Meningitis

What is meningitis?

Meningitis is a serious health condition where the membranes around the brain and spinal cord (called meninges) become inflamed. Viruses, bacteria or fungi can cause meningitis. It can affect people of any age and can cause serious complications if it’s not treated right away.

Types of meningitis

The three main types of meningitis are viral, bacterial and fungal.

• Viral meningitis: This is the most common type of meningitis – and it’s usually less severe than other types. Common viruses, such as enteroviruses, herpes simplex or mumps often cause it. It can develop along with a respiratory (breathing) or gastrointestinal (digestive) infection.
• Bacterial meningitis: This type is more serious and may be life-threatening, sometimes within hours. About one in five people who get bacterial meningitis have serious complications and about one in 10 people die from the infection.  It’s caused when certain bacteria enter the bloodstream and travel to the brain and spinal cord.
• Fungal meningitis: This type is rare and typically happens only in people who have weakened immune systems, such as people living with HIV/AIDS, people who have had solid organ or bone marrow transplants, or people undergoing chemotherapy or immunosuppressive therapy. It’s caused when certain fungi enter the body, usually by breathing them in. 

Other types of meningitis: Parasites, amoebas, tuberculosis, lupus, chemical reactions, drug allergies, some cancers and other diseases can cause meningitis.

Meningitis is similar to encephalitis (inflammation of the brain), but the two conditions are not the same. With meningitis, the membranes that cover the brain and spinal cord are affected. With encephalitis, the brain itself is affected.

Meningitis symptoms 

If you notice any symptoms of meningitis, it’s important to get medical care immediately. Go to the emergency room. With early diagnosis, health care providers can find what’s causing meningitis and start treatment right away.

Symptoms may start a few days after a cold, vomiting or diarrhea. Symptoms can vary depending on the type of meningitis, but often you’ll see:

• Fever
• Persistent, severe headaches
• Stiff neck
• Joint aches or pain
• Sensitivity to light (photophobia)
• Fatigue, drowsiness or trouble waking up
• Nausea and vomiting
• Confusion, irritability or difficulty concentrating
• Lack of appetite or lack of thirst
• Seizures
• Rash* (in bacterial meningitis)

*For people with darker skin a rash can be harder to spot, but it may be easier to see on the palms of the hands and soles of the feet.

It may be harder to notice the symptoms of meningitis in babies. Watch for:

• Poor eating
• Irritability or crying
• Inactivity or sluggishness
• Abnormal reflexes
• A bulging soft spot (fontanelle) on their head
• A stiff body or neck

Complications of meningitis

Delaying treatment, especially with bacterial meningitis, can lead to complications such as:

• Brain damage
• Hearing loss
• Vision problems
• Learning disabilities or behavioral issues in children
• Memory and concentration problems
• Trouble with movement, balance or walking
• Arthritis
• Organ damage or failure
• Shock
• Seizures or epilepsy
• Sepsis

In severe cases, meningitis can lead to death.

Diagnosing meningitis

It’s important to know which type of meningitis you have since treatments are different. To diagnose meningitis, health care providers may consider:

• Medical history, including your symptoms, how severe they are and how you were infected.
• Physical exam, including neurologic exam.
• Nasal or throat swab to check for infection.
• Spinal tap (lumbar puncture) to look for infection in the cerebrospinal fluid and to determine the type of meningitis.
• Blood tests to look for bacteria and viruses.
• CT or MRI scans to check for swelling or abnormalities in the brain.
• Chest x-rays to look for pneumonia, since meningitis may develop after pneumonia.
• Additional tests to rule out other conditions that may cause symptoms similar to meningitis.

Meningitis treatment

To treat meningitis, providers aim to address whatever is causing it and reduce symptoms. Meningitis treatment may include:

• Intravenous (IV) antibiotics, antiviral medications or antifungal treatments, depending on the cause.
• Steroids to treat swelling.
• Medication to treat headache, body aches and fever.
• IV fluids to keep you hydrated and manage complications.
• Oxygen to help with breathing.

Depending on the severity of your meningitis, you may need to be hospitalized for several days. 

It’s important to follow your treatment plan and listen to medical advice if you have meningitis. Take all of your medication as prescribed, attend your follow-up appointments, stay hydrated, get plenty of rest and share any concerns with your health care provider.

Meningitis prevention

You can lower your odds of getting meningitis by being vaccinated and taking steps to avoid infection.

Vaccinations help prevent bacterial infections that can cause meningitis. Depending on your age and risk factors, you may need these vaccinations:

• Haemophilus influenzae type b (Hib)
• Pneumococcal conjugate (PCV15 or PCV20)
• Pneumococcal polysaccharide (PPSV23)
• Meningococcal conjugate (MenACWY)
• Serogroup B meningococcal (MenB)

Vaccines can also protect against viral infections that can cause meningitis, such as chickenpox, measles, mumps and rubella. 

It’s especially important for college students to be up to date on vaccines, since living close to a lot of other people increases risk.

Most of the time, meningitis isn’t contagious, but the germs that can cause it can spread and increase your risk. To prevent infection and avoid catching or spreading the germs that may cause meningitis:

• Wash your hands often.
• Cover your mouth and nose when you cough or sneeze.
• Don’t share personal items like utensils, drinking glasses, straws, lip balm or toothbrushes. 
• Avoid close contact with people who are sick.
• Choose a healthy lifestyle to keep your immune system strong. Eat nutritious foods, get regular physical activity, don’t smoke and be sure to get plenty of rest.
• If you’re pregnant, reduce your risk of listeria by avoiding unpasteurized milk and cheese and premade deli salads and fruits. Deli meat, cold cuts and hot dogs should be reheated to 165 degrees F.

Talk to your provider about vaccination to help prevent meningitis if you are immunocompromised or if you are traveling to a place where your risk of meningitis is higher. 

Also talk to your provider if you’ve been in close contact with someone who has meningitis. They may want you to take antibiotics to lower your risk.

Risk factors for meningitis

These groups are more likely to get meningitis:

• Infants and young children, since their immune systems are still developing
• People with weakened immune systems, such as those with HIV/AIDS or organ transplants or who are having immunosuppressive therapy
• People who live in close quarters such as college dorms or military barracks
• People who have not been vaccinated
• People who have recently had an upper respiratory or ear infection
• People with no spleen or a damaged spleen
• People with frequent nose, ear or blood infections
• People with sickle cell disease
• People with alcohol use disorder
• People with traumatic head injuries that injure the brain’s protective barriers
• Travelers who go to high-risk areas such as sub-Saharan Africa, or Mecca during Hajj pilgrimage

Recovering from meningitis

Depending on how severe your meningitis is, recovery may take weeks or even months. It can help to:

• Educate yourself and your family about recovery so you know what to expect and how they can support you.
• Communicate openly with health care providers about your challenges and concerns.
• Choose a nutritious diet and stay hydrated so you can heal.
• Rest and slowly return to your normal activities as your energy levels allow. After meningitis, you may be tired for some time. It may be challenging to return to work, school or social activities.
• Share your feelings and concerns with loved ones. 
• Connect with others online or at in-person support groups to share your experiences.
• Get professional care if you have anxiety, depression or other mental health challenges.

If you have further questions about meningitis, reach out to your health care provider. And if you are experiencing symptoms, visit your closest emergency department to get immediate medical care.