage of development of the infectious process at the time of sampling. If antibiotic treatment has been carried out, the typical microbial cell morphology is lost. The study is recommended to be carried out in the active phase of the disease (the first two days after admission to the hospital).

Inoculation of CSF and blood on nutrient media with further incubation for 24 hours at 37°C in an atmosphere with 5–10% CO2 and high humidity makes it possible to identify the characteristic tinctorial properties of the pathogen. The study is recommended to be carried out in the active phase of the disease (the first two days after admission to the hospital) before the start of intensive antibiotic therapy.

When determining the saccharolytic activity, the results of sowing a pure culture on dense nutrient media with carbohydrates are taken into account. The method makes it possible to differentiate different types of Neisseria and some other types of microorganisms (Table 16). Sometimes there is variability in saccharolytic activity in different strains of the same species.

Clarification of the biochemical properties of meningococci is carried out using reagent kits for an extended study of their enzymatic and metabolic activity, which within 2 hours allows you to determine the species of the pathogen.

The determination of the serogroup of meningococci is carried out in the agglutination reaction on glass with a set of agglutinating serogroup antisera (serogroups A, B, C, X, Y, Z, W-135,29E). The reaction is carried out only with a pure culture of meningococci that has passed all stages of identification. Meningococci of serogroups A, B and C are most often the cause of generalized forms of meningococcal infection, the agglutination reaction is carried out primarily with antisera to meningococci of these serogroups. The absence of a reaction with one of the main serogroup antibodies indicates the need to continue similar studies with other specific antisera (X, Y, Z, W-135, 29e). Only if a strain of meningococcus confirmed by all tests did not show a positive result in the agglutination test with a full set of agglutinating antisera, it should be classified as a non-agglutinating strain (NA).

Latex agglutination reaction is used to detect AG in CSF and/or blood serum. The study of native cerebrospinal fluid (express method) is carried out if it contains signs of purulent inflammation and / or microscopic detection of pathogens. The use of the reaction allows in the shortest possible time (15-20 minutes) to identify specific AG of meningococci of the most common serogroups (A, B, C, Y, W-135). It is recommended to conduct a study in the active phase of the disease (the first two days after admission to the hospital).

CSF and/or a fresh pure culture of Neisseria meningitidis grown on Petri dishes is used to detect pathogen DNA. Detection of specific genetic fragments of the microorganism is performed using PCR. The method has high diagnostic sensitivity and specificity, allows to detect microorganisms contained in single quantities or in a non-viable state in a clinical sample, is characterized by high reproducibility and short deadlines for performing the study (within several hours).

Indications for conducting studies to detect DNA in the diagnosis of bacterial meningitis are:

• negative results of diagnosis by other methods, especially in the case of examination of CSF samples after massive antibiotic therapy or in the late stages of the disease;
• the need for an urgent response about the etiology of the pathogen;
• Examination of material samples delivered frozen or fixed in ethanol.

Detection of specific antibodies in the blood serum in the diagnosis of meningococcal infection is carried out using RNHA. It is recommended to conduct the study twice: in the active phase of the disease (the first two days after admission to the hospital) and on the 12-14th day of the disease. The diagnosis is considered confirmed when the increase in titers of antibodies by four or more times within the specified period.

The use of RNHA for research in “paired sera” reveals the dynamics of the increase in titers of specific antibodies to meningococcus in the blood and allows you to determine whether the pathogen belongs to the most common serogroups of meningococci (A and C). The detection of AT makes it possible to conduct a retrospective laboratory diagnosis of generalized forms of meningococcal infection, since the final answer is obtained only 12-14 days after the onset of the disease. The primary research opportunities are laboratory confirmation of meningococcemia, in which the use of other methods of laboratory diagnostics, as a rule, is not very effective.