By Dr Ananya Mandal, MD
Meningitis has been described in ancient texts. Hippocrates described meningitis in his work. Tuberculous meningitis was first described by Edinburgh physician Sir Robert Whytt in a posthumous report that appeared in 1768. However, the link with Tubercle bacilli that also causes tuberculosis took another 100 years to discover.
History of the organisms causing meningitis
Meningitis outbreak was first recorded in Geneva in 1805. Gaspard Vieusseux (1746-1814) and Andre Matthey (1778-1842) in Geneva, and Elisa North (1771-1843) in Massachusetts, described epidemic (meningococcal) meningitis. Several other epidemics in Europe and the United States were described shortly afterward.
In Africa the first outbreak was described in 1840. African epidemics became much more common in the 20th century. The first major one was reported in Nigeria and Ghana in 1905–1908. In early reports large number of people died of the disease.
The first evidence that linked bacterial infection as a cause of meningitis was written by Austrian bacteriology Anton Vaykselbaum who described meningococcal bacteria in 1887.
Heinrich Quincke (1842-1922) utilized his new technique of lumbar puncture (1891) to provide an early analysis of cerebrospinal fluid (CSF). William Mestrezat (1883-1929), and H. Houston Merritt (1902-1979) compiled large series of CSF profiles in meningitis.
Organisms causing meningitis were identified in the late 19th century including:
- Streptococcus pneumonia
- Neisseria meningitidis
- Haemophilus influenzae
History of clinical features of meningitis
By the end of 19th century more symptoms of the condition were described. The symptoms of meningitis were described in 1884 by Russian physician Vladimir Kernig (1840-1917) in 1899 and by Polish physician Jozef Brudzinski (1874-1917). The signs were thus called Kernig’s sign and Brudzinski sign in 1882 and 1909 respectively.
By the second half of the 20th century influenza viruses A and B, adenovirus were found to be linked to meningitis as well.
In 1968, AA Smorodintsev proved that there are more than 200 different viruses and their serotypes that may cause meningeal infections. Armstrong and Lilly in 1934 isolated the virus from the cerebrospinal fluid of patients.
History of vaccines
It was in 1906 that researchers noted that horses could be used to create antibodies against meningococcal bacteria. This was developed further by the American scientist Simon Flexner and markedly decreased mortality from meningococcal disease.
The introduction in the late 20th century of ''Haemophilus'' vaccines led to a decline in meningitis due to Hemophillus influenza type b.
History of antibiotics
In 1944, penicillin was first reported to be effective in meningitis. The first successful treatment of meningitis began with the introduction of serum therapy for meningococcal meningitis by Georg Joachmann (1874-1915) in Germany and Simon Flexner (1863-1946) in America.
Antibiotic therapy began in the 20th century with the use of sulfonamides by Francois Schwentker (1904-1954) and penicillin by Chester Keefer (1897-1972).
Other advances in the treatment of meningitis
In 2002, evidence emerged that treatment with steroids could improve the prognosis of bacterial meningitis. This also revolutionized therapy of meningitis and improved long term outcome of the condition.
In 2000, an Advisory Committee on Immunization Practices (ACIP), a part of the Centers for Disease Control and Prevention (CDC), recommended that colleges and universities inform all students and their parents about the risk of meningococcal disease and the availability of a vaccine.
Between 2005 and 2010 FDA licenses additional meningococcal disease vaccines to protect against 4 of the 5 major disease-causing serogroups, A, C, Y, and W-135. In 2007 the ACIP recommends routine vaccination for preteens against meningococcal disease at the 11- to 12-year-old checkup.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)