What You Need to Know About Meningitis

Thin layers of tissue — the “meninges” — surround the brain and spinal cord. And when they become infected, it’s called “meningitis.” Both bacteria and viruses can cause meningitis. And these infections can be serious and life-threatening because of how close they are to the central nervous system. We’ll go into more detail about the most common causes of meningitis, symptoms to look out for, along with prevention and treatment.

Types of meningitis 

Like any infection, all different sorts of pathogens can cause meningitis. But most often, either viruses or bacteria cause it.

Viral meningitis tends to be less serious than bacterial meningitis. Many times, the symptoms are milder and the condition goes away on its own (although there are some exceptions). Some examples of viruses that can lead to rare cases of meningitis are:

• Common cold viruses, like enteroviruses

• HIV

• Herpes simplex virus

• Varicella-zoster virus, which is the virus that causes chickenpox and shingles 

You are likely more familiar with bacterial meningitis, because this type of meningitis is always severe. People with bacterial meningitis need antibiotics for treatment, otherwise the condition can be fatal. Some of the bacteria that more commonly cause meningitis include:

• Neisseria meningitidis: This is the type of meningitis that gets attention for spreading among people in group-living situations, like college dorms.

• Streptococcus pneumonia: This is a leading cause of bacterial meningitis in young children.

• Listeria monocytogenes and Eschericia coli (E. coli): These are food-borne bacteria that can cause meningitis, particularly in people with very young or very old immune systems.

• Haemophilus influenzae: This type of meningitis is rare now that there’s a vaccine that protects against it.

There are less common causes of meningitis, like fungi or amoebas. But these infections are exceptionally rare. Bacteria and viruses make up the vast majority of these infections.

Is meningitis contagious?

Yes, meningitis is contagious. Most cases are spread by respiratory droplets from coughing or sneezing. Other types of close contact, like touching hands or kissing, can also spread meningitis. This means it can spread easily in situations where people live in close quarters, like in school dorms, military barracks, or prisons. 

Some of the organisms that cause meningitis spread through eating contaminated food, but this is less common. E. coli and Listeria are spread this way.

Signs and symptoms of meningitis 

Meningitis can cause symptoms that range from mild to severe. But most people with meningitis feel pretty lousy. It can feel like having the flu and a migraine at the same time. And in most cases, they have more than one of the following symptoms:

• Fever: Other types of infections, like a cold, don’t always cause a true fever. But meningitis will cause a fever over 100.4°F in 3 out of 4 cases.

• Headache: This is the most common symptom. Headaches can accompany any type of infection, especially when you have a fever, but meningitis headaches are typically more severe. 

• Neck stiffness: This is one of the hallmark symptoms of meningitis. People with meningitis feel particular discomfort when they try to touch their chin to their chest. 

• Confusion and lethargy: This is a concerning symptom when it occurs with one of the symptoms above.

Other symptoms that may be associated with meningitis are nausea, photophobia (sensitivity to looking at bright light), and a red or purple rash on the skin.

Babies can get meningitis as well. And since they can’t tell you the way they are feeling, their symptoms can be a little more subtle:

• Fever

• Irritability

• Vomiting

• Decreased feeding

• A bulging fontanelle (the soft spot on the top of a baby’s head)

When in doubt, talk with a healthcare provider to decide if you or your baby may need more testing.

How is meningitis diagnosed?

To diagnose meningitis, healthcare providers will do a lumbar puncture. For this procedure, a provider inserts a small needle into the lower back to get a sample of the fluid that surrounds the brain and spinal cord. Then they’ll send this fluid, called “cerebrospinal fluid,” to the lab to look for signs of meningitis. They can also use that fluid to isolate exactly which bacteria (or virus) is causing the infection. 

In addition to a lumbar puncture, someone with meningitis may also get a CT scan of the head. This is often done when there might be other causes of the symptoms, such as brain tumors or bleeding in the brain. But a CT isn’t necessary to diagnose meningitis.

Treatment for meningitis

The treatment for meningitis depends on what type of organism is causing the infection.

Bacterial meningitis is treated with antibiotics. Usually, people with this condition are admitted to the hospital to get high doses of intravenous (IV) antibiotics. They may also get the anti-inflammatory medication dexamethasone. This medication prevents inflammation of the meninges from worsening during treatment.

The treatment for viral meningitis is a bit more variable. Some types of viral meningitis, like those that influenza or common cold viruses cause, don’t need any specific treatment at all. These infections get better on their own in 7 to 10 days or so. But meningitis caused by other viruses, like herpes simplex virus, requires the antiviral medication acyclovir.

Prevention 

Vaccination is one of the best ways to protect yourself from meningitis. And there are a number of different vaccines that protect against meningitis:

• The Haemophilus influenzae vaccine is typically given during childhood. People who receive this vaccine almost never get serious infections from this bacteria. 

• Neisseria meningitidis also has a vaccine. People usually get this vaccine before moving into a group-living setting like a college dorm. 

• The pneumovax vaccine, which protects people from Streptococcus pneumonia, can also prevent meningitis. Children under 2 years of age get this vaccine. People over the age of 65 should get this one, too.

It’s also important to avoid close contact with someone who has meningitis as much as possible. But if you do get exposed to someone with a case of bacterial meningitis, you might choose to take prophylactic (preventive) medications. Some choices are oral antibiotics like rifampin or ciprofloxacin. Or some people may choose to get an injection of the antibiotic ceftriaxone. If you have had a high-risk exposure, a healthcare provider can help you figure out if you would benefit from prophylaxis.

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Written by:

Michael Dreis, MD

Dr. Dreis is an emergency medicine physician currently practicing in Milwaukee, Wisconsin. He went to medical school at the University of Wisconsin – Madison and completed his residency at Henry Ford Hospital in Detroit, Michigan.

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

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