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Meningitis is inflammation of the lining around the brain and spinal cord. It is usually caused by an infection.
infection occurs most often in children, teens, and young adults. Also at risk
are older adults and people who have long-term health problems, such as a
There are two main kinds
Viral meningitis is
caused by viruses. Bacterial meningitis is caused by bacteria.
Meningitis can also be caused by other organisms and some medicines, but
this is rare.
Meningitis is contagious. The germs that cause it
can be passed from one person to another through coughing and sneezing and
through close contact.
The most common symptoms
among teens and young adults are:
Children, older adults, and people with other medical
problems may have different symptoms:
It is very important to see a doctor right away if you or
your child has these symptoms. Only a doctor can tell whether they are caused
by viral or bacterial meningitis. And bacterial meningitis can be deadly if not
treated right away.
Your doctor will ask
questions about your health, do an exam, and use one or more tests.
Lumbar puncture is the most important lab test for
meningitis. It is also called a spinal tap. A sample of fluid is removed from
around the spine and tested to see if it contains organisms that cause the illness.
may also order other tests, such as
blood tests, a
CT scan, or an
meningitis is treated with antibiotics in a hospital. You may also get dexamethasone, a type of steroid medicine.
And you will be watched carefully to prevent serious problems such as hearing
loss, seizures, and brain damage.
But viral meningitis is more
common, and most people with this form of the illness get better in about 2
weeks. With mild cases, you may only need home treatment. Home treatment
includes taking medicine for fever and pain and drinking enough fluids to stay hydrated.
The best way to
protect your child from meningitis is to make sure he or she gets all the
standard immunizations for children. These include shots for measles,
chickenpox, Haemophilus influenzae type B (Hib) disease,
and pneumococcal infection.
Talk to your doctor about whether you
or your child also needs the meningococcal vaccine, which is a shot to prevent
bacterial meningitis. Two doses are recommended for all adolescents. And at least one dose is recommended for anyone 6 weeks of age and older who has immune system problems or a damaged or missing spleen. The vaccine is also needed for travel to countries known to have
meningitis outbreaks, such as the countries in Africa south of the Sahara Desert.
Learning about meningitis:
Most meningitis is caused by bacteria and viruses that often live in our bodies. Usually these germs stay in the intestines or in the nose and throat, where they may or may not make us sick. But if they spread to the tissues (meninges) that surround the brain and spinal cord, they cause inflammation. This inflammation is called meningitis.
The germs that can lead to meningitis are contagious, which means they can be passed from one person to another.
Viral meningitis is the most common and the least dangerous. It's caused by viruses, most often enteroviruses that live in the intestines. These viruses can be spread through food, water, or contaminated objects. Meningitis caused by enteroviruses occurs most often
in babies and young children.
Bacterial meningitis is caused by bacteria. It is a very serious illness. These germs are usually passed from one person to another through infected saliva or mucus. Most people who get bacterial meningitis get it
from one of two types of bacteria:1
In the United States, bacterial meningitis mainly affects
Other types of bacteria that sometimes cause meningitis are:
The Centers for Disease Control and
Prevention (CDC) recommends screening for group B streptococci in all pregnant
women at 35 to 37 weeks. Women who have the bacteria are given antibiotics
during labor in order to prevent infection in their newborns.3
In rare cases, other
kinds of bacteria cause meningitis, usually in people with long-term medical
conditions. Meningitis also can be caused by
other organisms, such as a fungus, and by conditions such as cancer or lupus. Meningitis also can be a
complication of an injury (particularly to the skull or face), or
Germs that cause meningitis can be spread:
Symptoms of bacterial
meningitis usually appear suddenly.
Symptoms of viral meningitis may appear suddenly or develop gradually over a period of days. For example, the symptoms of viral meningitis after mumps may take several days or weeks to develop.
The most common symptoms of either form of
Less common symptoms include:
Babies, young children, older adults, and
people with other medical conditions may not have the usual symptoms of
Other conditions with symptoms similar
to meningitis include
viral hepatitis and flu.
The course of
meningitis often depends on your age, general health,
and the organism causing the infection. The illness can range from mild to
Viral meningitis is more common in the late summer and
early fall. It usually doesn't cause serious illness. A visit to the doctor followed by home treatment may be all you need.
You may get better within 2 weeks.
But some people may feel lightheaded and tired for several months after the
Bacterial meningitis occurs most often from late winter
to early spring. It usually causes serious illness and can be life-threatening.
The symptoms usually develop suddenly and last for 2 to
3 weeks. A person with bacterial meningitis is treated with antibiotics in a
Complications, short-term and
long-term, are more common with bacterial
than with viral meningitis. People with bacterial meningitis can die if not treated right away. People who are more likely to have these problems include:
The risk of dying from bacterial meningitis is also higher for adults who:1
survivors recover completely.4
A risk factor is anything that makes you more likely to get a certain disease. Risk factors for
Medical problems that can increase your risk include:
Call 911 or other emergency services right away if:
Call your doctor right away
Call a doctor soon if you think you may have been
exposed to meningitis. You can be treated with
antibiotics, which may keep you from getting the
Watchful waiting is a period of time during
which you and your doctor observe your symptoms or condition without using
Watchful waiting isn't appropriate if you think that you or your
child has meningitis, because you can't tell what type of meningitis it may be. Call your doctor as soon as symptoms appear.
The following health professionals can diagnose and treat
Specialists may be needed to treat meningitis,
especially if complications develop:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
meningitis is based on a
medical history, a
physical exam, and tests.
Your doctor will almost always do
lumbar puncture. This is done by inserting a long, thin needle into the spinal canal. The doctor uses the needle to collect samples of spinal fluid to check for bacteria and viruses.
Other tests that may be done include:
with viral meningitis usually start getting better within 3 days of feeling
sick, and they recover within 2 weeks. With mild cases of viral meningitis, you may
only need home treatment, including drinking extra fluids and taking medicine
for pain and fever.
Bacterial or severe viral meningitis may require treatment in a hospital,
Most healthy adults who have
recovered from meningitis don't need follow-up care.
But adults who have
other medical problems that make them more likely to have long-term complications or get meningitis again should see their doctors after
Babies and children always need follow-up care
after recovery. They need to be checked for long-term complications such as
Childhood vaccinations are the best way to prevent meningitis. These shots prevent germs from causing some of the diseases that can lead to meningitis. They include shots for:
For more information about immunizations, see the
A link has been found
between meningitis and
cochlear implants for severe hearing loss. To help
protect against meningitis, experts recommend that people with cochlear implants get a pneumococcal shot. Also, some people with implants have ear
infections before they get meningitis, so it's important to treat ear infections right away with antibiotics.
Take steps to lower your
risk of getting or spreading meningitis:
Home treatment usually is all that is
needed for most people who have viral
meningitis. It includes:
When you or your child is recovering at home, watch for signs of
long-term complications of meningitis, such as hearing
The decision about what medicine to use depends on the
organism causing the infection, the extent of the infection, and the person's
age and general health.
Medicines used for treating meningitis include:
People who are very sick may need to be treated in
the intensive care unit of a hospital. They may need one or both of these additional treatments:
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Roos KL, Tyler KL (2012). Meningitis, encephalitis,
brain abscess, and empyema. In DL Longo et al., eds., Harrison's Principles of Internal Medicine, 18th ed., vol. 2,
pp. 3410–3434. New York: McGraw-Hill.
Tunkel AR, et al. (2010). Acute meningitis. In GL Mandell et al., eds., Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 7th ed., pp. 1189–1229. Philadelphia: Churchill Livingstone Elsevier.
Verani JR, et al. (2010). Prevention of perinatal group
B streptococcal disease: Revised guidelines from CDC, 2010. MMWR, 59(RR-10): 1–36. Also available online: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5910a1.htm?s_cid=rr5910a1_w.
Hirschmann JV (2006). Bacterial infections of the central nervous system. In DC Dale, DD Federman, eds., ACP Medicine, section 7, chap. 36. New York: WebMD.
Reefhuis J, et al. (2003). Risk of bacterial
meningitis in children with cochlear implants. New England Journal of Medicine, 349(5): 435–445.
Biernath KR, et al. (2006). Bacterial meningitis among
children with cochlear implants beyond 24 months after implementation.
Pediatrics, 117(2): 284–289.
Other Works Consulted
American Academy of Pediatrics (2009). Meningococcal
infections. In LK Pickering et al., eds., Red Book: 2009 Report of the Committee on Infectious Diseases, 28th ed, pp. 455–466. Elk Grove
Village, IL: American Academy of Pediatrics.
Biernath KR, et al. (2006). Bacterial meningitis among
children with cochlear implants beyond 24 months after implantation.
Pediatrics, 117(2): 284–289.
Centers for Disease Control and Prevention (2013). Prevention and control of meningococcal disease: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR, 62(RR-02): 1–22. Also available online: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6202a1.htm?s_cid=rr6202a1_x.
Feigin RD, Cutrer WB (2009). Bacterial meningitis
beyond the neonatal period. In RD Feigin et al., eds., Feigin and Cherry's Textbook of Pediatric Infectious Diseases, 6th ed., vol. 1, pp. 439–471.
Gilden DH (2008). Acute viral central nervous system
diseases. In DC Dale, DD Federman, eds., ACP Medicine,
section 11, chap. 16. Hamilton, ON: BC Decker.
Swartz MN (2012). Meningitis: Bacterial, viral, and
other. In L Goldman, A Shafer, eds., Goldman's Cecil Medicine,
24th ed., pp. 2355–2371. Philadelphia: Elsevier Saunders.
Tunkel AR, et al. (2004). Practice guidelines for the
management of bacterial meningitis. Clinical Infectious Diseases, 39(9): 1267–1284.
February 15, 2013
E. Gregory Thompson, MD - Internal Medicine & W. David Colby IV, MSc, MD, FRCPC - Infectious Disease
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