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Q. An employee of mine has a brother with meningitis and he is now in the intensive care unit. How contagious is it? Should I let her come back to work, where there are three pregnant women?

-- K.K.

A. I commend you for being concerned about your employees. And it can be a difficult challenge balancing the needs of one employee's health and well-being with the health of other employees.

The central nervous system is comprised of the brain and spinal cord. It usually remains well protected from infection by what's called the blood-brain barrier. But when infection occurs, the consequences can be serious. The two most common forms of CNS infection are meningitis and encephalitis.

Certain symptoms are common to all forms of CNS infection: headache, fever, sensory disturbances, neck and back stiffness and abnormal cerebrospinal fluid.

Meningitis is an inflammation of the covering of the brain and spinal cord, and is usually caused by a bacterial, fungal or viral infection. Infectious organisms can enter the covering around the brain and spinal cord through the bloodstream or by penetration from injury or surgery.

Meningitis is most common in children, but can occur in adults. And it can be transmitted among groups of people in close contact, such as in the military or in a college dorm.

There are three main categories of meningitis: purulent or bacterial meningitis, chronic meningitis and aseptic meningitis. The type of meningitis is determined by analysis of cerebrospinal fluid from a lumbar puncture.

Purulent meningitis is the acute and most dangerous form of the disease and is usually caused by bacteria. Three species of bacteria are responsible for 80 percent of this type of meningitis. The people most at risk of infections from these bacteria are those who abuse alcohol, have had their spleen removed or have chronic ear and nose infections.

Other species of bacteria can cause meningitis, usually in people with impaired immune systems.

Purulent meningitis is a medical emergency and should be treated immediately with intravenous antibiotics to kill the bacteria and intravenous steroids to reduce the inflammation.

Chronic meningitis is also caused by bacteria, but the history of symptoms can last for weeks or even months. Aseptic meningitis is usually caused by viruses and is self-limiting and less serious than purulent or chronic meningitis.

Meningitis is an infection that can be transmitted from one person to another, though not as easily as with other contagious diseases. And the various forms of meningitis differ in how easily they are transmitted.

So your concern about your employee may be justified. Although I suspect that the brother's visitors (including staff and doctors) are adequately protected from infection, you may want to have your employee ask her brother's doctor which form of meningitis he has and the likelihood of her passing the infection along to co-workers.

I don't know what human resource rules apply, but I'm sure your employee would not want to return to work if there was a chance of spreading the disease, especially if you provide sick leave for this situation.

Write to Allen Douma in care of kALIVE, 1777 N.E. Loop 410, San Antonio, Texas 78217, or contact him at This column is not intended to take the place of consultation with a health-care provider.

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